Determining the role of acculturative stress in predicting mental health service use among Latinx immigrants.

OBJECTIVES: Acculturative stress is an important factor that affects health for Latinx immigrants in the US, with multiple studies identifying a link between depression and acculturative stress in this population. However, far fewer studies have examined the specific role and relationship of acculturative stress on mental health service use in this population. Through the lens of Yang's 2016 Model of Immigrant Health Service Use, this study aimed to examine the role of acculturative stress in predicting mental health service use in a sample of Latinx immigrants in the Southeast US. DESIGN: We conducted a secondary data analysis from a longitudinal study of Latinx immigrant health (n = 391). RESULTS: Our study found that while total acculturative stress was not significantly associated with mental health service use in this sample, parenting stress was a significant predictor of mental health service use in the past six months when controlling for covariates (OR: 1.043, 95% CI [1.009, 1.078]). Additionally, important Predisposing and Need for Healthcare factors were significantly associated with mental health service use, specifically: males were less likely to utilize mental health services than females (OR: 0.401, 95% CI [0.166-0.968]), English language acculturation was positively associated with mental health service use (OR: 1.953, 95% CI [1.130, 3.377]), and depression was positively associated with mental health service use (OR: 1.107, 95% CI [1.027, 1.194]). CONCLUSION: These findings support the need for more culturally sensitive mental health services, and the need to develop strategies to engage males and less acculturated individuals in mental health services to promote health equity among Latinx immigrants.

US public charge policy and Latinx immigrants' thoughts about health and healthcare utilization.

OBJECTIVES: We examined Latinx immigrants' perceptions of US policy related to restrictions on immigrants' use of public resources and their thoughts about the influence of these on immigrants' healthcare utilization. DESIGN: A series of 16 focus group discussions with Latinx immigrant men and women (documented and undocumented) (N = 130) were conducted between May and July 2017 across four US cities. RESULTS: Four central themes emerged: participants attributed the limited resources available for affordable healthcare for many uninsured US immigrants (both documented and undocumented) to the US government's view of immigrants as burdens on public resources and its subsequent unwillingness to dedicate funds for their care; participants expressed concerns, some unfounded, about negative immigration ramifications arising from diagnosis with health conditions perceived to be serious and/or expensive to treat; participants noted that some immigrants avoided using health programs and services to which they were entitled because of immigration concerns; finally, participants described how access to information on immigration laws and healthcare resources, and conversely, misinformation about these, influenced healthcare utilization. CONCLUSIONS: Participants were acutely aware of the image of immigrants as public charges or potential burdens on government resources that underlies US immigration policy. In some cases, participants came to inaccurate and potentially harmful conclusions about the substance of laws and regulations based on their beliefs about the government's rejection of immigrants who may burden public resources. This underscores the importance of ensuring that immigrants have access to information on immigration-related laws and regulations and on healthcare resources available to them. Participants noted that access to information also fostered resilience to widespread misinformation. Importantly, however, participants' beliefs had some basis in US immigration policy discourse. Law and policy makers should reconsider legislation and political commentary that frame self-reliance, the guiding principle of US immigration policy, in terms of immigrants' use of publicly funded healthcare resources.

Telehealth for All? Assessing Remote Service Delivery for Latinx Immigrants.

The COVID-19 pandemic spurred a widespread shift to remotely delivered health services. Telehealth has shown promise in making healthcare more accessible. Little research has looked at the effects of this change on access to healthcare for Latinx immigrants. This qualitative study explored the shift to remote services during the COVID-19 pandemic in a new immigrant destination. Authors interviewed 23 service providers to assess if telehealth increased access to healthcare for Latinx immigrants. Results showed that telehealth improved access to services overall. Still, barriers to care remained. Immigrants experienced (a) limited access to technology and low digital literacy, (b) lack of privacy during the provision of services, (c) inability to utilize certain digital platforms due to confidentiality regulations, and (d) decreased quality of services. Findings suggest that telehealth is a promising modality to decrease healthcare disparities, but providers need to thoughtfully address barriers unique to Latinx immigrants to ensure their full participation.

