Recasting the Immigrant Health Paradox Through Intersections of Legal Status and Race

Racial/Ethnic and Linguistic Disparities in Self-reported Health-Related Quality of Life Among Children Undergoing Elective Surgery

OBJECTIVE

This study examines disparities in self-reported HRQoL among English-speaking non-Latinx White, English-speaking Latinx, and Spanish-speaking Latinx children ages 4-12 years undergoing surgery.

DESIGN

A total of 357 children completed the Child Health Rating Inventories, an animated, computer-administered method, to measure overall, physical, and mental health, as well as pre-operative anxiety. A multivariate general linear model was used to analyze the main effects of race/ethnicity and language on self-reported HRQoL.

RESULTS

Results demonstrated differences in child self-reported overall [F(2,311) = 3.11, p = 0.05)] and mental health F(2,311) = 3.56, p = 0.03)], and preoperative anxiety F(2,311) = 5.70, p = 0.004)] by race/ethnicity and language. Post hoc comparisons using the Bonferroni test indicated that English-speaking Latinx children reported significantly poorer overall (p = 0.04) and mental health (p = 0.04) compared to English-speaking non-Latinx children. English-speaking and Spanish-speaking Latinx children reported significantly higher preoperative anxiety (p = 0.004 and p = 0.02, respectively) compared to English-speaking non-Latinx White children.

CONCLUSION

Latinx children from English-speaking households as young as 4 years old reported their overall and mental health to be poorer compared to Non-Latinx White children from English-speaking households. Latinx children, regardless of spoken language, reported higher preoperative anxiety compared to non-Latinx White children. These findings highlight the need to consider early childhood experiences in understanding health disparities. Factors such as family dynamics, acculturative stress, and access to healthcare resources could potentially account for disparities in young children's health experiences.

Black and Latinx Foreign- and US-Born Young and Emerging Adults Living with HIV: Examining Social Ecological Risk Factors and Their Association with Depression, Post-traumatic Stress Disorder (PTSD), and Comorbid Depression/PTSD

OBJECTIVE

This paper examines depression, post-traumatic stress disorder (PTSD), and comorbid depression/PTSD among Black and Latinx young and emerging adults (YEA) living with HIV. We incorporated a social-ecological framework to examine risk factors associated with mental health conditions, comparing foreign and US-born groups.

METHODS

We used a hybrid recruitment strategy and surveyed 271 Black and Latinx YEA (ages 19-28 years) living with HIV in the Eastern USA. We used multivariable logistic regressions and hypothesized certain individual, interpersonal, community/societal risk factors would be positively associated with depression, PTSD, and comorbid depression/PTSD.

RESULTS

Participants experienced elevated rates of depression (33.9%), PTSD (34.0%), and comorbid depression/PTSD (19.1%). Contrary to our hypothesis, US-born participants had significantly higher rates of mental health conditions compared to foreign-born participants. At the individual-level, foreign-born was associated with lower comorbid depression/PTSD [RRR 0.38 (95% CI 0.15, 0.97)], cisgender with lower comorbid depression/PTSD [RRR 0.42 (95% CI 0.18, 0.99)], greater number of Adverse Childhood Experiences with PTSD [OR 1.18 (95% CI 1.08, 1.29)], and comorbid depression/PTSD [RRR 1.28 (95% CI 1.12, 1.47)], while moderate/high substance use with depression [OR 2.30 (95% CI 1.01, 5.25)] and comorbid depression/PTSD [RRR 3.74 (95% CI 1.07, 13.03)]. At the interpersonal-level, lower social support was associated with higher depression [OR 0.99 (95% CI 0.97, 1.00)], PTSD [OR 0.98 (95% CI 0.97, 0.99)], and comorbid depression/PTSD [RRR 0.97 (95% CI 0.96, 0.99)]. At the community/societal-level, discrimination was associated with higher depression [OR 1.05 (95% CI 1.02, 1.08)] and comorbid depression/PTSD [RRR 1.07 (95% CI 1.02, 1.11)].

IMPLICATIONS

Understanding social-ecological risk factors associated with mental health conditions of Black and Latinx YEA living with HIV is important in determining potential avenues for targeted prevention and intervention to improve mental health.

Neighborhood deprivation and racial disparities in severe maternal morbidity before and during the COVID-19 pandemic

PURPOSE

To examine whether racial and ethnic disparities in severe maternal morbidity (SMM) increased across all neighborhoods or mainly in resource-deprived neighborhoods before and during the COVID-19 pandemic.

METHODS

This study used Michigan's statewide linked databases from birth records and Medicaid claims between 01/01/2017 and 10/31/2021 (N = 214,406). Neighborhood deprivation was measured with Area Deprivation Index and categorized into tertiles. Multilevel logistic regressions with an interrupted time series approach were used to compare racial and ethnic disparities in SMM pre-pandemic (January 2017-February 2020) and during the pandemic (March 2020-October 2021) in low, medium, and high deprivation neighborhoods.

RESULTS

The Black-White disparity in the most deprived neighborhoods widened during the pandemic (adjusted risk ratio, aRR [95 % CI]: 1.72 [1.54, 1.92]; excess cases [95 % CI]: 201.7 [159.0, 244.5]) compared to pre-pandemic (aRR [95 % CI]: 1.23 [1.12, 1.35]; excess cases [95 % CI]: 75.4 [41.2, 109.5], p < .001), but persisted (not widened) in the least and medium deprived neighborhoods.

CONCLUSIONS

Widening racial and ethnic disparities in SMM during the pandemic were only observed in the most deprived neighborhoods, rather than being universally prevalent across neighborhood contexts. Community-engaged solutions are needed to improve neighborhood conditions and reduce maternal health inequities during times of crisis.

Disentangling the Consequences of Latino Immigrants' Unauthorized Status for the Health of Their U.S.-Born Children

Immigrants' legal status has been described as a social determinant of health that shapes health outcomes through multiple channels. Furthermore, legal status matters not only for immigrants themselves, but also for their family members, including their U.S.-born citizen children. Nonetheless, few studies have empirically disentangled the possible mediating mechanisms through which parents' legal status shapes their children's health. This paper applies path analysis to data from the 2014-2019 California Health Interview Survey to examine how Latino immigrant parents' unauthorized status impacts the health of their U.S.-born citizen children. I consider how the effects of parents' unauthorized status for their children's health are mediated by children's healthcare access, household food insecurity, family income, and parents' own physical and mental health. I find that parents' unauthorized status has a negative but indirect effect on their children's health through increasing household risk of poverty and food insecurity. These results have significant implications for the well-being of millions of children in the United States who have legally vulnerable parents.

