Boy in a mask with a stethascope at doctor's office.
Published on: Mar 22, 2021

Local law-enforcement of immigration policy may affect preventable hospitalization rates for children, according to new research led by a Penn State investigator.

“This research shows that there is an association between these policies and the health of the entire community’s children,” said Lindsay Fernández-Rhodes, assistant professor of biobehavioral health at Penn State.

Fernández-Rhodes and co-author Michelle J. White, assistant professor of pediatrics at Duke University, examined hospitalization data from eight North Carolina counties that instituted policies where local police agencies collaborated with the federal government to identify undocumented immigrants. In many parts of the nation, authorities check the immigration status of people when they are convicted of a crime, but, as part of everyday policing activities, the North Carolina programs also identified undocumented individuals who did not have outstanding warrants or criminal charges against them.

Fernández-Rhodes and White recently published their findings in the Journal of Immigrant and Minority Health.

Increases in preventable hospitalizations

Fernández-Rhodes and White examined pediatric hospitalization rates for conditions that can be effectively treated or managed through preventive care. Previous research has shown that increases in hospitalization for conditions like asthma, pneumonia, gastroenteritis and cellulitis occur when children are not receiving preventive care during regular medical visits.

The authors found that hospitalizations for these conditions — known in the medical field as ambulatory care sensitive conditions — increased by 2.5% for children across the affected counties. Fernández-Rhodes and White examined data from all children in the communities, not only from those who were identified as Latinx on medical forms.

“We anticipated the greatest changes in health care-seeking behavior among undocumented or mixed-status families with children who were identified as Latinx or as ‘Other’ race on their hospitalization records, as these are the people most likely to be affected by local immigration enforcement. And this is exactly what we saw,” said Fernández-Rhodes.

“Furthermore, communities are complicated,” Fernández-Rhodes continued. “We often have relationships with people of different backgrounds. So, Dr. White and I wanted to take a broader view to think about possible chilling effects throughout the community.”

The impact of federal immigration policy at the local level

Local law-enforcement jurisdictions in North Carolina partnered with the Immigration and Customs Enforcement Agency as part of what are called Section 287(g) programs. Under the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, Section 287(g), federal immigration law can be enforced by local law enforcement without needing a warrant or criminal charge. In the mid 2000s, several counties in North Carolina became some of the first jurisdictions in the nation to implement 287(g) programs.

North Carolina counties that implemented 287(g) programs saw an increase in preventable hospitalizations due to ambulatory care sensitive conditions. The researchers estimated the costs of these hospitalizations to be over $750,000 across eight counties during the first fiscal year of the 287(g) program in each county.

The impact on children

The health of infants and young children was affected more dramatically than the health of older children, likely because the youngest children are the most reliant on their parents for transportation and to schedule appointments.

Previous research has shown that laws strengthening immigration enforcement can exacerbate problems related to food insecurity, access to medical care, and participation in public insurance programs for eligible children who were born in the United States. The researchers believe that some parents who are undocumented immigrants are afraid to seek preventive care for their children for fear that the parents’ immigration status might be checked.

“There has not been a major federal reform of immigration policies for decades,” said Fernández-Rhodes. “Local and state politicians and agencies were searching for ways to enact change within their own communities. The impacts of these local actions need to be fully understood in terms of how they affect people’s lives and patterns of preventative care in the community at large.”

How to help children

Regardless of current trends in immigration law or enforcement at the federal level, Fernández-Rhodes says there are ways that children can be protected from the unintended effects of these policies.

“When people consider the impact of these policies, they often think primarily about undocumented immigration among working-age, Latinx adults,” said Fernández-Rhodes. “Clinicians who work where these policies exist need to be aware of their possible chilling effect on routine clinic visits, but these effects could be offset if the medical community responds proactively.”

For example, medical clinics can offer transportation to patients. Also, the clinics can partner with individuals within immigrant communities who serve as opinion leaders and can help others in the community understand that visiting the doctor is safe. In these ways, medical clinics can help families with infants and young children access preventive care and reduce the suffering and costs incurred by preventable hospitalizations.

The researchers analyzed North Carolina Hospital Discharge Data from the Cecil G. Sheps Center for Health Services Research as well as data from the American Community Survey, and Freedom of Information Acts request for this study.