The citizenship shield: Mediated and moderated links between immigration status, discrimination, food insecurity, and negative health outcomes for latinx immigrants during the COVID-19 pandemic.

A framework termed "the citizenship shield" is introduced to conceptualize how legal protections buffer against negative health outcomes among Latinx immigrants in the United States. In this study, we tested the citizenship shield framework in the context of the disproportionate impact of the COVID-19 pandemic on Latinx immigrants. We investigated the connection between immigration status, discrimination, food insecurity, and negative health outcomes. Analyses involved testing mediation and moderation models among a community-based sample of 536 Latinx immigrants holding five statuses (i.e., U.S. citizenship, permanent residency, Deferred Action for Childhood Arrivals, undocumented, and temporary status). Results suggested that food insecurity mediated the link between discrimination and negative impacts from the pandemic for Latinx immigrants across all statuses. Follow up analyses suggested that two of the three paths were moderated by immigration status. This research provides novel, important data to inform health interventions and federal policy targeted for the most vulnerable immigrants in the United States.

Impact of pre-migration assets and pre-migration trauma on acculturative stress among recent Latinx immigrant young adults.

BACKGROUND: Pre-migration trauma is associated with adverse mental health outcomes among Latinx immigrants. Pre-migration assets like family cohesion and social support may promote positive mental health outcomes in this population. The current study aims to identify the cumulative and interaction effects of pre-migration trauma, social support, and family cohesion on acculturative stress among recent Latinx immigrants (RLIs). METHOD: The current study utilizes baseline data from an on-going longitudinal study following 540 RLIs during their initial 3 years in the U.S. Simple main effects of the predictor variables on acculturative stress were estimated using hierarchical multiple regression (HMR). Predictor variables were entered into the HMR model as follows: (1) demographic variables were entered in the first block, (2) family cohesion and social support in the second block and (3) pre-migration trauma in the third block. Interaction effects between family cohesion and social support on the association between pre-migration trauma and acculturative stress were examined. RESULTS: Results showed that 20.6% of the variance of acculturative stress was explained by the predictor variables entered into the HMR model. The first predictor block included demographic variables and explained 13.5% of the variability in acculturative stress, R2 = 13.5, F(6, 521) = 13.55, p < .001. The second block added family cohesion and social support to the HMR model and showed an ΔR2 of 4.5%, R2 = 18.0, F(8, 519) = 14.22, p < .001. The third block added pre- migration trauma to the HMR model and showed an ΔR2 change of 2.6%, R2 = 20.6, F(9, 518) = 14.93, p < .001. Significant interaction effects were found for family cohesion among documented RLIs. Social support was not a significant moderator. CONCLUSION: Study findings suggest pre-migration resources such as family cohesion and social support may ameliorate post-immigration acculturative stress among RLI, while pre-migration trauma, may exacerbate acculturative stress.

Community-engaged asset mapping with Latinx immigrant families of youth with disabilities.

Asset mapping is a participatory methodology that engages community members in identifying services and settings that promote health and well-being. This study aimed to identify community assets from the perspective of Latinx immigrant families with youth with disabilities. Latinx immigrant families (n = 21) participated in the mapping, followed by a reflection session and an open forum (n = 30). The findings revealed that families identified faith-based organizations and social service agencies as some of the main assets in their communities, while they identified mental health services as the most needed. The results also showed that participants preferred to utilize services and resources that are within walking distance of their homes, provide safe spaces, treat them well, offer bilingual services, do not require documentation, and are affordable. This study has important implications for community scholars and practitioners interested in implementing asset-based methodologies that focus on participants as experts of their own realities and agents of change and that promote advocacy and empowerment actions.

The impact of public policies on acculturation: A mixed-method study of Latinx immigrants' experiences in four US states.

