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While the Affordable Care Act (ACA) promised to reduce inequalities in insurance coverage between Latinos and non-Latinos by expanding coverage, it also excluded a large portion of noncitizen immigrants. Past research has demonstrated that among Latinos, further inequalities have developed between citizens and noncitizens after the ACA took effect, but it is unclear if this pattern is unique to Latinos or is evident among non-Latinos as well. I use data from the 2011 to 2016 waves of the National Health Interview Survey (NHIS) (n = 369,386) to test how the relationship between citizenship status (native citizen, naturalized citizen, or noncitizen) and insurance coverage changed after the ACA, adjusting for health, demographic, and socioeconomic factors. I disaggregate the analysis by ethnicity to test whether this change differs between Latinos and non-Latinos. The analysis finds that after the ACA, naturalized citizens across ethnic groups moved toward parity with native citizens in health insurance coverage while the benefits of the ACA for noncitizens were conditional on ethnicity. For non-Latinos, lacking citizenship became less disadvantageous for predicting insurance coverage while for Latinos, lacking citizenship became even more disadvantageous in predicting insurance coverage. This bifurcation among noncitizens by ethnicity implies that while the ACA has strengthened institutional boundaries between citizens and noncitizens, this distinction is primarily affecting Latinos. The conclusion offers considerations on how legal systems of stratification influence population health processes.

Discrimination has been identified as a major stressor and influence on immigrant health. This study examined the role of perceived discrimination in relation to other factors, in particular, acculturation, in physical and mental health of immigrants and refugees. Data for US adults (18 +  years) were derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Mental and physical health was assessed with SF-12. Acculturation and perceived discrimination were assessed with multidimensional measures. Structural equation models were used to estimate the effects of acculturation, stressful life effects, perceived discrimination, and social support on health among immigrants and refugees. Among first-generation immigrants, discrimination in health care had a negative association with physical health while discrimination in general had a negative association with mental health. Social support had positive associations with physical and mental health and mediated the association of discrimination to health. There were no significant associations between discrimination and health among refugees, but the direction and magnitude of associations were similar to those for first-generation immigrants. Efforts aiming at reducing discrimination and enhancing integration/social support for immigrants are likely to help with maintaining and protecting immigrants’ health and well-being. Further research using larger samples of refugees and testing moderating effects of key social/psychosocial variables on immigrant health outcomes is warranted. This study used multidimensional measures of health, perceived discrimination, and acculturation to examine the pathways between key social/psychosocial factors in health of immigrants and refugees at the national level. This study included possibly the largest national sample of refugees.

Past research on the immigrant health paradox suggests that children with immigrant parents may have a health advantage over those with US-born parents, especially if the parent is a recent immigrant. Other research emphasizes the social and economic challenges children with immigrant parents face, in part due to disadvantaged social class and racial/ethnic positions. Underlying physiological changes due to chronic stress exposures among children in immigrant families is one potential health disadvantage that may not yet be apparent in traditional health measures. To explore these biological disparities during childhood, I use national biomarker and survey data from the National Health and Nutrition Survey (NHANES) (N = 11,866) to evaluate parent nativity and educational status associations with low-grade inflammation, indicated by C-reactive protein (CRP), in children ages 2–15 years. I find that children with an immigrant parent, and particularly a low-educated immigrant parent, have higher CRP, net of birth, body mass index (BMI) and other factors, than children with a US-born parent with either a low or higher education. Comparing children with low-educated parents, those with a foreign-born parent have higher predicted CRP. The findings from this study provide new evidence that children living in immigrant families in the US may be facing higher levels of chronic stress exposure, as indicated by the increased risk of low-grade inflammation, than those with US-born parents. The physiological changes related to increased risk of inflammation, could set children in immigrant families on pathways toward mental and physical health problems later in the life course.

The primary objective was to develop a user-centered mobile health application (app) tailored to the specific health information needs of among immigrant women from diverse backgrounds in Korea.

In-depth interviews were conducted with 24 immigrant women to gain insights into their health information-seeking behavior. Based on the findings, a mobile app was designed and developed. A beta version of the app underwent validation by an MD and seven expert reviewers who assessed the app for content accuracy and conformance to mobile heuristics. Last, immigrant women (n = 12) evaluated the usability of the app.

The study revealed that the interviewed immigrant women had strong health information needs related to pregnancy and parenting. Most of them used multiple sources to find and verify health information. Language barriers were identified as a major obstacle to accessing and evaluating health information. The results of the user test indicated that the app effectively facilitated study participants' search for reliable health information, meeting their specific needs.

This research extended the literature by addressing the limited availability of mobile apps tailored to the health information needs of immigrant women in Korea.

By incorporating multilingual support and focusing on pregnancy and parenting information, the health app serves as a valuable tool to bridge the gap in health information access and to facilitate the well-being of immigrant women in the country.

In this chapter, we have proposed that an important approach to understanding occupational stress and well-being among racial and ethnic minority workers is to integrate the occupational health disparities paradigm into work stress research. As such, the current chapter provides a state-of-the-art review of the existing literature on occupational health disparities for Latinos, Asian Americans, and African Americans. Each of the three sections has highlighted the unique occupational health problems encountered by the specific racial and ethnic group as well as the research and policy gaps. We end with a series of recommendations for future research.

