Health Care Utilization Before and After the "Muslim Ban" Executive Order Among People Born in Muslim-Majority Countries and Living in the US

Stress Among Immigrants in the United States

BACKGROUND

Immigrants comprise a sizable proportion (15%) of the population living in the United States (U.S.). Given these proportions, it is imperative that we understand immigrant experiences of well-being and stress toward improved well-being and integration.

METHODS

To examine the experiences of first- and second-generation immigrants using a comparative approach, we utilized data from two surveys collected under Trump (n = 490) and Biden (n = 306) administrations. Both studies employed non-probability quota and convenience sampling techniques. Questions about experiences of stress (PSS-4), discrimination (Everyday Discrimination Scale), resilience (Brief Resilience Scale), border stress (Border Community and Immigration Stress Scale), immigration policies (general questions) were included in the surveys. Each study sample included diverse racial groups across both immigrant generations. We report frequencies, descriptive statistics, and ANOVAs/post hoc test results.

RESULTS

Findings highlight that levels of both stress and discrimination among non-White participants under the Trump administration were significantly higher than those of White participants, though neither relationship was significant under the Biden administration. Further, White participants exhibited higher resilience under the Trump administration, but not under the Biden administration.

DISCUSSION AND CONCLUSION

To our knowledge, this is the first study to comparatively examine immigrant experiences under the two most recent federal administrations. This study is seminal in highlighting discussions and making policy recommendations to limit immigrant exclusion, curtail exclusionary policies regarding travel bans, and improve pathways to citizenship, enhancing immigrant integration in the U.S. Roles of social workers in supporting immigrant communities and pathways for future research with immigrants are discussed.

Risk of Adverse Perinatal Outcomes Among African-born Black Women in California, 2011-2020

BACKGROUND

African-born women have a lower risk of preterm birth and small for gestational age (SGA) birth compared with United States-born Black women, however variation by country of origin is overlooked. Additionally, the extent that nativity disparities in adverse perinatal outcomes to Black women are explained by individual-level factors remains unclear.

METHODS

We conducted a population-based study of nonanomalous singleton live births to United States- and African-born Black women in California from 2011 to 2020 (n = 194,320). We used age-adjusted Poisson regression models to estimate the risk of preterm birth and SGA and reported risk ratios (RR) and 95% confidence intervals (CI). Decomposition using Monte Carlo integration of the g-formula computed the percentage of disparities in adverse outcomes between United States- and African-born women explained by individual-level factors.

RESULTS

Eritrean women (RR = 0.4; 95% CI = 0.3, 0.5) had the largest differences in risk of preterm birth and Cameroonian women (RR = 0.5; 95% CI = 0.3, 0.6) in SGA birth, compared with United States-born Black women. Ghanaian women had smaller differences in risk of preterm birth (RR = 0.8; 95% CI = 0.7, 1.0) and SGA (RR = 0.9; 95% CI = 0.8, 1.1) compared with United States-born women. Overall, we estimate that absolute differences in socio-demographic and clinical factors contributed to 32% of nativity-based disparities in the risk of preterm birth and 26% of disparities in SGA.

CONCLUSIONS

We observed heterogeneity in risk of adverse perinatal outcomes for African- compared with United States-born Black women, suggesting that nativity disparities in adverse perinatal outcomes were not fully explained by differences in individual-level factors.

Experiences of gender-based violence among Somali refugee women: a socio-ecological model approach

Gender-based violence (GBV) is an all-encompassing term that speaks to acts or threats that may lead to physical, sexual or emotional harm to an individual based on their gender. This paper provides a scoping review of research on gender-based violence among Somali refugee women in different parts of the world. Using the socio-ecological model as a framework, we reviewed 30 empirical studies focusing on some form of GBV among Somali refugee women. We identified societal, community and individual factors contributing to the experience of GBV. We also discuss how these factors influence women's willingness to access care, especially healthcare and social services. The review reveals that oftentimes, institutions that work closely with this population have a limited understanding of how closely culture affects the willingness and ability to seek help about GBV. Based on our analysis, we suggest ways in which social institutions and healthcare providers can provide culturally-safe support to Somali refugee women who have experienced some form of GBV.

