Policy Environments & Immigrant Well-Being

Parker, Emily, Rebecca Anna Schut, and Courtney Boen. 2025. The Promise and Limits of Inclusive Public Policy: The Case of Federal Safety Net Clinics and Immigrant Access to U.S. Health Care. Social Forces 103(3), 992-1017.

In the United States, exclusionary public policies generate inequalities within and across labor, financial, and legal status hierarchies, which together undermine immigrant well-being. But can inclusive public policies improve immigrant health? We examine whether and how an immigrant-inclusive federal program, Federally Qualified Health Centers (FQHCs), shaped health care access and use among farmworkers over nearly three decades, paying particular attention to disparities at the intersection of nativity and legal status. Linking historical administrative data on the location and funding of FQHCs with the National Agricultural Workers Survey from 1989–2017, we first document trends in farmworkers’ county-level proximity to FQHCs and identify a steady increase in FQHC access among undocumented farmworkers following the Affordable Care Act. Next, using time-series cross-sectional regressions with a battery of fixed effects, we find that living in a county where FQHCs are available and better resourced is associated with increased health care use among undocumented farmworkers, but not among U.S.-born or documented immigrant farmworkers. We also find that county-level access to FQHCs is associated with reduced reports of language barriers to care among both documented and undocumented foreign-born farmworkers. These findings suggest that FQHCs may improve access for immigrants who are typically excluded from U.S. health care institutions. Still, county-level FQHC infrastructure is not associated with cost-related barriers to care for any nativity or legal status groups. Taken together, our study highlights both the potential and constraints of inclusive public policies for promoting health equity in a welfare state context characterized by commodification and stratification.

*Boen, Courtney, *Rebecca Anna Schut, and Nick Graetz. 2024. The Painful and Chilling Effects of Legal Violence: Immigration Enforcement and Racialized Legal Status Inequities in Worker Well-Being. Population Research and Policy Review 43(20): 1-29.

A wave of restrictive immigration policies implemented over the past several decades dramatically increased immigrant detentions and deportations in the United States (U.S.), with important consequences for a host of immigrant outcomes. Still, questions remain as to how temporal and geographic variation in immigration enforcement within and across the U.S. shaped racialized legal status inequities in health and well-being, particularly among those employed in precarious occupations. To fill this gap, we interrogated the links between changes in county-level immigration enforcement and racialized legal status inequalities in musculoskeletal pain and social welfare benefits utilization among U.S. agricultural workers over nearly two decades (2002–2018). We merged data from three sources [(1) restricted-access, geocoded data from the National Agricultural Workers Survey (NAWS) (n = 37,619); (2) county-level immigration enforcement data from the Transactional Records Access Clearinghouse (TRAC); and (3) population data from the Census and American Community Survey (ACS)] and estimated linear probability models with year, month, and state fixed effects. We show that, in counties with high enforcement rates, workers—especially undocumented workers—were at increased risk of musculoskeletal pain, including pain that was severe. Heightened enforcement was also associated with declines in needs-based benefits utilization, especially among documented and U.S.-citizen non-White workers and undocumented White and non-White workers. Together, these findings highlight how changes in sociopolitical and legal contexts can shift and maintain racialized legal status hierarchies, with especially important consequences for the well-being of vulnerable workers.

Schut, Rebecca Anna and Courtney Boen. 2022. State Immigration Policy Contexts and Racialized Legal Status Disparities in Healthcare Utilization among U.S. Agricultural Workers. Demography 59(6): 2079-2107. 

