Trump Immigration Policy Tied to Poor Health Outcomes in US-Born Teens

Batya Swift Yasgur, MA, LSW

June 27, 2019

The Trump administration's immigration policy has had an adverse effect on the health of US-born teens whose parents are immigrants, new research shows.

Investigators at the University of California, Berkeley, found that this adolescent population experienced higher levels of anxiety, sleep problems, and adverse blood pressure changes after the 2016 presidential election than before the election.

"Our results likely represent a best case scenario, since most of our children live in a sanctuary city and all live in a sanctuary state, while youth living in less supportive environments will likely be suffering more and potentially in silence and fear," lead investigator Brenda Eskenazi, PhD, Maxwell Professor of Maternal and Child Health and Epidemiology, School of Public Health, University of California, Berkeley, told Medscape Medical News.

"Our study shows it is not just youth who are undocumented themselves but children who are US citizens who are being affected," she said.

The study was published online June 24 in JAMA Pediatrics.

Hostile Immigration Policy

Of all children in the United States, 18 million (25%) live in immigrant families, most of which originated from countries in Latin America.

Although most are US-born citizens, approximately 7% have at least one undocumented immigrant parent. The proportion is higher in California and other immigrant destination states.

Since the 2016 presidential election, US policy toward immigrants has "turned notably hostile," the authors state, with "actions and statements [that] have generated considerable anxiety in the immigrant community."

The researchers wanted to understand whether concerns about immigration policy were related to the mental and physical health of US-born Latino children who have one or more undocumented immigrant parents.

They analyzed data from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), a multiyear study of primarily Mexican farmworker families.

Youth participants in CHAMACOS were born from 2000 to 2002 in the California agricultural region of the Salinas Valley and were enrolled in two waves. The first cohort consisted of 601 pregnant women (<20 weeks' gestation) who qualified for low-income health insurance (available to undocumented immigrants for prenatal care) and who planned to deliver at a public hospital.

These women delivered 536 live-born infants who remained in the study at birth.

The second cohort was enrolled from January 2010 to September 2011 and consisted of 305 US-born children of immigrant parents who were 9 years old, as well as their mothers.

Of the 412 children who completed study visits at age 16 years (between December 28, 2016, and January 8, 2018), 397 adolescents who had one or more immigrant parents were included.

The visits among 15-year-olds took place during the summer preceding the US presidential election.

At each visit, mothers were interviewed in Spanish or English, their teenagers completed a questionnaire in English, and youth anthropometrics were measured.

"We have been following many of these children since they were in utero. We suspected, having spent time in this community and from anecdotal evidence, that the anti-immigration rhetoric might be impacting the health of our children," said Eskenazi.

"We were about to start the next wave of our study in November 2016 and decided to include questions about this in the study, given these observations," she added.

The researchers used the Perceived Immigration Policy Effects Scale (PIPES) to assess adolescent self-reported concerns about immigration policy at age 16 years, which was the main independent variable.

The version of PIPES (administered in English) consisted of two subscales:

  • Threat to Family, which assessed worry about the impact of immigration policy, fear that the adolescent respondent or a family member would be reported to immigration officials, and worry about family separation due to deportation

  • Children's Vulnerability, which assessed stress about family members being deported or detained, feelings of being unsafe, being emotionally upset, being fearful of authorities, and having difficulties focusing in school because of immigration policies

Other outcome measures included blood pressure, height, and body mass index (BMI).

At the 14-year-old and 16-year-old visits, mothers and adolescents completed parent-report and youth self-report versions of the Behavioral Assessment System for Children 2nd Edition, using the Depression and Anxiety Subscales.

At the age-16-years visit, adolescents completed an adapted version of the Pittsburgh Sleep Quality Index (PSQI).

At both visits, mothers were asked to rate their child's health.

Anxiety, Sleep Disturbances

Of the 397 US-born adolescents (52.1% female) included in the study, 98.2% had a mother or father who had been born in Mexico, and 86.0% had parents who had both been born in Mexico.