A Pilot Efficacy Trial to Educate Muslim Americans about the Islamic Bioethical Perspectives in End-of-Life Healthcare

In the US, end-of-life health care (EOLHC) is often intensive and invasive, and at times may involve care that is inconsistent with patient values. US Muslims may not receive appropriate religious support, experience uncertainty around end-of-life decision-making, and under-utilize palliative and hospice care. As technological advancements and treatment options rise in EOLHC, Muslim American patients and their families need to understand more about the treatment options that are consistent with their beliefs. The objective of this study was to determine the efficacy of a pilot mosque-based educational workshop focused on increasing Muslim Americans' religious bioethics knowledge about end-of-life healthcare. Intervention sites were four mosques with racially and ethnically diverse members, two in the Chicago metropolitan area and two in the Washington, D.C. area. Eligible participants were self-reported Muslims, aged 18 years or older, who were proficient in English. The intervention included a pre and post-test survey and a workshop focused on the Islamic bioethical perspectives on EOLHC. Knowledge was measured with six true-false questions. Baseline and post-intervention scores were analyzed by McNemar's test and bivariate correlation. Overall, the analysis showed a significant improvement in post-intervention participant knowledge. There was increased knowledge of Islamic bioethical views on the moral status of seeking healthcare, brain death controversies, and religious perspectives on withholding or withdrawing life support near the end of life. Our pilot intervention successfully increased participant knowledge and underscores the need to improve the Muslim community's knowledge about the bioethical dimensions of EOLHC.

Funding for Refugee Health Research From the National Institutes of Health Between 2000 and 2020

Importance

The US has historically resettled more refugees than any other country, with over 3.5 million refugees since 1980. The National Institutes of Health (NIH) is the largest public funder of biomedical research and development, but its role in mitigating many health disparities refugees experience through its funded research remains unknown.

Objective

To examine the NIH's research funding patterns on refugee health research over the last 2 decades.

Design, Setting, and Participants

Secondary analysis of NIH-funded grants between 2000 and 2020 using a cross-sectional study design. The NIH Research Portfolio Online Reporting Tools database was used to find relevant grants. Data were analyzed from November 2021 to September 2022.

Main Outcomes and Measures

NIH grants awarded by year, state, grant type, research area, funding institute, grant duration, and amount funded.

Results

Of 1.7 million NIH grants funded over the 20-year study period, only 78 addressed refugee health. Funded grants were mostly training grants (23 grants [29%]), followed by hypothesis-driven research (R01 grants; 22 grants [28%]), pilot or preliminary investigation proposals (13 grants [17%]), and other types of grants (20 grants [26%]). The most studied research domain was mental health (36 grants [46%]), followed by refugee family dynamics and women's and children's health (14 grants [18%]). A total of 26 grants (33%) were funded by the National Institute of Mental Health and 15 (19%) were funded by the National Institute of Child Health and Human Development. Most grants were US-based (60 grants [76%]) and the state of Massachusetts received the greatest amount of funding ($14 825 852 [18%]). In 2020, the NIH allocated about $2.3 million to refugee health research, or less than 0.01% of its $42 billion budget that year. The number of grants funded in each time period did not always reflect changes in the number of refugees resettled in the US over the years.

Conclusions and Relevance

This cross-sectional study found that there remain significant gaps in the understanding of and interventions in the health research needs of refugees locally and along the migratory route. To close these gaps, the NIH should increase its investments in comprehensive studies assessing the physical, mental, and social well-being of this expanding population. This can be achieved by ensuring that all NIH institutes allocate budgets specifically for refugee health research and extend support for the training of refugee researchers.

