for the possibility that the drop in diagnoses
reflects a DACA-induced change in health care
visits, which could affect the probability of detection of mental health disorders. We found
no support for this. Mothers’ DACA eligibility
had no discernible impact on their children’s
health care utilization during the post-DACA
period, as measured either by the total number
of visits, the number of emergency room (ER) and
urgent care visits, or the number of outpatient
visits (fig. S12 and table S16). Consistent with
this, in a non-prespecified analysis, we also found
that the effects of mothers’ DACA eligibility on
child mental health were similar when we restricted the sample to children who had at least
one health care visit in the post-DACA period
(fig. S13 and table S17).
Our results provide causal evidence supporting the theory that parental unauthorized immigration status has important intergenerational
effects on the well-being and development of
children in immigrant families (4, 6). Protecting
unauthorized immigrants from deportation led
to immediate and sizable improvements in the
mental health of their U.S. citizen children. This
suggests that parents’ unauthorized status is a
substantial stressor that stymies normal child
development and perpetuates health inequalities by transferring parental disadvantages to
Our findings have important implications for
immigration and health care policy. As decision-makers evaluate whether to maintain, cancel, or
expand the DACA program, our results suggest
that a broader consideration is needed, one that
goes beyond the impacts for recipients alone and
takes into account the intergenerational consequences of deferred action for the health of unauthorized immigrants’ children, most of whom
are U.S. citizens (2). Early childhood exposure to
stress and adversity does not only cause poor
health and impaired development in the short
term; the issues can also persist into adulthood.
Anxiety and psychosocial stress are identified
as risk factors for depression, substance abuse,
cardiovascular diseases, and obesity (32, 34, 39, 40).
Treatment of mental disorders also carries considerable economic costs to society. They account
for the highest total health care expenditures of
all children’s medical conditions (41) and are associated with poor long-term outcomes for school
performance and welfare reliance (33, 42). By
reducing mental health problems, deferred action has important multiplier effects through
improving the future prospects of the children
of unauthorized immigrants.
Our results imply that expanding deferred
action to the millions of unauthorized immigrant parents who do not meet the current DACA
eligibility criteria could further promote the
health and well-being of this next generation of
American citizens. Moreover, it is reasonable to
expect that permanent legal status or a pathway to citizenship would have an equal, if not
greater, effect on improving children’s health.
Our study also has implications for health
policy research. Unauthorized immigration is
an important policy issue, but researchers have
struggled to generate a reliable evidence base.
Although we recognize the limitations of evalu-
ating health outcome data from one state, our
sampling strategy of using Emergency Medicaid
mothers and Medicaid children provides an ef-
fective way to overcome some of the challenges
in collecting systematic data from the unautho-
rized population. This approach opens the door
for future studies to examine the impacts of an
array of local, state, and federal policies that af-
fect unauthorized immigrant parents and that
may have health consequences for their children.
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This research was funded by a grant from the Russell Sage
Foundation (grant no. 93-16-12). We also acknowledge funding
from the Ford Foundation for operational support of the
Stanford Immigration Policy Lab. For helpful advice, we
thank K. Bansak, V. G. Carrion, A. Hainmueller, and J. Wang.
Replication code is available through Harvard Dataverse
10.7910/DVN/8EEDAP). A preregistered analysis plan is
available at the Evidence and Governance in Politics website
under study ID 20170227AC ( http://egap.org/design-registrations). The analysis plan is also reprinted in the
supplementary materials. The Institutional Review Boards
at Stanford University (protocol 40907) and Oregon
Health & Science University (protocol 15633) approved
Materials and Methods
Figs. S1 to S13
Tables S1 to S17
References (43, 44)
Preregistered Analysis Plan
5 May 2017; accepted 1 August 2017
Published online 31 August 2017
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