A social determinants framework identifying state-level immigrant policies and their influence on health

ICE Detainer Requests Were Associated With Lower Medicaid And SNAP Enrollment Among Eligible Adults, 2011-19

Legislative policies that criminalize immigrants have a "chilling effect" on public program participation among eligible immigrants. However, little is known about the effect of local enforcement actions by Immigration and Customs Enforcement (ICE). In this study, we linked county-level data on the number of detainer requests (or immigration holds) issued by ICE to individual-level data from the 2011, 2016, and 2019 American Community Surveys. We fit adjusted logistic regression models to assess the association between detainer requests and enrollment in Medicaid and the Supplemental Nutrition Assistance Program (SNAP) among those likely eligible for each program in US-born versus immigrant households. A higher volume of detainer requests was associated with lower enrollment in both Medicaid and SNAP, particularly among adults in households with at least one immigrant relative to US-born households. We observed the most pronounced effects in 2011 and 2019.

Mexican-origin women's individual and collective strategies to access and share health-promoting resources in the context of exclusionary immigration and immigrant policies

BACKGROUND

A growing literature has documented the social, economic, and health impacts of exclusionary immigration and immigrant policies in the early 21st century for Latiné communities in the US, pointing to immigration and immigrant policies as forms of structural racism that affect individual, family, and community health and well-being. Furthermore, the past decade has seen an increase in bi-partisan exclusionary immigration and immigrant policies. Immigration enforcement has been a major topic during the 2024 Presidential election cycle, portending an augmentation of exclusionary policies towards immigrants. Within this context, scholars have called for research that highlights the ways in which Latiné communities navigate exclusionary immigration and immigrant policies, and implications for health. This study examines ways in which Mexican-origin women in a midwestern northern border community navigate restrictive immigration and immigrant policies to access health-promoting resources and care for their well-being.

METHODS

We conducted a grounded theory analysis drawing on interviews with 48 Mexican-origin women in Detroit, Michigan, who identified as being in the first, 1.5, or second immigrant generation. Interviews were conducted in English or Spanish, depending on participants' preferences, and were conducted at community-based organizations or other locations convenient to participants in 2013-2014.

RESULTS

Women reported encountering an interconnected web of institutional processes that used racializing markers to infer legal status and eligibility to access health-promoting resources. Our findings highlight women's use of both individual and collective action to navigate exclusionary policies and processes, working to: (1) maintain access to health-promoting resources; (2) limit labeling and stigmatization; and (3) mitigate adverse impacts of immigrant policing on health and well-being. The strategies women engaged were shaped by both the immigration processes and structures they confronted, and the resources to which they had access to within their social network.

CONCLUSIONS

Our findings suggest a complex interplay of immigration-related policies and processes, social networks, and health-relevant resources. They highlight the importance of inclusive policies to promote health for immigrant communities. These findings illuminate women's agency in the context of structural violence facing immigrant women and are particularly salient in the face of anti-immigrant rhetoric and exclusionary immigration and immigrant policies.

Prevalence of Chronic Pain by Immigration Status and Latino Ethnicity

OBJECTIVE

The goal of this study was to evaluate the Latino paradox and healthy migrant hypotheses by estimating the association between the prevalence of chronic pain, immigration status, and Latino ethnicity.

METHODS

This cross-sectional study analyzed pooled data from 85,395 adult participants of the 2019-2021 National Health Interview Survey. The dependent variables were any pain and chronic pain in the past 3 months. The independent variables were immigration status (US born, naturalized citizen, non-citizen) and Latino ethnicity.

RESULTS

Chronic pain was prevalent for nearly a quarter of US born non-Latino adults (24%) and non-citizen non-Latino adults had the lowest prevalence at 8%. In multivariable adjusted models, US born non-Latino immigration status and ethnicity was associated with a higher probability of reporting chronic pain in the last 3 months compared to US born Latino adults (-3.0%; 95% CI = -4.4%, -1.6%), naturalized citizen non-Latino adults (-4.7%; 95% CI = -5.9%, -3.4%), naturalized citizen Latino adults (-6.7%; 95% CI = -8.5%, -4.9%), non-citizen non-Latino adults (-3.1%; 95% CI = -4.7%, -1.5%), and non-citizen Latino adults (-8.9%; 95% CI = -10.8%, -7.0%).

CONCLUSION

US Born non-Latino adults reported the highest prevalence of chronic pain and non-citizen Latino adults reported the lowest prevalence of chronic pain providing support for the Latino paradox and healthy migrant effect hypotheses.

Racialization processes and depressive symptoms among pregnant Mexican-origin immigrant women

This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (β = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (β = 2.81; p < .001) and no association of John Henryism and depressive symptoms (β = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.

Hitting closer to home: State policies' impacts on health by race and legal status

While the proliferation of inclusionary and exclusionary state policies has led to an increasingly heterogeneous patchwork of state climates, state policy and the climates they create have become increasingly important for health outcomes. We leverage the heterogeneity across state policy climates to test the relationship between state-level policies and health inequality across the US. We include 24 state policies related to public health and safety, immigration enforcement, integration, and healthcare to capture the state climate. Using the Survey of Income and Program Participation (SIPP), a nationally representative study of households in the U.S., we estimate multilevel regression models to assess the relationship between state policy climate and healthcare utilization. We further examine differential effects of the policy climate across various vulnerable groups, by examining differences by citizenship status and race. We find that more exclusionary policies may be detrimental to healthcare utilization for all residents regardless of race and legal status- but ultimately racial minorities and noncitizens see the greatest benefits from inclusive policy climates.

The Influence of Organizational Aspects of the U.S. Agricultural Industry and Socioeconomic and Political Conditions on Farmworkers' COVID-19 Workplace Safety

Farmworkers in the U.S. experienced high rates of COVID-19 infection and mortality during the COVID-19 pandemic. Their workplace may have been a significant place of exposure to the novel coronavirus. Using political economy of health theory, this study sought to understand how organizational aspects of the agricultural industry and broader socioeconomic and political conditions shaped farmworkers' COVID-19 workplace safety during the pandemic. Between July 2020 and April 2021, we conducted and analyzed fourteen in-depth, semi-structured phone interviews with Latinx farmworkers in California. Findings show that regulatory oversight reinforced COVID-19 workplace safety. In the absence of regulatory oversight, the organization of the agricultural industry produced COVID-19 workplace risks for farmworkers; it normalized unsafe working conditions and the worker-rather than employer-responsibility for workplace safety. Under these conditions, farmworkers enacted personal COVID-19 preventative practices but were limited by financial hardships that were exacerbated by the precarious nature of agricultural employment and legal status exclusions from pandemic-related aid. Unsafe workplace conditions negatively impacted workplace camaraderie. Study findings have implications for farmworkers' individual and collective agency to achieve safe working conditions. Occupational safety interventions must address the organizational aspects that produce workplace health and safety inequities and disempower farmworkers in the workplace.