East is east … or is it? Racialization of Asian, Middle Eastern, and Pacific Islander persons

The conventional use of racial categories in health research naturalizes "race" in problematic ways that ignore how racial categories function in service of a White-dominated racial hierarchy. In many respects, racial labels are based on geographic designations. For instance, "Asians" are from Asia. Yet, this is not always a tenable proposition. For example, Afghanistan resides in South Asia, and shares a border with China and Pakistan. Yet, people from Afghanistan are not considered Asian, but Middle Eastern, by the US Census. Furthermore, people on the west side of the Island of New Guinea are considered Asian, whereas those on the eastern side are considered Pacific Islander. In this article, we discuss the complexity of the racial labels related to people originating from Oceania and Asia, and, more specifically, those groups commonly referred to as Pacific Islander, Middle Eastern, and Asian. We begin with considerations of the aggregation fallacy. Just as the ecological fallacy refers to erroneous inferences about individuals from group data, the aggregation fallacy refers to erroneous inferences about subgroups (eg, Hmong) from group data (ie, all Asian Americans), and how these inferences can contribute to stereotypes such as the "model minority." We also examine how group averages can be influenced merely by the composition of the subgroups, and how these, in turn, can be influenced by social policies. We provide a historical overview of some of the issues facing Pacific Islander, Middle Eastern, and Asian communities, and conclude with directions for future research.

The Health Implications of Perceived Anti-Muslim Discrimination Among South Asian Muslim Americans

Introduction

Anti-Muslim discrimination in the U.S. has increased exponentially since 2001, but the impact of anti-Muslim discrimination has yet to be fully examined because of limited data available on this topic and population. The objectives of this study were to (1) examine the association between perceived anti-Muslim discrimination and health risk behaviors, with depressive symptoms as a potential mediator, among South Asian Muslim Americans and (2) examine the association between other forms of perceived discrimination and health risk behaviors, with depressive symptoms as a potential mediator, among South Asian Muslim Americans.

Methods

Data were collected using an online survey, which was disseminated on subscriber e-mail lists for organizations that serve South Asian or Muslim communities. Participants were asked about perceived discrimination, depressive symptoms, diet, physical activity, tobacco use, and alcohol consumption. Data were analyzed using structural equation modeling in Mplus 8.

Results

Societal anti-Muslim discrimination had a positive association with depressive symptoms (0.19, p<0.05), as did interpersonal anti-Muslim discrimination (0.20, p<0.05) and other forms of discrimination (0.22, p<0.05). None of the discrimination scales were associated with dietary patterns, tobacco use, or alcohol consumption.

Conclusions

Study results demonstrated a link between discrimination and depressive symptoms. Further research is needed to examine associations with other adverse health outcomes and potential buffers against discrimination.

Towards a better understanding between non-Muslim primary care clinicians and Muslim patients: A literature review intended to reduce health care inequities in Muslim patients

Although Muslims are a growing population within many non-Muslim countries, there are insufficient Muslim clinicians to care for them. Studies have shown that non-Muslim clinicians have limited knowledge and understanding of Islamic practices affecting health, which may lead to disparities in the quality of healthcare delivery and outcomes when caring for Muslim patients. Muslims come from many different cultures and ethnicities and have variations in their beliefs and practices. This literature review provides some insights which may strengthen therapeutic bonds between non-Muslim clinicians and their Muslim patients resulting in improved holistic, patient-centered care in the areas of cancer screening, mental health, nutrition, and pharmacotherapy. Additionally, this review informs clinicians about the Islamic perspective on childbirth, end of life issues, travel for Islamic pilgrimage, and fasting during the month of Ramadan. Literature was sourced by a comprehensive search in PubMed, Scopus, and CINAHL along with hand screening of citations. Title and abstract screening followed by full-text screening excluded studies including less than 30% Muslim participants, protocols, or reporting results deemed irrelevant to primary care. 115 papers were selected for inclusion in the literature review. These were grouped into the themes of general spirituality, which were discussed in the Introduction, and Islam and health, Social etiquette, Cancer screening, Diet, Medications and their alternatives, Ramadan, Hajj, Mental health, Organ donation and transplants, and End of life. Summarizing the findings of the review, we conclude that health inequities affecting Muslim patients can be addressed at least in part by improved cultural competency in non-Muslim clinicians, as well as further research into this area.

