Pathogenic Policy: Immigrant Policing, Fear, and Parallel Medical Systems in the US South

Health Care Discrimination and Immigration Fears: Unpacking COVID-19 Vaccine Hesitancy in Latino Adults

Objectives. To examine the relationship between health care discrimination and COVID-19 vaccine hesitancy attributed to fears of immigration status complications among unvaccinated Latino adults and to determine whether the association differs among immigrants and US-born individuals. Methods. After universal adult eligibility for the COVID-19 vaccine, a nationally representative sample of 12 887 adults was surveyed using online and mobile random digit dialing from May 7 to June 7, 2021. The analytic sample (n = 881) comprised unvaccinated Latino adults. We examined the association between individual and cumulative health care discrimination measures and COVID-19 vaccine hesitancy assignable to immigration-related fears. Results. Using a cumulative measure of health care discrimination, each additional experience corresponded to a 28% higher odds of reporting vaccine hesitancy Because of immigration-related fears. Findings were consistent across US-born and immigrant Latino adults. Four of the 5 discriminatory experiences were positively associated with vaccine hesitancy, including the absence of optimal treatment options, denial or delayed access to necessary health care, physician communication barriers, and lack of specialist referrals. Conclusions. Findings confirm a positive association between health care discrimination and COVID-19 vaccine hesitancy attributable to immigration-related fears among Latino adults, regardless of immigration status. (Am J Public Health. 2024;114(S6):S505-S509. https://doi.org/10.2105/AJPH.2024.307668) [Formula: see text].

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.

Extending Driver's Licenses to Undocumented Immigrants: Comparing Perinatal Outcomes Following This Policy Shift

Research shows that restrictive immigration policies and practices are associated with poor health, but far less is known about the relationship between inclusive immigration policies and health. Using data from the United States natality files, we estimate associations between state laws granting undocumented immigrants access to driver's licenses and perinatal outcomes among 4,047,067 singleton births to Mexican and Central American immigrant birthing people (2008-2021). Fitting multivariable log binomial and linear models, we find that the implementation of a license law is associated with improvements in low birthweight and mean birthweight. Replicating these analyses among U.S.-born non-Hispanic White birthing people, we find no association between the implementation of a license law and birthweight. These findings support the hypothesis that states' extension of legal rights to immigrants improves the health of the next generation.

"I Can Never Feel Safe": Latinx Youth Voices on Psychosocial Impacts of 287(g) in Georgia

Increasingly, immigration policies are understood as structural determinants, rooted in racism, nativism, and ethnocentrism, which raise serious public health concerns for Latinx adolescents' mental health. Our objective was to examine how immigration policy enforcement affects mental health of Latinx youth raised in a county with an aggressive interior immigration enforcement program. From 2009 to 2021, Gwinnett County, GA, led the nation in deportations under the 287(g) program as a "universal enforcement model," where local law enforcement were deputized to detain undocumented immigrants, primarily through traffic violations. From June to July 2022, we followed a participatory action research approach with two groups of Latinx youth who grew up in Gwinnett County. In total, 10 youth took photos related to the research question, and engaged in facilitated dialogue using photovoice guide SHOWED/VENCER for four, 2-hour sessions that were audio-recorded and transcribed. Transcripts were analyzed following grounded theory principles to arrive at a conceptual model codeveloped and validated by youth. Youth described how 287(g) led to policing and deportation in their communities, fueling stereotypes, and discrimination that criminalized Latinx immigrants. Youth linked immigration enforcement policies like 287(g) to exclusionary systems that contributed to fear, marginalization, and loss in their communities, bringing experiences of sadness, grief, isolation, hopelessness, and low self-worth. From youth-driven research, we identified mental health implications of the 287(g) program among Latinx youth. The cascading harms of immigration enforcement policies highlight the need to address these policies and identify immediate strategies to promote Latinx youth mental health.

Barriers and facilitators to healthcare for people without documentation status: A systematic integrative literature review

AIMS

To identify the barriers and facilitators to healthcare for people without documentation status.

DESIGN

We conducted a systematic integrative literature review following the Whittemore and Knafl methodology.

METHODS

Literature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social-ecological model.

DATA SOURCES

Searches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022.

RESULTS

The review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti-immigrant rhetoric) and policy-related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety-net clinics and supportive federal policies emerged as key facilitators.