Disparities in Diet Quality and Food Security Across Ethnic-Immigration Status and US Nativity

This study examines separate relationships between ethnic-immigration status, length of residence (US nativity), dietary quality, and food security status among US adults. Data from the National Health and Nutrition Examination Survey between 2017 and 2020 were used. The study sample included 6933 adults aged 18 and above. Food security status was categorized as either food secure or food insecure. Dietary quality was assessed using the Healthy Eating Index (HEI-2015) component scores. The ethnic-immigration status comprised US-born and immigrant groups, including Whites, Asians, Blacks, Hispanics, and multi-racial group. The US nativity was categorized as native, less than 5 years, 5-14 years, 15-30 years, and above 30 years of residency. Associations between ethnic-immigration status, US nativity, and food security were analyzed using logistic regression. Their associations with dietary quality used linear regression. The results showed that US-born Hispanics, multi-racial group, and immigrant Hispanics had about twice the odds of being at a risk of food insecurity compared to their US-born White counterparts, while US-born Blacks had about one and half odds. Food insecurity was higher among respondents with less than 5 years and over 30 years of residency in the USA, with odds slightly less than two. Immigrants had better overall dietary quality than US-born Whites and natives (p-values < 0.001). The study highlights the importance of nutrition interventions that consistently promote equitable access to affordable and nutritious foods while fostering the exchange of valuable dietary practices among groups and encouraging cross-cultural learning to improve overall health.

A mosaic of medicine: Acquainting pharmacy education with the rich tapestry of African-descent immigrant cultures

There is an increasing number of African-descent immigrants to the United States, often from the Caribbean, South America, and Africa. These immigrants tend to have different healthcare needs than native-born Black Americans because they come from diverse backgrounds with unique cultural health practices and beliefs. While these immigrants may be healthier when they initially present to the United States, research has found that this health advantage is not long-lasting. Acculturation, cultural beliefs, systemic, and social factors have been closely linked to the health and well-being of Black immigrants, especially with increased years of residency in the United States. Culturally competent care involves understanding the influence of culture, ethnicity, and social factors on health. It is crucial that student pharmacists are trained in understanding the cultural considerations of our continuously evolving and diverse patients. While pharmacy schools have begun incorporating cultural competency and implicit bias training in PharmD curricula, there is still room for improvement to bring about meaningful change in health outcomes. This review calls for an end to oversimplified views of Black immigrant health, advocates for better recognition of distinct African-descent cultures, and recommends tools and strategies to incorporate this population into multicultural pharmacy education.

Citizenship Status and Race/Ethnicity: Inequities in Access to Paid Family and Medical Leave and Workplace Flexibility

OBJECTIVES

Racial and ethnic minorities face disparities in access to paid family and medical leave (PFML) and workplace flexibility compared to non-Hispanic white workers. This study examines a new layer of inequity: citizenship status. Understanding citizenship-based disparities can inform policy changes to increase access to these benefits for all workers.

STUDY DESIGN

This cross-sectional analysis of the American Time Use Survey (2017-2018) focused on Hispanics, non-Hispanic Asians, and non-Hispanic White workers (N = 8602).

METHODS

We used weighted multivariate logistic regressions to investigate inequities in access to PFML and workplace flexibility across racial, ethnic, and citizenship categories. All models controlled for demographic, socioeconomic, and employment characteristics and included state fixed effects.

RESULTS

Despite overall low access (51.9% for PFML, 56.7% for flexible work hours, and 30.2% for work-from-home options), the study revealed significant disparities across race/ethnicity and citizenship status. In the fully adjusted models, non-citizen White (OR = 0.51, 95% CI = 0.28-0.93), US citizen Hispanic (OR = 0.65, 95% CI = 0.53-0.81), non-citizen Hispanic (OR = 0.37, 95% CI = 0.25-0.56), citizen Asian (OR = 0.59, 95% CI = 0.42-0.82), and non-citizen Asian workers (OR = 0.51, 95% CI = 0.31-0.85) had statistically significant lower odds of reporting access to paid family and medical leave compared to citizen White workers. In addition, non-citizen Hispanic workers had the lowest predicted probabilities of reporting being able to work from home.

CONCLUSIONS

This study underscores the need for equitable workplace policies. Addressing the unique challenges faced by different racial/ethnic and citizenship groups is crucial to achieving health equity.

Economic Insecurities and Mental Health Among Low-Income Pregnant People in the Central Valley Region of California

BACKGROUND

The association between economic insecurity and mental health among low-income pregnant people is understudied. We examined the relationship between economic insecurity and perinatal stress, anxiety, and depressive symptoms among a low-income, racially/ethnically diverse study population, and differentiated associations by nativity status.

METHODS

We used cross-sectional data from the EMBRACE Study that enrolled Medi-Cal (California's Medicaid program) eligible pregnant people in the Central Valley region of California. Economic insecurity was assessed through measures of food insecurity, low financial well-being, inability to pay an emergency expense, inability to pay bills, fear of eviction, and history of homelessness. We examined the association of these measures with perceived stress (Perceived Stress Scale), generalized anxiety symptoms (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9), adjusting for age, relationship status, and education level. We also examined effect measure modification by nativity among the Latinx population. We report the estimated differences and 95% confidence intervals for each exposure and outcome.

RESULTS

In our sample of 674 participants, we observed associations between economic insecurity and mental health. Among the 24 models, 15 showed medium to large effects (>0.35 standard deviation differences) and only three showed negligible effect sizes. Across all outcomes, we observed a stronger relationship between economic insecurity and mental health for U.S.-born Latinx people compared with their foreign-born (93% Mexico-born) counterparts.

CONCLUSION

We found low-income pregnant people experience significant economic insecurities that may impact mental health adversely. Programs that increase economic supports during pregnancy may serve as important maternal mental health interventions, especially among racial/ethnic minoritized groups.

The Health Status of Undocumented Immigrants from Asian Countries in the United States: A Scoping Review and Recommendations for Future Directions

Immigrants from Asian countries are the fastest-growing undocumented population in the United States (U.S.), yet not much is known about their health. This scoping review identifies the nature and extent of scientific literature on the health of undocumented Asian immigrants in the U.S. We conducted a comprehensive search of six electronic databases in 2024. Inclusion criteria were empirical articles written in English, published in peer-reviewed scientific journals from 2010 to 2024, and focused on a health outcome or health-related issue involving undocumented Asian immigrants. Results are summarized narratively. We identified 13 peer-reviewed publications. Nine studies were quantitative, and four were qualitative. Eight studies were conducted in California; two studies used national secondary data sources. Studies were mixed in their research focus. They covered a range of health outcomes and issues, such as mental health (n = 4), health services and access (n = 2), contraceptive use (n = 1), COVID-19 (n = 2), and HIV (n = 1). Three studies measured self-rated health alongside other conditions, such as disability, health insurance coverage, chronic health conditions, and obesity. Scholarship on the health of undocumented Asian immigrants is a growing research area. Given the small number of studies identified, future research with larger diverse samples, more robust methodology, and greater topical variety are warranted to understand the health of this population better and reduce potential inequities.