AIMS: This study sought to understand the impact of public policies on Latinx immigrants' acculturation. METHODS: Four hundred thirty-eight first generation Latinx immigrants completed survey measures and a subset (n = 73) participated in 12 focus groups across four US states with distinct immigration-related policies: Arizona, New Mexico, Maryland, and Virginia. RESULTS: Latinx immigrants living in states with more restrictive immigration-related public policies were less likely to make cultural changes in the ways they desired. Policies impacted acculturation directly by requiring and restricting certain cultural expressions, and indirectly through cultivating the community's climate. Multiple factors appeared to shape policies' influences on acculturation, including confusion from swift policy changes, inconsistent policy implementation, competing policies at divergent ecological levels, and individuals' relative privilege from intersecting personal characteristics. CONCLUSIONS: More inclusive and supportive immigration-related policies may improve Latinx immigrants' abilities to acculturate in their preferred ways.

Perceived Barriers and Preliminary PTSD Outcomes in an Open Pilot Trial of Written Exposure Therapy With Latinx Immigrants.

Latinx immigrants experience substantial disparities in mental health treatment access, particularly for posttraumatic stress disorder (PTSD). The availability of brief, flexible interventions in Spanish may assist in reducing these disparities. Written Exposure Therapy (WET) is a five-session PTSD intervention that appears as effective as longer, gold-standard interventions, but has yet to be tested among Latinx immigrants. To test the acceptability and preliminary effectiveness of WET, 20 Spanish-speaking, Latinx immigrants conducted structured interviews at pretreatment, were offered WET, and completed posttreatment structured interviews. Open thematic coding of pre- and posttreatment interview questions examined perceived barriers and benefits of WET. Quantitative components examined symptom change across PTSD (PCL-IV-C) and depression (PHQ-9). Quantitative results indicated clinically meaningful and statistically significant change in PTSD symptoms using intent-to-treat analyses (Mdiff = 17.06, SDdiff = 9.97, range = 0-29, t(15) = 6.84, p < .001). Open thematic coding identified four barrier-related themes and three benefit-related themes at pretreatment. At posttreatment, three barrier-related themes and two benefit-related themes were identified. Qualitative results largely suggested that perceived barriers were common to other PTSD interventions (e.g., exposure components). Only one participant identified barriers specific to WET. Results suggested WET may reduce PTSD symptoms among Latinx immigrants. WET also appeared to be acceptable and primarily viewed as beneficial among this population. WET is a promising intervention with Latinx immigrants and warrants further testing larger trials, including testing implementation strategies that may improve access to care.

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

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

Relative Privilege, Risk, and Sense of Community: Understanding Latinx Immigrants' Empowerment and Resilience Processes Across the United States.

Latinx immigrants regularly navigate adversity and oppression through resilience and empowerment; however, little research has sought to delineate when, how, and why they may engage in either process. Through the Transtheoretical Model of Empowerment and Resilience, this paper examines how Latinx immigrants living in distinct U.S. contexts interact with their communities. Seventy-three Latinx immigrants (ages 18 to 70, M = 40.85, SD = 13.65) participated in 12 focus groups in Albuquerque, NM; Maricopa County, AZ; Baltimore, MD; and Richmond, VA. Participants had lived in the United States for less than 1 to 39 years (M = 14.19, SD = 8.72) and had varying immigration statuses. Analyses revealed that empowerment and resilience goals diverged by individuals' beliefs in the degree to which external change was vital, possible, and theirs to attempt. Beliefs coincided with the fundamental risk posed, based on the interaction of a context's conditions with an individual's characteristics and sense of community. Results indicate that while resilience is important to navigate risky settings, it may uphold oppressive power structures because it is consistent with the status quo. Interventions to spur external change should involve empowering processes, including facilitating gains in relative privilege and fostering sense of community.

Directional Effects in Cultural Identity: A Family Systems Approach for Immigrant Latinx Families.