CONCLUSION

These findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population.

IMPACT

This paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide.

REPORTING METHOD

The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was needed.

TRIAL AND PROTOCOL REGISTRATION

The study protocol was registered with the PROSPERO database (registration number: CRD42022366289).

Immigrants' Enforcement Experiences and Concern about Accessing Public Benefits or Services

Although exclusionary immigration policies are associated with fear of deportation and avoidance of public benefits, relationships between immigration enforcement policy and public charge policies are largely unknown. Using a California population-based survey of 1103 Asian and Latinx immigrants in 2018, we tested the relationship between immigrants' experiences with law enforcement and their concern about public charge. Direct encounters with various forms of law enforcement, including being asked to show proof of citizenship by law enforcement, staying inside to avoid police or immigration officials, and having known someone who had been deported, were associated with immigrants' avoidance of public benefits due to public charge concerns. Latinx immigrants were more likely to be concerns about public charge than Asians. Intersections among immigration policies deserve further consideration. There is a need to provide accurate and reliable information to immigrant communities about public benefits and advocate for inclusive immigration policies.

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.

A Descriptive Qualitative Study of Foreign Caregivers of Older Adult Stroke Survivors

BACKGROUND AND OBJECTIVES

With a growing aging stroke population and the changing structure of the society, the demand for foreign caregivers has rapidly increased in Taiwan and many other developed countries. However, little is known regarding the perception, values, and abilities of foreign caregivers and how those may influence their quality of care. This study aimed to explore and describe the experiences of Indonesian foreign caregivers, the largest migrant working population in Taiwan, who reside with and provide support to older adults with stroke and their families.

RESEARCH DESIGN AND METHODS

By adopting a descriptive qualitative approach, we conducted semistructured interviews with 22 Indonesian caregivers (mean age: 36 years) who were providing care to community-dwelling older stroke survivors (age ≥ 65 years) in Taiwan. Data were analyzed through thematic analysis.

RESULTS

Six themes were constructed from the interviews: (a) foreign caregiver's background, (b) foreign caregiver's perception of the health and functional status of stroke survivors, (c) foreign caregiver's values and preferences, (d) consequences of caring for stroke survivors, (e) skills/abilities/knowledge of foreign caregivers to provide stroke survivors with required care, and (f) potential resources that foreign caregivers can use.

DISCUSSION AND IMPLICATIONS

Foreign caregivers described the positive and negative aspects of caring for stroke survivors. Differences in language, religion, culture, values, and expectations between foreign caregivers and stroke survivors influence the caregiving experience. These findings can help Taiwan and other developed countries to better support foreign caregivers providing critical care to older adults with stroke and their families.

Unequal Access and Use of Health Care Services among Settled Immigrants, Recent Immigrants, and Locals: A Comparative Analysis of a Nationally Representative Survey in Chile

Globally, and particularly in the Latin American region, international migration continues to grow. Access and use of health care services by migrants vary according to their country of origin and residence time. We aimed to compare the access and use of health care services between international migrants (including settled migrants from Peru, Argentina, Bolivia, Ecuador; Emerging migrants from Venezuela, Dominican Republic, Colombia, Haiti; and migrants from other countries) and the Chilean population. After performing a secondary data analysis of population-based nationally representative surveys (CASEN 2011-2017), access and use patterns (insurance, complementary insurance, non-consultation, and non-treatment coverage) were described and compared among settled immigrants, recent emerging immigrants, others, and locals. Immigrants had a significantly higher uninsured population compared to locals. Specifically, in CASEN 2017, 19.27% of emerging (95% CI: 15.3-24.1%), 11.79% of settled (95% CI: 10.1-13.7%), and 2.25% of locals (95% CI: 2.1-2.4%) were uninsured. After 2013, settled and recent emerging migrants showed higher percentages of non-consultation. Collaborative and interculturally relevant strategies from human rights and equity perspectives are needed. Initiatives with a particular focus on recent immigrants can contribute to reducing the existing disparities in health care access and use with locals due to lack of insurance and treatment coverage.

