Cardiovascular risk and access to primary care: Comparisons among Chinese documented and undocumented immigrants.

AIMS: The aim of this study was to examine main risk factors of undocumented Chinese migrants living in Italy when compared with Chinese migrants registered with National Health Service (NHS). METHODS: A cohort of 3435 Chinese first-generation immigrants living in Prato underwent blood pressure (BP) measurement and blood tests. Hypertension was diagnosed for BP ≥ 140/90 mmHg at 2 visits, and/or antihypertensive drug use; type 2 diabetes (T2DM) for fasting glucose ≥ 126 mg/dL at 2 visits, and/or use of hypoglycemic drugs; hypercholesterolemia (HC) for cholesterol ≥ 240 mg/dL and/or statins use. Subjects diagnosed with hypertension, T2DM, or HC unaware of their condition were considered newly diagnosed. Comparisons were performed using multivariable adjusted logistic regression analysis. RESULTS: A large proportion of Chinese migrants were undocumented (1766, 51 %); newly diagnoses of risk factors were performed especially among undocumented migrants; registration with NHS was associated with higher level of awareness for hypertension and T2DM and with 6 times higher rate of treatment for T2DM. Only a small minority of subjects with high cholesterol were treated with statins. CONCLUSIONS: Undocumented immigrants had high prevalence of risk factors with lower levels of awareness than migrants registered with the NHS. Health policies targeting this hard-to-reach population needs to be improved.

Enriching Thinking Through Discourse.

Great effort is invested in identifying ways to change people's minds on an issue. A first priority should perhaps be enriching their thinking about the issue. With a goal of enriching their thinking, we studied the views of community adults on the DACA issue-young adults who entered the United States illegally as children. A dialogic method was employed, offering dual benefits in providing participants the opportunity to further develop their own ideas and to consider differing ideas. Yet, participants engaged in dialog only vicariously by observing the talk of a pair of actors who held opposing positions on DACA. The effect on participants' thinking was greatest in the condition in which they viewed a dialog between the two actors, rather than a comparison condition in which the actors individually expressed their positions. In control conditions, no presentation was observed. Probing questions included in all conditions encouraged a participant to examine and clarify for themselves their own position, potentially enriching it. This condition proved unsuccessful in enriching thinking; participants' justifications for their own positions in fact became simpler and less qualified. In contrast, observing a video of a like-minded and opposing other did enrich observers' thinking, yet to a greater degree in the dialogic than nondialogic condition. The findings thus suggest observed dialog as a promising practical approach in promoting deeper thinking.

Navigating a climate of administrative burden: the perspectives of young adult undocumented immigrants in applying for COVID-19 disaster relief assistance for immigrants in California.

Undocumented immigrants experienced high levels of economic insecurity during the COVID-19 pandemic while being excluded from government-based relief and unemployment benefits. In April 2020, California became the first state to offer financial aid to undocumented immigrants through the innovative Disaster Relief Assistance for Immigrants (DRAI) program in collaboration with several community-based organizations (CBOs). However, the process of applying for aid was marked by many implementation challenges, such as intake and language access; however, little data exists on the direct experiences of the undocumented community. This qualitative study examines the experiences of undocumented Asian and Latinx young adults living in California in applying for DRAI through framework of administrative burden. Themes distilled from participant experiences highlight how administrative burden via learning, psychological, and compliance costs shape the ways in which undocumented immigrants navigate policies and programs, such as DRAI. These experiences highlight the need for policymakers to address structural and programmatic administrative burdens in policy development; failure to do so result in detrimental impacts that outweigh financial benefits or cause communities to forgo needed resources.

Everyday discrimination and risk for clinical depression among a community sample of undocumented Latino immigrants in the United States.

Undocumented Latino immigrants in the United States face pervasive discrimination that increases their risk for experiencing depressive symptomatology. Although research has linked discrimination to depressive symptoms more broadly, we do not know whether everyday forms of discrimination are associated with elevated risk for clinical depression among this population. Using data collected from a community sample of undocumented Latino immigrants during the 2015 Trump campaign, we found that everyday discrimination was associated with significantly higher odds of being classified as higher risk for clinical depression. Findings indicate everyday discrimination as a risk factor for clinical depression among undocumented Latino immigrants.