Impact of United States refugee ban and discrimination on the mental health of hypertensive Arabic-speaking refugees

Background

Hypertension is a global leading cause of death which disproportionately affects refugees. This chronic disease increases the risk of heart disease, stroke, brain, and other end-organ disease, if left uncontrolled. The 2017 United States travel or "Muslim" ban prevented immigrants and refugees from seven Muslim-majority countries from entering the United States, including Syria and Iraq; two major contributors to the global refugee population. As of 2020, the United States has admitted more than 133,000 and 22,000 Iraqi and Syrian refugees, respectively. Studies on the health effects of this policy on refugees are lacking. This study qualitatively explores the impact of the refugee ban on United States resettled Syrian and Iraqi refugees with hypertension.

Methods

Participants were recruited through a federally qualified health center system that is the largest healthcare provider for refugees in San Diego, CA. All participants were Arabic-speaking refugees diagnosed with hypertension from Syria and Iraq. In-depth interviews took place between April 2021 and April 2022. Inductive thematic analysis was used to analyze data from semi-structured interviews.

Results

Participants (N = 109) include 53 women and 56 men (23 Syrian, 86 Iraqi). The average age was 61.3 years (SD: 9.7) and stay in the United States was 9.5 years (SD 5.92). Four themes emerged linking the travel ban's impact on health, in line with the society to cells framework: (1) family factors: the refugee ban resulted in family separation; (2) physiological factors: the refugee ban worsened participants' mental health, exacerbating hypertension and perceived health outcomes; (3) community factors: perpetuation of Islamophobia, xenophobia, and perceived discrimination were structural barriers with links to poorer health; and (4) individual factors: trickle down consequences led to worsened participant self-image and self-perception within their host community.

Discussion

The refugee ban negatively impacted the mental and physical health of United States resettled Arabic-speaking refugees through perceived discrimination, stress, and poor social integration. It continues to have long-lasting effects years after the ban was instated. Centering family reunification within the United States Refugee Admissions Program and tailoring interventions through the healthcare and public health systems are warranted to reduce hypertension disparities in this growing and overlooked population.

Reduced health care utilization among young children of immigrants after Donald Trump's election and proposed public charge rule

Widespread fear among immigrants from hostile 2016 presidential campaign rhetoric decreased social and health care service enrollment (chilling effect). Health care utilization effects among immigrant families with young children are unknown. We examined whether former President Trump's election had chilling effects on well-child visit (WCV) schedule adherence, hospitalizations, and emergency department (ED) visits among children of immigrant vs US-born mothers in 3 US cities. Cross-sectional surveys of children <4 years receiving care in hospitals were linked to 2015-2018 electronic health records. We applied difference-in-difference analysis with a 12-month pre/post-election study period. Trump's election was associated with a 5-percentage-point decrease (-0.05; 95% CI: -0.08, -0.02) in WCV adherence for children of immigrant vs US-born mothers with no difference in hospitalizations or ED visits. Secondary analyses extending the treatment period to a leaked draft of proposed changes to public charge rules also showed significantly decreased WCV adherence among children of immigrant vs US-born mothers. Findings indicate likely missed opportunities for American Academy of Pediatrics-recommended early childhood vaccinations, health and developmental screenings, and family support. Policies and rhetoric promoting immigrant inclusion create a more just and equitable society for all US children.