Research links restrictive immigration policies to immigrant health and health care outcomes. Yet most studies in this area focus on the impact of single policies in particular years, with few assessing how broader state-level immigration policy contexts affect groups by nativity, race/ethnicity, and legal status. Linking data from the National Agricultural Workers Survey (2005–2012) with information on state immigration policies, we use an intersectional approach to examine the links between policy contexts and health care utilization by nativity, race/ethnicity, and legal status. We also assess the associations between two specific types of state immigration policies - those governing immigrant access to Medicaid and driver's licenses - and health care utilization disparities. We find that state-level immigration policy contexts are associated with health care utilization among U.S.-born and naturalized U.S. citizen non-White Latinx agricultural workers, who report lower levels of health care utilization and greater barriers to care-seeking in more restrictive policy contexts. By contrast, we find little evidence that state policies shaped health care utilization among undocumented workers. These findings advance understanding of the impact of “policies of exclusion” on the lives of marginalized groups and underscore the importance of racialized legal status in considering the links between sociopolitical contexts and health and health care disparities.

Flippen, Chenoa A. and Rebecca Anna Schut. 2022. Migration and Contraception among Mexican Women: Assessing Selection, Disruption, and Adaptation. Population Research and Policy Review 41(2): 495-520.

Despite the sizeable impact of migration on childbearing, less is known about how it shapes contraceptive use undergirding fertility. We utilize binational survey data collected in 2006/7 by the Migration, Gender, and Health among Immigrant Latinos in Durham, NC study to assess how selection, disruption, and adaptation shape contraceptive use among Mexican migrant women. We address selectivity with respect to both socio-demographic and formative sexual initiation characteristics, comparing migrants to non-migrants in Mexico. We examine the disruptive effect of migration on contraception among migrant women sexually initiated in Mexico. Finally, we compare current methods between Mexican migrants and non-migrants to assess adaptation to U.S. contraceptive practices. We find migrant selectivity is less important than context in shaping immigrant women’s contraceptive practices, though migrant women sexually initiated in the United States exhibit earlier and higher levels of contraceptive use than their migrant peers initiated in Mexico. Migration also disrupts contraceptive trajectories. Many migrants discontinue contraceptive use pre-migration in response to their husbands’ solo migration. Partner separation also reduces contraceptive use immediately after migration. Finally, migrants show numerous signs of adaptation to the U.S. context, mainly via the adoption of oral contraception. The main obstacle for contraceptive use in Durham is lack of information about where to obtain it. Efforts to improve immigrants’ reproductive health should recognize the deleterious effect of policies encouraging family separation. Health care must reach immigrant women soon after arrival, be attuned to pre-migration contraceptive practices, and recognize the unique vulnerabilities of women migrating at older ages.

Inequities in the Structure & Delivery of U.S. Health Care

Schut, Rebecca Anna. 2025. Blocked Paths, Unequal Trajectories: Examining the Career Outcomes of Health Professions Graduates by Race, Gender, and Place of Education. Social Science & Medicine 364: 117522.

Despite the need for more - and more diverse - health professionals to meet the U.S.’ growing healthcare needs, qualitative research suggests that many health professions school graduates (HPGs) are tracked away from pursuing a health professions career. To what extent do HPGs’ career trajectories vary across race, gender, and place of education (i.e., whether one received their health professions education in the U.S. or abroad)? Drawing on the National Survey of College Graduates, I identify that among 5,966 HPGs (medical, dental, veterinary, optometry, and podiatry school graduates), foreign-educated HPGs are less likely than U.S.-educated HPGs to become health professionals in the U.S. However, not all foreign-educated HPGs experience equal degrees of disadvantage; racially minoritized foreign-educated HPGs - and most strikingly, Asian foreign-educated men and women HPGs - demonstrate the lowest likelihoods of matriculating to a health professions career. Moreover, structural barriers, including initial U.S. visa status, significantly disadvantage foreign-educated HPGs on their path towards becoming practicing health professionals. Together, results suggest that the stunted career trajectories of foreign-educated HPGs might further stall the diversification of the health professions and limit the potential of immigrant HPGs to draw on their unique human capital post-migration. Findings both improve understanding of the contributors to the U.S. health professional shortage and advance sociological knowledge around how the health professions serve as key sites in the reproduction of inequality across axes of race, gender, and place of education. 

