State Factors on Asian and Latino Immigrants' Preventive Care Use in the United States: Moderation of Citizenship Status and Race/Ethnicity

Background: After the welfare reform in 1996, immigrants’ access to social service programs and health services has been largely limited, particularly for non-citizens. The recent Patient Protection and Affordable Act of 2010 does not include undocumented immigrant in the univeral health care plan. Latino and Asian immigrants in the United States as the major growing immigrant populations have been found to under use health care services compared to U.S.-born citizens. While prior literature identifies various individual barriers, contextual influence, such as state factors have not been widely examined. Adapted from Andersen’s Behavior Model of Health Service Use, this study examines the associations between state factors and immigrants’ preventive care use after controlling for individual-level factors. This study further investigates whether the associations of preventive care use and state factors are moderated by immigrants’ citizenship statuses and their race and ethnicity.

Methods: Data were obtained from the public and restricted data set of the National Latino and Asian American Survey (NLAAS), which consists of a sample of 4,254 Latino and Asian immigrant adults from 18 to 64 years of age living in the U.S. household across 50 states during 2002 and 2003. Binary logistic regression models were estimated to address the questions above based on a final sample of 3,895. Sampling weights, strata and cluster variables were applied.

Results: Findings indicated that immigrants who were female, not in the labor force, being older, had medical insurance or had better English proficiency were more likely to have physical checkups in the previous year. Immigrants who lived in states with the highest immigrant concentration (more than 20%, such as California, New York and New Jersey) were 60% less likely to have physical checkups than those who lived in non-traditional immigrant states (states with less than 5% of immigrants). Community cohesion and living in states that offered state-funded health programs to immigrants had no effect on immigrants’ preventive health care use.

In the analyses for the interactions between citizenship status and state immigrant concentration, non-citizens who lived in states with a moderately high concentration of immigrants (e.g. 10% and above) had a lot less odds for having physical checkups. In the interactions between race/ethnicity and state concentration of immigrants, Asian immigrants had 8-11 times greater odds for having physical checkups than Latino immigrants when they both lived in highly immigrant-concentrated states (e.g. 15% and above). Neither of the interactions, between citizenship status and state generosity or race/ethnicity and state generosity, were significant. This indicates that living in a more generous state does not affect immigrants differently than US-born counterparts, nor does it differently affect Latino or Asian immigrants' utilization of health care.

Conclusions & Implications: The current study suggests different risks and needs for Asian and Latino immigrants' access to preventive care in state contexts. It also concludes that having state-funded programs for immigrants alone is not enough for enhancing immigrants' access to physical checkups if other factors, such as sociocultural, structural and financial barriers, are not resolved.