O0658 Oct.4: 5:00pm - Assessment of Public Resource Use and Immigration-Related Fear in Families of Mixed Immigration Status: A Survey-Based Cross-Sectional Study

Background/Purpose:
Children of immigrants are a fast-growing population. 88% of children of immigrants are United States (US) citizens, and many qualify for government-issued benefits. Data is lacking on the effects of immigration status on families’ resource needs and use of public benefits. Our primary aim was to assess Supplemental Nutrition Assistance Program (SNAP), Women, Infants and Children (WIC) and Medicaid utilization rates in children with one or more undocumented parent (UP) compared to children without UP. Our secondary aim was to compare income level, food security, healthcare use, and immigration-related concerns between groups.

Methods:
We conducted an anonymous, cross-sectional, hospital-based survey of patients admitted to general pediatrics services from March – September 2019 at a large quaternary children’s hospital. We included English- and Spanish-speaking primary caregivers of hospitalized patients 0-18 years old. Caregivers completed an 89-item survey assessing demographics, SNAP, WIC, and Medicaid use, food security, healthcare access, and concerns relating to immigration status. Chi-square and Fisher’s exact tests were used to assess differences between groups. Our study team plans to conduct multivariate analyses.

Results:
Of the 565 families approached, 399 families completed a survey, 94 declined, and 72 were excluded (34 for incomplete surveys and 38 for not meeting inclusion criteria). Of the 399 included families, 380 reported documentation status. 105/380 (28%) families had UP and 275/380 (72%) families did not have UP. Families with UP reported a higher use of Medicaid (76% vs 56%; p<0.001) and higher use of WIC (63% vs 32%; p<0.001). SNAP use was not significantly different across groups (40% vs 30%; p=0.05). Compared to families without UP, more families with UP reported income levels of <$30,000 (49% vs 22%; p<0.001), food insecurity (46% vs 21%; p<0.001), lack of primary care provider (16% vs 3%; p<0.001), lack of insurance (15% vs 5%; p<0.001), and delays in obtaining prescribed medications (23% vs 9%; p<0.001). >70% of families with UP reported fear of deportation or separation from family, and several reported that their children have similar concerns (Table 1). 24% of families with UP feared that their hospitalization could affect their immigration status, and 29% reported discontinuation of public benefits as a result of immigration concerns.

Conclusion:
Families with UP have significantly higher levels of poverty, food insecurity, and healthcare access needs. Despite Medicaid and WIC use being significantly higher in families with UP, SNAP use is not significantly different. The vast majority of families with UP reported immigration-related fear, and many reported this fear as a barrier to healthcare and public resource use, which may be affecting enrollment rates in SNAP. More work is needed on how to address sensitive immigration challenges, such as fear, in the pediatric population.