*Mani, Sneha Sarah and Rebecca Anna Schut. 2023. The impact of the COVID-19 pandemic on inequalities in preventive health screenings: Trends and implications for U.S. population health. Social Science & Medicine. 328: 11603. 

The COVID-19 pandemic has profoundly impacted population well-being in the United States, exacerbating existing racial and socioeconomic inequalities in health and mortality. Importantly, as the pandemic disrupted the provision of vital preventive health screenings for cardiometabolic diseases and cancers, more research is needed to understand whether this disruption had an unequal impact across racialized and socioeconomic lines. We draw on the 2019 and 2021 National Health Interview Survey to explore whether the COVID-19 pandemic contributed to racialized and schooling inequalities in the reception of preventive screenings for cardiometabolic diseases and cancers. We find striking evidence that Asian Americans, and to a lesser extent Hispanic and Black Americans, reported decreased reception of many types of cardiometabolic and cancer screenings in 2021 relative to 2019. Moreover, we find that across schooling groups, those with a bachelor's degree or higher experienced the greatest decline in screening reception for most cardiometabolic diseases and cancers, and those with less than a high school degree experienced the greatest decline in screening reception for diabetes. Findings have important implications for health inequalities and U.S. population health in the coming decades. Research and health policy attention should be directed toward ensuring that preventive health care is a key priority for public health, particularly among socially marginalized groups who may be at increased risk of delayed diagnosis for screenable diseases.

Schut, Rebecca Anna. 2022. Disaggregating Inequalities in the Career Outcomes of International Medical Graduates in the United States. Sociology of Health and Illness 44(3): 535-565.

Although research finds that international medical graduates (IMGs) fill gaps in US health care left by US medical graduates (USMGs), the extent to which IMGs' career outcomes are stratified along the lines of their country of medical education remains understudied. Using data from the 2019 American Medical Association Physician Masterfile (n = 19,985), I find IMGs from developed countries chart less marginalised paths in their US careers relative to IMGs from developing countries; they are more likely to practise in more competitive and popular medical specialities; to attend prestigious residency programmes; and to practise in less disadvantaged counties that employ more USMGs relative to IMGs. These findings suggest IMGs experience divergent outcomes in the United States based on their place of medical education, with IMGs from developing countries experiencing more constraints in their careers relative to IMGs from developed countries. This understudied axis of stratification in medicine has important implications for our understanding of how nativism and racism may intersect to generate inequalities in the medical profession and in US health care more broadly.

Schut, Rebecca Anna. 2021. Racial disparities in provider-patient communication of incidental medical findings. Social Science & Medicine 277: 113901.

Health disparities research often focuses on the social patterning of health outcomes. Increasingly, there has been an emphasis on understanding the mechanisms perpetuating disparities, even after issues of patient access to health services are addressed. The following study utilizes a novel dataset of electronic medical records (EMR), radiology records, and U.S. Census data to investigate the racial/ethnic patterning of provider-patient communication among patients diagnosed with incidental medical findings requiring follow-up. My results indicate that racial/ethnic disparities in follow-up adherence stem from initial disparities in provider-patient communication. These communication disparities persist even after accounting for multiple socioeconomic, health, and provider characteristics, indicating a bias in medicine, whereby providers are less likely to communicate information about incidental medical findings to patients of color relative to White patients. This paper has important clinical implications, as it sheds new light on why we might see low adherence to medical advice among patients of color. Findings also have social, political, and policy relevance, as they suggest an important mechanism through which health inequalities persist. To finally eliminate racial/ethnic health inequalities in the United States, racial bias and discrimination within medical and public health infrastructures must be eliminated.

Schut, Rebecca Anna and Eduardo Jose Mortani Barbosa Jr. 2020. Racial/Ethnic Disparities in Follow-Up Adherence for Incidental Pulmonary Nodules: An Application of a Cascade-of-Care Framework. Journal of the American College of Radiology 17(11): 1410-1419. 

