From Generation to Generation The Health and Well-Being of Children in Immigrant Families (1998) / Chapter Skim
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5 Conclusions and Recommendations
5 Conclusions and Recommendations
Pages 155-181
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From page 155... ...
First, there are no currently available data on the effects of the recent major reduction in benefits to immigrant children and families brought about by enactment of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Second, the political environment that will influence the implementation of these new policies is in flux.
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From page 156... ...
FINDINGS AND CONCLUSIONS Whenever possible, we compare children in immigrant families with U.S.-born children in U.S.-born families. This provides a means of deciphering generational patterns of health and adjustment and examining immigrant families in the context of the range of life chances experienced by U.S.-born children in U.S.born families, including black children who, like immigrant children, are often considered to be at risk.
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From page 157... ...
Nevertheless, a few conclusions that point to interesting questions for future research may be drawn from the existing literature. · In 1990, first-generation immigrant children were substantially more likely to be poor than was the case in 1960 (32.9 percent versus 22.7 percent)
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From page 158... ...
The proportion of children who speak English, however, increases rapidly from the first to the second generation, such that, in 1990, 81 percent of second-generation children spoke English "exclusively or very well." Yet linguistic isolation remains a concern. In 1990, a sizeable number of immigrant children from several of the major sending countries, including over 40 percent of children from Laos, Cambodia, Vietnam, China, and the former Soviet Union, lived in households in which no person age 14 or older spoke English either "exclusively" or "very well." These general patterns, however, camouflage the diversity in socioeconomic circumstances that characterizes children in immigrant families from different countries of origin.
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From page 159... ...
Immigrant parents report that their children experience fewer acute and chronic health problems compared with third- and later-generation families. And adolescents in immigrant families report lower levels of neurological impairment, obesity, asthma, and health risk behaviors such as early sexual activity; use of cigarettes, alcohol, marijuana, or hard drugs; delinquency; and use of violence compared with their counterparts with U.S.-born parents.
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From page 160... ...
Although the limited available evidence suggests that protective factors specific to immigrants may diminish with increasing duration of residence in the United States and across generations, future research should assess the possibility that the increasing size and the geographic concentration of the immigrant population, especially from Mexico, may help to shield against the loss of the protective factors they brought with them from their home countries. Despite this generally positive portrait, not all conclusions that can be drawn about the health of immigrant children are favorable.
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From page 161... ...
But Asian groups, such as the Lao and Hmong, have scores that are well below national norms. Use of Public Benefits First-generation immigrant children are more likely than later-generation children to live in families receiving public assistance.
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From page 162... ...
Only among Asian, Cuban, and East European children at given socioeconomic levels was the first generation generally more likely than later generations to use public assistance, probably because of the access available in the past to these populations as refugees from Southeast Asia and the former Soviet Union. This portrait of reliance on public assistance reflects eligibility rules prior to welfare reform, when access to public benefits and programs for children in immigrant families were essentially identical for legal immigrants and citizens.
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From page 163... ...
Of particular importance is evidence linking expansions in Medicaid coverage that occurred between 1984 and 1992 to substantially reduced odds that a child went without a doctor's visit in the past year for both children who are immigrants and those who are not, but to a larger extent for immigrant children. Medicaid, in fact, plays a vital role in health coverage for firstand second-generation children in immigrant families, as well as for third- and later-generation children.
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From page 164... ...
Few of these major data collection efforts provide a scientifically sound basis for monitoring or studying the health status and resources available to children in immigrant families. This enormous gap in knowledge is of great concern, given the rapid growth of this population and the pressing need to assess how they are affected by the recent policy reforms that sharply restrict their eligibility for health care and social benefit programs.
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From page 165... ...
families on physical and mental health, access to publicly funded benefits and programs, health insurance coverage and health service utilization, and exposure to potential risk and protective factors, including those factors unique to immigrants because of their culture .
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From page 168... ...
Undocumented and legal immigrant children are not distinguished in national data collection efforts. Two central issues that emerged during the committee's review call specifically for longitudinal research.
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From page 169... ...
population, a diverse set of protective factors may be involved. These factors include the social capital or culturally sanctioned behaviors that immigrants bring with them, such as nuclear and intergenerational family cohesion; gender roles; norms about smoking cigarettes, drinking alcohol, sexual activity; and reciprocal responsibilities among members of the community.
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From page 170... ...