A multilevel framework to investigate cardiovascular health disparities among South Asian immigrants in the United States

PURPOSE

Prior studies of cardiovascular health (CVH) disparities among immigrants of South Asian origin in the United States have examined South Asians as one homogenous group, focused primarily on Indian-origin immigrants, and examined risk at the individual level.

METHODS

We present current knowledge and evidence gaps about CVH in the three largest South Asian-origin populations in the United States-Bangladeshi, Indian, and Pakistani-and draw on socioecological and lifecourse frameworks to propose a conceptual framework for investigating multilevel risk and protective factors of CVH across these groups.

RESULTS

The central hypothesis is that CVH disparities among South Asian populations exist due to differences in structural and social determinants, including lived experiences like discrimination, and that acculturation strategies and resilience resources (e.g., neighborhood environment, education, religiosity, social support) ameliorate stressors to act as health protective factors.

RESULTS

Conclusions: Our framework advances conceptualization of the heterogeneity and drivers of cardiovascular disparities in diverse South Asian-origin populations. We present specific recommendations to inform the design of future epidemiologic studies on South Asian immigrant health and the development of multilevel interventions to reduce CVH disparities and promote well-being.

Health outcomes and female genital mutilation/cutting: how much is due to the cutting itself?

While Female Genital Mutilation/Cutting (FGM/C) continues to garner global attention, FGM/C-affected migrant communities, who are often racialized minorities in the U.S., face additional challenges which may impact their physical and mental health and well-being. It has been proposed that an overly narrow focus on the female genitalia or FGM/C status alone, while ignoring the wider social experiences and perceptions of affected migrant women, will result in incomplete or misleading conclusions about the relationship between FGM/C and migrant women's health. A cross-sectional study was conducted across two waves of Somali and Somali Bantu women living in the United States, (n = 879 [wave 1], n = 654 [wave 2]). Socio-demographics, self-reported FGM/C status, perceived psychological distress, and self-reported FGM/C-related health morbidity was examined against self-reported experiences of everyday discrimination and perceived psychosocial support. In statistical models including age and educational attainment as potentially confounding socio-demographic variables, as well as self-reported FGM/C status, self-reported discrimination, and perceived psychosocial support, self-reported discrimination was the variable most strongly associated with poor physical health and psychological distress (i.e., FGM/C-related health morbidity and psychological distress), with greater perceived psychosocial support negatively associated with psychological distress, when controlling for all the other variables in the model. FGM/C status was not significantly associated with either outcome. Discrimination, more frequently reported among 'No FGM/C' (i.e., genitally intact or unmodified) women, was most frequently perceived as linked to religion and ethnicity. Our findings are consistent with views that discrimination drives negative outcomes. In this population, discrimination may include the 'quadruple jeopardy' of intersecting relationships among gender, race, religion, and migration status. We find that self-reported experiences of discrimination-and not FGM/C status per se-is associated with adverse physical and mental health consequences in our sample drawn from Somali migrant communities living in the United States, and that social support may help to mitigate these consequences. Our findings thus reinforce calls to better contextualize the relationship between FGM/C and measures of health and well-being among Somali women in the United States (regardless of their FGM/C status), taking psychosocial factors more centrally into account.Clinical Trials.Gov ID no. NCT03249649, Study ID no. 5252. Public website: https://clinicaltrials.gov/ct2/show/NCT03249649.

Beyond "Chilling Effects": Latinx and Asian Immigrants' Experiences With Enforcement and Barriers to Health Care

OBJECTIVES

Immigration enforcement policies are associated with immigrants' barriers to health care. Current evidence suggests that enforcement creates a "chilling effect" in which immigrants avoid care due to fear of encountering enforcement. Yet, there has been little examination of the impact of immigrants' direct encounters with enforcement on health care access. We examined some of the first population-level data on Asian and Latinx immigrants' encounters with law and immigration enforcement and assessed associations with health care access.

