Exploring risky health behaviors and vulnerability to sexually transmitted diseases among transnational undocumented labor migrants from Bangladesh: a qualitative study.

BACKGROUND: In Bangladesh, remittances constitute a substantial portion of the country's foreign exchange earnings and serve as a primary source of income. However, a considerable number of Bangladeshi citizens reside overseas without proper documentation, exposing them to significant challenges such as limited access to healthcare and socioeconomic opportunities. Moreover, their irregular migration status often results in engaging in risky health behaviors that further exacerbate their vulnerability. Hence, this study aimed to investigate the risky health behavior and HIV/STI susceptibility of Bangladeshi irregular international migrants residing across the globe with undocumented status. METHODS: Using a qualitative Interpretative Phenomenological Approach (IPA), 25 illegal migrants were interviewed who are currently living illegally or returned to their home country. The author used a thematic approach to code and analyze the data, combining an integrated data-driven inductive approach with a deductive approach. Concurrent processing and coding were facilitated by employing the Granheim model in data analysis. RESULTS: The study identified four risky health behaviors among irregular Bangladeshi migrants: hazardous living conditions, risky jobs, suicidal ideation, and tobacco consumption. Additionally, the authors found some HIV/STI risk behavior among them including engaging in unprotected sex, consuming alcohol and drugs during sexual activity, and having limited access to medical facilities. CONCLUSIONS: The findings of this study can be used by health professional, governments, policymakers, NGOs, and concerned agencies to develop welfare strategies and initiatives for vulnerable undocumented migrant workers.

Critical consciousness among undocumented immigrant college students: Responding to cultural stress and psychological distress.

OBJECTIVES: Cultural stress is experienced by undocumented students when they encounter discrimination in higher education and society. In response, undocumented students engage in critical consciousness, while simultaneously experiencing psychological distress. A conceptual model is introduced to describe the links between cultural stress, critical consciousness development, and psychological distress. METHOD: One hundred seventy-one undocumented college students were recruited to participate in this study and completed measures of cultural stress (discrimination). They also completed measures of psychological distress, critical consciousness, and social justice self-efficacy and outcome expectations. The proposed model was tested for global fit and path analysis in structural equation modeling. Indirect effects were probed to assess the mediating role of critical consciousness and psychological distress. RESULTS: The model fit the data excellently. Greater discrimination was associated with higher critical consciousness, which in turn was associated with elevated social justice self-efficacy and outcome expectations. Additionally, higher discrimination was also linked to greater psychological distress. The link between cultural stress and critical consciousness was not explained by psychological distress. CONCLUSIONS: This research expands theory by articulating the adaptive ways undocumented students respond to the conditions that cause cultural stress and psychological distress. This aligns with a growing literature documenting the psychology of undocumented immigrants' activism and advocacy. Findings may inform interventions by higher education institutional agents and research to offset cultural stress and psychological distress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cuento de nunca acabar [never-ending story]: Compounding trauma and mental health among undocumented Latinx immigrants.

Research examining the effects of traumatic events on undocumented Latinx immigrants often focuses on assessing posttraumatic stress disorder or general psychological distress, which may obscure the field's understanding of how trauma exposure impacts other common mental health disorders (e.g., anxiety, depression). This study sought to assess the cumulative, individual, and timing effects of immigration-related traumatic events on anxiety and depressive symptoms among undocumented Latinx immigrants. Participants were 253 undocumented Latinx immigrants recruited using respondent-driven sampling who reported their history of immigration-related trauma exposure and symptoms of depression and anxiety. Results suggest that cumulative immigration-related trauma was significantly associated with increases in anxiety and depressive symptoms, τ = .26. Significant positive correlations were found for cumulative trauma at each point in the immigration process (i.e., before immigration, while in transit to the United States, and while living in the United States) such that increases in the number of events were associated with higher anxiety and depressive symptom levels, τ = .11-.29. Trauma frequency differed throughout the immigration process such that some events more commonly occurred before immigration or during transit to the United States, whereas others occurred while an individual resided in the United States. Random forest algorithms uncovered differences in the relative importance of individual traumatic events in explaining the variance of depressive, R2 = .13, and anxiety symptoms, R2 = .14. The findings highlight the importance of providing trauma-informed care when treating anxiety and depression among undocumented Latinx immigrants and considering multidimensional epidemiological approaches in assessing immigration-related trauma.

Everyday Acts of Resistance: Mexican, Undocumented Immigrant Children and Adolescents Navigating Oppression With Mentor Support.