The Transplant Experience for Undocumented Immigrant Patients Formerly Receiving Emergency Dialysis and Caregivers.

Importance: Individuals of undocumented immigration status with kidney failure face barriers to receiving transplants due to lack of health insurance despite no regulatory barriers. Little is known about the perspectives on kidney transplant among individuals with undocumented immigration status with kidney failure who relied on emergency hemodialysis. Objective: To examine the overall experiences of transplant among transplant recipients of undocumented immigration status who previously relied on emergency hemodialysis and their family caregivers. Design, Setting, and Participants: In this qualitative study, semistructured 1-to-1 interviews were conducted with transplant recipients who had previously received emergency hemodialysis and transitioned to scheduled dialysis and their primary caregivers living in Denver, Colorado, between May 1, 2022, and March 31, 2023, in English or Spanish. Main Outcomes and Measures: Themes and subthemes regarding the experience of transplant as an undocumented immigrant previously receiving emergency hemodialysis were identified. Interview transcripts were translated, deidentified, and then analyzed using thematic analysis. Results: A total of 25 participants including 15 transplant recipients (5 [33.3%] female and 10 [66.7%] male; mean [SD] age, 49.5 [9.8] years) and 10 caregivers (7 [70.0%] female and 3 [30.0%] male; mean [SD] age, 44.5 [22.3] years) participated. Six themes were reported: limited kidney replacement therapy education while receiving emergency hemodialysis (lack of awareness of kidney disease and treatment options and discriminatory kidney replacement therapy education due to immigration status), hope for transplant once receiving scheduled dialysis (prospect of transplant through scheduled dialysis, family and quality of life as transplant motivators), transplant education and health insurance after transition to scheduled dialysis (inadequate transplant education in dialysis clinic, peer-to-peer transplant education, and peer-to-peer communication regarding availability of private health insurance), uncertainty during transplant evaluation (difficulty navigating the evaluation and wait-listing process, lack of communication regarding timeline, and concern for family limiting living donation), posttransplant improvements (ability to work after transplant is critically important given immigration status, autonomy with transplant improves mental health, and vigilance in maintaining transplant), and transplant facilitators (self-advocacy, spirituality and optimism, and peer support). Conclusions and Relevance: This qualitative study of transplant recipients of undocumented immigration status and their caregivers found that individuals formerly receiving emergency dialysis are excluded from education and access to transplant, and peer support throughout the transplant process helped with education and motivation to pursue transplant. These findings may be used to implement improvements in access to support and education for patients of undocumented immigration status with kidney failure, especially in areas where scheduled dialysis is not available.

"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.

Exploring the Effect of Anti-immigration Rhetoric on Emergency Department Use by Undocumented Adults.

An unwelcoming policy climate can create barriers to health care access and produce a 'Chilling Effect' among immigrant communities. For undocumented immigrants, barriers may be unique and have a greater impact. We used administrative emergency department (ED) data from 2015 to 2019 for a Midwestern state provided under a data use agreement with the state hospital association. General linear modelling was used to estimate the impact of anti-immigrant rhetoric on ED visit intensity among non-elderly adults who were likely Hispanic/Latino with undocumented status. Compared to 2015, the average ED visit intensity among adults who were likely Hispanic/Latino with undocumented status was significantly higher during 2016-2019 when anti-immigrant rhetoric was heightened. The magnitude of this change increased over time (0.013, 0.014, 0.021, and 0.020, respectively). Additionally, this change over time was not observed in the comparison groups. Our findings suggest that anti-immigrant rhetoric may alter health care utilization for adults who are likely Hispanic/Latino with undocumented status. Limitations to our findings include the use of only those likely to be Hispanic/Latino, data from only one Midwestern state and the loss of data due to non-classification using the NYU ED algorithm. Further research should focus on validating these findings and investigating these identification methods and anti-immigrant rhetoric effects among other undocumented groups including children and adults of different race or ethnicity such as black, both those that identify as Hispanic/Latino and those that do not. Developing strategies to improve health care access for undocumented Hispanic/Latino adults also warrants future research.