Caught Between a Well-Intentioned State and a Hostile Federal System: Local Implementation of Inclusive Immigrant Policies

Policy Points Inclusive state immigrant policies that expand rights and resources for immigrants may improve population health, but little is known about their local-level implementation. Local actors that have anti-immigrant attitudes can hinder the implementation of state policies, whereas the persistent influence of anti-immigrant federal policies reinforces barriers to accessing health and other resources granted by state policies. Local actors that serve immigrants and support state policy implementation lack the resources to counter anti-immigrant climates and federal policy threats.

CONTEXT

In the United States, inclusive state-level policies can advance immigrant health and health care access by extending noncitizens' access to public benefits, workplace rights, and protections from immigration enforcement. Although state policies carry promise as structural population health interventions, there has been little examination of their implementation at the local level. Local jurisdictions play multiple roles in state policy implementation and possess distinct immigration climates. Examining the local implementation of state immigrant policy can address challenges and opportunities to ensure the health benefits of inclusive policies are realized equitably across states' regions.

METHODS

To examine the local implementation of state immigrant policies, we selected a purposive sample of California counties with large immigrant populations and distinct social and political dynamics and conducted and analyzed in-depth interviews with 20 community-based organizations that provided health, safety net, and other services.

FINDINGS

We found that there were tensions between the inclusionary goals of state immigrant policies and local anti-immigrant climates and federal policy changes. First, there were tensions between state policy goals and resistance from local law enforcement agencies and policymakers (e.g., Board of Supervisors). Second, because of the ongoing threats from federal immigration policies, there was a mismatch between the services and resources provided by state policies and local community needs. Finally, organizations that served immigrants were responsible for contributing to policy implementation but lacked resources to meet community needs while countering local resistance and federal policy threats.

CONCLUSIONS

This study contributes knowledge regarding the challenges that emerge after state immigrant policies are enacted. The tensions among state immigrant policies, local immigration climates, and federal policy changes indicate that state immigrant policies are not implemented equally across state communities, resulting in challenges and limited benefits from policies for many immigrant communities.

The Intersection of State-Level Immigrant Policy Climates and Medicaid Expansion: an Examination Among Immigrants

States have broad discretion over the implementation of policies like Medicaid expansion and other policies that impact the well-being and integration of immigrants. While numerous studies document Medicaid expansion on immigrants' health insurance coverage and the role of state immigrant policy climates on immigrants' well-being, no research to date has studied whether the association between a state's Medicaid expansion on immigrants' health insurance coverage varies based on the inclusiveness or exclusiveness of a state's immigrant policy climate. We combine nationally representative data from the 2014-2018 American Community Survey (ACS) with state policy data and estimate multivariate regression models. The results reveal a state immigrant policy climate gradient whereby ACA Medicaid expansion on noncitizens is negative and most severe in exclusionary climates. This study highlights how state policies intersect as important structural forces that influence immigrant health and well-being.

The impact of social capital and social environmental factors on mental health and flourishing: the experiences of asylum-seekers in France

BACKGROUND

There is growing interest on how social capital and related social environmental factors impact overall population health and well-being. The nature of asylum-seekers' social environment alters once they migrate to a new context and these changes influence their mental health and well-being. However, there is limited scholarship on how these social environmental factors impact the mental health, well-being, and capacity to flourish of asylum-seekers.

METHODS

The aim of the study, therefore, was to examine how specific social environmental factors-social networks, social support, and social cohesion at various levels (micro, meso, and macro)-influence the mental health, well-being, and capacity to flourish of asylum-seekers in France. In collaboration with a community-based organization, we used a qualitative research design to conduct 120 semi-structured interviews with asylum-seekers in France.

RESULTS

The emerging salient themes depicted how the asylum-seekers' usual informal social networks comprised of family and friends had been disrupted since they migrated to France, which impacted their mental health and well-being. Conversely, staying connected with their informal transnational social networks via social media and developing ties with new local informal and formal social networks allowed them to receive different forms of social support, and buffered some of the negative mental health consequences. However, the lack of social cohesion due to a lack of belonging, marginalization, and current harmful migration-related policies impeded asylum-seekers' capacity to flourish.

CONCLUSION

While social support derived from social networks buffered some negative impacts on mental health and well-being, the overall lack of social cohesion ultimately impeded asylum-seekers' capacity to flourish within their host communities, which was further exacerbated by harmful migration policies of exclusion within France. Introducing more inclusive policies related to the governance of migration and an intersectoral approach that views health in all policies is key to promoting social cohesion and flourishing among asylum-seekers in France.

Immigration and Immigrant Policies, Health, and Health Equity in the United States

Policy Points There is growing attention to the role of immigration and immigrant policies in shaping the health and well-being of immigrants of color. The early 21st century in the United States has seen several important achievements in inclusionary policies, practices, and ideologies toward immigrants, largely at subnational levels (e.g., states, counties, cities/towns). National policies or practices that are inclusionary toward immigrants are often at the discretion of the political parties in power. Early in the 21st century, the United States has implemented several exclusionary immigration and immigrant policies, contributing to record deportations and detentions and worsening inequities in the social drivers of health.

Health Insurance Coverage as a Social Determinant of Osteoporosis Diagnosis in a Population-Based Cohort Study of Older American Adults

Social determinants of health theoretical frameworks identify health insurance coverage as a determinant of older adults' osteoporosis diagnoses, which results in health inequities. In this research, we used the longitudinal Health and Retirement Study dataset of older United States adults, sampled biennially from 2012 to 2016. Logistic regressions estimated odds of osteoporosis diagnosis with and without a bone scan and/or hip fracture, holding insurance type, and health and demographic factors constant. Results were validated using the National Health and Nutrition Examination Survey. Probable underdiagnosing is present in older adults identifying as Black/African American and as males without a bone scan, regardless of fracture status, potentially as products of structural racism and sexism. Models including a bone scan show a reduction in disparities. These findings suggest having a bone scan is still crucial for addressing health inequities in older adults, and remedying barriers to accessing a scan is paramount.

