Children In Immigrant Families Research Articles

Pediatric Support for Children Eligible for Legal Humanitarian Relief.

Many children in immigrant families may qualify for legal protection-for themselves if unaccompanied, or as a derivative on parents' claims-on humanitarian grounds related to persecution or forced migration. Pediatric providers can offer a spectrum of multidirectional medical-legal supports to increase access to medical-legal services and support children who are undocumented or in mixed-status families. These activities can include providing trusted information, incorporating screening for health-related social needs, establishing networks for multidirectional referrals, and providing letters of support for legal protection. To expand workforce capacity for medical-legal services related to immigration, pediatric providers can also receive training to conduct specialized, trauma-informed forensic evaluations and can advocate at individual, local, state, federal, and global levels to address factors leading to persecution and forced migration while supporting individuals who may be eligible for legal protection. [Pediatr Ann. 2024;53(5):e183-e188.].

Caregiver Experience with Bicultural, Bilingual Family Navigators to Support Early Childhood Development.

Recognizing the inequities in developmental screening and services for children in immigrant families, a pediatric primary care clinic in partnership with a community-based early childhood program co-created a bicultural, bilingual early childhood developmental (ECD) family navigator program in Seattle, Washington. The primary aim of this study is to explore caregivers' perspectives about this program. Twenty-seven caregivers of young children participated in semi-structured interviews that were thematically analyzed. Three key themes were identified: 1) sharing language and culture, 2) facilitating accessibility, and 3) promoting development. Caregivers valued linguistic and cultural concordance between the navigator and the family, the navigator's approach to screening to improve accessibility and reduce barriers, and the focus on supporting early childhood development. Understanding caregivers' experience with the ECD family navigator development program and the aspects they value, informs clinic-based approaches to ensure families of diverse language and cultural backgrounds have accessible development screening and connection to services.

Inequities Faced by Children in Immigrant Families in United States NICUs.

Inequities Faced by Children in Immigrant Families in United States NICUs.

Inequities Faced by Children in Immigrant Families in United States NICUs.

Inequities Faced by Children in Immigrant Families in United States NICUs.

Effects of acculturation stress and identity gaps on Mexican-heritage adolescent depressive symptoms and substance use behavior

ABSTRACT Children of immigrant families are placed at high risk of acculturation stress due to their role serving as a cultural broker for their family members. Communication theory of identity (CTI) explains that the discrepancies between one’s personal, enacted, relational, and communal layers of identity lead to negative health outcomes. Guided by CTI, the present study investigated indirect effects of acculturation stress on Mexican-heritage adolescents’ depressive symptoms and substance use behaviors via identity gaps. Using the cross-sectional survey data (N = 210), path analysis revealed direct effects of acculturation stress on the personal-enacted identity gap and on the personal-relational identity gap. Indirect effects of acculturation stress on depressive symptoms via the personal-relational identity gap were also detected.

Immigrant Mothers' Perspectives on Pediatric Primary Care: Challenges and Solutions to Improve Medical Home Use

Abstract: Children in immigrant families (CIF) constitute 25% of all children in the United States. Known barriers to accessing and navigating the health care system for immigrants (i.e., poverty, fear, limited English proficiency, lack of insurance) lead to decreased medical home establishment among CIF, although the ways in which these obstacles affect medical home access are less studied. With a focus on Congolese, Afghan, Syrian/Iraqi, and Central American immigrants, key informant interviews and focus groups were conducted to identify mothers' perceptions of and experiences with pediatric primary health care. Five common themes emerged: mothers' critical role in children's health, uniqueness of the U.S. health care system, logistical challenges, influence of prior clinical experiences, and importance of culturally appropriate communication. Few, but distinct, differences among the groups revealed specific obstacles for individual populations. Improving rates of medical home use among CIF requires targeted, immigrant-informed approaches that involve population outreach as well as systems-level changes.

Qualitative Study of Barriers and Facilitators to Care Among Children in Immigrant Families.