Implications of Undocumented Status for Latinx Families During the COVID-19 Pandemic: A Call to Action.

BACKGROUND: A disproportionate number of COVID-19 cases and deaths have been reported among Latinxs in the U.S. Among those most affected by the pandemic are marginalized families, including those that are undocumented and mixed-status, in which some, but not all members are undocumented. Undocumented and mixed-status families face multiple and chronic daily stressors that compromised their health and wellbeing. Salient stressors faced by undocumented Latinx families include poverty, social disadvantage, discrimination, dangerous living and working conditions, and limited access to healthcare. These stressors are frequently compounded with trauma, fear of detention, deportation, and family separation. PURPOSE: Informed by the literature and insights from our community-based work to address the health needs of undocumented and mixed status Latinx families during the pandemic, this paper uses a social determinants of health lens to present a narrative summary that highlights four primary psychosocial stressors faced by these families and their implications for mental health. DISCUSSION: These include stressors pertaining to (a) anti-immigrant rhetoric and actions; (b) family stressors and disruptions in family dynamics; (c) economic changes and financial losses; and (c) limited access to healthcare. Implications of the aforesaid stressors on the mental health of undocumented families and youth are also discussed. In addition, recommendations are provided for the provision of mental health services, best practices, and resources from a strengths-based approach.

Barriers to Disclosure of Intimate Partner Violence Among Undocumented Spanish-Speaking Immigrants in the United States.

Undocumented monolingual Spanish-speaking immigrants are one of the most vulnerable and marginalized groups to experience intimate partner violence (IPV) in the United States. This paper explores the barriers that prevent IPV disclosure in healthcare settings. Qualitative interviews (n = 14) were conducted with previously undocumented Spanish-speaking legal clients of a community domestic violence agency. The major barriers expressed by the interviewees regarding IPV screening and disclosure include limited opportunities for IPV screening, misinformation about legal rights from abusers, fear of deportation and separation from children, and lack of knowledge about resources.

State Public Insurance Coverage Policies and Postpartum Care Among Immigrants.

Importance: Professional medical organizations recommend that adults receive routine postpartum care. Yet, some states restrict public insurance coverage for undocumented immigrants and recently documented immigrants (those who received legal documentation status within the past 5 years). Objective: To examine the association between public insurance coverage and postpartum care among low-income immigrants and the difference in receipt of postpartum care among immigrants relative to nonimmigrants. Design, Setting, and Participants: A pooled, cross-sectional analysis was conducted using data from the Pregnancy Risk Assessment Monitoring System for 19 states and New York City including low-income adults with a live birth between 2012 and 2019. Exposure: Giving birth in a state that offered public insurance coverage for postpartum care to recently documented or undocumented immigrants. Main Outcomes and Measures: Self-reported receipt of postpartum care by the category of coverage offered (full coverage: states that offered publicly funded postpartum care regardless of immigration status; moderate coverage: states that offered publicly funded postpartum care to lawfully residing immigrants without a 5-year waiting period, but did not offer postpartum care to undocumented immigrants; no coverage: states that did not offer publicly funded postpartum care to lawfully present immigrants before 5 years of legal residence or to undocumented immigrants). Results: The study included 72 981 low-income adults (20 971 immigrants [29%] and 52 010 nonimmigrants [71%]). Of the 19 included states and New York City, 6 offered full coverage, 9 offered moderate coverage, and 4 offered no coverage; 1 state (Oregon) switched from offering moderate coverage to offering full coverage. Compared with the states that offered full coverage, receipt of postpartum care among immigrants was 7.0-percentage-points lower (95% CI, -10.6 to -3.4 percentage points) in the states that offered moderate coverage and 11.3-percentage-points lower (95% CI, -13.9 to -8.8 percentage points) in the states that offered no coverage. The differences in the receipt of postpartum care among immigrants relative to nonimmigrants were also associated with the coverage categories. Compared with the states that offered full coverage, there was a 3.3-percentage-point larger difference (95% CI, -5.3 to -1.4 percentage points) in the states that offered moderate coverage and a 7.7-percentage-point larger difference (95% CI, -10.3 to -5.0 percentage points) in the states that offered no coverage. Conclusions and Relevance: Compared with states without insurance restrictions, immigrants living in states with public insurance restrictions were less likely to receive postpartum care. Restricting public insurance coverage may be an important policy-driven barrier to receipt of recommended pregnancy care and improved maternal health among immigrants.