An intersectional analysis of the health status, work conditions, and nonwork conditions of the U.S. working-classed across class, sex, race, and nativity identities

BACKGROUND

Classism, sexism, racism, and nativism intersect to create inequitable conditions and health outcomes based on workers' social identities. This study describes the health status, work conditions, and nonwork conditions of the United States (U.S.) working-classed at the intersections of class, sex, racial, and nativity identities.

METHODS

Descriptive statistics (e.g., frequencies, percentages) were calculated from the 2015 National Health Interview Survey data for the total working classed sample (N = 11,884) and 16 intersectional groupings. General and psychosocial health status, work factors, and access to resources outside of work were examined.

RESULTS

Intersectional analysis revealed divisions in work and nonwork conditions despite the majority of each grouping reporting very good/excellent health. The majority of the female Latine born-outside-U.S. grouping (60%) reported not having paid sick leave. The majority of the male Latine born-outside-U.S. grouping reported having neither paid sick leave (62%) nor health insurance (55%). The majority of the female Latine (53%), male Latine (60%), and male Black (55%) born-outside-U.S. groupings reported workplaces as less safe. The majority of the female Latine born-outside-U.S. grouping (53%) was the only grouping to report being moderately/very worried about being able to afford housing costs.

CONCLUSION

The health status and precarity of work and nonwork conditions of the U.S. working classed may be shaped by intersecting systems of power across class, sex, racial, and nativity identities. Intersectional analysis increases our purview to see who is most affected, how, and where, which can inform future opportunities to mitigate worker health inequities.

Away from home, into the fields: Assessing the health of undocumented and indigenous farmworkers

A large and growing literature argues that the agricultural labor market is stratified by ethnicity and legal status. However, other markers of distinction, such as indigeneity, may overlap with legal status to reveal additional health inequalities. Our study contributes to this scholarly dialogue by assessing the relation between indigeneity, legality, and health among immigrant-origin farmworkers from Latin America. To this end, we use data from the National Agricultural Worker Survey (N = 21,092) to examine health outcomes among indigenous and non-indigenous immigrants. Results indicate that indigenous farmworkers experience higher rates of pain-but not chronic conditions-than their non-indigenous counterparts. While undocumented farmworkers who are not indigenous exhibit especially favorable health, indigenous workers who are documented are significantly more likely to suffer from pain. Finally, there is limited evidence that differences in insurance coverage can fully explain the patterning between legal status, indigeneity, and health. This project sheds light on the well-being of indigenous migrant laborers in the U.S. food system, a population that experiences pervasive barriers to socioeconomic advancement at home and abroad.

Patient Factors Associated with Missed Otolaryngology Appointments at an Urban Safety-Net Hospital

OBJECTIVE

To determine if patient factors related to ethnicity, socioeconomic status (SES), medical comorbidities, or appointment characteristics increase the risk of missing an initial adult otolaryngology appointment.

METHODS

This study is a retrospective case control study at Boston Medical Center (BMC) in Boston, Massachusetts, that took place in 2019. Patient demographic and medical comorbidity data as well as appointment characteristic data were collected and compared between those that attended their initial otolaryngology appointment versus those who missed their initial appointment. Chi-square and ANOVA tests were used to calculate differences between attendance outcomes. Multivariate analysis was used to compare the odds of missing an appointment based on various patient- and appointment-related factors.

RESULTS

Patients who were more likely to miss their appointments were more often female, of lower education, disabled, not employed, Black or Hispanic, and Spanish-speaking. Spring and Fall appointments were more likely to be missed. When a multivariate regression was conducted to control for social determinants of health (SDOH) such as race, insurance status, employment, and education status, the odds of females, Spanish-speaking, students, and disabled patients missing their appointment were no longer statistically significant.

CONCLUSION

A majority of patients at BMC come from lower SES backgrounds and have multiple medical comorbidities. Those who reside closer to BMC, often areas of lower average income, had higher rates of missed appointments. Interventions such as decreasing lag time, providing handicap-accessible free transportation, and increasing accessibility of telemedicine for patients could help improve attendance rates at BMC.

LEVEL OF EVIDENCE

IV Laryngoscope, 134:4003-4010, 2024.

Risk of Adverse Perinatal Outcomes Among African-born Black Women in California, 2011-2020

BACKGROUND

African-born women have a lower risk of preterm birth and small for gestational age (SGA) birth compared with United States-born Black women, however variation by country of origin is overlooked. Additionally, the extent that nativity disparities in adverse perinatal outcomes to Black women are explained by individual-level factors remains unclear.

METHODS

We conducted a population-based study of nonanomalous singleton live births to United States- and African-born Black women in California from 2011 to 2020 (n = 194,320). We used age-adjusted Poisson regression models to estimate the risk of preterm birth and SGA and reported risk ratios (RR) and 95% confidence intervals (CI). Decomposition using Monte Carlo integration of the g-formula computed the percentage of disparities in adverse outcomes between United States- and African-born women explained by individual-level factors.

RESULTS

Eritrean women (RR = 0.4; 95% CI = 0.3, 0.5) had the largest differences in risk of preterm birth and Cameroonian women (RR = 0.5; 95% CI = 0.3, 0.6) in SGA birth, compared with United States-born Black women. Ghanaian women had smaller differences in risk of preterm birth (RR = 0.8; 95% CI = 0.7, 1.0) and SGA (RR = 0.9; 95% CI = 0.8, 1.1) compared with United States-born women. Overall, we estimate that absolute differences in socio-demographic and clinical factors contributed to 32% of nativity-based disparities in the risk of preterm birth and 26% of disparities in SGA.

CONCLUSIONS

We observed heterogeneity in risk of adverse perinatal outcomes for African- compared with United States-born Black women, suggesting that nativity disparities in adverse perinatal outcomes were not fully explained by differences in individual-level factors.

The legacy of immigration policies and employment exclusion: Assessing the relationship between employment exclusions and immigrant health

Restrictive federal and state immigration policies create conditions of employment exclusion that may negatively influence the health of immigrants. In particular, these policy effects are reflected in labor market and workplace experiences that determine the types of work and employment opportunities that immigrants are able to access and pursue. This study examines the relationship between both cumulative and individual measures of employment exclusion and self-rated health and psychological distress among Asian and Latino immigrants in California, and whether this relationship is modified by legal status. We used data from the Research on Immigrant Health and State Policy (RIGHTS) study (n = 2010). We used both multivariable logistic regression and linear regression models for our analyses. For cumulative models, labor market exclusion was associated with poor health (OR = 1.21, 95% CI: 1.01, 1.46). Workplace exclusion was also associated with poor self-rated health (OR = 1.45, 95% CI: 1.15, 1.82) and increased psychological distress (β = 0.69, 95% CI: 0.31, 1.07). For individual measures of employment exclusion, settling for a job - a labor market exclusion - and working in a dangerous job and experiencing wage theft - workplace exclusions - were associated with poor health and increased psychological distress. There was no evidence that the association between employment exclusions and health varied by legal status. These findings demonstrate that the combined effect of employment exclusions is detrimental to immigrant health. To improve population health, public health researchers should continue to interrogate the policy conditions at the federal, state, and local level that exclude immigrants from employment opportunities and workplace protections.

Mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults: A population-based study on the mediating roles of lifestyle behaviors

BACKGROUND

Despite substantial efforts to investigate the inequalities in mental health among people with marginalized identities, most research has concentrated on single social identities rather than complete persons. The current study aimed to explore the mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults.

METHODS

Data for this study came from the National Health and Nutrition Examination Survey waves between 2015 and 2018, including a total of 11,268 US adults. A latent class analysis (LCA) was conducted to identify latent subpopulations based on sex, race/ethnicity, immigrant status, disability, household income, employment status, and education level. Interclass differences in lifestyle factors and depression were examined. Multiple mediation analysis was used to examine the mediating roles of lifestyle behaviors.

RESULTS

LCA identified four potential subpopulations: "least marginalized", "immigrant minorities", "disabled, less-educated non-workers", and "low-income minorities" groups. There was enormous heterogeneity in mental health among immigrant minority individuals. The "disabled, less-educated non-workers" group had the highest rates of depression; in contrast, the "immigrant minorities" group had the best mental health, even better than that of the "least marginalized" group. Distributions of lifestyle factors followed a similar pattern. In addition, lifestyle behaviors significantly mediated the relationship between intersectional social identities and depression.

LIMITATIONS

The cross-sectional design prevented establishment of the causality of relationships.

CONCLUSIONS

This study suggests that applying a person-centered approach is important when examining intersectional inequalities in mental health and highlights the effects of structural social hierarchies on individuals' health behaviors and mental health.

Immigration, Racialization, and Asian American Older Adults' Cognitive Difficulties

OBJECTIVES

The sociohistorical experiences of Asian American older adults (AAOA) vary, but limited research has examined how immigration status operates as social determinants. This study builds on an existing framework to examine the relationship among social determinants and the differential effects of immigration status on cognitive difficulties among AAOA.

METHODS

Using 5-year estimate data from the 2019 American Community Survey, the study sample consisted of AAOA aged 65 years and older identifying as Chinese, Filipino, Indian, Japanese, Korean, or Vietnamese (N = 100,584). AAOA were categorized as noncitizens, naturalized, or U.S. born for their immigration status. Participants who indicated having difficulty concentrating, remembering, or making decisions were categorized as having cognitive difficulties.

RESULTS

Chinese were the most prevalent ethnic group (30%). Over 70% were naturalized citizens. About 8% endorsed having cognitive difficulties. According to bivariate analyses, there were considerable differences in AAOA's characteristics (e.g., age, gender, marital status, medical insurance, employment status) by their immigration status. The results from the logistic regressions showed that immigration status was independently associated with poor cognitive difficulties. By AAOA's immigration status, unique protective and risk factors were presented for cognitive difficulties.

DISCUSSION

The differential pattern of cognitive difficulties among AAOA reveals a fuller picture of variations within AAOA by immigration status. The results imply that more research is needed to develop culturally sensitive practices that account for the racialized differences by AAOA's immigration status. Further research into the interplay between structural determinants is necessary to formulate practice and policy interventions to address better successful aging for AAOA.

The Impacts of Inclusionary State Immigrant Policies on Psychosocial Outcomes Among Latinx Adolescents

OBJECTIVE

State-level policies that exclude immigrants, primarily undocumented, from public services and benefits have been found to have negative psychosocial impacts on Latinx adults, regardless of nativity. The effects of inclusionary policies-that is, extending public benefits to all immigrants-remain underexamined, as well as the impacts on adolescents.

METHOD

We used data from the Youth Risk Behavior Survey from 2009 to 2019 to examine the association between 7 state-level inclusionary policies and bullying victimization, low mood, and suicidality among Latinx adolescents via 2-way fixed-effects log-binomial regression models.

RESULTS

Banning the use of eVerify in employment was associated with decreased bullying victimization (prevalence ratio [PR] = 0.63, 95% CI: 0.53-0.74), low mood (PR = 0.87, 95% CI: 0.78-0.98), and suicidality (PR = 0.73, 95% CI: 0.62-0.86). Extending public health insurance coverage was associated with decreased bullying victimization (PR = 0.57, 95% CI: 0.49-0.67), and mandating Culturally and Linguistically Appropriate Services (CLAS) training for health care workers was associated with decreased low mood (PR = 0.79, 95% CI: 0.69-0.91). Extending in-state tuition to undocumented students was associated with increased bullying victimization (PR = 1.16, 95% CI: 1.04-1.30), and extending financial aid was associated with increased bullying victimization (PR = 1.54, 95% CI: 1.08-2.19), low mood (PR = 1.23, 95% CI: 1.08-1.40), and suicidality (PR = 1.38, 95% CI: 1.01-1.89).

CONCLUSION

The relationships between inclusionary state-level policies and Latinx adolescent psychosocial outcomes were mixed. Although most inclusionary policies were associated with improved psychosocial outcomes, Latinx adolescents residing in states with inclusionary policies related to higher education had worse psychosocial outcomes. Results suggest the importance of elucidating the unintended consequences of well-intentioned policies and the importance of continued efforts to reduce anti-immigrant sentiment.

Hitting closer to home: State policies' impacts on health by race and legal status

While the proliferation of inclusionary and exclusionary state policies has led to an increasingly heterogeneous patchwork of state climates, state policy and the climates they create have become increasingly important for health outcomes. We leverage the heterogeneity across state policy climates to test the relationship between state-level policies and health inequality across the US. We include 24 state policies related to public health and safety, immigration enforcement, integration, and healthcare to capture the state climate. Using the Survey of Income and Program Participation (SIPP), a nationally representative study of households in the U.S., we estimate multilevel regression models to assess the relationship between state policy climate and healthcare utilization. We further examine differential effects of the policy climate across various vulnerable groups, by examining differences by citizenship status and race. We find that more exclusionary policies may be detrimental to healthcare utilization for all residents regardless of race and legal status- but ultimately racial minorities and noncitizens see the greatest benefits from inclusive policy climates.

"We have to lie low … that sort of poisons me more and more": A qualitative study of violent political rhetoric and health implications for Spanish and Chinese speaking immigrants

BACKGROUND

In recent years, the historical legacy of anti-immigrant sentiment in the US has resurfaced, fueled by a new wave of anti-immigrant political rhetoric. Violent political rhetoric, defined as either explicit or metaphorically targeted language to dehumanize targeted groups, can incite discriminatory treatment of immigrants at both interpersonal and institutional levels, shaping their health and healthcare experiences. This qualitative study explores and compares how Spanish- and Chinese-speaking immigrant populations in Chicago make sense of violent political rhetoric against their racial and ethnic identities, utilize coping strategies to maintain their sense of belonging, and experience downstream health consequences.

