State-Level Anti-Immigrant Sentiment and Policies and Health Risks in US Latino Children

Abstract

Background: Although systemic inequities, broadly defined, are associated with health disparities in adults, there is a dearth of research linking contextual measures of exclusionary policies or prejudicial attitudes to health impairments in children, particularly among Latino populations. In this study, we examined a composite measure of systemic inequities in relation to the cooccurrence of multiple health problems in Latino children in the United States.

Methods: Participants included 17 855 Latino children aged 3 to 17 years from the National Survey of Children's Health (2016-2020). We measured state-level systemic inequities using a factor score that combined an index of exclusionary state policies toward immigrants and aggregated survey data on prejudicial attitudes toward immigrants and Latino individuals. Caregivers reported on 3 categories of child health problems: common health difficulties in the past year, current chronic physical health conditions, and current mental health conditions. For each category, we constructed a variable reflecting 0, 1, or 2 or more conditions.

Results: In models adjusted for sociodemographic covariates, interpersonal discrimination, and state-level income inequality, systemic inequities were associated with 1.13 times the odds of a chronic physical health condition (95% confidence interval: 1.02-1.25) and 1.24 times the odds of 2 or more mental health conditions (95% confidence interval: 1.06-1.45).

Conclusions: Latino children residing in states with higher levels of systemic inequity are more likely to experience mental health or chronic physical health conditions relative to those in states with lower levels of systemic inequity.

Figure 1.

Distribution of systemic inequities for Latino populations across the United States Note: Darker shade reflects higher values of the state-level systemic inequity score.

Figure 2.

Adjusted odds ratios to display the relationship between state-level systemic inequities and health problems among Latino children (n=17,855) 3–17 years of age Notes: Models are adjusted for child’s age, sex, personal experience of racism, survey year, household income, highest education in household, family immigration history, social service use index, mother’s age at child’s birth, neighborhood safety, insurance status, caregiver health, family structure, and state income inequality. See Appendix 4 for numeric values corresponding to estimates presented in the figure and Wald p-values.