Assessment of COVID-19-Related Immigration Concerns Among Latinx Immigrants in the US

Using the Structural Influence Model to Explore U.S. Latina/O/X/E Undocumented Immigrants' COVID-19 Information Acquisition, Perceptions, and Prevention Behaviors

In the first year of the COVID-19 pandemic, U.S. undocumented immigrants were at heightened risk of contracting COVID-19, with many of them being "frontline essential workers" and residing in crowded living spaces. Given undocumented immigrants' elevated susceptibility to contracting COVID-19 at the peak of uncertainty surrounding the virus, we used the structural influence model of communication to explore: (1) how undocumented immigrants acquired information about COVID-19; (2) how they assessed information trustworthiness and accuracy; (3) their perceptions of COVID-19; and (4) how they prevented or managed COVID-19. Drawing from semi-structured interviews with 46 Latina/o/x/e undocumented immigrants residing in California, we found four key themes: (1) (dis)trust in traditional media as participants relied heavily on social media for COVID-19 information; (2) weak and strong ties played a crucial role in co-constructing health outcomes with different levels of organization; (3) learning about COVID-19 through (in)direct experiences; and (4) coping through health literacy and cultural beliefs. The study's findings can inform future efforts to reach highly-vulnerable immigrant communities during a crisis (or different outbreaks in COVID-19 variants), and hopefully, help reduce health inequities.

Everyday Violence: Immigration Enforcement, COVID-19, and Depression among Undocumented Young Adults in California

Background

The immigration enforcement system has significant effects on the health of immigrants, their families, and society. Exposure to the immigration enforcement system is linked to adverse mental health outcomes, which may have been exacerbated by sustained immigration enforcement activities during the COVID-19 pandemic.

Objectives

This study was conducted to investigate the association between exposure to immigration enforcement and the mental health of undocumented young adults in California during the COVID-19 pandemic.

Methods

Data are from the COVID-19 BRAVE (Building Community Raising All Immigrant Voices for Health Equity) Study, a community-engaged cross-sectional survey of the impacts of the COVID-19 pandemic on undocumented immigrants in California. A total of 366 undocumented immigrants between 18 and 39 years of age completed the online survey, which was conducted between September 2020 and February 2021. Multivariable logistic regression models were fit to examine the association between immigration enforcement exposure and depression.

Results

Almost all participants (91.4%) disclosed exposure to the immigration enforcement system, with most reporting an average of 3.52 (SD=2.06) experiences. Multivariate analyses revealed that an increase in the immigration enforcement exposure score was significantly associated with higher odds of depression (adjusted odds ratio [aOR]=1.24; 95% confidence interval [CI]: 1.10, 1.40), and women were 92% more likely to report depression than were men (aOR=1.92; 95% CI: 1.12, 3.31). Those who reported deportation fears were significantly more likely to be depressed (aOR=1.24; 95% CI: 1.10, 1.40).

Conclusions

Researchers should consider the mental health implications of a punitive immigration enforcement system, and policymakers should examine the impacts of immigration policies on local communities.

Promoting Latinx health equity through community-engaged policy and practice reforms in North Carolina

Introduction

The Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19) is a unique multi-sector coalition formed early in the COVID-19 pandemic to address the multi-level health inequities faced by Latinx communities in North Carolina.

Methods

We utilized the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to conduct a directed content analysis of 58 LATIN-19 meeting minutes from April 2020 through October 2021. Application of the NIMHD Research Framework facilitated a comprehensive assessment of complex and multidimensional barriers and interventions contributing to Latinx health while centering on community voices and perspectives.

Results

Community interventions focused on reducing language barriers and increasing community-level access to social supports while policy interventions focused on increasing services to slow the spread of COVID-19.

Discussion

Our study adds to the literature by identifying community-based strategies to ensure the power of communities is accounted for in policy reforms that affect Latinx health outcomes across the U.S. Multisector coalitions, such as LATIN-19, can enable the improved understanding of underlying barriers and embed community priorities into policy solutions to address health inequities.

Access to COVID-19 testing by individuals with housing insecurity during the early days of the COVID-19 pandemic in the United States: a scoping review

Introduction

The COVID-19 pandemic focused attention on healthcare disparities and inequities faced by individuals within marginalized and structurally disadvantaged groups in the United States. These individuals bore the heaviest burden across this pandemic as they faced increased risk of infection and difficulty in accessing testing and medical care. Individuals experiencing housing insecurity are a particularly vulnerable population given the additional barriers they face. In this scoping review, we identify some of the barriers this high-risk group experienced during the early days of the pandemic and assess novel solutions to overcome these barriers.

Methods

A scoping review was performed following PRISMA-Sc guidelines looking for studies focusing on COVID-19 testing among individuals experiencing housing insecurity. Barriers as well as solutions to barriers were identified as applicable and summarized using qualitative methods, highlighting particular ways that proved effective in facilitating access to testing access and delivery.

Results

Ultimately, 42 studies were included in the scoping review, with 143 barriers grouped into four categories: lack of cultural understanding, systemic racism, and stigma; medical care cost, insurance, and logistics; immigration policies, language, and fear of deportation; and other. Out of these 42 studies, 30 of these studies also suggested solutions to address them.

Conclusion

A paucity of studies have analyzed COVID-19 testing barriers among those experiencing housing insecurity, and this is even more pronounced in terms of solutions to address those barriers. Expanding resources and supporting investigators within this space is necessary to ensure equitable healthcare delivery.