Although there is a substantial body of work focusing on the processes underlying cultural identity in general, less is known regarding how these processes might operate within the context of Latinx families. Moreover, among the limited research that has included the adolescent and caregiver cultural identity, most of the research has primarily focused on how caregivers influence their adolescent's cultural identity. In the present study, the directional pathways between recently immigrated adolescents' and caregivers' ethnic and U.S. identity belonging were examined using data from a longitudinal study of acculturation and identity development among recently arrived Latinx immigrant families. The sample consisted of 302 primary caregivers (Mage = 41.09, SD = 7.13 at baseline; 67.5% mothers) and their adolescents (Mage = 14.51, SD = 0.88 at baseline; 46.7% female). The results indicated that caregivers' ethnic identity belonging significantly predicted adolescents' ethnic identity belonging over time. At the same time, adolescents' ethnic identity negatively predicted caregivers' ethnic identity belonging over time, whereas adolescents' U.S. identity belonging positively predicted caregivers' later ethnic identity belonging. The findings indicate that immigrant caregivers may retain their native culture to direct and respond to their children's changing cultural identifications.

Documentation status socialization among Latinx immigrant parents.

Discriminatory legislation targeting Latinx immigrants in the United States has shifted how parents communicate with their children about the hostile political climate. One way that Latinx parents talk about and prepare their children to face prejudice is through ethnic-racial socialization, which can promote children's positive development. Few scholars, however, have focused on how Latinx immigrant families with precarious documentation status socialize their children around issues of immigration, documentation status, and the potential for family separation. The current study seeks to broaden our understanding and conceptualization of ethnic-racial socialization practices among Latinx immigrant families living in the United States to include documentation status socialization to better capture the messages parents transmit to their children about the causes and potential impacts of their documentation status. Thirty-nine Latinx immigrant mothers aged 35-53 (M = 41.66), (22 undocumented, 17 documented) were interviewed regarding the ways in which their documentation status informs their ethnic-racial socialization practices. Five subthemes of Documentation Status Socialization were identified among both undocumented and documented parents. Example of subthemes included Limitations and Restrictions of Undocumented Status, and Documentation Privilege, in which parents discussed the limitation of being undocumented as well as the privilege that comes with the legal documentation status with their youth. Our findings yield important implications for practice and research alike.

Addressing Immigration-Related Stress in a Culturally Adapted Parenting Intervention for Mexican-Origin Immigrants: Initial Positive Effects and Key Areas of Improvement.

Culturally adapted evidence-based parenting interventions constitute a key strategy to reduce widespread mental health disparities experienced by Latinx populations throughout the United States. Most recently, the relevance of culturally adapted parenting interventions has become more prominent as vulnerable Latinx populations are exposed to considerable contextual stressors resulting from an increasingly anti-immigration climate in the country. The current study was embedded within a larger NIMH-funded investigation, aimed at contrasting the differential impact of two culturally adapted versions of the evidence-based parenting intervention known as GenerationPMTO©. Specifically, a sample of low-income Mexican-origin immigrants was exposed either to a culturally adapted version of GenerationPMTO primarily focused on parent training components, or to an enhanced culturally adapted version in which parenting components were complemented by sessions focused on immigration-related challenges. The sample for the study consisted of 103 Mexican-origin immigrant families (190 individual parents). Descriptive analysis and generalized estimating equations (GEEs) indicated that exposure to the enhanced intervention, which included context- and culture-specific sessions, resulted in specific benefits for parents. However, the magnitude of the impact was not uniform for mothers and fathers and differed according to the type of immigration-related stress being examined (i.e., intrafamilial vs. extrafamilial stress). Overall, findings indicate the relevance of overtly addressing contextual (e.g., discrimination) and cultural challenges in culturally adapted interventions, as well as the need to increase precision according to the extent to which immigration-related stressors impact immigrant mothers and fathers in common and contrasting ways. Implications for family therapy practice and research are discussed.

