Health Care Access and Utilization and the Latino Health Paradox.

BACKGROUND: The Latino health paradox is the phenomenon whereby recent Latino immigrants have, on average, better health outcomes on some indicators than Latino immigrants who have lived in the United States longer and US-born Latinos and non-Latino Whites. This study examined whether the paradox holds after accounting for health care access and utilization. METHODS: The 2019-2020 National Health Interview Survey data were used. The main predictors included population groups of foreign-born and US-born Latinos (Mexican or non-Mexican) versus US-born non-Latino Whites. Predicted probabilities of health outcomes (self-reported poor/fair health, overweight/obesity, hypertension, coronary heart disease, diabetes, cancer, and depression) were calculated and stratified by length of residence in the United States (<15 or ≥15 years) among foreign-born Latinos and sex (female or male). Multivariable analyses adjusted for having a usual source of care other than the emergency department, health insurance, a doctor visit in the past 12 months, predisposing and enabling factors, and survey year. RESULTS: After adjusting for health care access, utilization, and predisposing and enabling factors, foreign-born Latinos, including those living in the United States ≥15 years, had lower predicted probabilities for most health outcomes than US-born non-Latino Whites, except overweight/obesity and diabetes. US-born Latinos had higher predicted probabilities of overweight/obesity and diabetes and a lower predicted probability of depression than US-born non-Latino Whites. CONCLUSIONS: In this national survey, the Latino health paradox was observed after adjusting for health care access and utilization and predisposing and enabling factors, suggesting that, although these are important factors for good health, they do not necessarily explain the paradox.

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

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

Association between immigration enforcement encounters and COVID-19 testing and delays in care: a cross-sectional study of undocumented young adult immigrants in california.

BACKGROUND: Undocumented immigrants are expected to face increased risks related to COVID-19 due to marginalizing restrictive immigration policies. However, few studies have assessed the prevalence of direct encounters with the immigration enforcement system among the undocumented and its impacts on their COVID-related health behaviors and outcomes. In this study, we quantify undocumented immigrants' lifetime exposure to various immigration enforcement tactics and their association with delays in COVID-19 testing and healthcare behaviors. METHODS: This cross-sectional study included a non-random sample of 326 Asian and Latinx undocumented immigrants in California from September 2020 to February 2021. The primary exposure was immigration enforcement encounter scores ranging from 0-9, assessed through self-reports of direct experiences with the immigration system, immigration officials, and law enforcement. The main outcomes were positive test for COVID-19, had or suspected having COVID-19, and delayed or avoided testing and/or treatment for COVID-19 due to immigration status. We used multivariable logistic regression models to examine the association between the primary exposure and outcomes of interest. RESULTS: Among 326 participants, 7% had received a positive COVID-19 test result, while 43% reported having or suspected having COVID-19. Almost 13% delayed or avoided COVID-19 testing and/or treatment because of their immigration status. Overall, an increase in immigration enforcement encounters was associated with higher odds of suspecting having had COVID-19 (aOR = 1.13; 95% CI: 1.01,1.26). Reporting an additional enforcement encounter was associated with higher odds of delaying or avoiding testing and/or treatment because of immigration status (aOR = 1.53, 95% CI: 1.26,1.86). Compared to their Latino counterparts, Asian respondents were more likely to report higher odds of delaying or avoiding testing and/or treatment (aOR = 3.13, 95% CI: 1.17,8.42). There were no significant associations between the enforcement score and testing positive for COVID-19. Additionally, while Latinxs were more likely to report immigration enforcement encounters than Asians, there were no differences in the effects of race on COVID-19 testing and healthcare behaviors in models with race as an interaction term (p < 0.05). CONCLUSIONS: Immigration enforcement encounters compound barriers to COVID-19 testing and treatment for undocumented immigrants.

Preventing the Spread of COVID-19 in Immigration Detention Centers Requires the Release of Detainees.

Immigration detention centers are densely populated facilities in which restrictive conditions limit detainees' abilities to engage in social distancing or hygiene practices designed to prevent the spread of COVID-19. With tens of thousands of adults and children in more than 200 immigration detention centers across the United States, immigration detention centers are likely to experience COVID-19 outbreaks and add substantially to the population of those infected.Despite compelling evidence indicating a heightened risk of infection among detainees, state and federal governments have done little to protect the health of detained im-migrants. An evidence-based public health framework must guide the COVID-19 response in immigration detention centers.We draw on the hierarchy of controls framework to demonstrate how immigration detention centers are failing to implement even the least effective control strategies. Drawing on this framework and recent legal and medical advocacy efforts, we argue that safely releasing detainees from immigration detention centers into their communities is the most effective way to prevent COVID-19 outbreaks in immigration detention settings. Failure to do so will result in infection and death among those detained and deepen existing health and social inequities.

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

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

Lessons from Two Latino Communities Working with Academic Partners to Increase Access to COVID-19 Testing.

OBJECTIVE: We sought to examine the experiences of community partners in a community-academic partnership to promote COVID-19 testing in two majority Latino communities. METHODS: We conducted semistructured, in-depth interviews in English and Spanish with community-based organization leaders and community health workers/promotoras (n = 10) from June to July 2021. Interviews focused on identifying partner roles in planning and testing implementation and evaluating communication among partners. Interviews were transcribed and analyzed in ATLAS.ti version 8.4.5. Analyses involved deductive and inductive approaches to identify key themes. RESULTS: Participants described both strengths and challenges to the collaborative approach within each of three core themes: building relationships in the time of COVID-19; uplifting existing community leadership; and commitment of the academic partners and community-based organizations to conduct partnership activities in Spanish. CONCLUSION: Community-academic partnerships that invest in strong relationships, community leadership, and a commitment to the community's preferred language offer a promising approach to addressing COVID-19 testing barriers. Findings provide direction for future research on how community members and academic partners can come together to inform strategies to continue addressing the COVID-19 pandemic.

