Public Health Insurance and Health Care Utilization for Children in Immigrant Families.

Objectives To estimate the impacts of public health insurance coverage on health care utilization and unmet health care needs for children in immigrant families. Methods We use survey data from National Health Interview Survey (NHIS) (2001-2005) linked to data from Medical Expenditures Panel Survey (MEPS) (2003-2007) for children with siblings in families headed by at least one immigrant parent. We use logit models with family fixed effects. Results Compared to their siblings with public insurance, uninsured children in immigrant families have higher odds of having no usual source of care, having no health care visits in a 2 year period, having high Emergency Department reliance, and having unmet health care needs. We find no statistically significant difference in the odds of having annual well-child visits. Conclusions for practice Previous research may have underestimated the impact of public health insurance for children in immigrant families. Children in immigrant families would likely benefit considerably from expansions of public health insurance eligibility to cover all children, including children without citizenship. Immigrant families that include both insured and uninsured children may benefit from additional referral and outreach efforts from health care providers to ensure that uninsured children have the same access to health care as their publicly-insured siblings.

Family Structure Experiences and Child Socioemotional Development During the First Nine Years of Life: Examining Heterogeneity by Family Structure at Birth.

A vast amount of literature has documented negative associations between family instability and child development, with the largest associations being in the socioemotional (behavioral) domain. Yet, prior work has paid limited attention to differentiating the role of the number, types, and sequencing of family transitions that children experience, as well as to understanding potential heterogeneity in these associations by family structure at birth. We use data from the Fragile Families and Child Wellbeing Study and hierarchical linear models to examine associations of family structure states and transitions with children's socioemotional development during the first nine years of life. We pay close attention to the type and number of family structure transitions experienced and examine whether associations differ depending on family structure at birth. For children born to cohabiting or noncoresident parents, we find little evidence that subsequent family structure experiences are associated with socioemotional development. For children born to married parents, we find associations between family instability and poorer socioemotional development. However, this largely reflects the influence of parental breakup; we find little evidence that socioemotional trajectories differ for children with various family structure experiences subsequent to their parents' breakup.

Using vignettes to rethink Latino-white disparities in self-rated health.

Researchers often rely on respondents' self-rated health (SRH) to measure social disparities in health, but recent studies suggest that systematically different reporting styles across groups can yield misleading conclusions about disparities in SRH. In this study, we test whether this finding extends to ethnic differences in self-assessments of health in particular domains. We document differences between US-born whites and four Latino subgroups in respondents' assessments of health in six health domains using data from the second wave of the Los Angeles Family and Neighborhood Survey (N = 1468). We use both conventional methods and an approach that uses vignettes to adjust for differential reporting styles. Our results suggest that despite consistent evidence from the literature that Latinos tend to rate their overall health more poorly than whites, and that Latino immigrants report worse SRH than US-born Latinos, this pattern is not true of self-reports in individual health domains. We find that at the bivariate level, US-born whites (and often US-born Mexicans) have significantly more pessimistic reporting styles than Latino immigrants. After adding controls, we find evidence of significantly different reporting styles for only one domain: US-born Mexicans and whites consistently interpret head pain more severely than the other Latino subgroups. Finally, we find that both before and after adjusting for differences in rating styles across groups, non-Mexican Latino immigrants report better social and physical functioning and less pain than other groups. Our findings underscore the advantages of domain-specific ratings when evaluating ethnic differences in self-assessments of health. We encourage researchers studying social disparities in health to consider respondents' self-assessments in a variety of domains, and to also investigate (when possible) potential biases in their findings due to different reporting styles. The anchoring vignettes approach we use is one potential method for overcoming biases due to different rating styles across groups.

Young Adults' Roles as Partners and Parents in a Context of Family Complexity.

This article uses data from the 1979 and 1997 cohorts of the National Longitudinal Survey of Youth to estimate the proportions of young men and women who will take on a variety of partner and parent roles by age 30, as well as to describe how these estimates have changed across cohorts. It then draws from identity theory and related theoretical work to consider how the multiple family roles which young adults are likely to occupy-both over their life course and at a single point in time-may influence inter- and intra-family (unit) relationships in light of current trends in family complexity. This discussion highlights four key implications of identity theory as it relates to family complexity, and proposes several hypotheses for future empirical research to explore, such as the greater likelihood of role conflict in families with greater complexity and limited resources. Implications for public policy are also discussed.

Health insurance coverage within sibships: prevalence of mixed coverage and associations with health care utilization.