METHODS

We analyzed the 2018 and 2019 Research on Immigrant Health and State Policy survey in which Asian and Latinx immigrants in California (n=1681) reported on 7 enforcement experiences (eg, racial profiling and deportation). We examined the associations between measures of individual and cumulative enforcement experiences and the usual sources of care and delay in care.

RESULTS

Latinx, compared with Asian respondents, reported the highest levels of enforcement experiences. Almost all individual enforcement experiences were associated with delaying care for both groups. Each additional cumulative experience was associated with a delay in care for both groups (OR=1.30, 95% CI 1.10-1.50). There were no associations with the usual source of care.

CONCLUSION

Findings confirm that Latinx immigrants experience high levels of encounters with the enforcement system and highlight new data on Asian immigrants' enforcement encounters. Direct experiences with enforcement have a negative relationship with health care access. Findings have implications for health systems to address the needs of immigrants affected by enforcement and for changes to health and immigration policy to ensure immigrants' access to care.

Religious Identity Discrimination in the Physician Workforce: Insights from Two National Studies of Muslim Clinicians in the US

BACKGROUND

Discrimination negatively impacts physician career trajectories and well-being.

OBJECTIVE

Quantify perceived religious discrimination among US Muslim physicians and compare trends over time.

DESIGN/PARTICIPANTS/MAIN MEASURES

Two national surveys tabulated discrimination. The 2013 survey involved a mailed questionnaire to a random sample of 746 Islamic Medical Association of North America (IMANA) members, while the 2021 survey was administered online to subscribers of IMANA, American Muslim Health Professionals, and the US Muslim Physician network. Eligible participants had to be practicing US Muslim physicians, and English-proficient (the 2021 sample was further restricted to physicians in academic medicine). Questionnaires assessed experiences of religious discrimination and accommodation.

KEY RESULTS

In 2013, the 255 participants had a mean age of 52 years, were mostly male (70%), Sunni (91%), South Asian (70%), and adult immigrants (65%). In 2021, the 264 participants had a mean age of 39.5 years, were mostly male (65%) and Sunni (75%). In contrast to 2013, the majority were born in the USA (59%; p<0.01), and respondents were more diverse with 33% South Asians, 22% Arabs, and 16% African Americans. Greater proportions of the 2021 sample reported facing religious discrimination frequently in their career (24 to 53%; p<0.01), experiencing job turnover (7 to 32%; p<0.01), and having patients refuse their care (9 to 33%; p<0.01). A higher proportion of South Asians, Arabs, and participants under the age of 40 reported discrimination and job turnover in 2021 when compared to 2013. Higher proportions of South Asians and Whites reported being passed over for professional advancement and having patients refuse their care in 2021 relative to 2013.

CONCLUSIONS

Many American Muslim clinicians encounter religious discrimination at the workplace, and these experiences appear to be on the rise. Healthcare workforce diversity, inclusion, and equity programming should include a focus on accommodating the religious identities of physicians.

An Integrative Review of Community-Based Mental Health Interventions Among Resettled Refugees from Muslim-Majority Countries

Resettled refugees from Muslim-majority countries are underrepresented in research and meeting their mental health needs remains a challenge for countries of resettlement. In this integrative review, we synthesize community-based mental health interventions using an ecological framework. Eleven relevant studies were identified using PubMed and PsychInfo database. Most interventions focus on micro-system level factors like promoting integration and social connections suggest improvement of outcomes including depression, anxiety, and psychological distress. Studies suggest how mental health programs addressing psychosocial wellbeing improves outcomes across ecological levels through: (1) early screening upon resettlement; (2) education and raising awareness of mental health; and (3) engagement of refugees in local community social support systems. Largely qualitative studies suggest benefits of engagement and education program for refugees, but there is a need for high quality, rigorous mental health intervention studies with resettled refugees with explicit attention to equitable and collaborative partnerships across multiple sectors in the community.

