Living in an Immigrant Family in America

This article first appeared on the Henry J. Kaiser Family Foundation Disparities Policy site.

Immigration policy has been and continues to be a controversial topic in the U.S. Over the course of the election and since taking office, President Trump has intensified national debate about immigration as he has implemented policies to enhance immigration enforcement and restrict the entry of immigrants from selected countries the Administration believes may pose a threat to the country. The climate surrounding these policies and this debate potentially affect 23 million noncitizens in the U.S., including both lawfully present and undocumented immigrants, many of whom came to the U.S. seeking safety and improved opportunities for their families.1 They also have implications for the over 12 million children who live with a noncitizen parent who are predominantly U.S-born citizen children.2 We conducted focus groups with 100 parents from 15 countries and 13 interviews with pediatricians to gain insight into how the current environment is affecting the daily lives, well-being, and health of immigrant families, including their children. Key findings include:

Immigrant families, including those with lawful status, are experiencing resounding levels of fear and uncertainty. Fears affected participants across backgrounds and locations, with particularly pronounced effects for Latinos and Muslims. Undocumented parents fear being deported and separated from their children while many of those with lawful status feel uncertain about their status and worry they may lose their status or permission to remain in the U.S. These feelings of uncertainty escalated after rescission of the Deferred Action for Child Arrivals (DACA) program in September 2017. Parents said that although they try to shield their children from these issues, many children are hearing about them at school and fear potentially losing their parents to deportation or having to leave the U.S., the only home many have ever known.

“…we wake up every day with the fear of being deported, of the separation of our families, to have to leave the kids.” –Latino Parent, Boston, Massachusetts

“Uncomfortable and unstable; we feel that in any moment a new rule could be issued leading to expelling us and sending us back.” –Arabic-speaking Parent, Anaheim, California

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Parents and pediatricians said that racism and discrimination, including bullying of children, have significantly increased since the election. Many felt that Latinos and Muslims have been the primary targets of increased racism and discrimination. They also noted that the increased bullying of children in schools extends beyond immigrants to children of color, regardless of their immigration status.

“They get bullied… told things like, ‘now you and your family will have to leave.’ …And so, even though those kids don’t actually have to worry about their immigration status, I think obviously a child, they don’t know the details of how the system works.” –Pediatrician, Pennsylvania

Daily life has become more difficult for immigrant families due to increased fear and uncertainty. Some parents said that it is harder to find employment in the current environment, further increasing financial strains on families. Increased fears also are affecting some families’ daily routines. Some parents, particularly those who are undocumented or who have an undocumented family member, said they are only leaving the house when necessary, such as for work; limiting driving; and no longer participating in recreational activities, like visiting their local park. As a result, they and their children are spending long hours in the house behind locked doors. Parents also indicated that they and their children are increasingly fearful of interacting with police or authorities.

“Before, there were many kids in the parks… but now… the kids spend more time inside these days, because we are afraid of being deported.” –Latino Parent, Boston, Massachusetts

“My spouse does not go out of the house… The last thing she wants is to get stopped and that they start asking her questions…” –Latino Parent, San Diego, California

Most parents said they are continuing to access health care for their children and maintaining their children’s Medicaid and CHIP coverage, but there were some reports of changes in health care use and decreased participation in programs. Parents note that they highly prioritize their children’s health and generally view hospitals and doctors’ offices as safe spaces. However, there were some reports of changes in health care use, including decreased use of some care, and decreased participation in Medicaid and CHIP and other programs due to increased fears.

“The thing is… if you are at the hospital you are safe. They can’t go into a hospital, a school or a church… because it is a sanctuary.” –Latino Parent, Chicago, Illinois

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Increased fears are having significant negative effects on the health and well-being of children that have lifelong consequences. Parents and pediatricians reported that children are manifesting fears in many ways. They described behavioral changes, such as problems sleeping and eating; psychosomatic symptoms, such as headaches and stomachaches; and mental health issues, such as depression and anxiety. Parents and pediatricians also felt that fears are negatively affecting children’s behavior and performance in school. Pediatricians uniformly expressed significant concerns about the long-term health consequences of the current environment for children. They pointed to longstanding research on the damaging effects of toxic stress on physical and mental health over the lifespan. They also expressed concerns about negative effects on children’s growth and development, and felt that the current environment is compounding social and environmental challenges that have negative impacts on health.