The aim of this study was to evaluate racial/ethnic disparities in follow-up adherence for incidental pulmonary nodules (IPNs) using a cascade-of-care framework, representing the multistage pathway from IPN diagnosis to timely follow-up adherence. A cohort of 1,562 patients diagnosed with IPNs requiring follow-up in a tertiary health care system in 2016 were retrospectively identified. Racial/ethnic disparities in follow-up adherence were examined by developing a multistep cascade-of-care model (provider communication, follow-up examination ordering and scheduling, adherence) to identify where patients were most likely to fall off the path toward adherence. Racial/ethnic adherence disparities were measured using descriptive statistics and multivariate modeling, controlling for sociodemographic, communication, and health characteristics. Among 1,562 patients whose IPNs required follow-up, unadjusted results showed that nonwhite patients were less likely to meet each step on the cascade than White patients: for provider-patient IPN communication, 55% among Black patients and 80% among White patients; for follow-up ordering and scheduling, 42% and 41% among Black patients and 66% and 64% among White patients; and for timely adherence, 29% among Black patients and 54% among White patients. Adjusting for provider communication, sociodemographic, and health characteristics, Black patients had increased odds of never adhering to and delaying follow-up compared with White patients (odds ratios, 1.30 [95% confidence interval, 0.90-1.89] and 2.51 [95% confidence interval, 1.54-4.09], respectively). These findings demonstrate substantial racial/ethnic disparities in IPN follow-up adherence that persist after adjusting for multiple characteristics. The cascade of care demonstrates where on the adherence pathway patients are at risk for falling off, enabling specific targets for health policy and clinical interventions. Radiologists can play a key role in improving IPN follow-up via increased patient care involvement.

Immigrant Incorporation & Racial Stratification 

Boen, Courtney, Nick Graetz, Hannah Olson, Zohra Ansari-Thomas, Laurin Bixby, Rebecca Anna Schut, and Hedwig Lee. 2022. Early Patterns of Criminal Legal Involvement: Inequalities by Race-Ethnicity, Gender, and Parental Education. Demographic Research 46(5): 131-146.

Contacts with the criminal legal system have consequences for a host of outcomes. Still, early life age patterns of system involvement remain to be better understood. We estimate cumulative risks of arrest, probation, and incarceration from childhood through early adulthood and assess disparities by race/ethnicity, gender, and parental education. Data come from the Transition to Adulthood Supplement of the Panel Study of Income Dynamics (n = 2,736). We use Kaplan–Meier curves and Cox regression models to estimate cumulative risks of arrest, probation, and incarceration across the early life course and document disparities by race/ethnicity, gender, and parental education, as well as at their intersections. Criminal legal system involvement is common among recent cohorts, but Black and Latinx boys and young men face especially high risks. Among Black men whose highest-educated parent completed high school or less, an estimated six in ten had been arrested, four in ten had experienced probation, and four in ten had been incarcerated by age 26. Among Latinx men whose highest-educated parent completed high school or less, an estimated four in ten had been arrested and one in four had been incarcerated by age 26. Black women also experienced high risks, with an estimated one in four arrested by age 26. We document early life patterns of criminal legal system involvement among young people who came of age during the expansion of proactive policing and mass incarceration in the United States, providing important context for understanding the role of the system in generating and exacerbating life course inequalities.

Schut, Rebecca Anna. 2021. “New White Ethnics” or “New Latinos”? Hispanic/Latino Pan-ethnicity and Ancestry Reporting among South American Immigrants to the United States. International Migration Review 55(4): 1061-1088. 