COVID-19-Related Emergency Department Visits Among Undocumented Patients in Los Angeles County.

Undocumented immigrants may be vulnerable to poor COVID-19 outcomes, but also may be less likely to seek medical care. To our knowledge, there have not been any investigations of potential COVID-19 disparities by immigration status. We analyzed emergency department (ED) visit data from March 20, 2020 to September 30, 2020 among patients in a safety-net hospital in Los Angeles County (n=30,023). We compared the probability of COVID-19-related ED visits between undocumented immigrants and Medi-Cal patients. We also examined differences in these comparisons over time. Undocumented patients had higher odds of COVID-19-related ED visits than Medi-Cal patients (OR: 1.41, 95% CI: 1.24-1.60) for all months in the study period except September. Even in the earliest days of the pandemic, undocumented patients were more likely than Medi-Cal patients to have a COVID-19-related ED visit. Additional analyses suggest this was likely because of higher COVID-19 exposure rather than differences in ED utilization.

Psychiatric Admissions Among Undocumented Immigrants at an Urban County Hospital.

Little is known about the inpatient mental health needs of undocumented immigrants in the United States. Based on existing literature, we hypothesized that undocumented patients would have fewer psychiatric admissions than documented patients. We reviewed 2019 inpatient admission data for Hispanic/Latino patients at an urban hospital. Patients were coded as undocumented or documented using insurance proxies. Multivariable logistic regression was used to report odds ratio of admission diagnoses of interest by documentation status. There were no significant differences in psychiatric admissions between undocumented patients (2.1%) and documented patients (2.8%) (p=.77). Compared with documented counterparts, undocumented patients were more likely to be admitted for alcohol-related disorders (AOR=1.59, 95%CI=1.31-1.93) but had lower proportions of admission for substance-related disorders, mood disorders, anxiety disorders, and suicide and intentional self-inflicted injury among others. Future studies should examine factors contributing to alcohol use disorder and barriers to accessing and using mental health care.

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

INTRODUCTION: Immigrant-related social policies and immigration enforcement contribute to a sociopolitical environment that affects immigrants' health. This exploratory study in six metro-Atlanta counties examined associations among immigrants' perceived vulnerability to harmful immigrant-related social policies and county-level 287(g) agreements (which facilitate cooperation between local law enforcement and federal immigration authorities), county-level immigration enforcement levels (arrests, community arrests, detainers, and removals), and immigrants' mental health. METHODS: Using data from a 2020 study among Latinx parents who were undocumented or members of mixed-status families (N = 140), we merged data on individuals' perceived policy vulnerability and depressive and anxiety symptoms with county 287(g) status and immigration enforcement levels. RESULTS: Perceived policy vulnerability was not associated with county-level 287(g) status or immigration enforcement levels. Greater policy vulnerability and Immigration and Customs Enforcement arrests were associated with higher depressive and anxiety symptoms, but 287(g) status was associated with lower depressive and anxiety symptoms. CONCLUSION: Perceived policy vulnerability, 287(g) status, and immigration enforcement levels do not always align and can have different associations with mental health.

Health Advocacy for Undocumented Immigrant Pregnant Patients.

The challenges of providing prenatal care for undocumented immigrants require patience. Pregnant undocumented immigrant women should receive routine prenatal care tailored to their specific needs, with an emphasis on basic needs (eg, housing, safety, food, transportation to appointment). Financial, cultural, and language barriers can impede undocumented immigrants from receiving adequate or optimal prenatal care. Adverse maternal and fetal outcomes may be more common but have not been well-quantified and cannot be compared with outcomes if care had been provided in their country of origin. An example of a community-funded clinic is described in minimizing cost and optimizing outcomes.