Study aims were to examine oppression in education among Mexican immigrant youth with undocumented status and how mentors and other adults helped them resist oppression. Qualitative, narrative one-on-one interviews were conducted with 17 Mexican immigrant young adults with undocumented or DACA status in the U.S. Participants provided retrospective accounts from childhood through older adolescence. Analyses revealed critical junctures in which participants experienced oppression: (1) developmental milestones and school events, (2) college application process, (3) unforeseen life events, and (4) incidents of racial discrimination. Mentors and other adults helped participants to resist oppression through advocacy, social capital efforts, role modeling, and emotional, instrumental, and financial support. This study fills gaps in the literature on mentoring and immigrant youth who are undocumented.

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).

Interpretation of vulnerability and cumulative disadvantage among unaccompanied adolescent migrants in Greece: A qualitative study.

BACKGROUND: In settings of mass displacement, unaccompanied minors (UAMs) are recognized as a vulnerable group and consequently prioritized by relief efforts. This study examines how the interpretation of vulnerability by the national shelter system for male UAMs in Greece shapes their trajectories into adulthood. METHODS AND FINDINGS: Between August 2018 and April 2019, key informant interviews were carried out with child protection staff from Greek non-governmental organizations that refer UAMs to specialized children's shelters in Athens to understand how child protection workers interpret vulnerability. In-depth interviews and life history calendars were collected from 44 male migrant youths from Afghanistan, Pakistan, Bangladesh, and Iran who arrived in Greece as UAMs but had since transitioned into adulthood. Analysis of in-depth interviews and life history calendars examined how cumulative disadvantage and engagement with the shelter system altered youths' trajectories into adulthood. Younger adolescents were perceived as more vulnerable and prioritized for shelters over those who were "almost 18" years old. However, a subset of youths who requested shelter at the age of 17 years had experienced prolonged journeys where they spent months or years living on their own in socially isolated environments that excluded them from experiences conducive to adolescent development. The shelter system for UAMs in Greece enabled youths to develop new skills and networks that facilitated integration into society, and transferred them into adult housing when they turned 18 years old so that they could continue developing new skills. Those who were not in shelters by age 18 years could not access adult housing and lost this opportunity. Limitations included possible underrepresentation of homeless youth as well as the inability to capture all nationalities of UAMs in Greece, though the 2 most common nationalities, Afghan and Pakistani, were included. CONCLUSIONS: Due to the way vulnerability was interpreted by the shelter system for UAMs, youths who had the greatest need to learn new skills to facilitate their integration often had the least opportunity to do so. To avoid creating long-lasting disparities between UAMs who are placed in shelters and those who are not, pathways should be developed to allow young adult males to enter accommodation facilities and build skills and networks that facilitate integration. Furthermore, cumulative disadvantages should be taken into account while assessing UAMs' vulnerability. Following UAMs' trajectories into early adulthood was critical for capturing this long-term consequence of the shelter system's interpretation of vulnerability.

Health Care Access and Utilization for Latino Youth in the United States: The Roles of Maternal Citizenship and Distress.

OBJECTIVES: We sought to determine the associations between maternal citizenship and health care access and utilization for US-born Latino youth and to determine whether maternal distress is a moderator of the associations. METHODS: Using 2010-2017 Integrated Public Use Microdata Series National Health Interview Survey data, multivariable logistic regressions were run to examine the associations among maternal citizenship and health care access and utilization for US-born Latino youth. Maternal citizenship and distress interactions were tested. RESULTS: Noncitizen mothers had higher odds of reporting uninsurance, lack of transportation for delaying care, and lower odds of health care utilization for their youth than citizen mothers. Compared with no distress, moderate and severe distress were positively associated with uninsurance, delayed medical care due to cost, lack of transportation, and having had an emergency department visit for their youth. Moderate distress was positively associated with youth having had a doctor's office visit. Noncitizen mothers with moderate distress were less likely to report their youth having had an emergency department visit than citizen mothers with moderate distress. Among severely distressed mothers, noncitizen mothers were more likely to report youth uninsurance and delayed care due to lack of transportation compared with citizen mothers. CONCLUSIONS: Health care access and utilization among US-born Latino youth are influenced by maternal citizenship and distress. Maternal distress moderates the associations among maternal citizenship and youth's health care access and use. Almost one-third of all US-born youth in the United States are Latino and current federal and state noninclusive immigration policies and anti-Latino immigrant rhetoric may exacerbate health care disparities.