Children in immigrant families comprise ∼25% of US children and live in families with high levels of poverty and food insecurity. Studies suggest a decline in public benefit enrollment among children in immigrant families. We aimed to explore perspectives on barriers and facilitators in accessing care among immigrant caregivers of hospitalized children. With a general qualitative descriptive design, we developed a semistructured interview guide using an iterative process informed by literature and content expertise. Using purposive sampling, we recruited immigrant caregivers of hospitalized children in March 2020 and conducted interviews in English or Spanish. Interviews were recorded, transcribed, and translated to English. Three authors coded transcripts using Dedoose and identified themes via thematic analysis. Analysis of 12 caregiver interviews revealed barriers and facilitators in accessing healthcare and public benefit use. Barriers included healthcare system barriers, immigration-related fear, and racism and discrimination. Within healthcare system barriers, subthemes included language barriers, cost, complexity of resource application, and lack of guidance on available benefits. Within immigration-related fear, subthemes included fear of familial separation, fear of deportation, fear that benefit use affects immigration status, and provider distrust. Healthcare system facilitators of resource use included recruiting diverse workforces, utilizing language interpretation, guidance on benefit enrollment, legal services, and mental health services. Participants also recommended hospital partnership with trusted information sources, including media stations and low-cost clinics. Immigrant caregivers of hospitalized children identified barriers and facilitators in access to care. Further research is needed to assess the efficacy of caregiver-suggested interventions.

O.3.3-6 Brazilian immigrant parents' preferences for content and intervention modalities for the design of a family-based intervention to promote their preschool-age children’s healthful energy balance-related behaviors

Abstract Purpose Childhood obesity is a complex public health problem disproportionally affecting racial/ethnic minority populations and children in immigrant families. Promoting healthful energy balance-related behaviors (EBRBs) in young children, a fundamental obesity preventative strategy, is critical for addressing health disparities in childhood obesity among ethnic minority and immigrant populations. Accumulating evidence indicates that unhealthful EBRBs, including poor eating behaviors (e.g., high consumption of unhealthy foods and sugar-sweetened beverages [SSBs]), inadequate physical activity (PA), excessive sedentary behavior/screen time, and short sleep duration, increase the risk of childhood overweight and obesity. Brazilians are a rapidly growing ethnic immigrant population in the United States (U.S.) and currently, there is a lack of childhood obesity prevention interventions addressing the needs of Brazilian preschool-age children. Methods Guided by the family ecological model, this formative cross-sectional study assessed the preferences (content, intervention modality, and language) of 52 individual Brazilian immigrant families (27 mothers, 25 fathers) for the development of a family-based intervention to promote healthful energy balance-related behaviors (EBRB). Results Overall, 85% or more of parents reported being interested or very interested in content related to five (increase fruits and vegetables, reduce unhealthy foods and sugar-sweetened beverages, increase physical activity, and reduce screen time) out of the seven assessed EBRBs. Group sessions delivered by community health workers (CHWs), email, and text messages were the preferred intervention modalities with most parents (71.2%) indicating a preference for content delivered in Portuguese. Interventions integrating multiple components such as workshops offered by CHWs, text messaging using SMS and WhatsApp, and printed materials should all be considered. Conclusions Future steps should include investigating different communication channels and their integration into a pilot test of a linguistic and cultural-sensitive family-based intervention to promote healthful EBRBs of preschool-age children in Brazilian families in the U.S.

Relations between self-regulation and behavioral adjustment in Chinese American immigrant children during early elementary school years.

The present study examined associations between sociocultural factors and self-regulation (parent-report, teacher-report, laboratory tasks), and prospective relations between self-regulation and behavioral adjustment (parent-, teacher-, child-report) in a socioeconomically diverse sample of Chinese American children in immigrant families (N = 258, Wave 1 age = 6-9 years, Wave 2 age = 9-11 years, 52% boys, 57% low-income) in a longitudinal study (2007-2011) during early elementary school years. Family income uniquely related to a self-regulation latent factor (  = .22), and parent-child Chinese orientation gaps were associated with parent-reported effortful control (  = .40). Self-regulation at W1 negatively predicted parent- and teacher-reported behavioral maladjustment (  = -.22 and -.48) at W2, controlling for cross-time stability of both constructs and covariates (child sex, parental education).

Addressing health inequities for children in immigrant families: Psychologists as leaders and links across systems.