Examining the Correlates of HIV Testing for Venezuelan Migrants in Trinidad

An important preventive measure in the fight against the HIV epidemic is the adoption of HIV testing. The government of the Republic of Trinidad and Tobago conducted a registration exercise in 2019 for undocumented migrants and refugees from Venezuela residing in the country. These migrants were allowed access to the public health system. In this study, we observed the correlates of HIV testing in Venezuelan migrants residing in Trinidad. A convenience sample of n = 250 migrants was collected via telephone survey from September through December 2020. Variables of interest included social factors, health needs, and uptake of HIV testing. Pearson χ² tests examined the associations between study variables, and multivariable logistic regression with backward elimination produced the odds of taking an HIV test. In our study, 40.8% of migrants reported having received an HIV test since arriving in Trinidad. Persons who migrated with family or friends had greater odds of getting an HIV test relative to persons who arrived alone (OR = 2.912, 95% CI: 1.002-8.466), and migrants who knew where to get an HIV test also greater odds of getting a test relative to person who did not know where to get a test (OR = 3.173, 95% CI: 1.683-5.982). Migrants with known physical health problems had greater odds of getting an HIV test relative to migrants without these health problems (OR = 1.856, 95% CI: 1.032-3.337). Persons who arrived with family or friends had greater odds of experiencing difficulties accessing public health care relative to persons who arrived alone (OR = 3.572, 95% CI: 1.352-9.442). Migrants earning between $1000 and $2999 TT per month had greater odds of experiencing trouble accessing public health services relative to persons who had monthly earnings of less than $1000 TT (OR = 2.567, 95% CI: 1.252-5.264). This was the first quantitative study on HIV testing among Venezuelan migrants in Trinidad. Migrants still experience difficulties accessing healthcare, which, in turn influences national HIV prevention and control efforts. The results gathered may help in developing HIV prevention plans that are led by a national health policy that takes migrant communities' needs into account.

Immigration Enforcement Climate in Georgia and the Mental Health of Latinx Immigrants

INTRODUCTION

Immigrant-related social policies and immigration enforcement contribute to a sociopolitical environment that affects immigrants' health. This exploratory study in six metro-Atlanta counties examined associations among immigrants' perceived vulnerability to harmful immigrant-related social policies and county-level 287(g) agreements (which facilitate cooperation between local law enforcement and federal immigration authorities), county-level immigration enforcement levels (arrests, community arrests, detainers, and removals), and immigrants' mental health.

METHODS

Using data from a 2020 study among Latinx parents who were undocumented or members of mixed-status families (N = 140), we merged data on individuals' perceived policy vulnerability and depressive and anxiety symptoms with county 287(g) status and immigration enforcement levels.

RESULTS

Perceived policy vulnerability was not associated with county-level 287(g) status or immigration enforcement levels. Greater policy vulnerability and Immigration and Customs Enforcement arrests were associated with higher depressive and anxiety symptoms, but 287(g) status was associated with lower depressive and anxiety symptoms.

CONCLUSION

Perceived policy vulnerability, 287(g) status, and immigration enforcement levels do not always align and can have different associations with mental health.

European immigrant health policies, immigrants' health, and immigrants' access to healthcare

OBJECTIVE

Evidence indicates presence of immigrant health disparities in the European Union (EU) and the United States (US). We examined the association between immigrant health policies and the gap in health status, unmet needs and service use between immigrants and citizens, in the EU and US.

METHODS

We used the Migrant Integration Policy Index (MIPEX), European Health Interview Survey, and National Health Interview Survey for 2014. Our independent variables of interest were MIPEX Health strand score and citizenship. Our dependent variables were four measures of health status (self-reported poor health; severely limited in general activities; two or more comorbidities; one or more ambulatory care sensitive conditions) and four measures of health access and utilization (unmet need due to non-financial reasons; could not afford needed health care; one or more primary care visits last year; any hospitalization last year). We conducted linear probability models and presented the marginal effects of each outcome in percentage points.

FINDINGS

We found that immigrant-friendly health policies were significantly associated with better health and less unmet need due to non-financial reasons.

CONCLUSION

Our findings supported the promotion of immigrant-friendly and a 'Health-in-All Policies' (HiAP) approach to preserve the health of immigrants.

Analysis of Casual Relationships between Social Determinants of Health in Iran: Using Fuzzy Cognitive Map

BACKGROUND

Health is a fundamental issue in recent years, highlighting the importance of harmonizing the policies of any sector with health strategies. The present study aims to identify the socio-economic factors affecting health and to provide a cognitive map of the social determinants of health in Iran.

STUDY DESIGN

A retrospective cohort study.

METHODS

This study follows a developmental process with an exploratory sequential mixed methods approach. First, a meta-synthesis qualitative method determines the most critical health determinants by reviewing 54 studies from 2000 to 2019. Then, the fuzzy cognitive map (FCM) is drawn based on interviews with six experts to derive the causal relationships among the social determinants of population health in Iran.

RESULTS

Stage 1 introduces 170 factors as the health determinants, classified into four levels: individual, local, national, and global levels, with 7, 4, 13, and 3 branches, respectively. According to the causal relationships and the out-degree (od) index, the most effective factors are the economic system (18.24), governance and policy-making (17.13), and national policies (16.93). According to the degree of centrality, these factors are the economic system (33.27), health system (30.37), and governance and policy-making (30.15).

CONCLUSION

Considering health as a complex and comprehensive system, the resulting FCM displays that the policies developed in other sectors than health are profoundly affecting population's health in Iran. Specifically, the comparative analysis of this research shows that policies regarding the economic system and people's livelihood are more effective than the policies regarding the health system itself on the population's health in Iran.

