{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:20:12Z","timestamp":1789042812847,"version":"build-2803163510"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Promotion Practice"],"abstract":"<jats:p>Health insurance literacy\u2014the ability to locate, comprehend, and use information about health insurance\u2014is a critical yet understudied dimension of health equity for second-generation Nigerian Americans. Despite health insurance\u2019s known role in reducing disparities in preventive care, this population faces unique barriers in navigating the U.S. health system. This qualitative study explores how second-generation Nigerian Americans develop health insurance literacy within familial, environmental, technological, and cultural contexts. Twenty participants aged 18 to 24 were purposively recruited from churches in Metro Atlanta. Thematic analysis of semi-structured interviews identified four major themes: (a) limited knowledge of the health insurance system, (b) confusion and complexity surrounding U.S. health insurance, (c) reliance on parental coverage and knowledge, and (d) the significant impact of health care and insurance costs on health information-seeking and care decisions. Participants reported minimal health insurance education, confusion about complex terminology and processes, and a reliance on their parents for coverage and guidance. Many also reported anxiety about the transition to independent coverage and described how high health care costs drive them to self-care or online information. These findings underscore the urgent need for culturally tailored, accessible educational interventions to build health insurance literacy and confidence among Nigerian American youth. Addressing both practical knowledge gaps and systemic barriers may improve health outcomes and reduce disparities. This study presents actionable implications for educators, health systems, and policymakers to promote health equity within immigrant communities.<\/jats:p>","DOI":"10.1177\/15248399261481146","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:53:15Z","timestamp":1788760395000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Health Insurance Literacy Among Second-Generation Nigerian Americans"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5181-0740","authenticated-orcid":false,"given":"Omobolanle","family":"Kushimo","sequence":"first","affiliation":[{"name":"University of Maryland, College Park, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1793-7046","authenticated-orcid":false,"given":"Cynthia","family":"Baur","sequence":"additional","affiliation":[{"name":"University of Maryland, College Park, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"Adu-Boahene A. B. Laws M. B. Dapaah-Afriyie K. (2017). Health-needs assessment for West African immigrants in Greater Providence RI. http:\/\/www.rimed.org\/rimedicaljournal\/2017\/01\/2017-01-47-cont-adu-boahene.pdf"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Dean C. A. Wiltshire J. Liu E. Amamoo M. A. Garcia Colato E. Elder K. (2020). Confidence in understanding health insurance and challenges paying medical bills among men in the United States. American Journal of Men\u2019s Health 14(4) 1557988320943359. https:\/\/doi.org\/10.1177\/1557988320943359","DOI":"10.1177\/1557988320943359"},{"key":"e_1_3_3_4_1","doi-asserted-by":"crossref","unstructured":"DeCamp L. R. Bundy D. G. (2012). Generational status health insurance and public benefit participation among low-income Latino children. Maternal and Child Health Journal 16(3) 735\u2013743. https:\/\/doi.org\/10.1007\/s10995-011-0779-8","DOI":"10.1007\/s10995-011-0779-8"},{"key":"e_1_3_3_5_1","doi-asserted-by":"crossref","unstructured":"Devoe J. E. Baez A. Angier H. Krois L. Edlund C. Carney P. A. (2007). Insurance + access not equal to health care: Typology of barriers to health care access for low-income families. Annals of Family Medicine 5(6) 511\u2013518. https:\/\/doi.org\/10.1370\/afm.748","DOI":"10.1370\/afm.748"},{"key":"e_1_3_3_6_1","doi-asserted-by":"crossref","unstructured":"Douglas K. E. Monuteaux M. C. Peeler K. R. Tadikonda A. Coughlin C. G. Linton J. M. Lee L. K. (2025). Health care access outcomes for immigrant children and state insurance policy. JAMA Network Open 8(12) Article e2545826. https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.45826","DOI":"10.1001\/jamanetworkopen.2025.45826"},{"key":"e_1_3_3_7_1","doi-asserted-by":"crossref","unstructured":"Himmelstein D. U. Campbell T. Woolhandler S. (2020). Health care administrative costs in the United States and Canada 2017. Annals of Internal Medicine 172(2) 134\u2013142. https:\/\/doi.org\/10.7326\/M19-2818","DOI":"10.7326\/M19-2818"},{"key":"e_1_3_3_8_1","doi-asserted-by":"crossref","unstructured":"Kakar R. Combs R. M. Hoepf Young M. Ali N. Muvuka B. (2022). Health insurance literacy perceptions and the needs of a working-class community. Health Literacy Research and Practice 6(2) e62\u2013e69. https:\/\/doi.org\/10.3928\/24748307-20220309-01","DOI":"10.3928\/24748307-20220309-01"},{"key":"e_1_3_3_9_1","unstructured":"Migration Policy Institute. (2015). RAD diaspora profile: Nigeria. https:\/\/www.migrationpolicy.org\/sites\/default\/files\/publications\/RAD-Nigeria.pdf"},{"key":"e_1_3_3_10_1","unstructured":"National Research Council (US) and Institute of Medicine (US) Committee on the Health and Adjustment of Immigrant Children and Families. (1998). Health status and adjustment (Chapter 3). In Hernandez D. J. Charney E. (Eds.) From generation to generation: The health and well-being of children in immigrant families (pp. 59\u2013110). National Academies Press. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK230359\/rock"},{"key":"e_1_3_3_11_1","doi-asserted-by":"crossref","unstructured":"Omenka O. I. Watson D. P. Hendrie H. C. (2020). Understanding the healthcare experiences and needs of African immigrants in the United States: A scoping review. BMC Public Health 20(1) Article 27. https:\/\/doi.org\/10.1186\/s12889-019-8127-9","DOI":"10.1186\/s12889-019-8127-9"},{"key":"e_1_3_3_12_1","doi-asserted-by":"crossref","unstructured":"Perreira K. M. Allen C. D. Oberlander J. (2021). Access to health insurance and health care for Hispanic children in the United States. The Annals of the American Academy of Political and Social Science 696(1) 223\u2013244. https:\/\/doi.org\/10.1177\/00027162211050007","DOI":"10.1177\/00027162211050007"},{"key":"e_1_3_3_13_1","doi-asserted-by":"crossref","unstructured":"Portes A. 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