This article explores the identification patterns of South American immigrants to the United States, as measured via Hispanic/Latino ethnicity and ancestry reporting on the US Census. Using data from the 2006–2010 and 2011–2015 American Community Survey, my analysis reveals four main findings. First, I show significant heterogeneity in identity patterns and in sociodemographic, immigration, and geographic characteristics between South American and Mexican immigrants in the United States. Second, I find that Southern Cone immigrants opt not to report Hispanic/Latino ethnicity and “birth-country” ancestry (ancestry that is concordant with birth country, such as Colombian or Chilean) to a greater extent than Andean immigrants and, instead, report more distal “ancestral-origin” ancestries (i.e., Spanish, Japanese, etc.). Third, I show that those immigrants who do report Hispanic/Latino ethnicity are more likely to report “birth-country” ancestry than “ancestral-origin” ancestry, net of other factors. Finally, my analysis demonstrates that Brazilian immigrants chart a different path of identification among South American immigrants and almost unanimously do not report Hispanic/Latino ethnicity while overwhelmingly reporting “Brazilian” ancestry. Taken together, variation in Hispanic/Latino ethnicity and ancestry reporting across South American immigrant groups has implications for their incorporation into US society, as well as for the degree to which these immigrants see themselves as racialized actors in the United States. Some South American immigrant groups (Southern Cone immigrants) appear to be incorporating as “New White ethnics,” and others (Andean immigrants) appear to be incorporating as “New Latinos.” Researchers of international migration should carefully consider these identification differences and their implications for the measurement and study of “Hispanic/Latino” immigrants and their descendants in the United States.

Policing & Domestic Violence

Schut, Rebecca Anna, Susan B. Sorenson, and Richard J. Gelles. 2020. Police Response to Violence and Conflict between Parents and their Minor Children. Journal of Family Violence 35(2): 117-129.  

This study examines the nature of all domestic violence incidents involving parents and their minor children to which police in Philadelphia responded during the 2013 calendar year. We use a retrospective design to explore the nature and outcome of parent-child incidents to which police are summoned. Incidents that officers determined met the state statute definition of child abuse are not included. Of 54,456 domestic violence incidents in the city of Philadelphia in 2013, 2,361 involved a verbal incident or physical altercation between a minor child and at least one parent. Most reports (83.3%) identified the child as the offender and were for verbal incidents (89.6%), suggesting police were called to resolve conflict in the home. When a child was the offender, boys were the most common offenders and mothers the most common victims. When a parent was the offender, mothers were the most common offenders and daughters the most common victims. Parent-offender incidents were far fewer (16.7%) but more likely than child-offender incidents to involve physical violence (AOR = 6.19) and to result in arrest (AOR = 3.67). Parent-child incidents that are not child abuse constitute about 20% of all domestic violence incidents to which police are summoned. Parent-child incidents are an under-researched and perhaps under-served issue. We know of few resources beyond law enforcement for on-the-scene crisis intervention and, as such, officers appear to serve as mediators in these mostly verbal disagreements. The appropriateness and cost of such intervention merits investigation and discussion.

Sorenson, Susan B. and Rebecca Anna Schut. 2018. Nonfatal gun use in intimate partner violence: A systematic review of the literature. Trauma, Violence, & Abuse 19(4): 431-442. 

Guns figure prominently in the homicide of women by an intimate partner. Less is known, however, about their nonfatal use against an intimate partner. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched eight electronic databases and identified 10 original research articles that reported the prevalence of the nonfatal use of firearms against an intimate partner. Results indicate that (1) there is relatively little research on the subject of intimate partners’ nonfatal gun use against women. (2) The number of U.S. women alive today who have had an intimate partner use a gun against them is substantial: About 4.5 million have had an intimate partner threaten them with a gun and nearly 1 million have been shot or shot at by an intimate partner. Whether nonfatal gun use is limited to the extreme form of abuse (battering) or whether it occurs in the context of situational violence remains to be seen. Regardless, when it comes to the likely psychological impact, it may be a distinction without a difference; because guns can be lethal quickly and with relatively little effort, displaying or threatening with a gun can create a context known as coercive control, which facilitates chronic and escalating abuse. Implications for policy, practice, and research are discussed, all of which include expanding an implicit focus on homicide to include an intimate partner’s nonfatal use of a gun.

* = Equal authorship.