Perspectives of public health organizations partnering with refugee, immigrant, and migrant communities for comprehensive COVID-19 case investigation and contact tracing

Objectives

To understand public health organizations' experiences providing comprehensive COVID-19 case investigation and contact tracing, and related promising practices with refugee, immigrant and migrant communities.

Methods

We interviewed public health professionals (September 2020 to February 2021) from local and state health departments using a geographically stratified, purposive sampling approach. A multidisciplinary team at the National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM) conducted a thematic analysis of the data.

Results

Six themes were identified: understanding community and public health context, cultivating relationships, ensuring linguistic and cultural concordance, communicating intentionally, evolving response, and implementing equity. The interconnection of themes and promising practices is explored.

Conclusion

As public health continues to learn from and build upon COVID-19 response experiences, the thematic findings and potential promising practices identified in this project may foster proactive, community-engaged solutions for public health, and other organizations working and partnering with refugee, immigrant, and migrant communities. Implementing these findings with COVID-19 into current and future public health crisis responses may improve public health, collaborations with refugee, immigrant, and migrant communities, and staff wellbeing.

"I Use Sunglasses . . . the Sun Can Ruin the Eyes": Latino Day Laborers' Lay Strategies to Reduce Dangers at Work

Latino day laborers (LDLs) are at a high risk for injury and accidents at work and have limited socioeconomic resources to deal with their consequences. While little is known about LDLs' perceptions of their own vulnerability at the workplace, less is known about the strategies they adopt to confront these risks. The purpose of this qualitative study was to assess LDLs' perceptions of their workplace dangers and to document the strategies they adopt and endorse to confront them. Guided by a participatory research approach, four focus groups stratified by age were conducted with 34 LDLs in Houston, Texas. Main focus group themes were identified using a combination of qualitative analysis methods involving a thematic analysis conducted by the interview team, LDL advisors, and bilingual Latino researchers. All participants were Latino males (mean age = 40), the majority reported having completed sixth grade or less (64.2%) and having lived in the United States for an average of 12.7 years. We described three categories of strategies to reduce risk for workplace injury generated by local LDLs (practical knowledge and job experience, interpersonal, and personal). These strategies should be explored and encouraged to assist in planning risk-reduction programs, presented in the voice and language of Latino "inside experts" with firsthand experience. The findings of the focus group suggest that LDLs already possess a broad repertoire of strategies to cope with risks at work that can be incorporated in safety programs for LDLs and other immigrant Latino workers.

COVID-19 vaccine attitudes among youth experiencing homelessness: a qualitative analysis with opportunities for action

Youth experiencing homelessness (YEH) are uniquely vulnerable to COVID-19 infection, yet are often excluded from response planning during the COVID-19 pandemic and other public health crises. As part of a larger community- and youth-engaged project through a national network of Prevention Research Centers, our qualitative study sought to describe youth perspectives that influence COVID-19 vaccine confidence and uptake, and identify youth-driven strategies to guide public health efforts to improve vaccine confidence and access. We conducted focus groups with youth experiencing homelessness (n = 20) and semi-structured interviews with staff members (n = 10) at youth-serving agencies to solicit youth perspectives about COVID-19 vaccination. Focus groups and interviews were recorded, transcribed, and analyzed using thematic qualitative analysis. In partnership with youth and cross-sector partners, we distilled eight salient themes that influenced COVID-19 vaccine uptake and confidence among YEH: 1. historical harms and mistrust of systems, 2. access to reliable health information, 3. prioritization of basic needs, 4. personal health influence, 5. barriers to healthcare, 6. fear and uncertainty of the vaccines, 7. sense of bodily autonomy, and 8. community influence. We also identified three youth-driven opportunities to increase COVID-19 vaccination among this population: emphasizing autonomy, leveraging trusted sources of information, and improving vaccine access.Our study elucidates perspectives of YEH on COVID-19 vaccination, and identifies several opportunities to improve youth vaccine confidence and access. It also underscores the importance of centering youth voice in response planning during current and future public health crises.

Neighborhood-level COVID vaccination and booster disparities: A population-level analysis across California

Objectives

To describe vaccine and booster uptake by neighborhood-level factors in California.

Methods

We examined trends in COVID-19 vaccination up to September 21, 2021, and boosters up to March 29, 2022 using data from the California Department of Public Health. Quasi-Poisson regression was used to model the association between neighborhood-level factors and fully vaccinated and boosted among ZIP codes. Sub-analyses on booster rates were compared among the 10 census regions.

Results

In a minimally adjusted model, a higher proportion of Black residents was associated with lower vaccination (HR = 0.97; 95%CI: 0.96-0.98). However, in a fully adjusted model, proportion of Black, Hispanic/Latinx, and Asian residents were associated with higher vaccination rates (HR = 1.02; 95%CI: 1.01-1.03 for all). The strongest predictor of low vaccine coverage was disability (HR = 0.89; 95%CI: 0.86-0.91). Similar trends persisted for booster doses. Factors associated with booster coverage varied by region.

Conclusions

Examining neighborhood-level factors associated with COVID-19 vaccination and booster rates uncovered significant variation within the large and geographically and demographically diverse state of California. Equity-based approaches to vaccination must ensure a robust consideration of multiple social determinants of health.