Mechanisms of Deterrence: Federal Immigration Policies and the Erosion of Immigrant Children's Rights.

In this commentary, we highlight the US government's proposed changes to the Flores Settlement Agreement, a federal legal settlement from the 1990s that ensures that child welfare principles are applied to immigrant children.We describe how Flores should be understood as mitigating child trauma by ensuring a baseline standard of treatment of immigrant children. We outline how children experience trauma throughout the migration course and argue that the proposed changes decrease standards of care through indefinite child detention, separation, and delicensing immigrant child detention facilities.We draw on the Adverse Childhood Experiences Study to consider the effect these multiplying forms of trauma may have on children.

Immigration-related arrest, parental documentation status, and depressive symptoms among early adolescent Latinos.

OBJECTIVES: Experiencing an immigration-related arrest of a family member adversely impacts youth well-being, yet the role of parental documentation status for exacerbating adverse mental health outcomes following these arrests has not been investigated. METHOD: Using a general population sample of Latino 7th-grade students in an urban public school district in the south-central United States (N = 611), we examined the relationship between an immigration-related arrest of a family member and depressive symptoms as well as the moderating associations of perceived parental documentation status. RESULTS: Using ordinary least squares regression, findings indicate that experiencing or witnessing an immigration-related arrest of a family member is significantly associated with higher rates of depressive symptoms. Moreover, parental citizenship status has a moderating effect; depressive symptoms are magnified among youth who report that both of their parents have undocumented legal status. CONCLUSIONS: The study findings suggest that there are significant consequences for youth well-being when a family member is arrested for immigration-related violations. Further, among youth whose parents are both undocumented, there appears to be a compounding effect on mental health. Immigration policies, programs, and schools need to consider the emotional needs of youth who have undocumented parents, particularly in the context of elevated immigration enforcement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Miles over mind: Transnational death and its association with psychological distress among undocumented Mexican immigrants.

Objective: This study examined the association between transnational death and psychological distress among undocumented Mexican immigrants. The Minority Stress Model and a disenfranchised grief perspective were used as frameworks for this study.Method: Respondent driven sampling (RDS) was used to collect data from clinical interviews with 248 undocumented Mexican immigrants residing near the US-Mexico border.Results: After controlling for relevant covariates, experiencing transnational death was a significant predictor of clinically significant distress in this at-risk population.Conclusions: Our findings underscore the need to contextualize transnational death among undocumented immigrants from a perspective of disenfranchised grief that requires the development of contextually and culturally sensitive interventions aimed at addressing the high prevalence of transnational death and its associated distress in this marginalized population.

Application of the Minority Stress Theory: Understanding the Mental Health of Undocumented Latinx Immigrants.

This paper applies the Minority Stress framework to data collected from an ongoing community-based participatory research project with health and social service agencies in Southeast Michigan. We examine the stressors and coping strategies employed by undocumented Latinx immigrants and their families to manage immigration-related stress. We conducted in-depth interviews with 23 immigrant clients at Federally Qualified Health Care Centers (FQHC) in Southeast Michigan and 28 in-depth interviews with staff at two FQHC's and a non-profit agency serving immigrants. Findings suggest that immigrants face heightened anxiety and adverse mental health outcomes because of unique minority identity-related stressors created by a growing anti-immigrant social environment. Chronic stress experienced stems from restrictive immigration policies, anti-immigrant rhetoric in the media and by political leaders, fear of deportation, discriminatory events, concealment, and internalized anti-immigrant sentiment. Though identity can be an important effect modifier in the stress process, social isolation in the immigrant community has heightened the impact of stress and impeded coping strategies. These stressors have resulted in distrust in community resources, uncertainty about future health benefits, delayed medical care, and adverse mental health outcomes. Findings provide a framework for understanding the unique stressors experienced by immigrants and strategies for interventions by social service agencies.

A qualitative exploration of the experiences of undocumented African immigrant women in the health care delivery system.

BACKGROUND: It is widely acknowledged that experiences of poor treatment during health care encounters can adversely impact how individuals and communities engage with the health care system. Hence, understanding the health care seeking experiences of diverse patient populations is central to identifying ways to effectively engage with marginalized patients and provide optimal care for all patients, particularly those with marginalized identities. PURPOSE: Drawing on the narratives of 24 undocumented African immigrant women, this qualitative study aimed to understand their experiences seeking health care. METHODS: Our study was undergirded by a postcolonial feminist perspective which aims to situate participants' experiences within their given, broader societal context. Data were analyzed using the principles of thematic analysis. FINDINGS: Our findings indicate that women experienced insensitivity during health care encounters and harbored a mistrust of health care staff. DISCUSSION: Findings uncover the need for health care providers to provide culturally safe care and to identify ways to create safe spaces for undocumented patients within the health care setting.