Las intervenciones basadas en evidencia, dirigidas a padres y adaptadas a la cultura son una estrategia clave para reducir las desigualdades en salud mental generalizadas que las poblaciones de latin@s experimentan en los Estados Unidos. Más recientemente, la relevancia de intervenciones dirigidas a padres adaptadas a la cultura ha adquirido más peso al estar las poblaciones de latin@s expuestas a factores estresantes contextuales considerables como resultado de un ambiente cada vez más contrario a la inmigración en el país. Este estudio fue incluido dentro de una investigación de mayor escala financiada por NIMH cuyo objetivo era contrastar el impacto diferencial de dos versiones adaptadas a la cultura de la intervención basada en evidencia y dirigida a padres conocida como GenerationPMTO© . En específico, se expuso una muestra de inmigrantes de origen mexicano de bajo ingreso, o a una versión de GenerationPMTO adaptada a la cultura y enfocada principalmente en elementos de entrenamiento de padres, o a una versión reforzada adaptada a la cultura en la cual los elementos de padres se complementaron con sesiones enfocadas en retos asociados a la inmigración. La muestra para el estudio consistió de 103 familias inmigrantes de origen mexicano (190 padres individuales). Análisis descriptivos y ecuaciones de estimación generalizadas indicaron que la exposición una intervención reforzada, que incluía sesiones contextual y culturalmente específicas, generaron beneficios específicos para los padres. Sin embargo, la magnitud del impacto no fue uniforme para madres y padres y fue distinta según el tipo de estrés por inmigración examinado (p.ej., estrés intrafamiliar versus estrés extrafamiliar). En general, los hallazgos indican la relevancia de enfrentar abiertamente retos contextuales (p.ej., discriminación) y culturales en intervenciones adaptadas a la cultura, así como la necesidad de aumentar la precisión conforme a cómo los factores estresantes asociados a la inmigración afectan a madres y padres inmigrantes de la misma y diferentes maneras. Se discuten las implicaciones para la práctica e investigación de terapia familiar.

Meaningful Engagement in Research: Community Residents as Co-creators of Knowledge.

Community psychologists have contributed significantly to the body of literature on community-based participatory research (CBPR) and its application in understanding and addressing health and community participation disparities. At the core of CBPR are mutually beneficial partnerships with communities, whereby community members' voices are heard and they become co-researchers, helping guide the research process. In this article, I argue that for community psychologists to change the landscape of community participation, health, and well-being disparities experienced by many vulnerable populations who often face multiple forms of oppression, CBPR needs to be transformative and emancipatory. Stakeholders must be meaningfully involved as co-creators of knowledge and promoters of social justice embracing a human rights agenda. Drawing from work conducted with Latinx immigrant families with youth who have disabilities, I propose the following strategies moving forward: promoting meaningful participation of community members as co-creators of knowledge; promoting meaningful conversations that matter to communities; promoting civic engagement, activism, and advocacy; promoting an assets- and strengths-based approach to research; and promoting culturally relevant interventions. Community psychologists have the opportunity to make significant contributions to addressing disparities when community residents' knowledge is valued and recognized.

Barriers to and facilitators of community participation among Latinx migrants with disabilities in the United States and Latinx migrant workers in Canada: An ecological analysis.

Individuals migrate to improve their wellbeing and quality of life, and often experience adverse situations, both during the process of migration and once within the host country. The purpose of this paper is to unpack the barriers to and facilitators of community participation, among Latinx immigrants with disabilities in the United States and Latinx migrant workers in Canada, following the Social Ecological Model. The authors draw from an appraisal of existing literature and their own participatory research with Latinx immigrants. Based on this integrative literature review, Latinx experience individual issues such as language barriers and lack of knowledge of the services available to them. At the community level they experience discrimination, limited opportunities for community participation, and lack of opportunities for meaningful employment. At the systemic and policy level in the United States, the antimigrant political environment keeps Latinx immigrants with disabilities from participating in their communities due to fear of deportation. In Canada, Latinx workers experience the paradox of migration and discrimination. The discussion of barriers and facilitators is followed by recommendations for community research and action.

