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Understanding the impact of county immigration climate on birthweight among immigrant birthing people across restrictive and supportive federal and state immigration policy climates Kaitlyn K Stanhope* Kaitlyn Stanhope Margot Moinester
Goal: While a growing body of work shows impacts of state policies on immigrant health, only limited research examines local climates. Our goal was to quantify the effect of county immigration policy climate on birthweight and determine whether the effect was modified by overarching state or federal climate among foreign-born birthing people, 2012-2020.
Methods: We used data from the U.S. restricted use natality files, 2012 to 2020, linked to county- and state-level characteristics using resident county and birth year. We create a joint exposure based on the presence of a 287g agreement with Immigration Customs Enforcement and/or sanctuary policy active in the county at the time of delivery. We fit multivariable linear models including random effects for state, parity, age, insurance, race/ethnicity, year, county rurality, poverty, percent foreign-born, percent unemployed, percent with a high school education, and percent of households below federal poverty level. We examined potential effect modification by state climate (measured using the Immigration Policy Climate score, in quartiles) or federal climate (Obama’s (2012-2015) vs. Trump’s presidency (2016-2020)) by including multiplicative interaction terms.
Results: We included 6,033,418 births to foreign born birthing people. Living in a county with a sanctuary policy was associated with increased birthweight compared to a county without a sanctuary policy, both without and with a 287g policy in place (adjusted beta: 3.4, 95% confidence interval: (1.5, 5.2); 6.9, (3.9, 9.9), respectively). The estimates were stronger during the Trump presidency. There were not differences by state climate.
Conclusions: These results do not support the hypothesis that county climates can buffer against restrictive state or federal climate. However, they do support the role of counties in impacting immigrant health, possibly uniquely through passing inclusively policies in otherwise restrictive state and federal climates.