Preferred Language Mediates Association Between Race, Ethnicity, and Delayed Presentation in Critically Ill Patients With COVID-19

Which social factors explain racial and ethnic disparities in COVID-19 access to care and outcomes remain unclear.

OBJECTIVES

We hypothesized that preferred language mediates the association between race, ethnicity and delays to care.

DESIGN SETTING AND PARTICIPANTS

Multicenter, retrospective cohort study of adults with COVID-19 consecutively admitted to the ICU in three Massachusetts hospitals in 2020.

MAIN OUTCOME AND MEASURES

Causal mediation analysis was performed to evaluate potential mediators including preferred language, insurance status, and neighborhood characteristics.

RESULTS

Non-Hispanic White (NHW) patients (157/442, 36%) were more likely to speak English as their preferred language (78% vs. 13%), were less likely to be un- or under-insured (1% vs. 28%), lived in neighborhoods with lower social vulnerability index (SVI) than patients from racial and ethnic minority groups (SVI percentile 59 [28] vs. 74 [21]) but had more comorbidities (Charlson comorbidity index 4.6 [2.5] vs. 3.0 [2.5]), and were older (70 [13.2] vs. 58 [15.1] years). From symptom onset, NHW patients were admitted 1.67 [0.71-2.63] days earlier than patients from racial and ethnic minority groups (p < 0.01). Non-English preferred language was associated with delay to admission of 1.29 [0.40-2.18] days (p < 0.01). Preferred language mediated 63% of the total effect (p = 0.02) between race, ethnicity and days from symptom onset to hospital admission. Insurance status, social vulnerability, and distance to the hospital were not on the causal pathway between race, ethnicity and delay to admission.

CONCLUSIONS AND RELEVANCE

Preferred language mediates the association between race, ethnicity and delays to presentation for critically ill patients with COVID-19, although our results are limited by possible collider stratification bias. Effective COVID-19 treatments require early diagnosis, and delays are associated with increased mortality. Further research on the role preferred language plays in racial and ethnic disparities may identify effective solutions for equitable care.

The vulnerability to COVID-19 of migrants in large urban areas: structural exacerbators and community-level mitigators

BACKGROUND

Despite research on large urban areas in the context of COVID-19, evidence on how these settings impact migrants is still limited.

OBJECTIVE

To explore exacerbating and mitigating factors of large urban areas on migrants' vulnerabilities during the COVID-19 pandemic.

METHODS

We conducted a systematic review of peer-reviewed studies published between 2020 and 2022, focused on migrants (foreign-born individuals who have not been naturalized in the host country, regardless of legal immigration status) in urban areas with a population >500 000. After screening 880 studies, 29 studies were included and categorized within the following thematic framework: (i) pre-existing inequities, (ii) governance strategies, (iii) urban design and (iv) engagement of civil society organizations (CSOs).

RESULTS

Exacerbating factors include pre-existing inequities (e.g. unemployment, financial instability and barriers to healthcare access), exclusionary government responses (e.g. ineligibility for relief funds or unemployment benefits) and residential segregation. Mitigating community-level factors include the engagement of CSOs to fill institutional and governmental gaps through service provision and use of technology.

CONCLUSIONS

We recommend increased attention to pre-existing structural inequities faced by migrants, more inclusive governance strategies and partnerships between government and CSOs to improve the design and delivery of services to migrants in large urban areas. More research is needed on how urban design can be utilized to mitigate COVID-19 impacts on migrant communities. The factors identified in this systematic review should be considered as part of migrant-inclusive emergency preparedness strategies to address the disproportionate impact of health crises on migrant communities.

Challenges of COVID-19 Case Investigation and Contact Tracing in School Settings: An Initial Investigation

BACKGROUND

Case investigation and contact tracing (CI/CT) are important public health tools to interrupt COVID-19 transmission. Our study aims to understand how parents and school staff perceive COVID-19 CI/CT.

METHODS

Using a mixed methods approach, we distributed a community survey and conducted 15 focus group discussions (FGDs) in English and Spanish between December 2020 and March 2021 with 20 parents and 22 staff from schools in San Diego County ZIP Codes with COVID-19 rates in the top quintile as of August 2020.

RESULTS

One in 4 survey respondents reported that they would be reluctant to participate in CI/CT. FGDs revealed themes of mistrust in government authorities, overburdened institutions, unfamiliarity with CI/CT, and uncertainty about its reliability. School community members emphasized that parents trust schools to be involved in CI/CT efforts, but schools are overwhelmed with this added responsibility.

CONCLUSIONS

Investing in schools as community hubs is necessary so they can become important partners in prevention and mitigation in public health.

Learning from the COVID-19 pandemic response to strengthen undocumented migrant-sensitive health systems: case studies from four countries

Undocumented migrants are a vulnerable population group in the context of the COVID-19 pandemic due to increased risk of infection, severe morbidity, and mortality. In this Personal View, we analyze the COVID-19 pandemic responses, particularly vaccination campaigns, vis à vis undocumented migrants, and discuss lessons learned. Our empirical observations as clinicians and public health practitioners in Italy, Switzerland, France, and the United States are supplemented by a literature review, and presented through country case studies focusing on Governance, Service Delivery, and Information. We propose recommendations to capitalize on the COVID-19 pandemic response as an entry point to strengthen migrant-sensitive provisions into health system frameworks, by: providing specific guidance in health policies and plans; developing tailored implementation approaches with outreach and mobile services, with translated and socio-culturally adapted information, and engagement of migrant communities and third sector actors; and developing systematic monitoring & evaluation systems with disaggregated migrant data from National Health Service and third sector providers.