To investigate ethnic group differences in the utilization of preventive medical care services among U.S. Asian and Latino immigrant adults.

Using data from the 2002–2003 National Latino and Asian American Study, we examined whether differences exist in the reporting of any preventive physical care or dental/optician visit during the last year across Asian and Latino immigrant groups. Following, we applied Andersen’s (1995) Behavioral Model of Health Services Use to assess how ethnic disparities in preventive care use are a function of predisposing, enabling/impeding, and need-based factors.

Descriptive results showed that among Latinos, a much lower proportion of Mexican immigrants reported a preventive medical care visit during the last year than either Cuban or Puerto Rican immigrants. Asian immigrants show less variation in use, but significant differences still exist with Filipino immigrants reporting the highest level of use, followed by Vietnamese and then Chinese immigrants. Logistic regression models also indicated that predisposing characteristics, especially aspects of acculturation status, contribute strongly to ethnic group differences in preventive care use, while enabling/disabling and need-based characteristics are less important.

While studies of medical care use often treat Asians and Latinos as homogeneous groups, our findings illustrate the need for a more detailed view of the foreign-born population. Findings also highlight the role of acculturation status in shaping group differences in preventive medical care use – and as such, the importance of considering these differences when promoting the use of timely preventive care services among immigrant populations.

Age at migration is commonly utilized as a proxy measure for assimilation in health behavior research. We reconsider this approach by examining the role of continued connection with places of origin on alcohol use, an important marker of health behavior and overall population health. Cross-border connections may buffer the association between earlier age at migration and alcohol use by providing an alternative channel of influence for behavioral norms. Alternatively, a stress and coping perspective on cross-border ties suggests potentially countervailing adverse impacts of these connections on alcohol use. We used data from the 2002/2003 National Latino and Asian American Study (NLAAS) (n = 1,641/1,630 Asian and Latino origin respondents, respectively). We first estimated the association between age at migration (child/adolescent versus adult migrant) and any past-year alcohol use. We subsequently tested the interaction between age at migration and two measures of cross-border connections. All models were stratified by region of origin and gender. For Latin American-origin women, cross-border ties were associated with increased risk of past-year alcohol use among those who migrated early in life. In contrast, Asian-origin men and women who migrated as adults and had contact with family and friends abroad had the lowest predicted probabilities of past-year alcohol use. The results among Asians support the idea that cross-border ties may be alternative influences on health behavior outcomes, particularly for adult migrants. Overall, we find qualified support for both transnational and assimilationist perspectives on alcohol use behaviors among US immigrants – as well as the interaction between these two frameworks. The joint influences of cross-border ties and age at migration were observed primarily for immigrant women, and not always in expected directions. We nevertheless urge future research to consider both US and country of origin influences on a wider range of health and health behavior outcomes for immigrants, as well as the potential intersection between US and cross-border connections.

Purpose: Fear of deportation and its relationship to healthcare access has been less studied among immigrant Latinx men who have sex with men (MSM), a population at risk for HIV and characterized by their multiple minority statuses. The first step is to accurately measure their fear of deportation.

Approach: We used an exploratory sequential mixed methods design. Eligibility criteria were that research participants be ages 18–34 years; Latinx; cisgender male; having had sex with another male; residing in the District of Columbia metro area; and not a US citizen or legal permanent resident. In Study 1, we used in-depth interviews and thematic analysis. Using participants' interview responses, we inductively generated 15 items for a fear of deportation scale. In Study 2, we used survey data to assess the scale's psychometric properties. We conducted independent samples t-test on the associations between scale scores and barriers to healthcare access.

Findings: For the 20 participants in Study 1, fear of deportation resulted in chronic anxiety. Participants managed their fear through vigilance, and behaviors restricting their movement and social network engagement. In Study 2, we used data from 86 mostly undocumented participants. The scale was internally consistent (α = 0.89) and had a single factor. Those with higher fear of deportation scores were significantly more likely to report avoiding healthcare because they were worried about their immigration status (p = 0.007).

Originality: We described how fear of deportation limits healthcare access for immigrant Latinx MSM.

Research implications: Future research should examine fear of deportation and HIV risk among immigrant Latinx MSM.

In this chapter we examine how micro- and macro-level issues including access to child-only or family public health insurance shape low-income immigrant families’ health care experiences in two policy contexts in the Washington, DC metropolitan area.

This qualitative study includes 40 in-depth interviews with first-generation, low-income immigrant Latin American and African mothers in DC and Northern Virginia.

The majority of families living in Virginia had child-only health insurance, whereas most of the families living in Washington, DC, had family health insurance. Regardless of these insurance differences, all mothers had access to free health care for prenatal care. Pregnancy, for most, was their entry into the U.S. health care system. Families’ ongoing health care experiences differed in relation to insurance access, and culture, including parents’ previous experiences with health care in their countries of origin.

Future research should consider the experiences of other immigrant groups, mental health experiences of immigrants, and fathers’ experiences with health care.

Future initiatives to address health care should focus on providing family health care to low-income immigrant families across the country, improving access to mental health services for immigrant families, and creating more culturally and linguistically appropriate health care services.

This study points to the importance of family health care for immigrant families, as well as care that is culturally and linguistically competent.

This study illustrates the need for public family health insurance for low-income immigrant families, and the importance of culturally competent health care for immigrants.