Latinx immigrant experiences with chronic illness management in Central Texas: reframing agency and liminality through nepantla

Immigrant rights have become increasingly contentious and partisan issues in the United States, and especially within the U.S. healthcare system. It is particularly essential to pay attention to Latinx immigrants-the largest immigrant and uninsured population in the United States. Latinx immigrants face many structural and legal challenges that may impact their biomedical healthcare access and treatment, creating a state of liminality or in-betweenness, especially when managing a chronic illness such as diabetes, hypertension, or arthritis. Using qualitative methods at a free healthcare clinic in Central Texas, the study reveals how the chronic illness narrative becomes inextricable from the immigrant narrative for this particular group, and how a unique 'dual-liminality' emerges from living with both an immigrant status and chronic condition. This study also introduces how Gloria Anzaldúa's theory of nepantla can be used to push existing understandings of migrant liminality in medical anthropology by reframing the experiences of U.S. Latinx immigrants with chronic illness as ones of opportunity. Nepantla functions as a novel theoretical lens to better understand how Latinx immigrants may regain agency in their chronic illness management and promote social change by helping others in similar situations.

Cumulative Experiences of Immigration Enforcement Policy and the Physical and Mental Health Outcomes of Asian and Latinx Immigrants in the United States

Immigration enforcement policies in the United States and other nations have long been enacted and implemented as intentional tools of racial control. There is mounting evidence that immigration raids, arrests, and deportations in the United States are associated with poor immigrant health outcomes, but this research has primarily focused on associations between health and single, specific enforcement actions or experiences that may not capture the entirety of immigrants’ experiences with racialized exclusion. Further, there has been little examination of Asian immigrants’ experiences with enforcement in the United States. This article assesses the relationship between Asian and Latinx immigrants’ physical and mental health and their cumulative experiences of immigration enforcement. We analyze responses to a 2018 population-based telephone survey of 1,103 Asian and Latin American immigrants in California. Participants were asked about seven distinct exclusionary immigration and local law enforcement experiences and their self-rated health (SRH) and psychological distress. We tested the association between each enforcement experience and SRH and psychological distress, controlling for covariates. After creating a cumulative measure of exclusion by summing participants’ total number of enforcement experiences, we examined the association between cumulative enforcement experiences and SRH and psychological distress and tested interactions by ethnicity and citizenship. While a greater proportion of Latinx than Asian participants reported enforcement experiences, each additional enforcement experience was associated with poorer self-rated health and greater psychological distress for both groups. This article suggests that the overall immigration enforcement system, from surveillance to deportation, is associated with worse health outcomes for immigrants.

The structural impacts of enforcement policy on Latino immigrant health

As evidence of the negative health impact of immigration enforcement policy continues to mount, public health research has focused primarily on the psychosocial health mechanisms, such as fear and stress, by which immigration enforcement may harm health. We build on this research using structural vulnerability theory to investigate the structural processes by which enforcement policy may shape Latino immigrants' health. We conducted qualitative analysis of testimonios from a purposive sample of Latino immigrants (n=14) living in Southern California in 2015, a period of significant federal, state, and local enforcement policy change. Testimonios are a narrative methodology used across the social sciences and humanities to center the voices of marginalized people. Through unstructured testimonio interviews, we sought to understand Latino immigrants' experiences with immigration enforcement and identify specific structural factors by which those experiences may influence health. Respondents' narratives revealed that singular enforcement experiences were not viewed as the sole manifestation of enforcement, but as part of a system of intersecting physical, legal, institutional, and economic exclusions which shaped the social and economic conditions that influence health. These exclusions reinforced respondents' marginalization, produced instability about the future, and generated a sense of individual responsibility and blame. We discuss how physical, legal, institutional, and economic processes may influence health and propose a framework to inform population health research on intersecting structural health mechanisms.

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.

Stakeholders' perspectives on system-level barriers to and facilitators of HPV vaccination among Hispanic migrant farmworkers

OBJECTIVES

Latinx populations suffer from a disproportionate burden of HPV-related cancers, yet vaccination completion rates nationally among this population remain low, with 46% of females and 35% of males completing the vaccine series. Given the heterogeneity of Latinx populations, sub-populations such as Latinx individuals who live in migrant farmworker communities experience additional system-level barriers to healthcare utilization. Thus, we examined stakeholder perceptions of barriers and facilitators to Human Papillomavirus (HPV) vaccination among Latinx migrant farmworkers. Such information is critical to informing intervention development targeting vaccination uptake and completion, ultimately decreasing HPV-related cancer disparities.