Slowed progression: The utility of Test to Treat initiatives in improving the neglected inequities of COVID-19 among racially/ethnically minoritized groups

In the United States, coronavirus disease 2019 (COVID-19) has resulted in more than 95 million infections and 1 million deaths (as of September 2022), with individuals of racially/ethnically minoritized groups being disproportionately represented among these numbers. Despite the apparent pandemic fatigue in many communities, systemic and structural racism continue to place racially/ethnically minoritized groups at a disadvantage for overcoming the virus, especially as it relates to receiving vaccinations and COVID-19 targeted therapeutics. Test to Treat programs have the potential to mitigate these disparities by rapidly identifying the presence of a COVID-19 infection and readily offering treatment options. Nonetheless, Test to Treat programs must be optimized to adequately address the limitations to care within racially/ethnically minoritized communities.

US public charge policy and Latinx immigrants' thoughts about health and healthcare utilization

OBJECTIVES

We examined Latinx immigrants' perceptions of US policy related to restrictions on immigrants' use of public resources and their thoughts about the influence of these on immigrants' healthcare utilization.

DESIGN

A series of 16 focus group discussions with Latinx immigrant men and women (documented and undocumented) (N = 130) were conducted between May and July 2017 across four US cities.

RESULTS

Four central themes emerged: participants attributed the limited resources available for affordable healthcare for many uninsured US immigrants (both documented and undocumented) to the US government's view of immigrants as burdens on public resources and its subsequent unwillingness to dedicate funds for their care; participants expressed concerns, some unfounded, about negative immigration ramifications arising from diagnosis with health conditions perceived to be serious and/or expensive to treat; participants noted that some immigrants avoided using health programs and services to which they were entitled because of immigration concerns; finally, participants described how access to information on immigration laws and healthcare resources, and conversely, misinformation about these, influenced healthcare utilization.

CONCLUSIONS

Participants were acutely aware of the image of immigrants as public charges or potential burdens on government resources that underlies US immigration policy. In some cases, participants came to inaccurate and potentially harmful conclusions about the substance of laws and regulations based on their beliefs about the government's rejection of immigrants who may burden public resources. This underscores the importance of ensuring that immigrants have access to information on immigration-related laws and regulations and on healthcare resources available to them. Participants noted that access to information also fostered resilience to widespread misinformation. Importantly, however, participants' beliefs had some basis in US immigration policy discourse. Law and policy makers should reconsider legislation and political commentary that frame self-reliance, the guiding principle of US immigration policy, in terms of immigrants' use of publicly funded healthcare resources.

Exploring Latino Promotores/a de Salud (Community Health Workers) knowledge, attitudes, and perceptions of COVID-19 vaccines

Promotoras/promotores (i.e., community health workers) are uniquely positioned to provide much needed COVID-19 education and outreach in Latino communities, particularly in areas with disparities in vaccination rates. This study used qualitative methods to explore promotoras perspectives on COVID-19 vaccines, with a focus on understanding how vaccine knowledge and viewpoints among Latino communities can formulate recommendations to improve uptake of vaccination. Promotoras (N=22) were recruited to participate in semi-structured focus groups conducted virtually. Reflexive thematic analysis identified three overarching themes: (1) prevalence of misinformation (related to lack of trustworthy information, mistrust in the government, immigration status concerns, and conspiracy theories); (2) hesitancy (related to health concerns and eligibility confusion); and (3) recommendations for improving vaccine uptake. Delays in vaccination were not strictly due to doubts or fears but were also related to access barriers. The themes provide insight into the Latino communities' perceptions of COVID-19 vaccines and reasons why some remain unvaccinated. Promotoras' perspectives are integral to the development of strategies and approaches to address COVID-19 vaccine hesitancy, uptake, and implementation among underserved communities.

Challenges of undocumented immigrants in Canada and the USA during the COVID-19 pandemic: a review

Purpose

Pandemics pose challenges to all groups of people and all aspects of human lives. Undocumented migrants are likely to face more challenges during global pandemics. The purpose of this paper is to explore the possible challenges of undocumented immigrants in Canada and the USA in the ongoing COVID-19 pandemic.

Design/methodology/approach

From existing literature, the authors examined the challenges of undocumented migrants in Canada and the USA and suggested recommendations to address those challenges at both policy and national levels.

Findings

The undocumented status of some international immigrants makes them vulnerable in their host nations. They face myriad challenges in their host countries, spanning from economic, health, social isolation and employment challenges, and these are further exacerbated during pandemics such as the ongoing COVID-19. The provision of culturally sensitive and safe policies may support this particular population, especially in times of crisis like the COVID-19 pandemic.

Originality/value

This paper provides critical insights into the possible intersections that worsen the vulnerability of undocumented migrants in pandemic crises like COVID-19. Further, this review serves to initiate the discourse on policy and interventions for undocumented immigrants during pandemics or disease outbreaks.