Racism and health care: Experiences of Latinx immigrant women in NYC during COVID-19

The COVID-19 pandemic has disproportionately affected minoritized racial groups, especially Latinx immigrants, evidenced by the high rates of COVID-19 infections, hospitalizations, and deaths among this population. With increasing xenophobia and anti-immigrant sentiment in parallel to the pandemic, it is critical to understand the perspectives of Latinx populations. This study explores Latinx immigrant women's perceptions of racism and xenophobia in their health care experiences in New York City (NYC) during the COVID-19 pandemic and, further, seeks to understand the role of perceived discrimination in health care settings and on health care access. Data were analyzed using a constant comparative method of analysis from twenty-one in-depth interviews conducted with foreign-born women in the five boroughs of New York City from diverse countries across Latin America. Four central themes emerged including: structural inequalities, discriminatory health care experiences, victimization in public institutions, and overcoming discrimination in health care settings. Latinx immigrant women described the ways in which perceptions and experiences of discrimination shaped their capacity to address health-related needs during the COVID-19 pandemic. This study provides evidence to a growing body of literature suggesting that structural racism and xenophobia and perceptions of anti-immigrant discrimination, including resulting structural inequalities, may have a negative effect on individuals' ability to access and engage the health care system, resulting in avoidance of health care services - a critical need during a global pandemic. Scholars, policymakers, and practitioners alike should be mindful of how racism and xenophobia shape Latinx immigrant communities' engagement with the health care system.

The 2016 Presidential Election and Prenatal Care Utilization Among Foreign-born Hispanic Pregnant People

BACKGROUND

Few studies have evaluated the relationship between adequate and timely prenatal care among immigrant pregnant people and the recent political climate, including the 2016 election and associated campaigns.

OBJECTIVES

We examine whether the 2016 presidential election was associated with changes in prenatal care utilization among US foreign-born Hispanic pregnant people.

RESEARCH DESIGN

Interrupted time series.

SUBJECTS

All foreign-born Hispanic and US-born non-Hispanic White people delivering singleton infants from 2008 to 2017 who resided in the 23 states that fully implemented the 2003 version of the birth certificate before January 2008 (n=12,397,503).

MEASURES

We examine the relationship between the presidential election and changes in the odds of inadequate or late/no prenatal care among immigrant Hispanic pregnant people, as well as trends in prenatal care utilization before the election.

RESULTS

Our results show no unexpected changes in receipt of inadequate prenatal care, and late/no prenatal care, among the 7 monthly conception cohorts exposed to the election before the third trimester. However, we detected increases in the odds of both inadequate care and late/no prenatal care among foreign-born Hispanic pregnant people in June 2015 and January 2016, respectively. These upward level shifts persisted through the remainder of our time series ending with the cohort conceived around December 2016.

CONCLUSIONS

The worsening shifts in prenatal care utilization we observe may serve as a bellwether for worsening outcomes among immigrant women and their families. Research is therefore urgently needed to investigate the determinants and consequences of these concerning trends.

Self-rated health of both US citizens and noncitizens is associated with state-level immigrant criminalization policies

Evidence shows that state-level restrictive immigrant policies are associated with health disparities between noncitizens and citizens. Most research has focused on Latinos and there is limited knowledge of the relationship between restrictive policies and citizenship status among other groups, particularly Asian and Pacific Islanders (API). We examined whether state-level criminalization policy contexts (e.g., law enforcement collaboration with immigration authorities, E-Verify employment authorization) were associated with self-rated health (SRH) by citizenship, with a focus on Latinos and APIs. We expected that criminalization policies would be associated with worse health for noncitizens and citizens, but with a more negative influence for noncitizens; and that this pattern would be the same for Latinos and APIs. We merged a state-level immigrant criminalization policy database with a multi-racial/ethnic sample from 2014 to 2015 National Health Interview Survey (NHIS, n = 70,335). We tested the association between SRH and the number of state-level criminalization policies and generated predicted probabilities of noncitizens and citizens reporting excellent health in states with the most and fewest criminalization policies for the full sample, Latino, and API respondents. In states with the most criminalization policies, all noncitizens had a higher and all US-born citizens had a lower probability of excellent health. In states with the fewest criminalization policies there were no differences by citizenship status. Findings provide new evidence that state-level immigrant policies may harm the health of US-born citizens. As immigrant policymaking at the state level continues, understanding the relationship between state-level immigrant policies and health inequities across citizenship statuses will continue to be critical to improving population health.

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State policies that criminalize immigrants may harm the health of both noncitizens and citizens of different races/ethnicities.

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More state immigrant criminalization policies are associated with health inequities between US citizens and noncitizens.

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Immigrant criminalization policies are associated with worse self-reported health for US born citizens.

Perceived general, mental, and physical health of Latinos in the United States following adoption of immigrant-inclusive state-level driver's license policies: a time-series analysis

Background

In the United States (U.S.), several states have laws that allow individuals to obtain driver’s licenses regardless of their immigration status. Possession of a driver’s license can improve an individual’s access to social programs, healthcare services, and employment opportunities, which could lead to improvements in perceived mental and physical health among Latinos living in the U.S.

Methods

Using Behavioral Risk Factor Surveillance System data (2011–2019) for Latinos living in the U.S. overall (immigration status was not available), we compared the average number of self-reported perceived poor mental and physical health days/month, and general health status (single-item measures) before (January 2011-June 2013) and after implementation (July 2015-December 2019) of immigrant-inclusive license policies using interrupted time-series analyses and segmented linear regression, and a control group of states in which such policies were not implemented. We also compared the average number of adults reporting any perceived poor mental or physical health days (≥ 1 day/month) using a similar approach.

Results

One hundred twenty-three thousand eight hundred seven Latino adults were included; 66,805 lived in states that adopted immigrant-inclusive license policies. After implementation, average number of perceived poor physical health days significantly decreased from 4.30 to 3.80 days/month (immediate change = -0.64, 95% CI = -1.10 to -0.19). The proportion reporting ≥ 1 perceived poor physical and mental health day significantly decreased from 41 to 34% (OR = 0.89, 95% CI = 0.80–1.00) and from 40 to 33% (OR = 0.84, 95% CI = 0.74–0.94), respectively.

Conclusions

Among all Latinos living in the U.S., immigrant-inclusive license policies were associated with fewer perceived poor physical health days per month and fewer adults experiencing poor physical and mental health. Because anti-immigrant policies can harm Latino communities regardless of immigration status and further widen health inequities, implementing state policies that do not restrict access to driver licenses based on immigrant status documentation could help address upstream drivers of such inequities.

