From undocumented to lawfully present: Do changes to legal status impact psychological wellbeing among latino immigrant young adults?

Downgraded dreams: Labor market outcomes and mental health in undocumented migration

Undocumented immigrant workers are particularly exposed to mental health risk factors, including occupational downgrading - i.e. the loss in occupational status upon arrival. This study breaks new ground by examining the relationship between occupational downgrading and mental health among this hard-to-reach population, offering the first-ever investigation of its kind. Leveraging a unique dataset collected by a primary care outpatient clinic in Milan, Italy, which combines medical evaluations with detailed occupational information, we construct a direct measure of occupational downgrading, which adds to the literature. We employ logistic regression models to estimate odds ratios (ORs) for mental and behavioral disorders. The study also offers fresh evidence on the socioeconomic and health status of a sizable sample of undocumented migrants. The study sample consists of 1738 individuals that had their first medical examination in 2017-18. Prevalence of mental health conditions is 5.58%. Data also highlight poor labor market integration: one third of individuals in the sample is employed, mostly in elementary occupations; 66.63% of immigrant workers experienced occupational downgrading. Regression results show that undocumented immigrants who undergo occupational downgrading are at considerably higher risk of mental disorders. ORs range from 1.729 (95% CI 1.071-2.793), when the model only includes individual characteristics determined prior to migration, to 2.659 (CI 1.342-5.271), when it accounts for all the available controls. From a policy perspective, our study underscores the need to consider the broader impact of policies, including restrictive entry and integration policies, on migrant health. Additionally, ensuring access to primary care for all immigrants is crucial for early detection and treatment of mental health conditions.

Association of adversities and mental health among first- and second-generation Arab American young adults

The prevalence of mental health problems among young adults is widely recognized. However, limited research has examined the mental health of Arab American young adults specifically. To address this gap in the literature, this study aimed to investigate the effects of multiple stressors including adverse childhood experiences (ACEs), discrimination, and bullying victimization on the mental health of first- and second-generation Arab American young adults. The participants (N = 162) were recruited from a Midwest university using online and in-person methods. They were screened and completed a demographic questionnaire and self-report measures of ACEs, discrimination, bullying victimization, and mental health. Hierarchical multiple regression analysis was conducted to examine the effect of psychosocial stressors on mental health and the moderating effect of generation (first vs. second) on that relationship. Female gender, increased perceived discrimination, and more ACEs were associated with lower mental health scores (β = -0.316, p < 0.001, β = -0.308, p < 0.001, and β = -0.230, p = 0.002, respectively). There was a significant negative relationship between victimization and mental health for first-generation Arab Americans (β = -0.356, p = 0.010). However, that association all but disappeared for second-generation participants (β = 0.006, p = 0.953). The results highlight the impact of multiple adversities on Arab American young adults' mental health and indicate important nuances related to their generation in the association between bullying victimization and mental health. Implications for practice and future research are discussed.

Deportation threat predicts Latino US citizens and noncitizens' psychological distress, 2011 to 2018

The national context of deportation threat, defined as the federal government's approach to deportation and/or deportation's salience to the US public, fluctuated between 2011 and 2018. US Latinos across citizenship statuses may have experienced growing psychological distress associated with these changes, given their disproportionate personal or proximal vulnerabilities to deportation. Drawing on 8 y of public- and restricted-access data from the National Health Interview Survey (2011 to 2018), this article examines trends in psychological distress among Latinos who are US-born citizens, naturalized citizens, and noncitizens. It then seeks to explain these trends by considering two theoretical pathways through which the national context of deportation threat could distress Latinos: 1) through discrete dramatic societal events that independently signal a change to the country's approach to deportation and/or that render deportation temporarily more salient to the public or 2) through more gradual changes to the country's everyday institutional (i.e., quotidian efforts to detain and deport noncitizens) and social (i.e., deportation's ongoing salience to a concerned public) environment of deportation threat. We find that, though both pathways matter to some degree, there is more consistent evidence that the gradual changes are associated with Latino US citizens and noncitizens' overall experiences of psychological distress. The article highlights how, even absent observable spillover effects of dramatic societal events bearing on deportation threat, the institutional and social environment in which they occur implicates Latinos' well-being.