HIV Testing, Risk Behaviors, and Fear: A Comparison of Documented and Undocumented Latino Immigrants.

Latino immigrants in the United States are at elevated risk for HIV infection and delayed HIV diagnosis. Immigration documentation status and its contribution to fears are important barriers to accessing health services including HIV testing. A currently changing political climate within the United States may have increased the complexity of the intersection of documentation status and health care access. This study used an anonymous survey conducted in March and April 2017 in New York City to compare: sociodemographic characteristics, HIV testing behaviors, HIV risk behaviors, and perceptions of fear around HIV testing among documented and undocumented Latino immigrants (N = 301). We found that undocumented immigrants reported lower levels of education, income, and health insurance than did documented immigrants. However, groups did not differ in having tested for HIV in the last 12 months, in future intentions to test for HIV, or in emotional/cognitive perceptions of fear around HIV testing. Undocumented immigrants reported lower rates of having ever tested for HIV in their lifetime (68.6%) than documented immigrants (80.5%) (p = 0.027). In conclusion, we found that despite sociodemographic challenges, undocumented immigrants had similar HIV testing behaviors as their documented counterparts in our study community. Further understanding of the mitigating factors that resulted in seemingly equal access to HIV testing in this community for undocumented immigrants is warranted.

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.

Psychiatric problems among returned migrants in Mexico: updated findings from the Mexican Migration Project.

PURPOSE: Migration is often a stressful process that can have deleterious effects on health. We study the potential mental health consequences of migration by comparing Mexican migrants to the United States who have since returned to Mexico with Mexicans who have never migrated. METHODS: Data from the Mexican Migration Project were used to compare returned migrants and non-migrants in Mexico for the years 2007-2016 (N = 7716). Random intercept logistic regression models were used to estimate the associations between characteristics of migration and psychiatric problems. Coarsened exact matching was implemented to account for the selection bias inherent to migration. RESULTS: Relatively healthier Mexicans were more likely to migrate to the United States, regardless of their documentation status. Returned migrants in Mexico who traveled to the United States while undocumented were significantly more likely to report that they experienced psychiatric problems when compared with non-migrant Mexicans, even after adjusting for demographic, socioeconomic, pre-migration health, and community-level factors. CONCLUSIONS: Undocumented return migrants in Mexico are at-risk of developing psychiatric problems, despite evidence that suggests migrants tend to be healthier than non-migrants before they travel to the United States. Mental health services should encompass strategies for migrants on both sides of the border.

Future Directions in the Study and Treatment of Parent-Child Separation.

Children require adult caregivers to survive and thrive. In the absence of committed and nurturing care, children face increased risk for a number of difficulties, including internalizing and externalizing psychopathology, cognitive and language deficits, and social difficulties. Recent changes in the U.S. immigration system have resulted in a large number of children removed from their parents, drawing increased scrutiny to the impact of parent-child separation and best practices for caring for children who have been separated. Drawing from work on children exposed to institutional care, as well as research on children separated from caregivers due to validated abuse and neglect, it is clear that children belong in families that are safe and supportive and that some forms of substitute care (i.e., institutional or group-based care) are insufficient to meet children's needs. However, it is difficult to know the specific impact of parent-child separation on child outcomes given that stressors often cluster and pre-separation experiences and post-separation placements also contribute to the experience of separation from a parent and subsequent functioning. Attempts to parse the specific contributions of each separation-related stressor, examining sensitive periods in the impact of separation, studying the mechanisms by which separations affect children, and consideration of the broader social and political context are useful future directions for moving this area of study forward. We must also more fully probe the roles that caregivers play in child development. Lastly, we must endeavor to cease practices of removing children from loving and capable caregivers and, when necessary, provide support to parents and children who have experienced separation.

Immigrant health access in Texas: policy, rhetoric, and fear in the Trump era.

