COVID-19 amplified racial disparities in the US criminal legal system.

The criminal legal system in the USA drives an incarceration rate that is the highest on the planet, with disparities by class and race among its signature features1-3. During the first year of the coronavirus disease 2019 (COVID-19) pandemic, the number of incarcerated people in the USA decreased by at least 17%-the largest, fastest reduction in prison population in American history4. Here we ask how this reduction influenced the racial composition of US prisons and consider possible mechanisms for these dynamics. Using an original dataset curated from public sources on prison demographics across all 50 states and the District of Columbia, we show that incarcerated white people benefited disproportionately from the decrease in the US prison population and that the fraction of incarcerated Black and Latino people sharply increased. This pattern of increased racial disparity exists across prison systems in nearly every state and reverses a decade-long trend before 2020 and the onset of COVID-19, when the proportion of incarcerated white people was increasing amid declining numbers of incarcerated Black people5. Although a variety of factors underlie these trends, we find that racial inequities in average sentence length are a major contributor. Ultimately, this study reveals how disruptions caused by COVID-19 exacerbated racial inequalities in the criminal legal system, and highlights key forces that sustain mass incarceration. To advance opportunities for data-driven social science, we publicly released the data associated with this study at Zenodo6.

Latinos' deportation fears by citizenship and legal status, 2007 to 2018.

Deportation has become more commonplace in the United States since the mid-2000s. Latin American noncitizens-encompassing undocumented and documented immigrants-are targeted for deportation. Deportation's threat also reaches naturalized and US-born citizens of Latino descent who are largely immune to deportation but whose loved ones or communities are deportable. Drawing on 6 y of data from the National Survey of Latinos, this article examines whether and how Latinos' deportation fears vary by citizenship and legal status and over time. Compared with Latino noncitizens, Latino US citizens report lower average deportation fears. However, a more complex story emerges when examining this divide over time: Deportation fears are high but stable among Latino noncitizens, whereas deportation fears have increased substantially among Latino US citizens. These trends reflect a growing national awareness of-rather than observable changes to-deportation policy and practice since the 2016 US presidential election. The article highlights how deportation or its consequences affects a racial group that the US immigration regime targets disproportionately.

Risk and protective markers for well-being in Latinx immigrants in removal proceedings.

OBJECTIVES: There are currently 1,308,327 immigrants in removal proceedings, over 80% of whom are Latinx (TRAC, 2021b). This study examined the relation among putative protective markers (i.e. social support, religious support, and legal support) and the emotional and physical well-being of Latinx individuals facing removal proceedings. HYPOTHESES: We hypothesized that increased social support, religious support, and legal support would buffer the negative relations between hopelessness, poor self-efficacy, and well-being measures (depression, anxiety, stress, mental well-being, somatic symptoms, and physical well-being). METHOD: Participants (N = 157; 31.2% men, M age = 33.4 years) had an active immigration court case in Texas and completed a demographic questionnaire, the Beck Hopelessness Scale, General Self-Efficacy Scale, Multidimensional Scale of Perceived Social Support, Multi-Faith Religious Support Scale, Depression, Anxiety, Stress Scale-21, Patient Health Questionnaire-15, and Short Form Health Survey-12. RESULTS: Higher levels of hopelessness and poor self-efficacy were associated with more negative well-being outcomes, while social support was associated with more positive well-being outcomes. Contrary to hypotheses, religious support and legal support served as risk markers independently, while legal support interacted with hopelessness, such that decreased legal support was associated with higher mental well-being at lower levels of hopelessness and interacted with poor self-efficacy, such that increased legal support was associated with poorer mental well-being at lower levels of self-efficacy. All effect sizes were small (rsp2 = .04 to .16). CONCLUSIONS: Targeting hopelessness and poor self-efficacy while promoting social support may help mental health professionals improve the well-being of immigrants in removal proceedings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Role of Campus Support, Undocumented Identity, and Deferred Action for Childhood Arrivals on Civic Engagement for Latinx Undocumented Undergraduates.