Immigration and the Life Course: Contextualizing and Understanding Healthcare Access and Health of Older Adult Immigrants

OBJECTIVE

Immigrant health discussions often focus on acculturation and omit discussions on historical events that may underlie health differences among immigrant older adults. This paper provides a historical overview of immigration policy and flows to the U.S. and examines insurance access and health difficulties by sending country.

METHODS

We analyzed the "Immigrants Admitted to the United States, Fiscal Years 1972-2000" and 2015-2019 American Community Survey datasets to examine the number of admitted immigrants, sociodemographic profiles for current immigrant older adults, and the predicted probabilities of health insurance access and health difficulties.

RESULTS

Our results highlight alignment of immigration flows with immigration legislation and vast heterogeneity in migration, health, and healthcare access of immigrants by sending country.

DISCUSSION/IMPLICATIONS

Public health practitioners must consider how historical events and social factors contribute to the healthcare access and health of immigrant populations, as demographic shifts will require interventions that promote equitable healthy aging.

The political determinants of the health of undocumented immigrants: a comparative analysis of mortality patterns in Switzerland

BACKGROUND

The health of undocumented immigrants is an important concern in most societies. However, there is no conclusive evidence that inclusive health care policies lead to better outcomes for this group of the population. The aim of this study is to analyse whether there is an association between inclusive health care policies and the mortality patterns of undocumented immigrants, or the distribution of different causes of death among those who have died.

METHODS

We analyse individual data concerning the deceased in Switzerland between 2011 and 2017. We proceed in two steps. First, we estimate and compare the patterns of mortality of Swiss citizens, documented immigrants, and undocumented immigrants. Second, we test whether there is an association between cantonal authorities' policies and differing mortality patterns. We use logistic regressions and multinomial regressions to estimate the relationship between legal status and mortality patterns both in Switzerland and across different cantons.

RESULTS

We find a difference in the patterns of mortality between undocumented immigrants and the other groups of the population. Specifically, death from circulatory system diseases is twice as frequent among undocumented immigrants compared to documented immigrants and Swiss citizens. However, this difference is smaller in the Swiss cantons that have more inclusive health care policies towards undocumented immigrants.

CONCLUSIONS

We interpret these results as an indication that policies that expand access to health services lead to better outcomes for undocumented immigrants. This finding has implications for research on civic stratification and public health. Further analysis is needed to evaluate the effects of extending public health care for undocumented immigrants in different contexts.

Legal Relief for Children in Immigrant Families: A Mixed-Methods Study

Objective: Immigration status is a known social driver of health. Little research exists on addressing concerns about immigration status in primary care. The objective of this study is to understand the experiences of immigrant families that received a clinical-community intervention to address immigration-related concerns. Methods: We conducted a mixed-methods study: an embedded experimental design study. We implemented an immigration-focused legal needs screening tool and referral intervention at one academic primary care clinic in January 2018. Caregivers who screened positive for immigration-related concerns and were referred to a local immigration law firm were invited to participate in a semi-structured interview. Interviews were recorded, de-identified, transcribed, and systematically coded using an inductive content analysis approach. A modified constant comparative method was used to iteratively review codes, identify emerging themes, and resolve differences through consensus. Results: Nineteen caregivers reported immigration-related legal concerns, seven of whom were interviewed. Most (84.2%) were mothers, identified as Hispanic (94.7%), were from Mexico (52.6%), and reported persecution and fear of returning to their country of origin (57.9%). In interviews, we identified three major themes: (1) families were motivated to immigrate due to mental health trauma and persecution; (2) families sought legal services for several immigration-related concerns; and (3) families experienced challenges in navigating the legal system, with which clinics may assist. Conclusion: This study demonstrates the need for immigration-related services in primary care settings and the feasibility and potential benefits of implementing a legal screening and referral intervention.

Mexican-Origin Women's Construction and Navigation of Racialized Identities: Implications for Health Amid Restrictive Immigrant Policies

This study examines how Mexican-origin women construct and navigate racialized identities in a postindustrial northern border community during a period of prolonged restrictive immigration and immigrant policies, and it considers mechanisms by which responses to racialization may shape health. This grounded theory analysis involves interviews with 48 Mexican-origin women in Detroit, Michigan, who identified as being in the first, 1.5, or second immigrant generation. In response to institutions and institutional agents using racializing markers to assess their legal status and policing access to health-promoting resources, women engaged in a range of strategies to resist being constructed as an "other." Women used the same racializing markers or symbols of (il)legality that had been used against them as a malleable set of resources to resist processes of racialization and to form, preserve, and affirm their identities. These responses include constructing an authorized immigrant identity, engaging in immigration advocacy, and resisting stigmatizing labels. These strategies may have different implications for health over time. Findings indicate the importance of addressing policies that promulgate or exacerbate racialization of Mexican-origin communities and other communities who experience growth through migration. Such policies include creating pathways to legalization and access to resources that have been invoked in racialization processes, such as state-issued driver's licenses.

Acculturation Stress, Age at Immigration, and Employment Status as Predictors of Sleep Among Latinx Immigrants

Sleep is important for physical and mental health. Latinx individuals are thought to experience worse sleep and associated health outcomes, resulting in health disparities. There is a dearth of research on the factors (e.g., employment status, age at immigration) that predict poor sleep among Latinx immigrants. The present study aimed to (1) examine the link between demographic factors, immigration-related factors, and acculturation stress, and sleep, and (2) identify factors that either attenuate or intensify the link between acculturation stress and sleep among Latinx immigrants in the US South, an immigrant-hostile area that is home to an increasing Latinx population that remains understudied. Hierarchical regressions were used to analyze data from 391 Latinx adult immigrants, examining the link between demographic factors, immigration-related factors, acculturation stress, and two sleep variables (sleep quality, difficulty falling asleep). Employment status and age at immigration were examined as moderators of the link between acculturation stress and sleep. Data were collected through in-person surveys. Regressions showed that acculturation stress was significantly linked to worse sleep quality (β = 0.30, p = 0.001) and more difficulty falling asleep (β = 0.41, p < 0.001), while controlling for participant characteristics. Younger age at immigration (β = - 0.14, p = 0.005) and being unemployed (β = - 0.13, p = 0.006) were associated with more difficulty falling asleep. Age at immigration intensified the relationship between acculturation stress and sleep quality (β = 0.14, p = 0.005), difficulty falling asleep (β = 0.15, p = 0.002). Reducing acculturation stress is a meaningful intervention focus, with important implications for sleep health, particularly for recent Latinx immigrants. Age at immigration and employment status are also important factors to consider when designing targeted interventions.