Ideally, the sample would represent: · all children in immigrant families that currently live in the United States and children who are subsequently born into these families; · children in immigrant families in (at a minimum) the 6 states with the largest number of such children, or alternatively, those living in the 8 or 10 metropolitan areas with the largest number of children in immigrant families supplemented with a nonmetropolitan or rural sample; · specific countries in each of the major geographic regions that send substantial numbers of immigrants, including the Caribbean; Central and South America; East, Southeast, Central, and West Asia; East and West Europe; and Africa; and · children in populations that are difficult to enumerate, such as children of undocumented immigrants and of migrant Because limited resources may preclude selection of a sample that fully meets all of these criteria, the committee urges the National Institute of Child Health and Human Development to convene an advisory group to develop design guidelines that balance these sample characteristics, especially national, state, and metropolitan sampling frames.
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From page 171... ...
It would not represent children in immigrant families that currently live in the United States, or in the states or metropolitan areas with the largest number of immigrants, because sample selection would include only persons who were given a visa during specified future years. It would not permit explicit comparisons between various immigrant groups and third- and later-generation white, black, Hispanic, and Asian children, because the sample would not include persons currently in the United States.
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From page 172... ...
A series of ethnographic studies on the physical and mental health of children and youth in diverse immigrant families should, insofar as possible, be embedded in the proposed longitudinal survey of children in immigrant families or in other national surveys. The proposed longitudinal survey of children in immigrant families can provide statistically reliable estimates of major outcomes and processes for this population as a whole and for important social and cultural subgroups.
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From page 173... ...
are undergoing dramatic change and reassessment. Welfare reform, in particular, represents the most significant shift in the modern era in the treatment of immigrant children and youth.
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From page 174... ...
Department of Health and Human Services; the 50-State Database Set and the National Survey of American Families of the Assessing New Federalism Project of the Urban Institute; and the study called Welfare Reform and Children: A Three-City Study. At the present time, none of these efforts includes a specific focus on children in immigrant families, although a new federally supported effort to examine the effects of welfare reform at selected sites on the economic and health status of immigrants generally is being conducted by the Urban Institute.
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From page 175... ...
Despite the inherent difficulties that face efforts to obtain information on undocumented children and citizen children with undocumented parents, it is important that the continuing reexamination of public policy be informed by a dedicated effort to gather through available public records and other sources all available knowledge about their health and nutritional status, and their access to and utilization of pertinent benefits and programs, including those for which they are not legally eligible. The need for health care to be provided in a culturally compe
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From page 176... ...
Efforts supported by federal and state governments, professional organizations, and health care institutions should be systematically assessed to provide the basis for implementing and evaluating community intervention programs. Data Collection and Dissemination In addition to these recommended new research studies, the committee recommends measures to improve existing data resources and highlight immigrant children in existing data reports, each of which would substantially improve the available knowIedge about these children.
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From page 177... ...
The federal government funds public health information and surveillance systems and national surveys to monitor physical and mental health, and circumstances and risk factors related to family, education, employment, income, housing, crime, and participation in public programs (see Box 5-1~. It has been recognized for decades that accurate interpretation of these data requires analysis using the basic demographic measures of age, sex, race, and ethnicity.
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From page 178... ...
The CDC surveillance systems and surveys that should collect these data include those focused on behavioral risk factors, birth defects, immunizations, cancer registration, HIV/ AIDS, sexually transmitted diseases, tuberculosis, youth risk behavior, and chronic diseases. The National Center for Health Statistics within the CDC has immediate responsibility for compiling data from the birth and death registration systems, and for conducting the National Health Interview Survey, the National Health and Nutrition Examination Survey, the National Survey of Family Growth, and the Medical Expenditure Pane!
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From page 179... ...
Among these data collection systems and surveys, only the Current Population Survey collects the full set of immigration data recommended here beginning in 1994, with funding from the Immigration and Naturalization Service and the National Institute of Child Health and Human Development. As the immigrant population grows and these data elements become essential to a proper understanding of trends in the social, economic, and health status health of the U.S.
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From page 180... ...
Recommendation 6. Key indicators of child well-being published in the annual report of the Federal Interagency Forum on Child and Family Statistics should, insofar as possible, distinguish among foreign-born immigrant children (first generation)
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From page 181... ...
, but as yet there is virtually no public dissemination of information on even the most basic indicators on the lives and well-being of children in immigrant familiesthe fastest-growing segment of the child population. Precedents for federal publication of annual reports on important minority groups include the Current Population Reports of the Census Bureau on the black and Hispanic populations.
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