What can psychologists do to address social determinants of health and promote health equity among America's approximately 20 million children in immigrant families (CIF)? This article identifies gaps in current research and argues for a stronger role for psychologists. Psychologists can advocate for and enact changes in institutional systems that contribute to inequities in social determinants of health and promote resources and services necessary for CIF to flourish. We consider systemic exclusionary and discriminatory barriers faced by CIF, including a heightened anti-immigrant political climate, continued threat of immigration enforcement, restricted access to the social safety net, and the disproportionate health, economic, and educational burden of the COVID-19 pandemic. We highlight the potential role of psychologists in (a) leading prevention that addresses stressors such as poverty and trauma; (b) changing systems to mitigate risk factors for CIF; (c) expanding workforce development across multiple disciplines to better serve their needs; (d) identifying mechanisms, such as racial profiling, that contribute to health inequity, and viewing them as public health harms; and (e) guiding advocacy for resources at local, state, and federal levels, including by linking discriminatory policies or practices with health inequity. A key recommendation to increase psychologists' impact is for academic and professional institutions to strengthen relationships with policymakers to effectively convey these findings in spaces where decisions about policies and practices are made. We conclude that psychologists are well positioned to promote systemic change across multiple societal levels and disciplines to improve the well-being of CIF and offer them a better future. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Collateral Damage: Increasing Risks to Children in a Hostile Immigration Policy Environment.

To identify how recent immigration policies have affected the health of children in immigrant families (CIF). As the number of children and families arriving to the US border has increased, so too have immigration policies directly targeting them. Anti-immigrant policies increase the dangers experienced by children migrating to the USA, while also limiting access to needed resources and medical care for CIF inside the country, including many who are US citizens. The resultant deprivation and toxic stress are associated with adverse consequences for children's physical and mental health.

Child Citizenship Status in Immigrant Families and Differential Parental Time Investments in Siblings

This study describes how parental time investments in children in immigrant families vary according to children’s citizenship status. In families with multiple children, parents make allocation decisions about how to invest in each child. In immigrant households, a child’s citizenship status may shape parental time allocations because of how this status relates to a child’s prospects for socioeconomic mobility. It is unclear whether parents reinforce citizenship differences among siblings, compensate for these differences, or treat all siblings equally regardless of citizenship status. Moreover, past empirical research has not investigated differences in parental time investments in siblings with different citizenship statuses. To evaluate differential time investments in children based on citizenship, we conduct a quantitative analysis using data from the American Time Use Survey from 2003–2019 and focus on children in immigrant households with at least two children (N = 13,012). Our research shows that parents spend more time with children who have citizenship, but this result is primarily explained by a child’s age and birth order. Our study provides a basis for further inquiry on how legal contexts shaping socioeconomic mobility may influence micro-level family processes in immigrant households.

Barriers to Service Access for Immigrant Families of Children With Developmental Disabilities: A Scoping Review.

This scoping review explores (a) barriers faced by immigrant families of children with intellectual and developmental disabilities (IDD) when accessing healthcare-related services in the United States, (b) where research stands based on the health disparity research framework, and (c) implications for future health disparities research with this population. Our scoping review found 26 empirical studies published between 2000 and 2020 that met our inclusion criteria. Data were extracted and synthesized based on the stages of research outlined in the health disparity research framework. Overall, immigrant families experienced barriers on multiple levels including patient, provider, and healthcare system levels. Studies focusing on detecting and reducing disparities are emerging. We conclude with recommendations for future research and practice with immigrant families of children with IDD.

Group well-child care model for Latino children in immigrant families: Adapting to and learning from the coronavirus disease 2019 (COVID-19) context.

Group well-child care (GWCC) is an alternative to traditional pediatric well-child care designed to increase parental social support and peer learning. This mixed methods study explored the adaptation and implementation of GWCC to a virtual format during coronavirus disease 2019 (COVID-19 pandemic) among Spanish-speaking Latino immigrant families. Interviews were conducted with eight providers and 10 mothers from May through September 2020. Qualitative analyses used a priori codes based on an implementation science framework. Quantitative data included demographics, the COVID-19 Impact Scale, and virtual group attendance. Bivariate analyses identified correlates of virtual visit attendance. Eighty percent of mothers reported the pandemic had moderately or extremely impacted at least one major life domain such as daily life, food security, or family conflict. Of 27 mothers offered virtual groups, 67% attended. Mothers who attended virtual groups reported lower English proficiency (p = .087) and fewer friends and family members with COVID-19 (M = 1.0 vs. 5.1, p < .05) than those who did not attend. Women described virtual GWCC as acceptable and a source of social support. Some described differences in group dynamics compared with in-person groups and had privacy concerns. Providers noted scheduling and billing challenges affecting feasibility and sustainability. They reported that visits with good attendance were productive. Mothers and pediatric providers offered recommendations to improve feasibility and privacy and address sustainability. Competing demands for those most impacted by COVID-19 may outweigh benefits of attendance. Virtual Spanish language GWCC appears acceptable and feasible for Spanish speaking Latina mothers. Thematic analysis and recommendations identify areas of improvement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Clinician's commentary to accompany "group well-child care model for Latino children in immigrant families: Adapting to and learning from the COVID-19 context".