Coalition of Faith Leaders, Community Organizations, and Governmental Organizations to Implement a COVID-19 Campaign in a Latino Neighborhood, Baltimore, Maryland, 2020-2021

The disproportionate impact of COVID-19 on low-income Latinos with limited access to health care services prompted the expansion of community-based COVID-19 services. From June 25, 2020, to May 20, 2021, we established a coalition of faith leaders, community organizations, and governmental organizations to implement a Spanish-language hotline and social media campaign that linked people to a COVID-19 testing site at a local church in a high-density Latino neighborhood in Baltimore, Maryland. This retrospective analysis compared the characteristics of Latinos accessing testing in community versus health care facility-based settings. (Am J Public Health. 2022;112(S9):S913-S917. https://doi.org/10.2105/AJPH.2022.307074).

COVID-19 case counts and COVID-19 related Emergency Department visits: differences by immigration status, March-December 2020

Background

Undocumented immigrants face barriers to health care access, which may have been exacerbated during the early days of the COVID-19 pandemic. We test whether undocumented immigrants in Los Angeles County accessed COVID-19 related medical care by examining their Emergency Department (ED) patterns through high and low periods of COVID-19 infection. If undocumented immigrants were underutilizing or foregoing health care, we expect null or weaker associations between COVID-19 cases and COVID-19 related ED visits relative to Medi-Cal patients.

Methods

We analyzed all ED visits to the Los Angeles County + University of Southern California (LAC + USC) Medical Center between March - December 2020 (n = 85,387). We conducted logistic regressions with Los Angeles County weekly COVID-19 case counts as our main independent variable and an interaction between case counts and immigration status, stratified by age (over and under 65 years).

Results

We found that undocumented immigrants under 65 years old had a higher odds for a COVID-19 related ED visit compared to Medi-Cal patients and that both undocumented and Medi-Cal patients had higher odds of a COVID-19 related ED visit as COVID-19 cases in Los Angeles County increased. For patients over 65 years, Medi-Cal patients actually had a weaker association between ED visits and county COVID-19 counts; as COVID-19 case counts rose, the odds of a COVID-19 related ED visit increased for the undocumented patients.

Conclusion

While the overall likelihood of undocumented patients having a COVID-19 related ED visit varies compared to Medi-Cal patients - for younger patients, the odds is higher; for older patients, the odds is lower - it does not appear that undocumented patients underutilized the ED during the early COVID-19 pandemic relative to Medi-Cal patients. The ED may be a viable source of contact for this high-risk population for future outreach.

"Me Cuesta Mucho": Latina immigrant mothers navigating remote learning and caregiving during COVID-19

Before the pandemic, immigrant mothers from Latin America in the United States typically shouldered the weight of caregiving for children, maintained jobs, and managed transnational care responsibilities. But as COVID-19 erupted across the globe, the combination of gendered roles and a collapsing economy ruptured the already fragile arrangement of childcare and paid labor for Latina immigrant mothers. In this article, I examine how school closures intersected with Latina women's identities and social positions as immigrant mothers who suddenly confronted job loss, illness, and increased familial responsibilities. I show how Latina immigrant women renegotiated relationships to schooling, becoming teachers overnight in an unfamiliar system. Mothers shifted educational aspirations for their children to prioritize safety, as they managed increased stress and conflict while schools remained remote. I demonstrate how the breakdowns in care infrastructure forced mothers to rethink the elusive balance between paid labor and childcare, especially for those who were undocumented. Throughout, I explore how immigrant women's intersecting identities left them vulnerable to structural racism and exclusionary immigration policies. Despite the multiple layers of struggle, women continued to support their children's education and socio-emotional well-being, even in the face of multiple levels of gendered, racialized inequalities.

Association between immigration enforcement encounters and COVID-19 testing and delays in care: a cross-sectional study of undocumented young adult immigrants in california

BACKGROUND

Undocumented immigrants are expected to face increased risks related to COVID-19 due to marginalizing restrictive immigration policies. However, few studies have assessed the prevalence of direct encounters with the immigration enforcement system among the undocumented and its impacts on their COVID-related health behaviors and outcomes. In this study, we quantify undocumented immigrants' lifetime exposure to various immigration enforcement tactics and their association with delays in COVID-19 testing and healthcare behaviors.

METHODS

This cross-sectional study included a non-random sample of 326 Asian and Latinx undocumented immigrants in California from September 2020 to February 2021. The primary exposure was immigration enforcement encounter scores ranging from 0-9, assessed through self-reports of direct experiences with the immigration system, immigration officials, and law enforcement. The main outcomes were positive test for COVID-19, had or suspected having COVID-19, and delayed or avoided testing and/or treatment for COVID-19 due to immigration status. We used multivariable logistic regression models to examine the association between the primary exposure and outcomes of interest.

RESULTS

Among 326 participants, 7% had received a positive COVID-19 test result, while 43% reported having or suspected having COVID-19. Almost 13% delayed or avoided COVID-19 testing and/or treatment because of their immigration status. Overall, an increase in immigration enforcement encounters was associated with higher odds of suspecting having had COVID-19 (aOR = 1.13; 95% CI: 1.01,1.26). Reporting an additional enforcement encounter was associated with higher odds of delaying or avoiding testing and/or treatment because of immigration status (aOR = 1.53, 95% CI: 1.26,1.86). Compared to their Latino counterparts, Asian respondents were more likely to report higher odds of delaying or avoiding testing and/or treatment (aOR = 3.13, 95% CI: 1.17,8.42). There were no significant associations between the enforcement score and testing positive for COVID-19. Additionally, while Latinxs were more likely to report immigration enforcement encounters than Asians, there were no differences in the effects of race on COVID-19 testing and healthcare behaviors in models with race as an interaction term (p < 0.05).

