Family Structure and Health Outcomes Among Children of Immigrants

Background and Purpose:

Following the national trend, the proportion of children of immigrants residing in cohabiting and single parent families rises as immigrant generation increases. Considered an important health determinant for children in general, family structure may have a profound implication for immigrant families who tend to be highly interdependent and family-oriented as a response to immigrant challenges, such as linguistic barrier, poverty, limited access to resources, and anti-immigrant sentiment, which affect children’s health outcomes. However, a lack of knowledge about the role of family structure among immigrant families hinders a systematic understanding of whether family arrangement is a significant health determinant for children of immigrants, which could be critical to policy and program development. To this end, driven by Andersen’s behavioral model, this study investigates the association between family structure and a wide range of health outcomes among children of immigrants compared to children of natives.

 

Method:

This study uses the National Health Interview Survey (NHIS) data between 2010-2014, including 55,152 children between the ages of 0-17 who have at least one parent. The health outcomes include children’s poor health status, chronic (overweight/obesity and asthma), and acute (injury and cold/flu) illness, all in a dichotomous variable form (1=yes and 0=no). By combining family structure (married, cohabiting, and single parent families) and immigrant generation (US-born natives, 2^nd generation, and 1^st generation), this study constructs a categorical variable with nine categories as a predictor. This study employs a logistic multivariate model to estimate the risk for adverse health outcomes among the sample children, controlling for predisposing, enabling, and need factors following Andersen’s model.

Results:

We find that 2^nd generation children of single parents had a higher risk of being in poor or fair health condition (OR=1.330, p<0.0001), and 2^nd generation children of cohabiting parents had higher odds of being overweight or obese (OR=1.752, p<0.01) compared to native children of married parents, after controlling for multiple covariates. At the same time, most children of immigrants across family structure and generation had significantly lower odds of having asthma, cold/flu, and injuries compared to native children of married parents.

Conclusions and Implications:

The findings based on a wide range of health indicators suggest that family structure is an important health and disease determinant for children of immigrants, and 2^nd generation children in single and cohabiting parent families are particularly vulnerable to negative health outcomes. Tentative patterns emerged; children of immigrants tend to have low prevalence of having health outcomes, such as asthma, cold/flu, and injuries, that commonly require a diagnosis by a healthcare provider. On the contrary, there is increased risk of having health outcomes, that are evaluated and reported by parents, not requiring a physicians diagnosis; including general health status and overweight/obesity. Differential reporting of children’s illness may explain the contradictory patterns, which calls for further research. The findings can be beneficial to social workers and organizations in creating health care services and health education intervention reflecting different needs based on family structure disparities.