DESIGN

Guided by the PRECEDE-PROCEED model and the Social Ecological Model (SEM), interviews were conducted with diverse stakeholders (n = 13) representative of health, social services, and political sectors. Stakeholders were asked about their perceptions of barriers to and facilitators of HPV vaccination among migrant farmworkers. Interviews were audio-recorded, transcribed, and thematically analyzed. Responses were coded according to components of the SEM.

RESULTS

Micro-level facilitators identified included positive attitudes and vaccine acceptance among parents. Meso-level facilitators included availability of free or low-cost health care clinics, and macro-level facilitators included federal programs (e.g. Medicaid, Vaccine for Children). Micro-level barriers included lack of education and low health literacy. Meso-level barriers included poor patient-provider communication, lack of access (e.g. clinics not stocking/administering the vaccine; limited clinic hours; lack of reminder systems; insufficient organizational structure), public perceptions/attitudes towards HPV vaccination, and lack of healthcare service continuity due to migratory patterns. Macro-level barriers included public perceptions and attitudes towards HPV vaccination, transportation, vaccine availability and coverage for non-citizens, and lack of school entry policy.

CONCLUSIONS

Findings suggest that multi-level interventions should be developed to leverage existing facilitators while addressing system-level barriers, ultimately creating a supportive environment for HPV vaccine initiation and completion among this marginalized population comprised of individuals living in migrant farmworker communities.

Challenging federal exclusion: Immigrant safety, health, and healthcare access in sanctuary cities

As the United States (U.S.) continues to prioritize federal immigration enforcement, subnational localities increasingly enact their own immigration policies. Cities limiting cooperation with federal immigration enforcement are commonly referred to as sanctuary cities, which aim to improve immigrant safety and wellbeing. Yet, little is known about how these cities accomplish this beyond immigration enforcement non-cooperation. We draw from qualitative interviews with 54 organizational workers in Seattle, Washington and Boston, Massachusetts. Our findings illuminate lingering challenges immigrants face within sanctuary cities and demonstrate how organizational workers mitigate the shortcomings of sanctuary policies to addressing broad definitions of safety and health by enacting their own sanctuary practices.

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.

Health and immigration systems as an ethnographic field: Methodological lessons from examining immigration enforcement and health in the US

The complexity of health systems and their social, political, and economic contexts has resulted in a call for multidisciplinary research that can appropriately examine the relationships and interactions surrounding health systems. Anthropologists, who have a disciplinary training that emphasizes social structures and human relationships, are well-suited to conduct health systems research. However, there remains a gap in anthropologically-ground methodological approaches for conducting in-depth, qualitative research that simultaneously conceptualizes and maps out a health system and examines connections between health systems and other social structures, such as immigration enforcement systems. Without such methodological approaches, limitations in examining a health system and its constituent elements will persist, and health and social scientists will miss opportunities to identify links between different factors in a health system and outside the system itself. In this article, I use ethnographic research examining the health-related consequences of immigration enforcement laws and police practices in the United States to show how to examine relationships between multiple social systems. In doing so, I provide an example for how to conduct in-depth, qualitative health systems research by merging theoretical frameworks in health sciences and anthropology to demonstrate how medical anthropologists can conceptualize a health system as a social field for ethnographic inquiry. Overall, I argue that such an approach permits anthropologists a way to conduct rigorous health systems research that emphasizes relationships and reveals potentially hidden interactions.

"Not a free version of a broken system:" Medical humanitarianism and immigrant health justice in the United States

Medical humanitarian organizations are increasingly the primary healthcare providers for unauthorized migrants in high-income countries. Existing studies of medical humanitarianism in the Global North reveal tensions between principles of traditionally apolitical humanitarianism and human rights. In practice, these tensions translate into organizational debates about prioritizing direct service provision to meet immediate needs or advocacy to effect long-term systemic change. Informed by these debates, this paper asserts the importance of immigration and health policy contexts as central to shaping the relationship between healthcare provision and political advocacy within medical humanitarian NGOs. Drawing from twelve months of fieldwork with medical humanitarian NGOs in Arizona, I analyze data from ethnographic participant observation and interviews with volunteer healthcare providers at a medical humanitarian organization I call Community Clinic of Phoenix (CCP), a free clinic for uninsured, undocumented immigrants. I find that, in the context of Arizona's anti-immigrant rhetoric and policies, CCP employs medical humanitarianism as both a discourse and a model of care to challenge immigrants' exclusion from health coverage and criminalization through immigration enforcement. The clinic's emphasis on immigrant health justice shapes their critiques of the structural failures of U.S. immigration and health systems, their approach to providing equitable access to quality healthcare for uninsured immigrants, and their work to create broad social change for immigrant rights and health justice. Driven by their mission of "not replicating a free version of a broken system," the clinic's healthcare provision amid a climate inhospitable to immigrants demonstrates the importance of both conceptualizing and practicing medical humanitarianism as healthcare advocacy.