CONCLUSIONS

Immigration enforcement encounters compound barriers to COVID-19 testing and treatment for undocumented immigrants.

A Framework for Inspiring COVID-19 Vaccine Confidence in African American and Latino Communities

The COVID-19 pandemic has disproportionately impacted racial and ethnic minority communities, particularly African American and Latino communities. The impacts of social determinants of health, structural racism, misinformation, and mistrust have contributed to a decreased COVID-19 vaccine uptake. Effective methods of addressing and combatting these barriers are essential. Accurate and targeted messaging delivered by trusted voices from community-based organizations, government health systems and organizations, and healthcare and academic systems is imperative. Outreach and communication should be culturally sensitive, provided in the preferred language of the community, flexible, and tailored for in-person and virtual outlets. This communication must also increase trust, combat misinformation, and inspire COVID-19 vaccine confidence. In this manuscript, we outline a framework for inspiring COVID-19 vaccine confidence in African American and Latino communities. These methods of targeted outreach should be considered and implemented for urgent and nonurgent community public health efforts beyond the COVID-19 pandemic (e.g., monkeypox) and as a framework to inspire vaccine confidence in those living in racial and ethnic minority communities globally.

Equity and Accessibility of Washington State’s COVID-19 Digital Exposure Notification Tool (WA Notify): Survey and Listening Sessions Among Community Leaders

Background

In November 2020, WA Notify, Washington State’s COVID-19 digital exposure notification tool, was launched statewide to mitigate ongoing COVID-19 transmission. WA Notify uses the Bluetooth proximity–triggered, Google/Apple Exposure Notification Express framework to distribute notifications to users who have added or activated this tool on their smartphones. This smartphone-based tool relies on sufficient population-level activation to be effective; however, little is known about its adoption among communities disproportionately impacted by the COVID-19 pandemic or what barriers might limit its adoption and use among diverse populations.

Objective

We sought to (1) conduct a formative exploration of equity-related issues that may influence the access, adoption, and use of WA Notify, as perceived by community leaders of populations disproportionately impacted by the COVID-19 pandemic; and (2) generate recommendations for promoting the equitable access to and impact of this novel intervention for these communities.

Methods

We used a 2-step data collection process to gather the perspectives of community leaders across Washington regarding the launch and implementation of WA Notify in their communities. A web-based, brief, and informational survey measured the perceptions of the community-level familiarity and effectiveness of WA Notify at slowing the spread of COVID-19 and identified potential barriers and concerns to accessing and adopting WA Notify (n=17). Semistructured listening sessions were conducted to expand upon survey findings and explore the community-level awareness, barriers, facilitators, and concerns related to activating WA Notify in greater depth (n=13).

Results

Our findings overlap considerably with those from previous mobile health equity studies. Digital literacy, trust, information accessibility, and misinformation were highlighted as key determinants of the adoption and use of WA Notify. Although WA Notify does not track users or share data, community leaders expressed concerns about security, data sharing, and personal privacy, which were cited as outweighing the potential benefits to adoption. Both the survey and informational sessions indicated low community-level awareness of WA Notify. Community leaders recommended the following approaches to improve engagement: tailoring informational materials for low-literacy levels, providing technology navigation, describing more clearly that WA Notify can help the community, and using trusted messengers who are already engaged with the communities to communicate about WA Notify.

Conclusions

As digital public health tools, such as WA Notify, emerge to address public health problems, understanding the key determinants of adoption and incorporating equity-focused recommendations into the development, implementation, and communication efforts around these tools will be instrumental to their adoption, use, and retention.

COVID-19 testing, infection, and vaccination among deported Mexican migrants: Results from a survey on the Mexico-U.S. border

Background

Migrants detained and held in immigration and other detention settings in the U.S. have faced increased risk of COVID-19 infection, but data on this population is scarce. This study sought to estimate rates of COVID-19 testing, infection, care seeking, and vaccination among Mexican migrants detained by U.S. immigration authorities and forcibly returned to Mexico.

Methods

We conducted a cross-sectional probability survey of Mexican migrants deported from the U.S. to three Mexican border cities: Tijuana, Ciudad Juárez, and Matamoros (N = 306). Deported migrants were recruited at Mexican migration facilities after being processed and cleared for departure. A two-stage sampling strategy was used. Within each city, a selection of days and shifts were selected during the operating hours of these deportation facilities. The probability of selection was proportional to the volume of migrants deported on each day of the month and during each time period. During the selected survey shifts, migrants were consecutively approached, screened for eligibility, and invited to participate in the survey. Survey measures included self-reported history of COVID-19 testing, infection, care seeking, vaccination, intentions to vaccinate, and other prevention and risk factors. Weighted data were used to estimate population-level prevalence rates. Bivariate tests and adjusted logistic regression models were estimated to identify associations between these COVID-19 outcomes and demographic, migration, and contextual factors.