Deferred depression? Mediation analysis of Deferred Action for Childhood Arrivals and immigration enforcement among Undocumented Asian and Pacific Islander students

OBJECTIVES

Undocumented Asians and Pacific Islanders (UndocuAPI) comprise 25% of undocumented students. Yet few studies have examined UndocuAPI mental health in the context of the contradictory political environment which encompasses both inclusionary policies, such as Deferred Action for Childhood Arrivals (DACA), and exclusionary policies, like immigration enforcement.

METHODS

Using cross-sectional survey data collected in 2019 from UndocuAPI college students and recent alumni in California (n = 174), we used multiple logistic regression to estimate the effect of DACA status on clinical levels of depressive symptoms. We tested whether immigration enforcement experiences mediated this relationship using the Karlson, Holm, and Breen (KHB) method.

RESULTS

Adjusted logistic regression results revealed that UndocuAPI with DACA had significantly lower odds of depression (OR = 0.32, 95% CI: 0.13-0.79). Out of five immigration enforcement factors, limited contact with friends and family (OR = 2.36, 95% CI: 1.08, 5.13) and fearing deportation most or all of the time (OR = 3.62, 95% CI: 1.15, 11.34) were associated with significantly higher odds of depression. However, we did not detect a statistically significant mediation effect of immigration enforcement using KHB decomposition.

CONCLUSION

Findings suggest that the benefits of DACA protected UndocuAPI in California from depressive symptoms, even when accounting for immigration enforcement experiences. Because it was unclear whether immigration enforcement mediates DACA, future research should investigate the underlying mechanisms between immigration policies and mental health with larger samples. Practitioners should consider the short-term need for mental health support and legal services for UndocuAPI students as well as the long-term goal to decriminalize immigrant communities to advance racial health equity.

A Novel Application of Non-Negative Matrix Factorization to the Prediction of the Health Status of Undocumented Immigrants

Introduction: Undocumented immigrants (UIs) in the United States are less likely to be able to afford health insurance. As a result, UIs often lack family doctors and are rarely involved in annual screening programs, which makes estimating their health status remarkably challenging. This is especially true if the laboratory results from limited screening programs fail to provide sufficient clinical information.

Methods: To address this issue, we have developed a machine learning model based on the non-negative matrix factorization technique. The data set we used for model training and testing was obtained from the 2004 cost-free hepatitis B screening program at the Omni Health Center located in Plano, Texas. Total 300 people were involved, with 199 identified as UIs.

Results: People in the UIs group have higher cholesterol (219.6 mg/dL, p=0.038) and triglycerides (173.2 mg/dL, p=0.03) level. They also have a lower hepatitis B vaccination rate (38%, p=0.0247). No significant difference in hepatitis B⁽⁺⁾ was found (p=0.8823). Using 16 individual clinical measurements as training features, our newly developed model has a 67.56% accuracy in predicting the ratio of cholesterol to high-density lipoprotein; in addition, this newly developed model performs 9.1% better than a comparable multiclass logistic regression model.

Conclusions: Elderly UIs have poorer health status compared with permanent residents and citizens in the United States. Our newly developed machine learning model demonstrates a powerful support tool for designing health intervention programs that target UIs in the United States.

State Preemption of Municipal Laws and Policies that Protect Immigrant Communities: Impact on Latine Health and Well-Being in North Carolina

BACKGROUND

Some U.S. municipalities have proclaimed themselves "sanctuary cities" and/or adopted laws and policies limiting local involvement in enforcement of federal immigration policies. Several states, however, have adopted laws that preempt municipal laws and policies designed to protect immigrants. We explored the consequences of House Bill (H.B.) 318, one such preemption law in North Carolina (NC), on the health and well-being of Latine immigrants.

METHODS

We conducted focus groups with Latine immigrants (n=49) and in-depth interviews with representatives from health, social service, and immigrant-serving organizations and local government (including law enforcement) (n=21) in NC municipalities that, before HB 318, adopted laws and policies supporting immigrants. Data were analyzed using constant comparison.

RESULTS

Twelve themes emerged, including the positive impacts of municipal sanctuary laws and policies are limited by preemption and other state and federal actions; laws and policies like HB 318 are confusing, have a chilling effect on health services use, and make life harder overall for Latine communities; intensified federal immigration enforcement has increased fear among Latine communities; Trump administration policies worsened anti-immigrant climates; and use of community identification cards and greater information dissemination and inter-organization coordination can lessen the consequences of preemption and other restrictive laws and policies.

CONCLUSION

State preemption of protective municipal laws and policies negatively and profoundly affects immigrant health and well-being. However, creative strategies have been implemented to respond to preemption. These findings provide critical data for decision-makers and community leaders regarding the detrimental impacts of preemption laws and mitigation of these impacts.

Integration of Waiting Room “Know Your Rights” Education into Medical Care of Immigrant Patients in a Federally Qualified Health Center: A Case Study

Background: Federally qualified health centers (FQHCs) are implementing innovative interventions to address heightened anxieties of immigrant patients amid changing immigration policies.

Purpose: To describe the integration of “Know Your Rights” legal rights education in clinic waiting rooms of an FQHC in Los Angeles, California.

Methods: This is a qualitative study using key informant interviews, direct field observations, and document review.

Results: Collaboration with community health workers and local immigrant-serving community-based and legal organizations was key to intervention design and implementation.

Conclusion: Integrating legal education into medical care is one action health centers can take to support immigrant patients, address their complex realities, and optimize patients.