Chronic Stress and Preconception Health Among Latina Women in Metro Atlanta

BACKGROUND

Underserved subgroups are less likely to have optimal health prior to pregnancy. We describe preconception health indicators (behavior, pregnancy intention, and obesity) among pregnant Latina women with and without chronic stress in metro Atlanta.

DESIGN

We surveyed 110 pregnant Latina women enrolled in prenatal care at three clinics in Atlanta. The survey assessed chronic stress, pregnancy intention, preconception behavior changes (taking folic acid or prenatal vitamins, seeking healthcare advice, any reduction in smoking or drinking), and previous trauma.

RESULTS

Specific behaviors to improve health prior to pregnancy were uncommon (e.g., taking vitamins (25.5%) or improving nutrition (20.9%)). Just under half of women were experiencing a chronic stressor at the time of conception (49.5%). Chronically stressed women were more likely to be obese (aOR: 3.0 (1.2, 7.4)), less likely to intend their pregnancy (aOR: 0.3 (0.1, 0.7)), and possibly less likely to report any PHB (45.5% vs. 57.4%; aOR: 0.5 (0.2-1.1)).

CONCLUSIONS

Chronically stress women were less likely to enter prenatal care with optimal health. However, preconception behaviors were uncommon overall.

The adverse health effects of punitive immigrant policies in the United States: A systematic review

BACKGROUND

Immigrants in the United States (US) today are facing a dynamic policy landscape. The Trump administration has threatened or curtailed access to basic services for 10.5 million undocumented immigrants currently in the US. We sought to examine the historical effects that punitive laws have had on health outcomes in US immigrant communities.

METHODS

In this systematic review, we searched the following databases from inception-May 2020 for original research articles with no language restrictions: Ovid MEDLINE, Ovid EMBASE, Cochrane Library (Wiley), Web of Science Core Collection (Clarivate), CINAHL (EBSCO), and Social Work Abstracts (Ovid). This study is registered with PROSPERO, CRD42019138817. Articles with cohort sizes >10 that directly evaluated the health-related effects of a punitive immigrant law or policy within the US were included.

FINDINGS

6,357 studies were screened for eligibility. Of these, 32 studies were selected for inclusion and qualitatively synthesized based upon four themes that appeared throughout our analysis: (1) impact on healthcare utilization, (2) impact on women's and children's health, (3) impact on mental health services, and (4) impact on public health. The impact of each law, policy, mandate, and directive since 1990 is briefly discussed, as are the limitations and risk of bias of each study.

INTERPRETATION

Many punitive immigrant policies have decreased immigrant access to and utilization of basic healthcare services, while instilling fear, confusion, and anxiety in these communities. The federal government should preserve and expand access for undocumented individuals without threat of deportation to improve health outcomes for US citizens and noncitizens.

Diabetes Risk and Control in Multi-ethnic US Immigrant Populations

PURPOSE OF REVIEW

The goal of this review is to assess current evidence on diabetes risk and control among adult immigrants in the USA.

RECENT FINDINGS

Patterns of diabetes risk in US immigrants may reflect global diabetes trends. Asian, Black, and Latinx immigrants all see a diabetes disadvantage relative to US-born Whites. Diabetes risk in Asian immigrants also surpasses US-born Asians. Relative diabetes risk among all groups increases with time in the USA. Research to explain patterns in diabetes risk and control among immigrants has broadened from lifestyle factors to include multi-level, life course influences on trajectories of risk. Some determinants are shared across groups, such as structural racism, healthcare access, and migration stress, whereas others such as diet are embedded in sending country culture. Current literature on diabetes in immigrant populations suggests a need to shift towards a transnational lens and macro-level social determinants of health framework to understand diabetes risk and potential prevention factors.