Results

About 84.1% of migrants were tested for COVID-19, close to a third were estimated to have been infected, and, among them, 63% had sought care for COVID-19. An estimated 70.1% had been vaccinated against COVID-19 and, among those not yet vaccinated, 32.5% intended to get vaccinated. Close to half (44.3%) of respondents had experienced crowdedness while in detention in the U.S. Socio-demographic (e.g. age, education, English fluency) and migration-related (e.g. type of detention facility and time in detention) variables were significantly associated with COVID-19 testing, infection, care seeking, and vaccination history. Age, English fluency, and length of detention were positively associated with testing and vaccination history, whereas detention in an immigration center and length of time living in the U.S. were negatively related to testing, infection, and vaccination history. Survey city and survey quarter also showed adjusted associations with testing, infection, and vaccination history, reflecting potential variations in access to services across geographic regions and over time as the pandemic unfolded.

Conclusion

These findings are evidence of increased risk of COVID-19 infection, insufficient access to testing and treatment, and missed opportunities for vaccination among Mexican migrants detained in and deported from the U.S. Deportee receiving stations can be leveraged to reduce disparities in testing and vaccination for deported migrants. In addition, decarceration of migrants and other measures informed by public health principles must be implemented to reduce COVID-19 risk and increase access to prevention, diagnostic, and treatment services among this underserved population.

Disparities in SARS-CoV-2 Testing for Hispanic/Latino Populations: An Analysis of State-Published Demographic Data

Racial and ethnic minorities in the United States have been disproportionately affected by the COVID-19 pandemic, experiencing increased risk of infection, hospitalization, and death. In this study, we sought to examine race- and ethnicity-based differences in SARS-CoV-2 testing. We used publicly available US state dashboards to extract demographic data for COVID-19 cases and tests. Poisson regression models were used to model the effect of race and ethnicity on the number of SARS-CoV-2 tests performed per case. In total, just 8 states reported testing data by race and ethnicity. In regression models, race and ethnicity was a significant predictor of testing rate per case. In all states, Hispanic/Latino patients had a significantly lower testing rate than their non-Hispanic/Latino counterparts, with an incident rate ratio varying from 0.45 to 0.81, depending on the state and referent race category. These results suggest disparities in testing access among Hispanic/Latino individuals, who are already at a disproportionate risk for infection and severe outcomes.

Vaccines alone will not prevent COVID-19 outbreaks among migrant workers-the example of meat processing plants

BACKGROUND

Migrant populations in high-income countries have faced myriad health and social inequities during the COVID-19 pandemic. Migrants often work in frontline essential services that expose them to COVID-19. Migrant workers in meat processing plants have endured large COVID-19 outbreaks across multiple countries.

OBJECTIVES

We examine current scientific evidence around COVID-19 transmission, outcomes, and prevention for migrant workers and highlight meat processing plants as an example.

SOURCES

We performed a series of PubMed searches between January 1, 2020 and January 12, 2022.

CONTENT

Migrant workers in high-income countries often work in occupations at high risk for COVID-19 transmission, contract COVID-19 at higher rates, and experience worse outcomes than native-born counterparts. For example, meat processing plants represent almost ideal environments for rapid and large-scale SARS-CoV-2 viral transmission; often, large migrant workforces confined to small workspaces perform physically demanding work in noisy environments that require shouting to communicate, increasing workers' respiratory rates and the quantity of aerosolized droplets expelled and thus increasing viral transmission risk. Although enhanced vaccination outreach programs remain an important equity approach for migrant worker safety, they alone are insufficient. The emergence and rapid spread of multiple increasingly transmissible SARS-CoV-2 variants of concern with variable vaccine escape properties, including Omicron in November 2021, highlight the importance of improved infection prevention and control strategies to protect migrant workers. Across countries, strategies such as improving ventilation and mask quality in many high-risk occupational settings are already required by employment law. Universal mandatory vaccination program should also be considered.

IMPLICATIONS

COVID-19 transmission prevention for migrant workers requires an aggressive multicomponent plan that includes (a) improved on-site ventilation and infection prevention and control strategies; (b) improved social supports such as paid sick leave; (c) mobile vaccination clinics and community engagement to overcome vaccine hesitancy and barriers; and (d) consideration of universal mandatory vaccination programs.

Perspectives of Latinx Individuals Who Were Unvaccinated And Hospitalized for COVID-19: A Qualitative Study

Importance

Latinx individuals in the United States have lower COVID-19 vaccination rates and higher rates of COVID-19 infections, hospitalizations, and deaths than non-Latinx White individuals. Little is known about the perspectives of Latinx adults who had not received the COVID-19 vaccination and were hospitalized for COVID-19.

Objective

To describe the perspectives of Latinx individuals who were unvaccinated and subsequently hospitalized for COVID-19.

Design, Setting, and Participants

This qualitative study was conducted using semistructured phone interviews with 25 Latinx adults who were unvaccinated and survived a COVID-19 hospitalization in a public safety net hospital in Colorado from February to November 2021. Interviews were audio recorded, and transcripts were analyzed using thematic analysis.

Main Outcomes and Measures

Themes and subthemes of perspectives on vaccination.