METHODS

In 2019, 14 semi-structured focus groups were conducted among immigrants to the U.S. (n = 79). Participants were recruited from four community sites in either Hispanic/Latino or Chinese neighborhoods in Chicago. Focus groups were conducted by racially- and linguistically concordant interviewers in Spanish, Mandarin, or Cantonese. The research team developed a codebook iteratively and analyzed transcripts using grounded theory and the constant comparison method.

RESULTS

Participants included Chinese (61%) and Spanish-speaking immigrants (39%), with an average age of 61.4 years (sd = 13); the majority were female (62%), unemployed (68%), and attained less than a high school diploma (53%). Self-reported stress due to political rhetoric was more pronounced among Spanish-speaking participants (93%) than Chinese participants (39.6%). Immigrants responded to manifestations of violent political rhetoric in numerous ways including mobilizing the model minority myth with internalized racism, anticipatory stress, and "high effort" coping mechanisms (John Henryism), all with downstream health effects.

CONCLUSION

Violent political rhetoric is one of the mechanisms by which racism and xenophobia exacerbate a toll on the health of racialized immigrant groups. These processes have implications for both interpersonal and institutional experiences, as well as health and healthcare interactions. We propose a conceptual model that outlines these mechanisms and points to potential areas of intervention to ameliorate immigrant health inequities.

[Placing survival above the ideal of motherhood: experiences of migratory mourning of migrant mothers in Chile]

This article presents an approach to the phenomenon of migratory mourning of migrant mothers in Chile. Between 2021 and 2022, a qualitative exploratory study based on symbolic interactionism was carried out, in which semi-structured interviews were conducted with 39 migrant mothers of Venezuelan (18), Peruvian (11) and Haitian (9) origin. Based on a theoretically-informed thematic analysis, three analytical categories emerged: 1) the loss of social ties and distance to their place of origin; 2) expectations versus reality; and 3) the validation of overexertion. Migrant mothers express migratory mourning with varying levels of nuance depending on their country of origin, and to a greater or lesser degree signify their experiences in terms of uprooting and the absence of support networks, which they identify as the main cause of the sadness they experience on a daily basis. This sadness increases when they negotiate their ideals regarding the upbringing of their sons and daughters in favor of material subsistence in order to achieve the goals of a better life, and for which they justify overexertion as a strategy for improvement. These pressures bring with them psychological and physical consequences and interfere with their processes of migratory mourning, compromising their mental health and that of their children.

Uninsured immigrants in the United States significantly delayed the initiation of prenatal care after the changes to the Public Charge Rule

OBJECTIVE

We estimated the impact of the changes made to the Public Charge Rule on the initiation of prenatal care among uninsured immigrants in the United States.

STUDY DESIGN

We used a difference-in-differences approach to analyse the impact of the changes made to the Public Charge Rule (first difference) on initiation of prenatal care between uninsured and privately insured immigrants (second difference).

METHODS

We used the natality data by the National Center for Health Statistics as the main data source, which includes all singleton births in a hospital to an immigrant birthing person aged from 15 to 44. The study covers three phases: (1) the period prior to the leaked draft Executive Orders concerning changes made to the public charge policy-from January 2014 to December 2016; (2) the period after the draft Executive Orders were leaked until the proposal of the Public Charge Rule-from January 2017 to September 2018; and (3) post proposal of the Public Charge Rule -from October 2018 to December 2019.

RESULTS

After the proposal of the Public Charge Rule in 2018, the odds of initiating prenatal care in the first trimester decreased among uninsured immigrants by 12% (odds ratio [OR]: 0.880; 95% confidence interval [CI]: 0.832, 0.931) compared to privately insured immigrants. The odds of second trimester initiation of prenatal care was also negatively associated with the leak of the draft Executive Orders (OR: 0.942; 95% CI: 0.905, 0.981).

CONCLUSION

The results of this study suggest that uninsured immigrants in the United States significantly delayed prenatal care after the changes were made to the Public Charge Rule.

Willingness to Receive the COVID-19 Vaccine in California: Disparities by Race and Citizenship Status

Although it is widely acknowledged that racialized minorities may report lower COVID-19 vaccine willingness compared to non-Hispanic white individuals, what is less known, however, is whether the willingness to receive the COVID-19 vaccine also differs by citizenship. Understanding disparities in vaccine willingness by citizenship is particularly important given the misleading rhetoric of some political leaders regarding vaccine eligibility by citizenship status. This study used the 2020 California Health Interview Survey (n = 21,949) to examine disparities in vaccine willingness by race/ethnicity and citizenship among Asian, Latinx, and non-Hispanic white individuals. Overall, 77.7% of Californians indicated that they were willing to receive the COVID-19 vaccine if it was made available. However, there were distinct differences by race/ethnicity and citizenship. Asian people, regardless of citizenship, had the highest predicted probability of vaccine willingness, accounting for demographic, socioeconomic, and health factors. Non-citizen Latinx and non-citizen non-Hispanic white people had higher predicted probabilities of vaccine willingness compared to their US-born counterparts, accounting for demographic, socioeconomic, and health factors. Our results reveal that although vaccine willingness may be high among non-citizen individuals, it may not necessarily translate into actual vaccine uptake. Furthermore, while individual-level factors may account for some of the differences in vaccine willingness by race/ethnicity and citizenship, other institutional and structural barriers prevent vaccine uptake.

Receiving hemodialysis in Hispanic ethnic dense communities is associated with better adherence and outcomes among young patients: a retrospective analysis of the Dialysis Outcomes and Practice Patterns Study

BACKGROUND

Hispanic ethnic density (HED) is a marker of better health outcomes among Hispanic patients with chronic disease. It is unclear whether community HED is associated with mortality risk among ethnically diverse patients receiving maintenance hemodialysis.

METHODS

A retrospective analysis of patients in the United States cohort of the Dialysis Outcomes and Practice Patterns Study (DOPPS) database (2011-2015) was conducted (n = 4226). DOPPS data was linked to the American Community Survey database by dialysis facility zip code to obtain % Hispanic residents (HED). One way ANOVA and Kruskal Wallis tests were used to estimate the association between tertiles of HED with individual demographic, clinical and adherence characteristics, and facility and community attributes. Multivariable Cox proportional hazards models were used to estimate the mortality hazard ratio (HR) and 95% CIs by tertile of HED, stratified by age; a sandwich estimator was used to account for facility clustering.