Legal Violence, Health, and Access to Care: Latina Immigrants in Rural and Urban Kansas

Using interviews and ethnography started in 2016 in rural and urban Kansas, we examine the consequences of an amplified immigration enforcement combined with a local limited health care infrastructure that reproduce legal violence manifesting on Latina immigrants' health, access to care, and community participation. We highlight the conditions rooted in place that generate short- and long-term negative impacts for Latina immigrants' health. Fear and anxiety about the deportation of themselves and their family members make them ill and also generate apprehension about contacting medical institutions, driving, and spending time in public spaces. These circumstances coalesce in women's lives to block access to medical care and undermine women's roles in their communities. Following gendered expectations, women turn to their informal networks to seek health care for their families. In the context that the enforcement regime has created, these ties can turn exploitative.

Rethinking COVID-19 Vulnerability: A Call for LGTBQ+ Im/migrant Health Equity in the United States During and After a Pandemic

Public health responses to the coronavirus disease 2019 (COVID-19) pandemic have emphasized older adults' vulnerability, but this obfuscates the social and political root causes of health inequity. To advance health equity during a novel communicable disease outbreak, public health practitioners must continue to be attentive to social and political circumstances that inform poor health. Such efforts are especially needed for populations who are exposed to numerous social and political factors that structure health inequity, such as lesbian, gay, bisexual, transgender, or otherwise-queer identifying (LGBTQ+) populations and im/migrant populations. The COVID-19 outbreak is, therefore, a critical time to emphasize root causes of health inequity.

No Te Tratan Bien Porque Eres Mexicana: Intersectional Systemic Violence and Precarity in Latina Adolescent Life in the U.S. South

Young Latina women (YLW) in Alabama are disproportionately affected by sexual health disparities. However, to access needed reproductive services, YLW must navigate a healthcare landscape that restricts access for youth. YLW also face racialized immigration enforcement in their communities which is designed to attrition the region's emergent Latina/o/x immigrant population. This paper describes the intersectional, structural forces that contribute to experienced systemic violence for YLW as they try to access sexual healthcare services. In 2017, we conducted semi-structured qualitative interviews with 20 YLW and 24 key stakeholders (parents, providers, Latino/a/x community leaders etc.) in West Alabama to examine attitudes and perceptions about sexual health and healthcare access (HCA) among YLW in the region. We used purposeful convenience sampling and snowballing to recruit a community-based sample. That is, we purposefully recruited YLW, adjusting through the recruitment period for a diverse sample, who represented the various voices that we were trying to capture in the study (i.e., younger and older adolescents, adolescents born in the U.S. and those born in other countries etc.). Through a focus on YLW's access to sexual/reproductive healthcare, we conclude that YLW experience systemic violence and resulting precarity because laws and health policies restrict access to evidence-based sexual health education and reproductive healthcare services. We discuss implications for future research and policy recommendations.

Impact of change over time in self-reported discrimination on blood pressure: implications for inequities in cardiovascular risk for a multi-racial urban community

Objectives: The 21st century has seen a rise in racism and xenophobia in the United States. Few studies have examined the health implications of heightened institutional and interpersonal racism. This study examines changes in reported discrimination and associations with blood pressure over time among non-Latino Blacks (NLBs), Latinos, and non-Latino Whites (NLWs) in an urban area, and variations by nativity among Latinos.Design: Data from a probability sample of NLB, Latino, and NLW Detroit, Michigan residents were collected in 2002-2003, with follow-up at the same addresses in 2007-2008. Surveys were completed at 80% of eligible housing units in 2008 (n = 460). Of those, 219 participants were interviewed at both time points and were thus included in this analysis. Discrimination patterns across racial/ethnic groups and associations with blood pressure were examined using generalized estimating equations.Results: From 2002 to 2008, NLBs and Latinos reported heightened interpersonal and institutional discrimination, respectively, compared with NLWs. There were no differences in associations between interpersonal discrimination and blood pressure. Increased institutional discrimination was associated with stronger increases in systolic and diastolic blood pressure for NLBs than NLWs, with no differences between Latinos and NLWs. Latino immigrants experienced greater increases in blood pressure with increased interpersonal and institutional discrimination compared to US-born Latinos.Conclusions: Together, these findings suggest that NLBs and Latinos experienced heightened discrimination from 2002 to 2008, and that increases in institutional discrimination were more strongly associated with blood pressure elevation among NLBs and Latino immigrants compared to NLWs and US-born Latinos, respectively. These findings suggest recent increases in discrimination experienced by NLBs and Latinos, and that these increases may exacerbate racial/ethnic health inequities.