The measurement of racism in health inequities research

There is limited literature on the measures and metrics used to examine racism in the health inequities literature. Health inequities research is continuously evolving, with the number of publications increasing over time. However, there is limited knowledge on the best measures and methods to examine the impact of different levels of racism (institutionalized, personally mediated, and internalized) on health inequities. Advanced statistical methods have the potential to be used in new ways to examine the relationship between racism and health inequities. In this review, we conduct a descriptive examination of the measurement of racism in the health inequities epidemiologic literature. We examine the study design, methods used for analysis, types of measures used (e.g., composite, absolute, relative), number of measures used, phase of research (detect, understand, solutions), viewpoint (oppressor, oppressed), and components of structural racism measures (historical context, geographical context, multifaceted nature). We discuss methods (e.g., Peters-Belson, latent class analysis, difference in differences) that have demonstrated potential for future work. The articles reviewed were limited to the detect (25%) and understand (75%) phases, with no studies in the solutions phase. Although the majority (56%) of studies had cross-sectional designs, many authors pointed to the need for longitudinal and multilevel data for further exploration. We examined study design features as mutually exclusive elements. However, racism is a multifaceted system and the measurement of racism in many studies does not fit into a single category. As the literature grows, the significance of methodological and measurement triangulation to assess racism should be investigated.

Mechanism mapping: A qualitative study of how different forms of instability mediate the relationship between legal status and immigrant mental well-being

Scholarship on undocumented immigrants has linked irregular forms of legal status to depressed mental health experiences and outcomes. The children of undocumented immigrants have also been shown to report mental health issues. More regular forms of legal status, like Deferred Action for Childhood Arrivals (DACA), have been shown to improve psychological outcomes for migrants and their children. Though the relationship between legal status and mental well-being has appeared again and again in the literature, less work has explored the mechanisms through which legal status impacts mental well-being. This paper aims to help detail this link by drawing on 50 in-depth interviews with DACA-recipient and undocumented (DACA-ineligible) immigrants conducted from 2017 to 2018 (pre- and post-DACA rescindment). Thematic analysis identified three forms of instability (nation-state, residential and household) that mediate the influence of legal status on the mental well-being of immigrants and their families. Coping with nation-state, residential and household changes depleted immigrant's mental and emotional resources, hurting their mental well-being. More regular forms of legal status (like DACA) suppressed the occurrence of instability, bolstering the mental well-being reports of DACA-recipients compared to their undocumented counterparts. Yet the program's rescission in September 2017, spiked the threat of future instability for DACA-respondents leading their negative mental well-being reports to echo those of undocumented respondents. We propose that experiencing or even expecting these forms of instability to occur mediates the influence of legal status on mental well-being. Findings shed light on how legal status influences mental well-being and contribute to the immigrant mental health literature.

Impact of legal status regularization on undocumented migrants’ self-reported and mental health in Switzerland

Undocumented migrants face cumulative difficulties like precarious living and working conditions or exclusion from health services that might negatively influence their health. Little is known about the evolution of undocumented migrants' self-reported health (SRH) and mental health after they get documented. This study aims to observe the effect of legal status regularization on SRH and mental health in a cohort of migrants undergoing regularization in Geneva, Switzerland. We evaluate SRH with the first item of the Short Form Survey (SF12) and depression as a proxy of mental health with the PHQ-9 questionnaire over four years among 387 undocumented and newly documented migrants. Using hybrid linear models, our data show that regularization has no direct effect on SRH, but has direct positive effects on mental health in a longitudinal perspective, even when controlling for competing factors. The arrival of the pandemic did not alter these effects. Migrants tend to evaluate their subjective health status more positively than the prevalence of screened depression shows. Those findings point towards better targeted policies that could reduce the burden of depression among undocumented migrants.