Measuring structural xenophobia: US State immigration policy climates over ten years

There is an increasing need to understand the structural drivers of immigrant health inequities, including xenophobic and racist policies at the state level in the United States. Databases aggregate state policies related to immigration and research using single year indices examines state policy and immigrant health. Yet none of these sources use a theoretically informed social determinants of immigrant health approach to consider state environments longitudinally, include both exclusionary and inclusionary policies, and are relevant to immigrants from any region of the world or ethnic group. Using an established social determinants of immigrant health framework, a measure of structural xenophobia was created using fourteen policies across five domains: access to public health benefits, higher education, labor and employment, driver's licenses and identification, and immigration enforcement over a ten-year period (2009-2019). To create the Immigration Policy Climate (IPC) index, we used data from state legislatures as well as policy databases from foundations, advocacy organizations, and scholarly articles. We identified and coded 714 US state policies across the 50 US States and the District of Columbia from 2009 to 2019. We calculated annual IPC index scores (range: 12 - 12) as a continuous measure (negative scores: exclusionary; positive scores: inclusionary). Results show that the US has an exclusionary immigration policy climate at the state-level (mean IPC score of -2.5). From 2009 to 2019, two-thirds of state-level immigration policies are exclusionary towards immigrants. About 75% of states experienced a 4-point change or less on the IPC index, and no state changed from largely exclusive to largely inclusive. By aggregating comprehensive, detailed data and a measure of state-level immigration policies over time, the IPC index provides population health researchers with rigorous evidence with which to assess structural xenophobia and an opportunity for longitudinal research on health inequities and immigrant health.

Immigrant Health Inequities: Exposing Diversions and White Supremacy

Diversions occur when research disregards the inequality-generating actions of advantaged groups and instead focuses attention on the actions and behaviors of disadvantaged groups. We incorporate important insights from COVID-19 to illustrate historical and contemporary examples of diversions. This paper highlights US immigrant health inequities—a burgeoning subfield within the broader health inequalities canon—to explore: (1) if and how diversions appear in immigrant health studies; (2) how often white supremacy and intersectionality are explicitly named in grants, publicly available datasets, and published research. The data derive from: NIH R01 grants (17), publicly available datasets that focus on immigrant health (7), and research published in three health journals (14). Using a qualitative content analysis approach, we analyzed these data as evidence concerning the knowledge production cycle, and investigate whether: (a) the role of advantaged groups in generating inequalities is explicitly mentioned; (b) disadvantaged groups are asked about discriminatory actions perpetuated by advantaged groups; (c) health inequalities are placed on the conditions of disadvantaged groups; (d) if white supremacy and intersectionality are explicitly mentioned in grants, publicly available datasets, and research articles. The findings demonstrate the prevalence of diversions in immigrant health research, given an overemphasis on health behaviors and cultural explanations towards explaining immigrant health inequities. There was no mention of white supremacy across the knowledge production cycle. Intersectionality was mentioned once in a research article. We argue that understanding white supremacy’s role in the knowledge production cycle illuminates how diversions occur and prevail. We provide suggestions on moving away from diversionary research, toward adopting an intersectional approach of the study of immigrant health inequities.

Duration of United States Residence and Self-Reported Health Among African-Born Immigrant Adults

Although researchers have found an inverse relationship between length of U.S. residence and health, research on this issue among African-born immigrants is limited. Data from the 2011-2015 National Health Interview Surveys were pooled for African-born immigrants (N = 1137) and used to estimate weighted ordinary least squares regression models on self-reported health, adjusting for common immigrant health predictors. Length of U.S. residence was associated with significant health status declines only among those that had lived in the U.S. for 10 to less than 15 years (b = - 0.235, p < 0.05), net of covariates. African-born immigrants may have both different selection processes than other immigrants and not follow common integration patterns. These findings suggest that existing immigrant health frameworks may need modification to fully apply to this growing U.S. immigrant population.

Heightened immigration enforcement impacts US citizens' birth outcomes: Evidence from early ICE interventions in North Carolina

We examine how increased Immigration and Customs Enforcement (ICE) activities impacted newborn health and prenatal care utilization in North Carolina around the time Section 287(g) of the Immigration and Nationality Act was first being implemented within the state. Focusing on administrative data between 2004 and 2006, we conduct difference-in-differences and triple-difference case-control regression analysis. Pregnancies were classified by levels of potential exposure to immigration enforcement depending on parental nativity and educational attainment. Contrast groups were foreign-born parents residing in nonadopting counties and all US-born non-Hispanic parents. The introduction of the program was estimated to decrease birth weight by 58.54 grams (95% confidence interval [CI], -83.52 to -33.54) with effects likely following from reduced intrauterine growth. These results are shown to coexist with a worsening in the timing of initiation and frequency of prenatal care received. Since birth outcomes influence health, education, and earnings trajectories, our findings suggest that the uptick in ICE activities can have large socioeconomic costs over US-born citizens.

Association of Maternal Citizenship and State-Level Immigrant Policies With Health Insurance Coverage Among US-Born Latino Youths

IMPORTANCE

The association of state-level immigrant policies with uninsurance among Latino youths remains unknown.

OBJECTIVE

To assess the association of state-level immigrant integration and criminalization policies with health insurance coverage among US-born Latino youths by maternal citizenship.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study analyzed secondary data from the American Community Survey, January 1, 2016, to December 31, 2018, for US-born Latino youths (age, ≤17 years) and their mothers (age, 18-64 years) as well as state-level indicators of immigrant integration and criminalization policies (in all 50 states and the District of Columbia).

EXPOSURES

Immigrant integration and criminalization policies.

MAIN OUTCOMES AND MEASURES

The main outcome was maternal reports of youth uninsurance status at the time of the American Community Survey interview. Variation in youth uninsurance by maternal citizenship, state immigrant integration policy context, and state immigrant criminalization policy context were examined. All analyses were conducted with weighted survey data.