Results

Among 25 adults (14 [56.0%] women, 11 [44.0%] men; mean [SD] age, 51 [15] years) who participated, all participants self-identified as Latino, Latina, or Latinx or Hispanic. There were 11 individuals who relied on emergency Medicaid (hospital coverage for Denver residents who are undocumented), while 10 individuals (40.0%) were essential workers and 13 individuals (52.0%) were unemployed. In interviews, 3 themes (with subthemes) were identified: factors associated with vaccination after hospitalization (subthemes: fear of death, avoiding hospitalization and reinfection, convinced COVID-19 is real, and responded to pressure from others), concerns about the COVID-19 vaccine (subthemes: experimental status and short timeline for production, contents of vaccine unknown or concerning, vaccine considered ineffective, worrisome immediate and long-term adverse effects, mixed and conflicting information, and government aimed to control or mark population through vaccination), and opportunities to improve vaccine uptake (subthemes; sharing personal experiences through social media, testimonials about minimal vaccine adverse effects, connecting with friends and family about the hospitalization experience, making the vaccine more accessible, and connecting with trusted sources of information).

Conclusions and Relevance

This study found that Latinx individuals who were unvaccinated and subsequently hospitalized for COVID-19 were motivated to engage in advocacy to encourage vaccination in their communities. These findings suggest that supporting patient advocacy after hospital discharge and continued efforts to create low-barrier, patient-informed public health strategies may be associated with increased vaccine uptake in Latinx communities.

Geographic variation in COVID-19 vulnerability by legal immigration status in California: a prepandemic cross-sectional study

OBJECTIVE

To quantify COVID-19 vulnerabilities for Californian residents by their legal immigration status and place of residence.

DESIGN

Secondary data analysis of cross-sectional population-representative survey data.

DATA

All adult respondents in the restricted version of the California Health Interview Survey (2015-2020, n=128 528).

OUTCOME MEASURE

Relative Social Vulnerability Indices for COVID-19 by legal immigration status and census region across six domains: socioeconomic vulnerability; demography and disability; minority status and language barriers; high housing density; epidemiological risk; and access to care.

RESULTS

Undocumented immigrants living in Southern California's urban areas (Los Angeles, Orange, San Diego-Imperial) have exceptionally high vulnerabilities due to low socioeconomic status, high language barriers, high housing density and low access to care. San Joaquin Valley is home to vulnerable immigrant groups and a US-born population with the highest demographic and epidemiological risk for severe COVID-19.

CONCLUSION

Interventions to mitigate public health crises must explicitly consider immigrants' dual disadvantage from social vulnerability and exclusionary state and federal safety-net policies.

COVID-19 vaccine hesitancy among undocumented migrants during the early phase of the vaccination campaign: a multicentric cross-sectional study

STUDY OBJECTIVES

The marginalisation of undocumented migrants raises concerns about equitable access to COVID-19 vaccination. This study aims to describe migrants' hesitancy about the COVID-19 vaccination during the early phase of the vaccination campaign.

SETTING

This multicentric cross-sectional survey was conducted in health facilities providing care to undocumented migrants in the USA, Switzerland, Italy and France in February-May 2021.

PARTICIPANTS

Eligibility criteria included age >16 years, being of foreign origin and living without valid residency permit in the country of recruitment. A convenience sample of minimum 100 patients per study site was targeted.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data were collected using an anonymous structured questionnaire. The main outcomes were perceived access to the local COVID-19 vaccination programme and demand for vaccination.

RESULTS

Altogether, 812 undocumented migrants participated (54.3% Geneva, 17.5% Baltimore, 15.5% Milano and 12.7% Paris). Most (60.9%) were women. The median age was 39 years (interquartile range 1). Participants originated from the Americas (55.9%), Africa (12.7%), Western Pacific (11.2%) Eastern Mediterranean (7.9%), Europe (7.6%) and South-East Asia (4.7%). Overall, 14.1% and 26.2% of participants, respectively, reported prior COVID-19 infection and fear of developing severe COVID-19 infection. Risk factors for severe infection were frequently reported (29.5%). Self-perceived accessibility of COVID-19 vaccination was high (86.4%), yet demand was low (41.1%) correlating with age, comorbidity and views on vaccination which were better for vaccination in general (77.3%) than vaccination against COVID-19 (56.5%). Participants mainly searched for information about vaccination in the traditional and social media.

CONCLUSIONS

We found a mismatch between perceived accessibility and demand for the COVID-19 vaccination. Public health interventions using different communication modes should build on trust about vaccination in general to tackle undocumented migrants' hesitancy for COVID-19 vaccination with a specific attention to men, younger migrants and those at low clinical risk of severe infection.

Digitalization and Artificial Intelligence in Migration and Mobility: Transnational Implications of the COVID-19 Pandemic

Digitalization and artificial intelligence (AI) technologies in migration and mobility have incrementally expanded over recent years. Iterative approaches to AI deployment experienced a surge during 2020 and into 2021, largely due to COVID-19 forcing greater reliance on advanced digital technology to monitor, inform and respond to the pandemic. This paper critically examines the implications of intensifying digitalization and AI for migration and mobility systems for a post-COVID transnational context. First, it situates digitalization and AI in migration by analyzing its uptake throughout the Migration Cycle. Second, the article evaluates the current challenges and, opportunities to migrants and migration systems brought about by deepening digitalization due to COVID-19, finding that while these expanding technologies can bolster human rights and support international development, potential gains can and are being eroded because of design, development and implementation aspects. Through a critical review of available literature on the subject, this paper argues that recent changes brought about by COVID-19 highlight that computational advances need to incorporate human rights throughout design and development stages, extending well beyond technical feasibility. This also extends beyond tech company references to inclusivity and transparency and requires analysis of systemic risks to migration and mobility regimes arising from advances in AI and related technologies.