An increasing proportion of children in the United States lives in families with complicated family structures and a mix of immigrant and US-born family members. Eligibility rules for health insurance coverage, however, were not designed with these families in mind. The result can be complicated insurance patterns among siblings within families, with some "sibships" only being partially-insured, and other sibships having both private and public coverage. We hypothesize that mixed coverage among siblings causes confusion and logistical difficulties for parents and may lead to less access to appropriate health care for their children. In this article, we use data from the 2009-2011 National Health Interview Survey (n = 51,418 children in 20,478 sibships) to present estimates of the prevalence of mixed health insurance coverage among siblings and describe the predictors of such coverage. We also use linked data from the 2001-2005 National Health Interview Survey and 2002-2007 Medical Expenditure Panel Survey (n = 17,871) to show how mixed coverage is related to health care utilization. We find that although few sibships are characterized by different health insurance coverage types, mixed coverage among siblings is far more common among families with mixed nativity status, and blended families with step- and half-siblings. In terms of outcomes, children living in sibships with mixed coverage have significantly lower odds of having a usual source of health care. We also consider whether the association between mixed insurance coverage and health care outcomes differs across particular combinations of insurance coverage. We find that both publicly-insured children who have uninsured siblings and privately-insured children with publicly-insured siblings are less likely to have a usual source of care than similar children with uniformly-insured siblings. Because a usual source of care is associated with better health care outcomes, we argue that policymakers should consider ways to reduce mixed coverage among children and families.

Mothers' Repartnering after a Nonmarital Birth.

This paper examines the prevalence, predictors and outcomes of unmarried mothers' repartnering patterns following a nonmarital birth. Results indicate that, within five years after a birth, approximately two-thirds of unmarried mothers ended their relationship with the focal child's biological father, and over half of these mothers entered new partnerships. Among those who repartnered, 60 percent of mothers formed unions with men with higher economic capabilities than their former partners, 20 percent formed unions with men with similar capabilities, and 20 percent formed unions with men with lower capabilities. This pattern holds for both nonresidential and coresidential unions. Our findings are consistent with marriage market, learning, and evolutionary biology theories about union formation, and they provide support for qualitative evidence that unmarried mothers have high standards for new partners. While many mothers are able to successfully find new partners with better economic capabilities, many other mothers remain unpartnered, likely due (at least in part) to the limited pool of potential partners with relatively high levels of economic capabilities.

Familial instability and young children's physical health.

This paper uses recent longitudinal data about a cohort of young children born in the United States to mostly unmarried parents to examine the association between increasingly-complex patterns of family instability and physical health in early childhood. The analyses assess whether, and how, the association between family instability and child health varies across a number of family types. We consider several measures of children's health at age five (overweight/obesity, asthma diagnosis and overall health) and examine to what extent the association between family instability and child health varies across outcomes and depends on the number and timing of any familial transitions. We also explore a number of potential mechanisms through which family instability may affect child health. The results suggest that familial instability is related to worse child health, particularly among children born to coresident (married or cohabiting) biological parents and for children who experience high levels of residential instability.

Race, ethnicity, and the education gradient in health.

Using pooled data from the 2000-2006 National Health Interview Survey, we document how the relationship between education and a broad range of health measures varies by race/ethnicity and nativity. We found that education is a more powerful determinant of health behaviors and outcomes for some groups than it is for others. In addition, the education differentials for foreign-born groups are typically more modest than those for corresponding native-born populations. We also show how the education-health relationship varies across Hispanic and Asian subgroups. We argue that any intervention for eliminating health disparities must take these patterns into account.

Parenting Practices of Resident Fathers: The Role of Marital and Biological Ties.

This paper uses data from the Fragile Families and Child Wellbeing Study (N = 2,098) to examine differences in the parenting practices of four types of resident fathers, defined by their biological relationship to a focal child and their marital status with regard to the focal child's mother. Regression results suggest that biological and social (i.e., stepfathers or mothers' cohabiting partners) fathers differ significantly, and in some unexpected ways, on most measures of parenting. However, a considerable portion of these differences can be explained by variation in the background characteristics of the individuals and families in each group. Additionally, difference-in-difference analyses reveal a stronger link between marriage and higher quality parenting practices among social fathers than among biological fathers.

Why do Hispanics in the USA report poor health?

Despite the health and survival advantages of Hispanics relative to non-Hispanic whites in the USA, Hispanics report themselves to be in worse health than whites. Prior research indicates that these ethnic differences in self-rated health (SRH), measured by a simple question asking individuals to assess their overall health status, persist in the presence of an extensive set of explanatory variables. In this paper we use data from the first wave of the Los Angeles Family and Neighborhood Survey (L.A.FANS-1) to test three hypotheses regarding Hispanic-white differences in SRH. We evaluate whether poorer health reports among Hispanics result from: (1) acculturation and language-related differences in reports; (2) measures of socioeconomic status (SES) that are often omitted in other studies; and (3) somatization of emotional distress by Hispanics. Our results provide new insights into the validity of these explanations and suggest avenues for future research. First, they underscore the importance of language of interview over other measures of acculturation, suggesting that translation issues between the Spanish and English versions of the SRH question may give rise to some of the differences. Second, adjustment for SES - especially years of schooling - narrows, but does not eliminate, the gap between whites' and Hispanics' SRH. Finally, although respondents who are depressed are more likely to report poor SRH, this study provides little evidence to support the somatization hypothesis. The second wave of L.A.FANS incorporates new questions that are likely to permit more in-depth assessments of these hypotheses in future analyses.