RESULTS

Patients dialyzing in facilities located in the highest HED tertile communities were younger (61.4 vs. 64.4 years), more commonly non-White (62.4% vs. 22.1%), had fewer comorbidities, longer dialysis vintage, and were more adherent to dialysis treatment, but had fewer minutes of dialysis prescribed than those in the lowest tertile. Dialyzing in the highest HED tertile was associated with lower hazard of mortality (HR, 0.86; 95% CI, 0.72-1.00), but this association attenuated with the addition of individual race/ethnicity (HR, 0.92; 95% CI, 0.78-1.09). In multivariable age-stratified analyses, those younger than 64 showed a lower hazard for mortality in the highest (vs. lowest) HED tertile (HR, 0.66; 95% CI, 0.49-0.90). Null associations were observed among patients ≥ 64 years.

CONCLUSIONS

Treating in communities with greater HED and racial/ethnic integration was associated with lower mortality among younger patients which points to neighborhood context and social cohesion as potential drivers of improved survival outcomes for patients receiving hemodialysis.

Acculturation Experiences and Preterm Birth in Berlin: Does Acculturative Stress Contribute to Preterm Birth?

Acculturation and acculturative stress are potential risk factors for adverse perinatal outcomes. This study investigates whether and how acculturative stress affects preterm birth (PTB) in a sample of migrant women in Berlin. We interviewed 955 women who recently gave birth using standardized questionnaires (Frankfurt Acculturation Scale and Acculturative Stress Index). Multivariable logistic regression analyses assessed the effects of acculturation and acculturative stress on PTB. Women with migrant backgrounds did not have significantly higher PTB rates than German natives. First-generation migrants experienced higher acculturative stress levels than second-generation migrants, 38.8% vs. 13.2%. Acculturative stress could not be identified as a risk factor for PTB in our sample. These results need to be considered in the context of an international city and the wide use of antenatal care services in our population, which could be responsible for similarly good perinatal outcomes and highlights the potential of good access to perinatal care for vulnerable groups.

Pandemic-Related Stress and Resilience Among Latinx Mothers with a History of Depression: Differences by Immigration Status

This study explores the impact of the COVID-19 pandemic on low-income, Latinx mothers in Southern California with a history of depression, including undocumented mothers and members of mixed status families. Drawing participants from a parent study that provided a maternal depression intervention to Head Start mothers (n = 119), this mixed method study integrates qualitative and quantitative data in a convergent design. Thirty-four mothers completed semi-structured qualitative interviews and standardized questionnaires in the fall of 2020. Mothers shared overwhelming economic difficulties, with the majority reporting that their family income decreased and half reporting that they were unable to pay for housing. Stressors were compounded for undocumented mothers and members of mixed-status families who were excluded from major relief programs. Stress affected maternal mental health, and mothers with precarious status reported differences in functioning. Mothers also identified positive ways that they coped with adversity. Results show that Latinx mothers with a history of depression, particularly mothers with precarious immigration status, continue to suffer considerable economic, social, and emotional impacts of the COVID-19 pandemic. Social workers can support the human rights of this population by advocating for financial relief, food assistance, and the expansion of medical-legal partnerships and physical and mental health services.

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.

Looking Across and Within: Immigration as a Unifying Structural Factor Impacting Cardiometabolic Health and Diet

Introduction

Immigration has been identified as an important social determinant of health (SDH), embodying structures and policies that reinforce positions of poverty, stress, and limited social and economic mobility. In the public health literature with regard to diet, immigration is often characterized as an individual-level process (dietary acculturation) and is largely examined in one racial/ethnic subgroup at a time. For this narrative review, we aim to broaden the research discussion by describing SDH common to the immigrant experience and that may serve as barriers to healthy diets.

Methods

A narrative review of peer-reviewed quantitative, qualitative, and mixed methods studies on cardiometabolic health disparities, diet, and immigration was conducted.

Results

Cardiometabolic disease disparities were frequently described by racial/ethnic subgroups instead of country of origin. While cardiovascular disease and obesity risk differed by country of origin, diabetes prevalence was typically higher for immigrant groups vs United States (US)-born individuals. Common barriers to achieving a healthy diet were food insecurity; lack of familiarity with US food procurement practices, food preparation methods, and dietary guidelines; lack of familiarity and distrust of US food processing and storage methods; alternative priorities for food purchasing (eg, freshness, cultural relevance); logistical obstacles (eg, transportation); stress; and ethnic identity maintenance.

Conclusions

To improve the health of immigrant populations, understanding similarities in cardiometabolic health disparities, diet, and barriers to health across immigrant communities-traversing racial/ethnic subgroups-may serve as a useful framework. This framework can guide research, policy, and public health practices to be more cohesive, generalizable, and meaningfully inclusive.

Disparities in Colorectal Cancer Screening by Time in the U.S. and Race/Ethnicity, 2010-2018

INTRODUCTION

Longer time lived in the U.S. has been associated with worse health outcomes, especially preventable diseases, among racially and ethnically diverse groups of foreign-born individuals. This study evaluated the association between time lived in the U.S. and colorectal cancer screening adherence and whether this relationship differed by race and ethnicity.

METHODS

Data from the National Health Interview Survey for 2010-2018 among adults aged 50-75 years were used. Time in the U.S. was categorized as U.S.-born, foreign-born ≥15 years, and foreign-born <15 years. Colorectal cancer screening adherence was defined according to U.S. Preventive Services Task Force guidelines. Generalized linear models with Poisson distribution were used to calculate adjusted prevalence ratios and 95% CIs. Analyses were conducted in 2020-2022, were stratified by race and ethnicity, accounted for the complex sampling design, and were weighted to be representative of the U.S.

RESULTS

Prevalence of colorectal cancer screening adherence was 63% overall, 64% for U.S.-born, 55% for foreign-born ≥15 years, and 35% for foreign-born <15 years. In fully adjusted models for all individuals, only foreign-born <15 years had lower adherence than U.S.-born (foreign-born ≥15 years: prevalence ratio=0.97 [0.95, 1.00], foreign-born <15 years: prevalence ratio=0.79 [0.71, 0.88]). Results differed by race and ethnicity (p-interaction=0.002). In stratified analyses, findings for non-Hispanic White individuals (foreign-born ≥15 years: prevalence ratio=1.00 [0.96, 1.04], foreign-born <15 years: prevalence ratio=0.76 [0.58, 0.98]) and non-Hispanic Black individuals (foreign-born ≥15 years: prevalence ratio=0.94 [0.86, 1.02], foreign-born <15 years: prevalence ratio=0.61 [0.44, 0.85]) were similar to all individuals. Disparities by time in the U.S. were not observed among Hispanic/Latino individuals (foreign-born ≥15 years: prevalence ratio=0.98 [0.92, 1.04], foreign-born <15 years: prevalence ratio=0.86 [0.74, 1.01]) but persisted among Asian American/Pacific Islander individuals (foreign-born ≥15 years: prevalence ratio=0.84 [0.77, 0.93], foreign-born <15 years: prevalence ratio=0.74 [0.60, 0.93]).