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.

When deservingness policies converge: US immigration enforcement, health reform and patient dumping

As immigration and health policy continue to be contentious topics globally, anthropologists must examine how policy creates notions of health-related deservingness, which may have broad consequences. This paper explores hidden relationships between immigration enforcement laws and the most recent health reform law in the United States, the Patient Protection and Affordable Care Act (ACA), which excludes immigrants from certain types of health services. Findings in this paper show how increasingly harsh immigration enforcement efforts provide health facilities a 'license to discriminate' against undocumented immigrants, resulting in some facilities 'dumping' undocumented patients or unlawfully transferring them from one hospital to another. Due to changes made through the ACA, patient dumping disproportionately complicates public hospitals' financial viability and may have consequences on public facilities' ability to provide care for all indigent patients. By focusing on the converging consequences of immigrant policing and health reform, findings in this paper ultimately show that examining deservingness assessments and how they become codified into legislation, which I call 'deservingness projects', can reveal broader elements of state power and demonstrate how such power extends beyond targeted populations. Exercises of state power can thus have 'spillover effects' that harm numerous vulnerable populations, highlighting the importance of medical anthropology in documenting the broad, hidden consequences of governmental actions that construct populations as undeserving of social services.

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

BACKGROUND

Many conceptual frameworks that touch on immigration and health have been published over the past several years. Most discuss broad social trends or specific immigrant policies, but few address how the policy environment affects the context of settlement and incorporation. Research on the social determinants of health shows how policies across multiple sectors have an impact on health status and health services, but has not yet identified the policies most important for immigrants. Understanding the range and content of state-level policies that impact immigrant populations can focus health in all policies initiatives as well as contextualize future research on immigrant health.

METHODS

Our framework identifies state-level policies across five different domains that impact the health of immigrants and that vary across states, especially for those without legal status. Our scan shows that immigrants are exposed to different contexts, ranging from relatively inclusive to highly exclusive; a number of states have mixed trends that are more inclusive in some areas, but exclusive in others. Finally, we examine how the relative inclusiveness of state policies are associated with state-level demographic and political characteristics.

RESULTS

Contrary to the image that exclusive policies are a reaction to large immigrant populations that may compete for jobs and cultural space, we find that the higher the proportion of foreign born and Hispanics in the state, the more inclusive the set of policies; while the higher the proportion of Republican voters, the less inclusive.

CONCLUSIONS

Variation across immigrant policies is much larger than the variation in state demographic and political characteristics, suggesting that state-level policies need to be included as a possible independent, contextual effect, when assessing immigrant health outcomes. This policy framework can be particularly useful in bridging our understanding of how large macro processes are connected to the daily lives and health of immigrants.

Racial/Ethnic Discrimination and Diabetes-Related Outcomes Among Latinos with Type 2 Diabetes

Discrimination is associated with adverse health outcomes, but few studies have examined the association of discrimination with diabetes-related outcomes including mental health and glycemic control, particularly for immigrant and US-born Latinos. We analyzed survey data (n = 222) collected at baseline of a diabetes intervention. Using multiple linear regression, we examined the association of racial/ethnic discrimination with depressive symptoms, diabetes-related distress, and HbA1c, and variation in these associations by nativity and, for immigrants, length of US residence. Racial/ethnic discrimination was positively associated with depressive symptoms (b = 2.57, SE = 0.45, p < 0.01) and diabetes-related distress (b = 0.30, SE = 0.09, p < 0.01). We could not reject the null hypothesis of no cross-sectional association of racial/ethnic discrimination with HbA1c (b = - 0.27, SE = 0.18, p = 0.14). Although racial/ethnic discrimination did not directly affect HbA1c, racial/ethnic discrimination had a significant mediating effect on HbA1c through diabetes-related distress (p = 0.02). Results suggest that racial/ethnic discrimination is detrimental for health for Latinos with diabetes.