The remainder of the sample had an immigrant parent who had been born elsewhere in Central America.

Almost half of the mothers had been living in the United States for ≤5 years at delivery and had a sixth grade education or less.

At the age-14-years visit, most mothers were married or were living as married and were living in poverty.

Youth participants most frequently endorsed the PIPES subscale of Threat to Family — ie, being concerned "at least sometimes" about the implications of the US immigration policy for the family (44.8%), about family separation because of deportation (44.6%), and about being reported to the immigration officials (41.3%).

In general, female adolescents had higher PIPES scores, compared with their male counterparts (29.5% vs 11.1%, respectively; PIPES scores were within the high range).

Offspring of mothers who had immigrated to the United States more recently had somewhat higher PIPES scores, compared with other participants.

For adolescents with high vs low or moderate PIPES scores, self-reported mean anxiety T scores were higher (5.43; 95% confidence interval [CI], 2.64 – 8.23), maternally reported anxiety T scores were higher (2.98; 95% CI, 0.53 – 5.44), and PSQI scores were worse (0.98; 95% CI, 0.36 – 1.59).

Moreover, for youth with higher PIPES scores, levels of anxiety increased from the first to the second visit (adjusted mean difference-in-differences, 2.91; 95% CI, 0.20 – 5.61).

By contrast, there was no significant increase in depression levels (adjusted mean difference-in-differences, 2.63; 95% CI, –0.28 to 5.54).

Physicians as Advocates

Although few participants had hypertension, 16% were prehypertensive, and more than half were overweight or obese (17.8% and 41.6%, respectively), with mean BMIs in the 75th percentile.

Close to one fifth of participants (16.3%) reported "fairly bad" or "very bad" sleep quality; 21.3% took a long time to fall asleep, and 10.8% experienced daytime dysfunction ≥1 times weekly because of sleepiness.

A higher PIPES score in females was associated with lower systolic blood pressure, lower diastolic blood pressure, and lower mean arterial pressure.

"Physicians need to be aware and sensitive to these issues for children of immigrant parents [and] provide social services to the youth and their families that do not put them in further jeopardy," Eskenazi declared.

"These services should include providing bilingual mental health services for the families, since this is both an individual — and a family-centered issue," she advised.

She also urged physicians to "advocate for children who do not have a voice themselves and to consider strongly supporting the American Academy of Pediatrics (AAP) 2017 statement on protecting immigrant children."

Safe Clinical Space

Commenting on the study for Medscape Medical News, Elizabeth Dawson-Hahn, MD, MPH, acting assistant professor, Division of Hospital Medicine and General Pediatrics, Department of Pediatrics, University of Washington, Seattle, said clinicians "can be the most supportive to these youngsters by acknowledging and celebrating their resilience and contributions to their community [and] by creating a trusting environment where youth and families can talk about their concerns."

Additional support includes "developing a safe clinical space for youth and families to receive care, supporting the development of family preparedness plans, partnering with schools, and asking youth what they need," said Dawson-Hahn, who is also an investigator at the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, and is the coauthor of an accompanying editorial.

"We do not know what the long-term consequences of this toxic stress are on the future health and well-being of these citizen children, but it is likely to affect other aspects of children's well-being, including their ability to stay focused in school and their overall health, possibly into adulthood," Eskenazi added.

The research was funded by grants from the National Institute of Environmental Health Sciences, the National Institute on Drug Abuse, and the Environmental Protection Agency. Eskenazi received grants from the National Institutes of Health and the Environmental Protection Agency during the conduct of the study. The other authors' disclosures are listed on the original article. Dawson-Hahn has received grants from the Center for Diversity and Health Equity at the Seattle Children's Research Institute, the University of Washington Population Health Initiative, and the Health Equity Research Mentored Scholar program. She also has received nonfinancial support from the International Organization for Migration outside the submitted work. Her coauthor have disclosed no relevant financial relationships.

JAMA Pediatrics. Published online June 24, 2019. Abstract, Editorial

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