“When you’re worried every day that your parents are going to be taken away or that your family will be split up, that really is a form of toxic stress… we know that it’s going to have long-term implications for heart disease, for health outcomes for these children in adulthood.”  –Pediatrician, Minnesota

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Together these findings show that immigrant families across different backgrounds and locations are feeling increased levels of fear and uncertainty amid the current climate, and that these feelings extend to those with lawful status. The findings show that these fears are having broad effects on the daily lives and routines of some immigrant families. In addition, they point to long-term consequences for children in immigrant families, including poorer health outcomes over the lifespan, compromised growth and development, and increased challenges across social and environmental factors that influence health.


Data Footnotes
  1. Kaiser Family Foundation, Health Coverage and Care for Immigrants, (Washington, DC: Kaiser Family Foundation, December 2017),
  2. Ibid.
  3. Since these groups were conducted, the Department of Homeland Security announced that TPS will be eliminated for people from Nicaragua effective January 5, 2019. Department of Homeland Security, Acting Secretary Elaine Duke Announcement on Temporary Protected Status for Nicaragua and Honduras, (Washington, DC: Department of Homeland Security, November 6, 2017),
  4. Lisa M Edwards and Jacki Black, Stress Related to Immigration Status in Students: A Brief Guide for Schools, (Milwaukee, WI: Marquette University: February 2017),; Omar Martinez, Elwin Wu, Theo Sandfort, et. al., “Evaluating the Impact of Immigration Policies on Health Status Among Undocumented Immigrants: A Systematic Review,” Journal of Immigrant and Minority Health 17, 3 (June 2015):947-970; Human Impact Partners, Family Unity, Family Health: How Family-Focused Immigration Reform Will Mean Better Health for Children and Families, (Oakland, CA: Human Impact Partners, June 2013),; Jorge Delva, Pilar Horner, Ramiro Martinez, et. al., “Mental Health Problems of Children of Undocumented Parents in the United States: A Hidden Crisis,” Journal of Community Positive Practices XIII, 3 (2013):25-35; Karen Hacker, Jocelyn Chu, Carolyn Leung, et. al., “The Impact of Immigration and Customs Enforcement on Immigrant Health: Perceptions of Immigrants in Everett, Massachusetts, USA,” Social Science & Medicine 73, 4 (August 2011):586-594; David K Androff, Cecilia Ayon, David Becerra, et. al., “U.S. Immigration Policy and Immigrant Children’s Well-being: The Impact of Policy Shifts,” The Journal of Sociology & Social Welfare 38, 1 (March 2011):77-98; Ajay Chaudry, Randy Capps, Juan Manuel Pedroza, et. al., Facing Our Future: Children in the Aftermath of Immigration Enforcement, (Washington, DC: Urban Institute, February 2010),; Randy Capps, Rosa Maria Castañeda, Ajay Chaudry, and Robert Santos, Paying the Price: The Impact of Immigration Raids on America’s Children, Prepared for the National Council of La Raza, (Washington, DC: Urban Institute, 2007):
  5. American Academy of Pediatrics (AAP), “AAP Statement on Protection Immigrant Children,” [Website], January 25, 2017, Accessed September 18, 2017,
  6. Center on the Developing Child, NGA Center for Best Practices, and National Conference on State Legislatures, In Brief: The Impact of Early Adversity on Children’s Development, (Cambridge, MA: Center on the Developing Child, Harvard University, 2015),; Hillary A Franke, “Toxic Stress: Effects, Prevention and Treatment,” Children 1 (2014):390-402; Sara B Johnson, Anne W Riley, Douglas A Granger, and Jenna Riis, “The Science of Early Life Toxic Stress for Pediatric Practice and Advocacy,” Pediatrics 131, 2 (February 2013):319-327; Jack P Shonkoff, Andrew S Garner, et. al., “The Lifelong Effects of Early Childhood Adversity and Toxic Stress,” Pediatrics 129, 1 (2012):e232-e246; Committee on Psychosocial Aspects of Child and Family Health, et. al., “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science into Lifelong Health,” Pediatrics 129, 1(2012):e224-e231; National Scientific Council on the Developing, Child Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9, (Cambridge, MA: National Scientific Council on the Developing Child, 2010),; Jack P Shonkoff, W Thomas Boyce and Bruce S McEwen, “Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention,” Journal of the American Medical Association 301, 201 (2009):2252-2259; Jennifer S Middlebrooks and Natalie C Audage, The Effects of Childhood Stress on Health Across the Lifespan, (Atlanta, GA: Centers for Disease Control and Prevention (CDC), 2008),; Stanley D Rosenberg, Weili Lu, Kim T Mueser, et. al., “Correlates of Adverse Childhood Events Among Adults with Schizophrenia Spectrum Disorders,” Psychiatric Services 58, 2 (2007): 245-253; Shanta R Dube, Robert F Anda, Vicent J Felitti, et. al., “Childhood Abuse, Household Dysfunction, and the Rise of Attempted Suicide Throughout the Life Span: Findings from the Adverse Childhood Experiences Study,” JAMA 286, 24 (December 2001): 3089-3096; Vincent J Felitti, Robert F Anda, Dale Nordenberg, et. al., “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Casues of Death in Adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 14, 4 (1998):245-258.