This study examined civic engagement in a sample of 790 undocumented Latinx undergraduates (aged 18-30). The relations between social supports (campus safe spaces and peer support) and civic engagement and whether a strong sense of undocumented identity mediated this relation were examined. Competing statistical models examined the role of participants' status (whether or not they received temporary protection from deportation with Deferred Action for Childhood Arrivals [DACA]) in this mediational process. Results revealed that having a strong identification with being undocumented mediated the role of social supports on civic engagement in the overall sample, and that this process was specifically important for those with DACA status. The intersection of policies such as DACA and the lived experiences of Latinx undocumented college students are discussed.

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.

The Mobility of Youth in the Justice System: Implications for Recidivism.

Both residential mobility and community disadvantage have been shown to be associated with negative outcomes for adolescents generally and juvenile offenders specifically. The current study examines the effects of moving among a large sample (n = 13,096) of previously adjudicated youth (31.6 % female, 41.2 % Black, 16.5 % Hispanic). Additionally, we examine whether moving upward to a more affluent neighborhood, moving downward to an area of greater disadvantage, or moving laterally to a similar neighborhood tempers the effects of residential mobility. We use a combination of analytical techniques, including propensity score matching to untangle the effects of mobility sans pre-existing conditions between movers and non-movers. Results show relocation increases recidivism, irrespective of the direction of the move with regard to socioeconomic context. Moving upward has the most detrimental impact for adjudicated male adolescents, while downward relocations evidenced the largest effect for female youth. Implications for policy and future research needs are discussed.

The impact of local immigration enforcement policies on the health of immigrant hispanics/latinos in the United States.

OBJECTIVES: We sought to understand how local immigration enforcement policies affect the utilization of health services among immigrant Hispanics/Latinos in North Carolina. METHODS: In 2012, we analyzed vital records data to determine whether local implementation of section 287(g) of the Immigration and Nationality Act and the Secure Communities program, which authorizes local law enforcement agencies to enforce federal immigration laws, affected the prenatal care utilization of Hispanics/Latinas. We also conducted 6 focus groups and 17 interviews with Hispanic/Latino persons across North Carolina to explore the impact of immigration policies on their utilization of health services. RESULTS: We found no significant differences in utilization of prenatal care before and after implementation of section 287(g), but we did find that, in individual-level analysis, Hispanic/Latina mothers sought prenatal care later and had inadequate care when compared with non-Hispanic/Latina mothers. Participants reported profound mistrust of health services, avoiding health services, and sacrificing their health and the health of their family members. CONCLUSIONS: Fear of immigration enforcement policies is generalized across counties. Interventions are needed to increase immigrant Hispanics/Latinos' understanding of their rights and eligibility to utilize health services. Policy-level initiatives are also needed (e.g., driver's licenses) to help undocumented persons access and utilize these services.

The influence of mitigation evidence, ethnicity, and SES on death penalty decisions by European American and Latino venire persons.

The purpose of the research was to determine whether European American and Latino mock jurors would demonstrate bias in death penalty decision making when mitigation evidence and defendant ethnicity and socioeconomic status (SES) were varied. A total of 561 actual venire persons acted as mock jurors and read a trial transcript that varied a defendant's case information (mitigating circumstances: strong/weak, defendant ethnicity: European American/Latino, and defendant SES: low/high). European American jurors recommended the death penalty significantly more often for the low SES Latino defendant when strength of mitigation evidence was weak. In addition, they also assigned this defendant higher culpability ratings and lower ratings on positive personality trait measures compared with all other conditions. Strong mitigation evidence contributed to lower guilt ratings by European American jurors for the high SES European American defendant. Latino jurors did not differ in their death penalty sentencing across defendant mitigation, ethnicity, or SES conditions. Discussion of in-group favoritism and out-group derogation, as well as suggestions for procedures to diminish juror bias in death penalty cases, is provided.

Restraint use law enforcement intervention in Latino communities.