Serial Mediation Analysis of the Association of Familiarity with Transgender Sports Bans and Suicidality among Sexual and Gender Minority Adults in the United States

BACKGROUND

Discriminatory laws and policies are a form of structural stigma that is associated with increased suicidality among sexual and gender minority (SGM) people. Unfortunately, in the United States, there has been an increase in state-level discriminatory laws and policies targeting SGM people in 2021 and 2022, particularly, transgender sports bans. The purpose of this study was to (1) determine if familiarity with transgender sports bans was associated with suicidality among SGM adults; and (2) determine if interpersonal stigma and/or individual stigma mediated this association.

METHODS

This was a cross-sectional study of data collected from a national sample of 1033 SGM adults in the United States between 28 January and 7 February 2022. Univariate and serial mediator models were used in this analysis.

RESULTS

The increased suicidality was associated with familiarity with state-level transgender sports bans among SGM adults (p-value = 0.0150). Even after interpersonal and individual stigma mediated this relationship, the association between suicidality and familiarity with state-level transgender sports bans remained (p-value = 0.0106).

CONCLUSION

State-level transgender sports bans appear to exacerbate existing disparities in mental health, especially for individuals who are familiar with the bans. They directly discriminate against people who are transgender and indirectly stigmatize the broader SGM community.

Reporting of health equity considerations in equity-relevant observational studies: Protocol for a systematic assessment

Background: The mitigation of unfair and avoidable differences in health is an increasing global priority. Observational studies including cohort, cross-sectional and case-control studies tend to report social determinants of health which could inform evidence syntheses on health equity and social justice. However, the extent of reporting and analysis of equity in equity-relevant observational studies is unknown. Methods: We define studies which report outcomes for populations at risk of experiencing inequities as “equity-relevant”. Using a random sampling technique we will identify 320 equity-relevant observational studies published between 1 January 2020 to 27 April 2022 by searching the MEDLINE database. We will stratify sampling by 1) studies in high-income countries (HIC) and low- and middle-income countries (LMIC) according to the World Bank classification, 2) studies focused on COVID and those which are not, 3) studies focused on populations at risk of experiencing inequities and those on general populations that stratify their analyses. We will use the PROGRESS framework which stands for place of residence, race or ethnicity, occupation, gender or sex, religion, education, socioeconomic status, social capital, to identify dimensions where inequities may exist. Using a previously developed data extraction form we will pilot-test on eligible studies and revise as applicable. Conclusions: The proposed methodological assessment of reporting will allow us to systematically understand the current reporting and analysis practices for health equity in observational studies. The findings of this study will help inform the development of the equity extension for the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) reporting guidelines.

Health Implications of Racialized State Violence Against South Asians in the USA

South Asians, one of the fastest growing ethnic groups in the USA today, trace their roots to countries in the Indian subcontinent (e.g., Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, Sri Lanka) and its global diaspora. With a wide range of cultural, religious, and linguistic diversity, as well as immigration experiences and inequality, South Asians have experienced racialized violence and discrimination since first arriving in the USA in the 1700s. Following September 11, 2001, South Asians and other groups racialized as "Brown," including Muslim, Sikh, Middle Eastern, and Arab Americans, have experienced a marked increase in state violence, including racist laws, policies, and immigration enforcement. Despite abundant evidence of the adverse effects of violence on mental and physical health, there is limited research examining the impact of this racialized state violence on the health of South Asians in the USA. We summarize and synthesize existing peer-reviewed and gray literature on the prevalence and types of violence experienced by South Asians in the USA and enumerate their potential detrimental health impacts. We highlight the paucity of public health data and propose a conceptual framework describing how racialized violence and hate have significant implications for health among South Asians in the USA. Ultimately, these findings illuminate the need for change at the highest levels of governance to mitigate and resist hate violence, including through political participation and inclusion and equitable allocation of social and economic resources, to improve the health of South Asians in the USA.