Comments on an article by Nomi S. Weiss-Laxer et al. (see record 2022-71815-001). Providing virtual services takes time for many providers and families to get familiar with and many prefer in-person contact over telehealth; however, many of the challenges of doing telehealth can be overcome with creativity and flexibility. As clinicians, they agree with the authors that using the features of the technology to our advantage was helpful and that confirming with each person that they had privacy was vital to effective communication. Problem-solving was often needed, and most times parents had the best ideas for working around the limitations of their home environment. The article highlighted the possibility of hybrid models of care considering the needs and wants of both patients and providers. Such a hybrid approach can increase connection to clinics through in-person visits which can jump-start the establishment of therapeutic relationships and build trust (confianza) with clinicians and clinic staff. As the pandemic becomes more controlled, giving parents a choice and flexibility to change modalities can help them stay engaged and reduce drop out. Clinics will need to assess the language preferences of the families they serve to ensure they have enough staff and providers who are bilingual or multilingual to deliver such programs or use trained interpreters. These concerns would need to be addressed if implementation were increased on a large scale. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"The First Step to Changing Something": Addressing Latinx Childhood Obesity through Photovoice.

Latinx children in immigrant families have disproportionately high obesity rates; effective obesity treatment for this subset of Latinx children is critically needed. To inform the development of weight management interventions we explored: 1) community facilitators and barriers to achieving childhood healthy weight through photovoice; and 2) participant reflections on the photovoice process. Photovoice was conducted using established methods in a local church. After photovoice, participants completed semi-structured interviews to reflect on their experience. Transcripts were analyzed using a general thematic analysis approach to arrive at preliminary themes, which were presented to participants for validation. Participant input was used to finalize the themes. Six adults and two youth Latinx immigrants identified photograph themes over seven sessions. Four themes emerged regarding community barriers and facilitators to achieving childhood healthy weight: 1) family habits, 2) cultural influences on food, 3) built environment, and 4) food marketing. Participant reflections revealed they were motivated to participate in photovoice to learn more about health, recognized personal growth as a result of group sharing, valued representation as a community, and felt empowered to be role models. Findings from both photovoice and participant reflections reinforced the need for multi-level approaches to treating childhood obesity. Though participant reflections were gathered to inform continued engagement of Latinx families, they ultimately had a significant impact on our conclusions about priority intervention components.

Insurance and Health Care Outcomes in Regions Where Undocumented Children Are Medicaid-Eligible.

Expansion of insurance eligibility is associated with positive health outcomes. We compared uninsurance and health care utilization for (1) all children, and (2) children in immigrant families (CIF) and non-CIF who resided inside and outside of the seven US states/territories offering public health insurance to children regardless of documentation status ("extended-eligibility states/territories"). Using the cross-sectional, nationally representative National Survey of Children's Health-2019, we used survey-weighted, multivariable Poisson regression to assess the association of residence in nonextended- versus extended-eligibility states/territories with uninsurance and with health care utilization measures for (1) all children, and (2) CIF versus non-CIF, adjusting for demographic covariates. Of the 29 433 respondents, the 4035 (weighted 27.2%) children in extended- versus nonextended-eligibility states/territories were more likely to be CIF (27.4% vs 20.5%, P < .001), 12 to 17 years old (37.2% vs 33.2%, P = .048), non-White (60.1% vs 45.9%, P < .001), and have a non-English primary language (20.6% vs 11.1%, P < .001).The relative risk of uninsurance for children in nonextended- versus extended-eligibility states/territories was 2.0 (95% confidence interval 1.4-3.0), after adjusting for covariates. Fewer children in extended- versus nonextended-eligibility states/territories were uninsured (adjusted prevalence 3.7% vs 7.5%, P < .001), had forgone medical (2.2% vs 3.1%, P = .07) or dental care (17.1% vs 20.5%, P = .02), and had no preventive visit (14.3% vs 17.0%, P = .04). More CIF than non-CIF were uninsured, regardless of residence in nonextended- versus extended-eligibility states/territories: CIF 11.2% vs 5.7%, P < .001; non-CIF 6.1% vs 3.1% P < .001. Residence in nonextended-eligibility states/territories, compared with in extended-eligibility states/territories, was associated with higher uninsurance and less preventive health care utilization.