BACKGROUND: Motor vehicle crashes are the leading cause of death for U.S. Latinos aged 1 to 35 years. Restraint use is an effective means of prevention of motor vehicle crash injury. Effective interventions to raise restraint use include the following: legislation, law enforcement, education, and equipment distribution. The effects of law enforcement interventions in Latino immigrant communities are understudied. We measured the community-level effect of a combined intervention that included warnings and citations phase enforcement in Latino communities. METHODS: We designed and implemented in two of three Latino-majority communities a multicomponent intervention consisting of a community awareness campaign, restraint use education with equipment distribution, and a two-staged law enforcement intervention. Restraint use observations were conducted in all three communities at baseline, after the warnings phase and again after the citations phase of the intervention were completed. RESULTS: The combined intervention of community awareness, education, child passenger restraint distribution, and law enforcement focused on educational traffic stops with incentives and warnings was associated with a significant increase in both driver and child passenger restraint use in one intervention community, but only driver restraint increased to a level of significance in the other intervention community; significant increase was also noted among nonintervention drivers. The citations phase of the intervention did not result in a significant increase in restraint use and was complicated by interruptions due to unlicensed drivers. CONCLUSION: The combined effort of community awareness, education, equipment distribution and law enforcement intervention that included incentives and warnings may be effective at increasing seat belt use in Latino communities without the need for citations.

Between black and brown: blaxican (black-Mexican) multiracial identity in California.

This article explores the racial/ethnic identities of multiracial Black-Mexicans or "Blaxicans." In-depth interviews with 12 Blaxican individuals in California reveal how they negotiate distinct cultural systems to accomplish multiracial identities. I argue that choosing, accomplishing, and asserting a Blaxican identity challenges the dominant monoracial discourse in the United States, in particular among African American and Chicana/o communities. That is, Blaxican respondents are held accountable by African Americans and Chicanas/os/Mexicans to monoracial notions of "authenticity." The process whereby Blaxicans move between these monoracial spaces to create multiracial identities illustrates crucial aspects of the social construction of race/ethnicity in the United States and the influence of social interactions in shaping how Blaxicans develop their multiracial identities.

Health Care Use Among Latinx Children After 2017 Executive Actions on Immigration.

BACKGROUND: US immigration policy changes may affect health care use among Latinx children. We hypothesized that January 2017 restrictive immigration executive actions would lead to decreased health care use among Latinx children. METHODS: We used controlled interrupted time series to estimate the effect of executive actions on outpatient cancellation or no-show rates from October 2016 to March 2017 ("immigration action period") among Latinx children in 4 health care systems in North Carolina. We included control groups of (1) non-Latinx children and (2) Latinx children from the same period in the previous year ("control period") to account for natural trends such as seasonality. RESULTS: In the immigration action period, 114 627 children contributed 314 092 appointments. In the control period, 107 657 children contributed 295 993 appointments. Relative to the control period, there was an immediate 5.7% (95% confidence interval [CI]: 0.40%-10.9%) decrease in cancellation rates among all Latinx children, but no sustained change in trend of cancellations and no change in no-show rates after executive immigration actions. Among uninsured Latinx children, there was an immediate 12.7% (95% CI: 2.3%-23.1%) decrease in cancellations; however, cancellations then increased by 2.4% (95% CI: 0.89%-3.9%) per week after immigration actions, an absolute increase of 15.5 cancellations per 100 appointments made. CONCLUSIONS: There was a sustained increase in cancellations among uninsured Latinx children after immigration actions, suggesting decreased health care use among uninsured Latinx children. Continued monitoring of effects of immigration policy on child health is needed, along with measures to ensure that all children receive necessary health care.

The effects of racial/ethnic segregation on Latino and Black homicide.

Racial/ethnic residential segregation has been shown to contribute to violence and have harmful consequences for minority groups. However, research examining the segregation­crime relationship has focused almost exclusively on blacks and whites while largely ignoring Latinos and other race/ethnic groups and has rarely considered potential mediators (e.g., concentrated disadvantage) in segregation­violence relationships. This study uses year 2000 arrest data for California and New York census places to extend segregation­crime research by comparing the effects of racial/ethnic residential segregation from whites on black and Latino homicide. Results indicate that (1) racial/ethnic segregation contributes to both Latino and black homicide, and (2) the effects for both groups are mediated by concentrated disadvantage. Implications for segregation­violence relationships, the racial-invariance position, and the Latino paradox are discussed.

The color of welfare sanctioning: exploring the individual and contextual roles of race on TANF case closures and benefit reductions.