BACKGROUND: Since the 2016 presidential election, reports have suggested that President Trump's rhetoric and his administration's proposed policies could be exacerbating barriers to accessing health care for undocumented as well as lawfully present immigrants and their families in the United States. However, very little empirical work has analyzed this possibility or detailed how these reports and rhetoric have altered the health seeking behavior of mixed immigration status families. METHODS: Using a series of focus groups throughout Texas in both English and Spanish, this qualitative study analyzes changes to health access for immigrants. We consulted Community Health Workers to better understand the barriers encountered by their otherwise hard-to-reach undocumented clients and their families as they interface with the health system, revealing key insights about the changing nature of barriers to access under the Trump administration. RESULTS: We identify four key themes about the changing nature of immigrant health access in the United States: growing fear of interacting with health and social services; that social networks are paradoxically limiting health access in the current political climate; that the administration's rhetoric and proposed policies are impeding health seeking behavior; and that children are encountering new barriers to social program participation. CONCLUSIONS: The Trump administration, its proposed immigration policies, and his rhetoric are posing new and significant barriers to health access for immigrants and their families.

Central American Immigrant Mothers' Mental Health in the Context of Illegality: Structural Stress, Parental Concern, and Trauma.

Using a community-based participatory research approach, we surveyed 134 undocumented Central American immigrant mothers to examine correlates of maternal mental health. Drawing upon an ecosystemic framework, predictors of depression included structural and familial stressors, parental concerns, and maternal health factors. Mothers' perceptions of child affect, traumatic stress, and general health ratings were among the most salient predictors. However, structural and familial stressors, such as food insecurity and single parenting, also accounted for significant variance in depression scores. Findings informed community actions such as advocating for mental health care and building awareness of families' lived experiences within the local school system.

Alternative kinship structures, resilience and social support among immigrant trans Latinas in the USA.

Latinas comprise the largest racial/ethnic group of trans women (male-to-female transgender people) in New York City, where HIV seroprevalence among trans Latinas has been found to be as high as 49%. Despite this population's high risk of HIV, little is known about resilience among trans Latinas that may provide protective health factors. Six focus groups and one in-depth interview were conducted with 34 low-income trans/gender-variant people of colour who attended transgender support groups at harm reduction programmes in New York City. This paper reports on data from 13 participants who identified as immigrant trans Latinas. Focus groups were coded and analysed using thematic qualitative methods. The majority of immigrants were undocumented but reported having robust social support. Unique characteristics of immigrant trans Latinas included alternative kinship structures and sources of income. Social creativity was used to develop achievable ways in which to improve their health outcomes. Resilience was evident in informal kinship dynamics, formal support groups, gender-transition, educational access and skills training and substance use reduction. Individual-level resilience increased as a result of strong community-level resilience.

Exploring childhood immunization among undocumented migrants in Sweden - following qualitative study and the World Health Organizations Guide to Tailoring Immunization Programmes (TIP).

OBJECTIVES: National vaccination coverage in Sweden is high. Recurrent outbreaks of measles and rubella however highlight some immunity gaps in the population. Current knowledge about immunization status of undocumented migrant children is scant. The World Health Organization/Europe has developed the Guide to Tailoring Immunization Programmes (TIP) to assist countries in diagnosing barriers and motivators to vaccination in communities with low vaccination coverage. Based on the TIP guide, the objective of this study was to explore determinants to vaccination among undocumented immigrants, using qualitative approach. STUDY DESIGN: The study consisted of three steps: (i) an initial workshop for problem statement; (ii) qualitative research for increased understanding of the vaccination practices of children in the undocumented community; and (iii) a second workshop to incorporate the qualitative interview findings together with data from key stakeholders into a conceptual framework. METHODS: This was a qualitative study featuring interviews of seven undocumented parents recruited at non-governmental clinics, three nurses at Child Health Centers, and information from key stakeholders retrieved at workshops as part of the TIP process. RESULTS: The content analysis revealed two main themes: parental fear of being questioned and parental acceptance of child immunization. Undocumented parents had a positive view and attitude toward childhood immunization but expressed strong fear of being asked for identification papers at healthcare facilities. Owing to lack of knowledge on entitlements of the undocumented among health personnel, parents were incorrectly rejected when seeking care for their children. Frequent mobility among undocumented may limit access to complete the immunization schedule. Undocumented parents mistrust healthcare providers and avoid health facilities, further delaying childrens' access to health care, including immunization services. CONCLUSIONS: The findings of this study confirm the complexity of barriers that undocumented parents face regarding childhood immunization. The TIP guide offers a valuable process for a deeper understanding of the determinants of immunization challenges among undocumented migrants.