The Role of Documentation Status Concerns, Perceived Discrimination, and Social Support on Latinx Adults' Physical and Mental Health.

There is a growing number of immigrants arriving in the USA, with the majority being of Latinx descent. Coupled with this increase, there has also been growing anti-immigration legislation which impacts the experiences this group faces and creates additional concerns for those who are residing in this country without documentation. Experiences of overt and covert discrimination and marginalization have been shown to relate to poorer mental and physical health outcomes. Drawing from Menjivar and Abrego's Legal Violence Framework, this paper explores the impact of perceived discrimination and social support on the mental and physical health of Latinx adults. We further observe whether these relationships differ based on participants' concerns about their documentation status. This data comes from a community-based participatory study conducted in a Midwestern County. Our analytic sample was comprised of 487 Latinx adults. We found social support to be related to fewer self-reported days of mental health symptoms for all participants regardless of documentation status concern. Perceived discrimination was found to be related to worse physical health for participants with concerns about their status. These findings point to the pernicious role of discrimination for Latinx's physical health and the importance of social support as an asset beneficial for their mental health.

Coloniality and Ethnic Variation in Psychological Distress Among US Latinx Immigrants.

To address ethnic variation and potential cross-cultural measurement error in diagnostic criteria, this study extends on the racialized ethnicities framework to examine how Latinxs' self-reported psychological distress differ among ethnic groups. Utilizing data from the National Health Interview Survey, logistic regression models and partial proportional odds models assessed differences in likelihood of self-reporting frequent anxiety, depression, and psychological distress among Mexican, Puerto Rican, Cuban, Dominican, and Central and South American immigrants. Membership in Caribbean Latinx ethnic groups, and the Puerto Rican ethnic group in particular, was significantly associated with higher predicted probabilities of frequent anxious and depressive feelings, and severe psychological distress, relative to membership in non-Caribbean Latinx ethnic groups. This work highlights the need for research on Latinxs to disaggregate among ethnic groups, and proposes the existence of a gradient of exposure to the psychosocial consequences of US coloniality that might explain some of these variations.

Buscando la Calma Dentro de la Tormenta: A Brief Review of the Recent Literature on the Impact of Anti-Immigrant Rhetoric and Policies on Stress Among Latinx Immigrants.

The mental health burden associated with anti-immigrant rhetoric and ever-changing immigration policies is undeniable, though the psychological and emotional sequalae may remain invisible for years to come. Exclusionary immigration policies, as a form of structural racism, have also led to an epidemic of stress-related health within the Latinx community, particularly the Latinx immigrant community, across the United States. Recent examples of anti-Latinx and anti-immigrant rhetoric and policies include the 45th President's implementation of the Zero Tolerance policy, Migrant Protection Protocols, and Title 42. The recognition of previous and existing anti-immigrant policies, and the impact on Latinx immigrants, is critical in understanding the manifestation of psychological stress to prevent it from becoming chronic. For mental health providers, attention to existing policies that can be detrimental to the Latinx immigrant community is essential to understanding their mental health trajectory and applying frameworks that honor an individual's psychological stress to prevent pathologizing the immigrant experience and negative health outcomes. The objective of the present brief review is to shed light on recent research and offer recommendations for practice (eg, educating the Latinx community about the link between the immigrant experience and psychological stress) and policy (eg, drafting of legislation aimed at rescinding harmful immigration policies) regarding the relation between aggressive anti-immigration rhetoric and psychological stress among Latinx immigrants in the United States.

A Peer-Based Intervention to Increase HIV and Sexually Transmitted Infection Testing Among Latinx Immigrant Sexual Minority Men in the US Pacific Northwest: Pilot Randomized Controlled Trial Conducted During the COVID-19 Pandemic.