CONCLUSIONS

The relationship between colorectal cancer screening adherence and time in the U.S. varied by race and ethnicity. Culturally and ethnically tailored interventions are needed to improve colorectal cancer screening adherence among foreign-born people, especially among the most recently immigrated individuals.

Divergent Immigrant Health Trajectories: Disparities in Physical Health Using a Multidimensional Conceptualization of Legal Status

Immigrant health research demonstrates that foreign-born individuals generally experience lower morbidity rates relative to native-born individuals. However, this research often overlooks structural factors that influence the immigrant experience, such as legal status. The present study examines legal status as a multidimensional and dynamic characteristic that shapes immigrant health over time. I use two waves of the New Immigrant Survey (n = 3550) to assess if three dimensions of legal status — initial documentation classification, legal permanent residence (LPR) admission category, and US citizenship — predict likelihoods of reporting a chronic condition among a sample of immigrants who attained LPR. Results indicate that each of the three dimensions of legal status predicted health. Immigrants who obtained US citizenship improved their relative health over time, while immigrants with previous temporarily documented, undocumented, legalization, or refugee experience exhibited persistent disadvantage in the hierarchy of immigrant health. Findings demonstrate that the sociopolitical context continually shapes the physical health of immigrants, and a dynamic and multidimensional conceptualization of legal status can expose previously obscured disparities in the overarching pattern of an immigrant health advantage.

Visa type and financial strain on depressive symptoms among Filipino migrants to the United States

Migrants have been theorized to be healthier than their non-migrant counterparts; however, there is limited examination of health selection using binational data and how selection occurs, particularly for mental health outcomes. This study examines the role of visa status and financial strain as critical factors for mental health selection among Filipino migrants to the U.S. and non-migrants who remain in the Philippines. We used the baseline data from the Health of Philippine Emigrants Study (HoPES; n = 1631) to compare depressive symptoms between non-migrants and migrants who were both surveyed prior to their departure to the U.S. We assessed depressive symptoms using linear regression by migration status, financial strain, and by visa categories including fiancée/marriage, unlimited family reunification, limited family reunification, and employment. Overall, all migrants reported lower depressive symptoms than non-migrants; however, depressive symptoms varied by visa type. Fiancée/marriage migrants had lower depressive symptoms than compared to limited family reunification migrants. Additionally, those who reported financial strain had higher depressive symptoms than those without any financial strain. We find that migrants were positively selected for mental health using a unique sample of Filipino migrants before they left for the U.S.

Brokering Resources during a Pandemic: Exploring How Organizations and Clinics Responded to the Needs of Immigrant Communities during COVID-19

Though COVID-19 has had sweeping implications, many immigrant groups in the United States have been disproportionately affected. The purpose of the present study is to explore the impact of COVID-19 on immigrant communities and how local immigrant-serving organizations (ISOs) have responded during the pandemic. The authors conducted in-depth qualitative interviews with executive directors and program coordinators of 31 ISOs and health clinics in Kentucky, North Carolina, and South Carolina. Findings highlight the needs of immigrants and refugees during the pandemic, including economic burden, lack of information, and limited access to testing and treatment for COVID-19. The authors find that ISOs have responded to these needs by providing basic supports, partnering with other local organizations to channel needed resources to immigrant communities, and collaborating with state-level entities to improve outreach, testing, and treatment. The authors also identify mechanisms that enabled the organizations to make nimble accommodations during the pandemic as well as the burden and compromises that these organizations have experienced. The authors argue that ISOs represent an important aspect of safety nets available for immigrants and provide insights into how other organizations can prepare for public health crises like COVID-19 in the future.

Race/ethnicity, immigrant generation, and physiological dysregulation among U.S. adults entering midlife

This study aimed to better understand racial/ethnic and immigrant generation disparities in physiological dysregulation in the early portion of the adult life course. Using biomarker-measured allostatic load, we focused on the health of child/adolescent immigrant, second-, and third-plus-generation Asian, Black, Hispanic, and White Americans in their late 30s and early 40s. We drew on restricted-access data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Waves I and V. The results indicate lower levels of physiological dysregulation for most racial/ethnic groups of child/adolescent immigrants relative to both third-plus-generation Whites and third-plus-generation same race/ethnic peers. Socioeconomic, social, and behavioral control variables measured in different parts of the life course had little impact on these patterns. Thus, evidence of an immigrant health advantage is found for this cohort using allostatic load as a measure of physiological dysregulation, even though immigrants in Add Health arrived at the United States during childhood and adolescence. Implications of these findings in the context of immigrant health advantages and trajectories are discussed.

Cumulative Experiences of Immigration Enforcement Policy and the Physical and Mental Health Outcomes of Asian and Latinx Immigrants in the United States

Immigration enforcement policies in the United States and other nations have long been enacted and implemented as intentional tools of racial control. There is mounting evidence that immigration raids, arrests, and deportations in the United States are associated with poor immigrant health outcomes, but this research has primarily focused on associations between health and single, specific enforcement actions or experiences that may not capture the entirety of immigrants’ experiences with racialized exclusion. Further, there has been little examination of Asian immigrants’ experiences with enforcement in the United States. This article assesses the relationship between Asian and Latinx immigrants’ physical and mental health and their cumulative experiences of immigration enforcement. We analyze responses to a 2018 population-based telephone survey of 1,103 Asian and Latin American immigrants in California. Participants were asked about seven distinct exclusionary immigration and local law enforcement experiences and their self-rated health (SRH) and psychological distress. We tested the association between each enforcement experience and SRH and psychological distress, controlling for covariates. After creating a cumulative measure of exclusion by summing participants’ total number of enforcement experiences, we examined the association between cumulative enforcement experiences and SRH and psychological distress and tested interactions by ethnicity and citizenship. While a greater proportion of Latinx than Asian participants reported enforcement experiences, each additional enforcement experience was associated with poorer self-rated health and greater psychological distress for both groups. This article suggests that the overall immigration enforcement system, from surveillance to deportation, is associated with worse health outcomes for immigrants.