This article investigates the individual and contextual roles of race on welfare sanctions: benefit cuts for failing to comply with work or other behavioral requirements under the Temporary Assistance for Needy Families program. Using six years of federal administrative data, I advance previous welfare research by providing a nationally representative analysis of participant-, county-, and state-level predictors of welfare sanctioning. Using theories of racial classification, racialized social systems, and racial threat as guiding frameworks, I find that black and Latina women are at a greater risk of being sanctioned than white women. Further, although odds of a sanction are slightly reduced for black women living in counties with greater percentages of blacks, the opposite holds for Latinas, who are at an increased risk of being sanctioned in counties with greater percentages of Latinos.

Pipeline programs in the health professions, part 2: the impact of recent legal challenges to affirmative action.

BACKGROUND: Despite recent challenges to educational pipeline programs, these academic enrichment programs are still an integral component in diversifying the health professions and reducing health disparities. This is part 2 of a 2-part series on the role of pipeline programs in increasing the number of racial and ethnic minorities in the health professions and addressing related health disparities. Part 1 of this series looked at the role of pipeline programs in achieving a diverse health professional workforce and provided strategies to expand pipeline programs. METHODS: This paper presents an historical overview of affirmative action case law, anti-affirmative action legislation, and race-conscious and race-neutral admission programs in education. Additionally, part 2 reviews current legal theory and related law that impact the diversity and cultural competence pipeline programming at higher-education institutions. Finally, based on recommendations from a review of legal and other literature, the authors offer recommendations for reviewing and preserving diverse pipeline programs for health professional schools. CONCLUSION: Affirmative action is an essential legal means to ensure the diversity-related educational programs in the health profession educational programs. Anti-affirmative action legislation and state-sponsored antiaffirmative voter initiatives have the potential to limit the number of underrepresented minorities in the health professions and create even greater opportunity gaps and educational disparities. Therefore, we must shift the paradigm and reframe the dialogue involving affirmative action and move from debate to a collaborative discussion in order to address the historical and contemporary disparities that make affirmative action necessary today.

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.

Immigration Enforcement and Children's Living Arrangements.

Tougher immigration enforcement was responsible for 1.8 million deportations between 2009 and 2013 alone--many of them were fathers of American children. We exploit the geographic and temporal variation in the escalation of interior immigration enforcement to assess its impact on the structure of families to which many of the deported fathers of U.S.-born children belonged. We find that the average increase in immigration enforcement during the 2005 to 2015 period has raised by 19 percent the likelihood that Hispanic U.S.-born children might live without their parents in households headed by naturalized relatives or friends unthreatened by deportation. Likewise, the same increase in immigration enforcement has raised by 20 percent these children's propensity to live with likely undocumented mothers who report their spouses as being absent--a reasonable finding given that most children with a likely undocumented father have undocumented mothers. Given the negative consequences of being raised by a single parent or without parents, plus the parallel increase in interior immigration enforcement, gaining a better understanding of the collateral damage of heightened enforcement on the families to which these children belong is well warranted.

Hispanics, Mental Health, and Discriminating Policies: Brief Report.

Hispanics, the largest minority group in the United States, are a heterogeneous group that contains a large portion of immigrants from Latin America. Recently, anti-immigrant policies and anti-Hispanic discriminatory practices have heightened at state and national levels. These policies and practices serve to endanger the mental health of Hispanics and play a major role in health care disparities. Positive correlations have been found between chronic discrimination and depression as well as other comorbid conditions, such as anxiety and substance use, and physical disorders. This report provides an overview of the changes in law/policy in recent history that negatively affect the well-being of Hispanics. Recommendations for health care professionals, educators, and researchers are presented.

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)).

Racial and Ethnic Disparities in Meeting MTM Eligibility Criteria Based on Star Ratings Compared with the Medicare Modernization Act.