BACKGROUND: Hispanic and Latinx gay, bisexual, and other sexual minority men (SMM) are disproportionately affected by HIV in the United States. With the availability of self-testing services, HIV and sexually transmitted infection (STI) testing may be more accessible for Latinx immigrant SMM who face obstacles to obtaining HIV-related services. Combining the potential of self-testing kits and the influence of peer educators may present an opportunity to increase HIV and STI testing and preexposure prophylaxis (PrEP) uptake or linkage to HIV care among Latinx immigrant SMM. OBJECTIVE: This study aimed to develop and pilot a peer intervention to distribute HIV and STI self-testing kits and provide peer counseling based on the information-motivation-behavioral skills model to increase PrEP uptake and HIV and STI testing among Latinx immigrant SMM. Our evaluation focused on determining the differences in HIV testing, STI testing, and PrEP uptake outcomes between the intervention and control groups. METHODS: We conducted semistructured interviews with community stakeholders to elicit factors to consider for training and intervention. The interview findings informed the development of the intervention and peer training protocols. We piloted the intervention with Latinx immigrant SMM and randomly assigned participants to the intervention group, who received peer counseling and HIV and STI self-testing kits, or the control group, who only received peer counseling. We administered baseline, 1-week, 6-week, and 12-week follow-up surveys to assess behaviors related to HIV testing, STI testing, and PrEP uptake. Owing to the COVID-19 pandemic, the intervention components were delivered via web-based modalities. Chi-square tests were performed to examine the associations between HIV testing, STI testing, and PrEP motivation and behaviors across the study arms (intervention vs control). We conducted Cramer V test to determine the strength of the association between study arm and each of the outcome variables. We also assessed the impact of the COVID-19 pandemic on participants. RESULTS: Overall, 50 (intervention, n=30 and control, n=20) Latinx immigrant SMM participated in the program. Participants reported life disruptions owing to COVID-19, with 68% (34/50) reporting job loss after the declaration of the pandemic. After intervention participation, a higher proportion of participants in the intervention group reported having been tested for STIs (76% vs 36.8%; P=.01; Cramer V=0.394). Among the participants in the intervention group, 91% (21/23) reported being motivated to use PrEP compared with 59% (10/17) in the control group (P=.02; Cramer V=0.385). CONCLUSIONS: By facilitating access to HIV and STI testing through peer-delivered information, motivational support, and behavioral skills training as well as the provision of self-testing kits, our intervention demonstrated the potential to increase HIV prevention behaviors in Latinx immigrant SMM. Peer-based programs that offer self-testing and internet-based modes of accessing information may be a feasible strategy for reaching Latinx immigrant SMM. TRIAL REGISTRATION: ClinicalTrials.gov NCT03922126; https://clinicaltrials.gov/ct2/show/NCT03922126.

Latinx Immigrants' Legal Concerns About SARS-CoV-2 Testing and COVID-19 Diagnosis and Treatment.

Immigration concerns can deter immigrants from utilizing healthcare services. We examined Latinx immigrants' immigration concerns related to COVID-19 testing and treatment. A multi-state sample of 336 US Latinx immigrants (documented and undocumented) completed a cross-sectional online survey in Spanish. Factor analysis informed the construction of a COVID-19 Immigration Concerns Scale. Multiple logistic regression was used to examine associations between the scale and indices of perceived immigration risk and healthcare access and utilization. Concerns clustered around two factors: (1) providers' release of information to immigration authorities and drawing government attention; and (2) eligibility for COVID-19 services and the immigration ramifications of using these. The regression equation highlighted strong associations between these and perceived instability of immigration laws and enforcement concerns after controlling for healthcare access and utilization. COVID-19-related immigration concerns were substantial and multifaceted. Perceived instability of laws was strongly related to concerns but remains understudied.