Mental health among rural Latino immigrants during the COVID-19 pandemic.

The mental health of the United States' Latino population significantly deteriorated during the SARS-CoV-2 (COVID-19) pandemic, and Latino immigrants living in rural areas faced unique vulnerabilities. However, few studies have specifically examined the mental health burden and experiences of rural Latino immigrants during the COVID pandemic. To understand the mental health experiences of first- and second-generation Latinos in rural areas, we conducted semi-structured interviews with 35 Latino residents of rural California counties during July 2020-February 2021 and screened all respondents for major depression and generalized anxiety symptoms using the Patient Health Questionnaire [PHQ]-2 and Generalized Anxiety Disorder [GAD]-2 screeners. We explored the prevalence of symptoms of depression and anxiety in our sample, iteratively analyzed participants' narratives regarding the mental health impact of the pandemic, and used their mental health screener status to contextualize these narratives. Results indicated that nearly all respondents viewed mental health as a major concern, and 34% (n â€‹= â€‹12) of respondents screened positive for major depression or generalized anxiety disorder. Respondents connected their mental health concerns to experiences of financial precarity, fear of contracting COVID-19, social isolation, and the challenges of remote schooling. Additional themes emerged around problems accessing the mental health care system, the utility of pre-pandemic mental health services, and using healthy coping mechanisms to alleviate psychological problems. Respondents' narratives tended to focus on the mental health challenges facing their family members, particularly their children. Our findings suggest that mental health intervention models that engage with multiple family members, policies that support infrastructure for encouraging exercise and outdoor activity, and ensuring access to culturally and linguistically appropriate mental health care for Latino communities may be important for protecting population mental health.

Cumulative Risk of Immigration Prison Conditions on Health Outcomes Among Detained Immigrants in California.

OBJECTIVES: The USA maintains the world's largest immigration detention system. This study examines the mechanisms by which detention serves as a catalyst for worsening health. METHODS: Using data from detained immigrants in California (n = 493) from 2013 to 2014, we assessed the prevalence of exposure to conditions of confinement hypothesized to negatively influence health; the extent to which conditions of confinement are associated with psychological stress, diagnosed mental health conditions, and/or declines in general health; and the cumulative impact of confinement conditions on these outcomes. RESULTS: We found that each condition increased the likelihood of one or more negative health conditions, but there was also a cumulative effect: for each additional confinement condition, the odds of worsening general health rose by 39% and reporting good health decreased by 24%. CONCLUSIONS: Confinement conditions are associated with poor physical and mental health outcomes among immigrants detained in immigration prisons. Policies that seek to improve specific conditions in detention centers may remove some risks of harm, but alternatives to detention are likely to be most effective.

Social exclusion at the intersections of immigration, employment, and healthcare policy: A qualitative study of Mexican and Chinese immigrants in California.

While immigrants in the US suffer poor access to healthcare in general, access within immigrant populations varies notably by legal status and employment. Intersections between immigration, employment, and healthcare policy have shaped immigrants' access or exclusion from healthcare; however, little research has examined how immigrants experience and navigate these intersections. Drawing on social exclusion theory and the theory of bounded agency, we aimed to investigate Mexican and Chinese immigrants' experiences of exclusion from healthcare as one key dimension of social exclusion-and how this was shaped by interactions with the institutions of immigration and employment. The examination of two ethnic immigrant groups who live under the same set of policies allows for a focus on the common impacts of policy. We selected Mexican and Chinese immigrants as the two largest subgroups in California's Latinx and Asian immigrant population. We use a policy lens to analyze qualitative data from the mixed-methods Research on Immigrant Health and State Policy (RIGHTS) Study, involving 60 in-depth interviews with Mexican and Chinese immigrants in California between August 2018-August 2019. We identified two primary themes: pathways of social exclusion and access, and strategies used to address social exclusion. Findings show that immigrants' exclusion from healthcare is fundamentally linked to legal status and employment, and that immigrants navigate difficult choices between opportunities for improved employment and changes in legal status. We argue that multiple categories of legal status affect immigrants' employment opportunities and social position, which, in turn, translates to stratified healthcare access. Our findings support the literature establishing legal status as a mechanism of social stratification but challenge legal-illegal binary paradigms.

Understanding US Immigration Detention: Reaffirming Rights and Addressing Social-Structural Determinants of Health.

A crisis of mass immigration detention exists in the United States, which is home to the world's largest immigration detention system. The immigration detention system is legally classified as civil, rather than criminal, and therefore non-punitive. Yet it mimics the criminal incarceration system and holds detained individuals in punitive, prison-like conditions. Within immigration detention centers, there are increasing reports and recognition of civil and human rights abuses, including preventable in-custody deaths. In this paper, we propose understanding the health impacts of detention as an accumulation of mental and physical trauma that take place during the entirety of a detained immigrant's experience, from migration to potential deportation and removal. Further, we explore the social-structural determinants of health as they relate to immigration detention, contextualize these determinants within a human rights framework, and draw parallels to the larger context of US mass incarceration. Realizing the right to health requires addressing these social-structural determinants of health. For the care of immigrant patients to be effective, clinicians and public health professionals must incorporate an awareness of the health risks of the immigration detention system into trauma- and human rights-informed models of care during and after detention.