BACKGROUND: Previous research found racial and ethnic disparities in meeting medication therapy management (MTM) eligibility criteria implemented by the Centers for Medicare & Medicaid Services (CMS) in accordance with the Medicare Modernization Act (MMA). OBJECTIVE: To examine whether alternative MTM eligibility criteria based on the CMS Part D star ratings quality evaluation system can reduce racial and ethnic disparities. METHODS: This study analyzed the Beneficiary Summary File and claims files for Medicare beneficiaries linked to the Area Health Resource File. Three million Medicare beneficiaries with continuous Parts A, B, and D enrollment in 2012-2013 were included. Proposed star ratings criteria included 9 existing medication safety and adherence measures developed mostly by the Pharmacy Quality Alliance. Logistic regression and the Blinder-Oaxaca approach were used to test disparities in meeting MMA and star ratings eligibility criteria across racial and ethnic groups. Multinomial logistic regression was used to examine whether there was a disparity reduction by comparing individuals who were MTM-eligible under MMA but not under star ratings criteria and those who were MTM-eligible under star ratings criteria but not under the MMA. Concerning MMA-based MTM criteria, main and sensitivity analyses were performed to represent the entire range of the MMA eligibility thresholds reported by plans in 2009, 2013, and proposed by CMS in 2015. Regarding star ratings criteria, meeting any 1 of the 9 measures was examined as the main analysis, and various measure combinations were examined as the sensitivity analyses. RESULTS: In the main analysis, adjusted odds ratios for non-Hispanic blacks (backs) and Hispanics to non-Hispanic whites (whites) were 1.394 (95% CI = 1.375-1.414) and 1.197 (95% CI = 1.176-1.218), respectively, under star ratings. Blacks were 39.4% and Hispanics were 19.7% more likely to be MTM-eligible than whites. Blacks and Hispanics were less likely to be MTM-eligible than whites in some sensitivity analyses. Disparities were not completely explained by differences in patient characteristics based on the Blinder-Oaxaca approach. The multinomial logistic regression of each main analysis found significant adjusted relative risk ratios (RRR) between whites and blacks for 2009 (RRR = 0.459, 95% CI = 0.438-0.481); 2013 (RRR = 0.449, 95% CI = 0.434-0.465); and 2015 (RRR = 0.436, 95% CI = 0.425-0.446) and between whites and Hispanics for 2009 (RRR = 0.559, 95% CI = 0.528-0.593); 2013 (RRR = 0.544, 95% CI = 0.521-0.569); and 2015 (RRR = 0.503, 95% CI = 0.488-0.518). These findings indicate a significant reduction in racial and ethnic disparities when using star ratings eligibility criteria; for example, black-white disparities in the likelihood of meeting MTM eligibility criteria were reduced by 55.1% based on star ratings compared with MMA in 2013. Similar patterns were found in most sensitivity and disease-specific analyses. CONCLUSIONS: This study found that minorities were more likely than whites to be MTM-eligible under the star ratings criteria. In addition, MTM eligibility criteria based on star ratings would reduce racial and ethnic disparities associated with MMA in the general Medicare population and those with specific chronic conditions. DISCLOSURES: Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award number R01AG049696. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Cushman reports an Eli Lilly grant and uncompensated consulting for Takeda Pharmaceuticals outside this work. The other authors have no potential conflicts of interest to report. Study concept and design were contributed by Wang and Shih, along with Wan, Kuhle, Spivey, and Cushman. Wang, Qiao, and Wan took the lead in data collection, with assistance from the other authors. Data interpretation was performed by Wang, Kuhle, and Qiao, with assistance from the other authors. The manuscript was written by Spivey and Qiao, along with the other authors, and revised by Cushman, Dagogo-Jack, and Chisholm-Burns, along with the other authors.

Legal status, emotional well-being and subjective health status of Latino immigrants.

Among the many stresses that undocumented Latino immigrants experience, worries about their legal status and preoccupation with disclosure and deportation can heighten the risk for emotional distress and impaired quality of health. To better document these effects, this study examined the relationship between deportation concern and emotional and physical well-being among a group of Latino immigrants in a midwestern city. One-hundred-forty-three persons were recruited through community sources. Fifty-six participants (39%) expressed concern with seeking services for fear of deportation, while 87 did not endorse this concern. Measures of emotional distress, Hispanic immigrant stress and subjective health status were administered. Results indicate that Latino immigrants with concerns about deportation are at heightened risk of experiencing negative emotional and health states (particularly anger), Hispanic immigrant stress associated with extrafamilial factors and substandard health status. Findings inform policymakers of culturally relevant stressors of undocumented Latino immigrants that help to create and perpetuate the health and mental health disparities of this group.