Systemic and Individual Factors That Shape Mental Health Service Usage Among Visible Minority Immigrants and Refugees in Canada: A Scoping Review

There exists considerable research which reports that mental health disparities persist among visible minority immigrants and refugees within Canada. Accessing mental health care services becomes a concern which contributes to this, as visible minority migrants are regarded as an at-risk group that are clinically underserved. Thus, the purpose of this review is to explore the following research question: "what are the barriers and facilitators for accessing mental health care services among visible immigrants and refugees in Canada?". A scoping review following guidelines proposed by Arksey and O'Malley (International Journal of Social Research Methodology 8(1): 19-32, 2005) was conducted. A total of 45 articles published from 2000 to 2020 were selected through the review process, and data from the retrieved articles was thematically analyzed. Wide range of barriers and facilitators were identified at both the systemic and individual levels. Unique differences rooted within landing and legal statuses were also highlighted within the findings to provide nuance amongst immigrants and refugees. With the main layered identity of being a considered a visible minority, this yielded unique challenges patterned by other identities and statuses. The interplay of structural issues rooted in Canadian health policies and immigration laws coupled with individual factors produce complex barriers and facilitators when seeking mental health services. Through employing a combined and multifaceted approach which address the identified factors, the findings also provide suggestions for mental health care providers, resettlement agencies, policy recommendations, and future directions for research are discussed as actionable points of departure.

Immigration and the Life Course: Contextualizing and Understanding Healthcare Access and Health of Older Adult Immigrants

OBJECTIVE

Immigrant health discussions often focus on acculturation and omit discussions on historical events that may underlie health differences among immigrant older adults. This paper provides a historical overview of immigration policy and flows to the U.S. and examines insurance access and health difficulties by sending country.

METHODS

We analyzed the "Immigrants Admitted to the United States, Fiscal Years 1972-2000" and 2015-2019 American Community Survey datasets to examine the number of admitted immigrants, sociodemographic profiles for current immigrant older adults, and the predicted probabilities of health insurance access and health difficulties.

RESULTS

Our results highlight alignment of immigration flows with immigration legislation and vast heterogeneity in migration, health, and healthcare access of immigrants by sending country.

DISCUSSION/IMPLICATIONS

Public health practitioners must consider how historical events and social factors contribute to the healthcare access and health of immigrant populations, as demographic shifts will require interventions that promote equitable healthy aging.

COVID-19 and decreased asylum access: mother work, precarity and preocupación among Central American asylum-seekers in Los Angeles

In 2020, the public health response to the COVID-19 pandemic and the U.S. government's increased legal restrictions on asylum-seekers acted together to increase social, economic and legal precarity in the lives of Central American asylum-seeking mothers in Los Angeles. In this context, these asylum-seeking mothers discussed their intersectional precarities through the idiom of distress "preocupación", which signalled the concerns, worries, and fears they had in relation to the daily mother work of raising their children. Using ethnographic data collected during the COVID-19 pandemic, I examine how the intersectional precarities Central American asylum-seeking mothers faced necessitated protecting their children from their own preocupación. Through this, I argue that by using the analytic of preocupación it is possible to see exactly how racial and legal barriers to care increase precarity in the lives of asylum-seeking mothers in the U.S., and the detrimental impact that intersectional precarities have on asylum-seekers' mother work today.

Citizenship Matters: Non-Citizen COVID-19 Mortality Disparities in New York and Los Angeles

U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020–January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. Multiple linear regression analyses revealed significant positive associations between the percentage of non-citizen residents and COVID-19 mortality rates in NYC (95% CI 0.309, 5.181) and LAC (95% CI 0.498, 8.720). Despite NYC and LAC policies intended to provide sanctuary and improve healthcare access for non-citizen residents, communities with larger proportions of non-citizens appear to endure higher COVID-19 mortality rates. The challenges that non-citizens endure—e.g., inequitable access to public benefits—may discourage help-seeking behaviors. Thus, improved health surveillance, public health messaging, and sanctuary policies will be essential for reducing COVID-19 mortality disparities in communities with large shares of non-citizens.

Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID-19

BACKGROUND

Racial and ethnic minority groups in the United States experience a disproportionate burden of COVID-19 deaths.

OBJECTIVE

To evaluate whether outcome differences between Hispanic and non-Hispanic COVID-19 hospitalized patients exist and, if so, to identify the main malleable contributing factors.

DESIGN, SETTING, PARTICIPANTS

Retrospective, cross-sectional, observational study of 6097 adult COVID-19 patients hospitalized within a single large healthcare system from March to November 2020.

EXPOSURES

Self-reported ethnicity and primary language.

MAIN OUTCOMES AND MEASURES

Clinical outcomes included intensive care unit (ICU) utilization and in-hospital death. We used age-adjusted odds ratios (OR) and multivariable analysis to evaluate the associations between ethnicity/language groups and outcomes.

RESULTS

32.1% of patients were Hispanic, 38.6% of whom reported a non-English primary language. Hispanic patients were less likely to be insured, have a primary care provider, and have accessed the healthcare system prior to the COVID-19 admission. After adjusting for age, Hispanic inpatients experienced higher ICU utilization (non-English-speaking: OR, 1.75; 95% CI, 1.47-2.08; English-speaking: OR, 1.13; 95% CI, 0.95-1.33) and higher mortality (non-English-speaking: OR, 1.43; 95% CI, 1.10-1.86; English-speaking: OR, 1.53; 95% CI, 1.19-1.98) compared to non-Hispanic inpatients. There were no observed treatment disparities among ethnic groups. After adjusting for age, Hispanic inpatients had elevated disease severity at admission (non-English-speaking: OR, 2.27; 95% CI, 1.89-2.72; English-speaking: OR, 1.33; 95% CI, 1.10- 1.61). In multivariable analysis, the associations between ethnicity/language and clinical outcomes decreased after considering baseline disease severity (P < .001).

CONCLUSION

The associations between ethnicity and clinical outcomes can be explained by elevated disease severity at admission and limited access to healthcare for Hispanic patients, especially non-English-speaking Hispanics.

The Impact of Structural Inequities on Older Asian Americans During COVID-19

Structural racism manifests as an historical and continued invisibility of Asian Americans, whose experiences of disparities and diverse needs are omitted in research, data, and policy. During the pandemic, this invisibility intersects with rising anti-Asian violence and other persistent structural inequities that contribute to higher COVID-19 mortality in older Asian Americans compared to non-Hispanic whites. This perspective describes how structural inequities in social determinants of health-namely immigration, language and telehealth access, and economic conditions-lead to increased COVID-19 mortality and barriers to care among older Asian Americans. Specifically, we discuss how the historically racialized immigration system has patterned older Asian immigrant subpopulations into working in frontline essential occupations with high COVID-19 exposure. The threat of "public charge" rule has also prevented Asian immigrants from receiving eligible public assistance including COVID-19 testing and vaccination programs. We highlight the language diversity among older Asian Americans and how language access remains unaddressed in clinical and non-clinical services and creates barriers to routine and COVID-19 related care, particularly in geographic regions with small Asian American populations. We discuss the economic insecurity of older Asian immigrants and how co-residence in multigenerational homes has exposed them to greater risk of coronavirus transmission. Using an intersectionality-informed approach to address structural inequities, we recommend the disaggregation of racial/ethnic data, meaningful inclusion of older Asian Americans in research and policy, and equitable investment in community and multi-sectoral partnerships to improve health and wellbeing of older Asian Americans.