Partnership Spotlight: Ozarks Health Commission

In an effort to better understand and improve the health status of populations in the Ozarks, organizations in the region formed the Ozark Health Commission. Participants in the commission included Burrell Behavioral Health, CoxHealth, Freeman Health System, Mercy and several local health departments. It’s the largest collaboration in the region, spanning four states—Missouri, Oklahoma, Arkansas and Kansas—51 counties and four hospital systems. 

After completing the Regional Health Assessment and identifying health priority areas, Springfield-Greene County Health Department turned to Community Commons to build a reporting tool that would keep the community informed of the progress they’re making. Julie Viele, who coordinated the implementation of Community Commons for the Springfield-Greene County Health Department discusses the project below. 

Hi Julie, thanks for talking with us. Could you talk a little about the Springfield-Greene County Health Department and the department’s work with Community Commons?  

In Greene County, we serve a population of 288,000 people. We provide a wide variety of services, from food inspections to smoking cessation classes; nutrition programs to health education within our vision helping people live longer, healthier, happier lives.   We became very familiar with Community Commons as we collected our secondary data for the regional health assessment. We found it to be a very useful tool that was community-friendly that made it easy to pull data.  

Could you talk about the Regional Health Assessment process and how that is guiding your strategy moving forward? 

The regional health assessment included 51 counties, four states and four hospital systems. From the assessment, we were able to identify three priority areas, which were pretty universal throughout the 51 counties. They include lung disease, cardiovascular disease and mental health. From those three priority areas we identified five common threads:

  • Access to appropriate care
  • Social determinants of health
  • Tobacco use
  • Mental health 
  • Physical activity and nutrition

Based off these five common threads, we developed our local community health improvement plan (CHIP), which we are currently working on the objectives that were identified in the plan.  

What kind of data was used for the Regional Health Assessment and CHIP? 

For the regional health assessment, we used over 150 indicators, which helped us determine our priorities and common threads. The majority from Community Commons.  From the list of 150 indicators, we identified specific indicators for the five common threads, which are highlighted in the Springfield CHIP.

Do you intend for it to be used by community members, so they can see for themselves? 

We incorporated maps and comparison dials into the different pages that address the common threads so community members can play with the data and make sense of it.

How does having a hublet fit into your overall strategy of community health improvement? 

We are using the Ozarks Health Commission hub and the CHIP hublet as a reporting tool to our community, so the community knows what we’re working on and how we are progressing on the objectives within the health improvement plan. We want to keep the community informed and make them feel like they have a part in our community’s health. We are a very data-driven department, so our hope is to provide the data to help community partners make healthier decisions, which will help led to a healthier community.