RESULTS

Of the 226 691 US-born Latino youths (115 431 [50.92%] male; mean [SD] age, 7.66 [4.92] years) included in the study, 36.64% (95% CI, 36.21%-36.92%) had noncitizen mothers. Overall, 7.09% (95% CI, 6.78%-7.41%) of noncitizen mothers reported that their youths were uninsured compared with 4.68% (95% CI, 4.49%-4.88%) of citizen mothers. Of uninsured youths who resided in states with a low level of immigrant integration policies, 9.10% (8.22%-10.06%) had noncitizen mothers and 4.75% (95% CI, 4.19%-5.37%) had citizen mothers; of uninsured youths who resided in states with high criminalization policies, 9.37% (95% CI, 8.90%-9.87%) had noncitizen mothers and 5.91% (95% CI, 5.64%-6.20%) had citizen mothers. In states with few immigrant integration policies, the probability of uninsurance among youths with noncitizen mothers was 3.3% (95% CI, 2.3%-4.4%) higher than that among youths with citizen mothers. Among youths with noncitizen mothers, the difference in the probability of uninsurance between those residing in states with a low level vs a high level of immigrant integration policies was 2.1% (95% CI, 0.6%-3.6%). Among youths residing in states with high levels of immigrant criminalization policies, those with noncitizen mothers had a 2.6% (95% CI, 1.9%-3.0%) higher probability of being uninsured compared with those whose mothers were citizens. Among youths with noncitizen mothers, the difference in the probability of uninsurance between those who resided in a state with a low level vs a state with a high level of immigrant criminalization policies was 1.7% (95% CI, 0.7%-2.7%).

CONCLUSIONS AND RELEVANCE

The findings of this cross-sectional study suggest that among US-born Latino youths, disparities in uninsurance by maternal citizenship are associated with state-level immigrant integration and criminalization policies and that anti-immigrant policies may be associated with disparities in health care access for US-born Latino youths.

International migration and health: it is time to go beyond conventional theoretical frameworks

The large-scale international migration in the 21st century has emerged as a major threat to the global health equity movement. Not only has the volume of migration substantially increased but also the patterns of migration have become more complex. This paper began by focusing on the drivers of international migration and how health inequalities are linked to migration. Situating migration within the broader structural contexts, the paper calls for using the unharnessed potential of the intersectionality framework to advance immigrant health research. Despite coming from poorer socioeconomic backgrounds and facing disparities in the host society, the immigrants are often paradoxically shown to be healthier than the native population, although this health advantage diminishes over time. Studies on immigrant health, however, are traditionally informed by the acculturation framework which holds the assimilation of unhealthy lifestyles primarily responsible for immigrant health deterioration, diverting the attention away from the structural factors. Although the alternative structural framework came up with the promise to explore the structural factors, it is criticised for an overwhelming focus on access to healthcare and inadequate attention to institutional and societal contexts. However, the heterogeneity of the immigrant population across multiple dimensions of vulnerability demands a novel approach that can bring to the fore both premigratory and postmigratory contextual factors and adequately capture the picture of immigrant health. The paper concludes by questioning the acculturation perspective and pushing the structural paradigm to embrace the intersectionality framework which has the potential to address a wide range of vulnerabilities that intersect to produce health inequalities among the immigrants.

Immigrant policies as health policies: State immigrant policy climates and health provider visits among U.S. immigrants

The geographic dispersion of the U.S. immigrant population has occurred alongside a dramatic increase in state-level immigration laws that has unfolded unevenly across states, creating markedly different state immigrant policy climates. Although not all such laws are health-related, they have potential implications for immigrants' health care utilization. Using data from the 2014 Survey of Income and Program Participation, we leverage the geographic variation in the restrictiveness of state immigrant policy climates to examine the association between state-level immigrant policies and health provider visits—a fundamental indicator of health care utilization—among immigrant adults. Results indicate that restrictive immigrant policy climates exacerbate nativity gaps in health provider visits among working-age adults and, to a lesser extent, among older adults. Our findings suggest that even immigrant policies not directly related to health have consequences for immigrants’ health care utilization.

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We model the association between state immigrant policy climates and health provider visits among U.S. adults.

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More restrictive policy climates are associated with lower odds of health provider visits for working-age immigrant adults.

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Nativity disparities in health provider visits among working-age adults are larger in more restrictive policy climates.

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A small nativity gap exists for older adults in restrictive climates, with immigrants less likely to visit a health provider.

Receptionists, doctors, and social workers: Examining undocumented immigrant women's perceptions of health services

In this paper, we examine the attitudes, experiences, and perceptions of health care among unauthorized immigrant women in Philadelphia, Pennsylvania. Research on health care utilization among undocumented immigrants usually focuses on barriers to securing health care access, but little attention has been paid to how these barriers shape patients' experiences. Patients' experiences are important because they affect persistence in care seeking, adherence to treatment regimens, and self-reported health. Drawing from interviews with undocumented Mexican women, we find that receptionists, staff, and social workers play an important role in shaping women's perceptions of health care. In contrast to previous research which finds that negative experiences with providers lead undocumented immigrants to withdraw from seeking medical services, without fail, our respondents persisted and sought care elsewhere. This strategy ensured that all women eventually found care with which they were satisfied, but sometimes after significant delays.

Restrictive sub-federal immigration policy climates and very preterm birth risk among US-born and foreign-born Hispanic mothers in the United States, 2005-2016

Immigration policy climate may have pervasive effects on the health of immigrants and their families. We examine how living in a state at the time of delivery with a more restrictive immigration policy climate impacts risk of very preterm birth (VPTB) among Hispanic mothers in the United States. We used data from the United States live birth files, 2005-2016. We fit generalized linear mixed models predicting VPTB including information on individual (e.g., age, parity, specific Hispanic origin group) and geographic (e.g., county level poverty, ethnic density) risk determinants. Living in a state with a more restrictive immigration policy climate is associated with a slight increase in odds of VPTB for Hispanic women (aOR: 1.07 (1.04-1.10)).

Included, but Deportable: A New Public Health Approach to Policies That Criminalize and Integrate Immigrants

There has been a burst of research on immigrant health in the United States and an increasing attention to the broad range of state and local policies that are social determinants of immigrant health. Many of these policies criminalize immigrants by regulating the "legality" of their day-to-day lives while others function to integrate immigrants through expanded rights and eligibility for health care, social services, and other resources.Research on the health impact of policies has primarily focused on the extremes of either criminalization or integration. Most immigrants in the United States, however, live in states that possess a combination of both criminalizing and integrating policies, resulting in distinct contexts that may influence their well-being.We present data describing the variations in criminalization and integration policies across states and provide a framework that identifies distinct but concurrent mechanisms of deportability and inclusion that can influence health. Future public health research and practice should address the ongoing dynamics created by both criminalization and integration policies as these likely exacerbate health inequities by citizenship status, race/ethnicity, and other social hierarchies.