Stratified citizenship, stratified health: Examining latinx legal status in the U.S. healthcare safety net

Our paper explores how legal status stratification shapes the health and health care of low-income patients with chronic illnesses in the U.S. healthcare safety net. Drawing on data from over two years of ethnographic fieldwork at urban safety-net clinics, we examine efforts by Complex Care Management (CCM) teams to stabilize patients with uncontrolled chronic illnesses through primary care-integrated support. We show that stratified citizenship and geographic variability correspond to different possibilities for health care. We suggest an approach to immigration as a structural determinant of health that accounts for the complex, stratified, and changing nature of citizenship status. We also highlight how geographical differences and interactions among local, state, and federal policies support the notion that citizenship is stratified across multiple tiers with distinctive possibilities and constraints for health. While county-based health plans at each of the study sites include residents with varying legal status, lack of formal legal status remains a substantial obstacle to care. Many immigrants are unable to take full advantage of primary and specialty care, resulting in unnecessary morbidity and mortality. In some cases, patients have returned to their country of origin to die. While CCM teams provide an impressive level of support to assist immigrant patients in navigating healthcare and immigration bureaucracies, legal and geographic stratification limit their ability to address broader aspects of these patients' social context.

The Health Impact of Experiences of Discrimination, Violence, and Immigration Enforcement Among Latino Men in a New Settlement State

Among Latinos in the United States, particularly in new settlement states, racial/ethnic discrimination, violence, and immigration enforcement contribute to health disparities. These types of experiences were explored among Latino men in North Carolina through quantitative assessment data ( n = 247). Qualitative in-depth interviews were also conducted with a subsample of Latino men who completed the assessment ( n = 20) to contextualize quantitative findings. Participants reported high rates of unfair treatment, discrimination or violence, and questioning about their immigration status. Having been questioned about one's immigration status was significantly associated with increased drug use (adjusted odds ratio [AOR] = 2.16; 95% confidence interval [CI] [1.07, 4.38]) and increased depressive symptoms (AOR = 2.87; 95% CI [1.07, 7.67]). Qualitative themes included: reports of frequent discrimination based on immigration status, race/ethnicity, and language; workplaces and police interactions as settings where reported discrimination is most common and challenging; frequent violent victimization; psychological consequences of experiences of discrimination and violence and concerns related to immigration enforcement for Latino men and their families; inter- and intra-community tensions; health-care services as safe spaces; use of coping strategies; and system-level approaches for reducing discrimination and violent victimization of Latinos. Findings point to the need to address underlying causes of discrimination and violence toward Latinos, particularly those related to immigration enforcement, to support health and well-being.

Access to health care for uninsured Latina immigrants in South Carolina

Background

South Carolina is considered a “new destination” state for Latino immigrants. Language barriers, transportation difficulties, low socioeconomic status, inflexible work schedules, different cultural norms, and anxiety and fear related to the current anti-immigrant political climate all negatively impact Latino immigrants’ frequency of contact with the health care system, and consequently they suffer poor health outcomes. The study objective was to explore uninsured Latina immigrant women’s access to health care and alternative treatment strategies in coastal South Carolina.

Methods

The study design was a qualitative interview design. Thirty women participated in semi-structured interviews in community sites. Thematic analysis identified salient categories of topics across interview participants.

Results

The themes were organized into four primary categories including: 1) Barriers and Facilitators to Healthcare, 2) Health Behaviors and Coping Mechanisms, 3) Disease Management Strategies, and 4) Cultural Factors. Participants demonstrated determination for accessing care but reported that their primary health care access barriers included the high cost of services, lack of health insurance, family and work responsibilities, and language barriers. Coping mechanisms included activating their social networks, visiting family and friends and assisting one another with navigating life challenges.

Conclusion

Participants overcame obstacles to obtain healthcare for themselves and their family members despite the multiple barriers presented. Social networks were leveraged to protect against some of the negative effects of financial barriers to health care access.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3138-2) contains supplementary material, which is available to authorized users.

Immigration Basics for Nurses

The United States is known as a nation of immigrants and a land of promise that welcomes the needy, poor, and oppressed. Immigrants represent some of the most vulnerable in society. It is vital that nurses and other health care providers possess knowledge of social, economic, and political factors related to health care for immigrant populations. This article provides definitions of the various immigrant populations, addresses health needs within this group, and offers suggestions for nursing practice and advocacy.