DACA Recipient Health Care Workers' Barriers to Professionalization and Deployment of Navigational Capital in Pursuit of Health Equity for Immigrants.

The COVID-19 pandemic has laid bare entrenched health inequalities in the U.S. health care system faced by structurally marginalized immigrant communities. Deferred Action for Childhood Arrivals (DACA) recipients are well suited to address these social and political determinants of health due to their large presence in service positions and skill sets. Yet their potential in health-related careers is limited by unique barriers related to uncertainty about their status and training and licensure processes. We report findings from a mixed-method (interview and questionnaire) study of 30 DACA recipients in Maryland. Nearly half of participants (14; 47%) worked in health care and social service fields. The longitudinal design featured three research phases conducted between 2016 and 2021, which enabled us to observe participants' evolving career trajectories and capture their experiences during a tumultuous period (due to the DACA rescission and COVID-19 pandemic). Using a community cultural wealth (CCW) framework, we present three case studies that demonstrate challenges recipients encountered as they embarked on health-related careers, including protracted educational journeys, concerns about program completion/licensure, and uncertainty about future employment. Yet participants' experiences also revealed valuable forms of CCW they deploy, including building on social networks/collective knowledge, forging navigational capital and sharing experiential knowledge, and leveraging identity to devise innovative strategies. Results highlight the critical value of DACA recipients' CCW that renders them particularly apt brokers and advocates in promoting health equity. Yet they also reveal the urgent need for comprehensive immigration and state-licensure reform to promote DACA recipients' inclusion in the health care workforce.

Assessment of a Peer Support Group Intervention for Undocumented Latinx Immigrants With Kidney Failure.

Importance: Most undocumented immigrants with kidney failure rely on emergency dialysis (defined as dialysis after a patient presents as critically ill) and experience significant depression and anxiety and high mortality. Culturally and language-concordant peer support group interventions may be associated with reduced depression and anxiety and may provide emotional support. Objective: To investigate the feasibility and acceptability of a single-group peer support group intervention. Design, setting, and participants: This qualitative and single-group prospective study for undocumented immigrants with kidney failure receiving emergency dialysis was conducted in Denver, Colorado, from December 2017 to July 2018. The 6-month intervention included peer support group meetings in the hospital while participants were hospitalized for emergency dialysis. Data were analyzed from March to June 2022. Main outcomes and measures: To assess feasibility, the recruitment, retention, implementation, and delivery for the intervention were tracked. To measure acceptability, interviews were conducted with participants using a structured format. To assess the value of the peer support group intervention, themes and subthemes were identified from interviews with participants and group meetings. Results: Of 27 undocumented immigrants with kidney failure receiving emergency dialysis, 23 participants (9 females [39.1%] and 14 males [60.9%]; mean [SD] age, 47 [8] years) agreed to participate (recruitment rate, 85.2%). Among them, 5 individuals withdrew and did not attend meetings and 18 participants (retention rate, 78.3%) attended a mean of 6 of 12 meetings (50.0%). From interviews and meetings, 3 themes, with associated subthemes, were identified: camaraderie and emotional support from peers (subthemes: peer support is vital for people newly diagnosed with kidney failure, safe space to build relationships and share hardship with peers, hospital setting for peer support is ideal, solidarity to survive and change policy, and sustainability of the peer support group), solutions to improve care and resilience (subthemes: self-advocacy, self-motivation and optimism, kidney disease education, emotional support from peers caregivers, and faith), and emotional and physical aspects of receiving emergency dialysis (subthemes: psychosocial and physical distress, mixed experiences with language-concordant care, emotional exhaustion from end-of-life conversations, and gratitude for clinicians). Conclusions and relevance: This study found that peer support group intervention achieved feasibility and acceptability. The findings suggest that a peer support group may be a patient-centered strategy to build camaraderie and provide emotional support in kidney failure, especially for socially marginalized uninsured populations who report limited English proficiency.