Do state laws reduce uptake of Medicaid/CHIP by U.S. citizen children in immigrant families: evaluating evidence for a chilling effect

BackgroundRestrictive state laws aimed at immigrants can have unintended consequences for health insurance coverage of United States citizens in immigrant families due to both actual barriers created by the laws and perceived barriers among immigrants. Increasing numbers of children in the U.S. are part of immigrant families, and these children are more likely to be living in poverty than their counterparts in native families. Immigrant restrictive policies could lead to reduced access to Medicaid and CHIP even for citizen children in immigrant families.MethodsUsing data from the Current Population Survey's (CPS) March Supplement, linear probability models with difference-in-differences (DD) estimates compare probability of enrollment in Medicaid/CHIP among low-income U.S. citizen children in immigrant families and low-income children in native families and U.S. citizen children in immigrant families in states that did not adopt restrictive legislation, in order to estimate the impact of restrictive state laws aimed at immigrants. An additional model explores the effect of mother’s citizenship on enrollment among all immigrant families in states with and without restrictive legislation.ResultsResults suggest a significant chilling effect where the magnitude of the effect varies according to family demographics and by the types of laws being passed. Immigrant restrictive social welfare laws being adopted have a strong negative effect on U.S. citizen children in immigrant families’ enrollment in Medicaid/CHIP, a 5.5 percentage point reduction in coverage. Among the subsample of only immigrant families, results point toward a global chilling effect created by an overall restrictive policy environment. All immigrant restrictive related laws, including those aimed at education, job restriction, identification access, and social welfare restrictions have a significant and negative impact on access to public insurance for U.S. citizen children with non-citizen mothers.ConclusionsThis research shows that the unintended consequence of restrictive state legislation aimed at immigrants is the reduction in access to Medicaid and CHIP by low-income U.S. citizen children living in immigrant families. Reduced access to health insurance can increase unmet medical needs for an already vulnerable group.

Legal Relief for Children in Immigrant Families: A Mixed-Methods Study.

Objective: Immigration status is a known social driver of health. Little research exists on addressing concerns about immigration status in primary care. The objective of this study is to understand the experiences of immigrant families that received a clinical-community intervention to address immigration-related concerns. Methods: We conducted a mixed-methods study: an embedded experimental design study. We implemented an immigration-focused legal needs screening tool and referral intervention at one academic primary care clinic in January 2018. Caregivers who screened positive for immigration-related concerns and were referred to a local immigration law firm were invited to participate in a semi-structured interview. Interviews were recorded, de-identified, transcribed, and systematically coded using an inductive content analysis approach. A modified constant comparative method was used to iteratively review codes, identify emerging themes, and resolve differences through consensus. Results: Nineteen caregivers reported immigration-related legal concerns, seven of whom were interviewed. Most (84.2%) were mothers, identified as Hispanic (94.7%), were from Mexico (52.6%), and reported persecution and fear of returning to their country of origin (57.9%). In interviews, we identified three major themes: (1) families were motivated to immigrate due to mental health trauma and persecution; (2) families sought legal services for several immigration-related concerns; and (3) families experienced challenges in navigating the legal system, with which clinics may assist. Conclusion: This study demonstrates the need for immigration-related services in primary care settings and the feasibility and potential benefits of implementing a legal screening and referral intervention.

Subtractive Bilingualism among Children in Immigrant Families, Family Cohesion and Acculturation

Subtractive bilingualism is a phenomenon that is common among children of immigrants, and refers to a process in which the acquisition of a second language results in the deterioration of the heritage language. This article is a critical overview of some of the literature surrounding this phenomenon in immigrant families residing in English speaking countries, as well as how it can affect family relationships. It is concluded that heritage language proficiency, as well as the simultaneous mastery of the heritage language and the dominant language, typically leads to improved relationships, while subtractive bilingualism often is associated with intergenerational conflict. However, many immigrant families navigate issues of communication brought about by subtractive bilingualism in a multitude of different ways, thus illustrating that the families do not necessarily become dysfunctional due to linguistic barriers, rather they employ strategies to minimize miscommunication.