"Si Mis Papas Estuvieran Aquí": Unaccompanied Youth Workers' Emergent Frame of Reference and Health in the United States

Relying on in-depth interviews and ethnographic data in Los Angeles, California, this study examines the health experiences of unaccompanied, undocumented Latin American-origin immigrant youth as they come of age as low-wage workers. Findings demonstrate that unaccompanied, undocumented youth undergo cumulative physical and mental health disadvantages in the United States's secondary labor market and during critical developmental life stages while lacking the parental monitoring and guidance to navigate them. Developing comparisons between their past and present living conditions and between themselves and other youth in Los Angeles-what I refer to as an emergent frame of reference-youth workers come to perceive family disruptions, and especially separation from their parents, as the most salient factor affecting their health. While some youth ultimately resign themselves to short-term attempts to assuage illness, injury, or distress through activities like substance abuse, others pursue community connections and support groups that can sustain them long term.

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.

Measuring Latinx/@ immigrant experiences and mental health: Adaptation of discrimination and historical loss scales

Migration processes encompass uncertainty, discrimination, racism, stigma, social isolation, lack of access to resources, fear of deportation, and family separation, having a critical impact on the health of Latinx/@ immigrants in the United States. It is essential to accurately measure the ways in which social, legal, economic, and political contexts impact mental health. This article discusses adaptation and use of discrimination and historical loss measures in a multilevel community-based advocacy, learning, and social support intervention (Immigrant Well-Being Project) with Latinx/@ immigrants in New Mexico, using participatory research approaches. Participants (n = 52) were recruited through community partner organizations and completed four qualitative and quantitative interviews over a 12-month period. The present analysis draws on the baseline quantitative data. Results show it is possible to adapt standardized measures of discrimination developed to assess the experiences of other racial/ethnic groups; however, the most common responses involved response options added by our research team. For the historical loss instrument, there was a high frequency of "never" answers for many items, suggesting that they were not relevant for participants or did not capture their experiences of loss. As with the discrimination measures, the items we added resonated the most with participants. The contexts of discrimination and loss for Latinx/@ immigrant populations are complex, thus the tools we use to measure these experiences and their impact on health must account for this complexity. This study contributes to these endeavors through involving community members in the conceptualization and measurement of discrimination and historical loss among Latinx/@ immigrants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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.

Institutional Racism and Health: a Framework for Conceptualization, Measurement, and Analysis

Despite growing interest in the health-related consequences of racially discriminatory institutional policies and practices, public health scholars have yet to reach a consensus on how to measure and analyze exposure to institutional racism. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. We begin by providing definitions of key concepts (e.g., racialization, racism, racial inequity) and describing linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. We then provide a framework to advance empirical research on institutional racism and health, informed by a literature review that summarizes measures and analytic approaches used in previous studies. The framework addresses six considerations: (1) policy identification, (2) population of interest, (3) exposure measurement, (4) outcome measurement, (5) study design, and (6) analytic approach. Research utilizing the proposed framework will help inform structural interventions to promote minority health and reduce racial and ethnic health disparities.

The Contradictions of Liminal Legality: Economic Attainment and Civic Engagement of Central American Immigrants on Temporary Protected Status

This study examines how Temporary Protected Status (TPS) may shape immigrants' integration trajectories. Building on core themes identified in the immigrant incorporation scholarship, it investigates whether associations of educational attainment with labor market outcomes and with civic participation, which are well established in the general population, hold for immigrants who live in the "liminal legality" of TPS. Conducted in 2016 in five U.S. metropolitan areas, the study is based on a unique survey of Salvadoran and Honduran TPS holders, the majority of immigrants on this status. The analyses find that TPS holders with higher levels of educational attainment do not derive commensurate significant occupational or earnings premiums from their education. In contrast, the analysis of the relationship between educational attainment and civic engagement detects a positive association: more educated TPS holders are more likely to be members of community organizations and to participate in voluntary community service, compared to their less educated counterparts. These findings illustrate the contradictions inherent to TPS as it may hinder certain aspects of immigrant integration but not others. This examination contributes to our understanding of the implications of immigrants' legal statuses and of immigration law and policy for key aspects of immigrant integration trajectories.

The Deferred Action for Childhood Arrivals program and birth outcomes in California: a quasi-experimental study

BACKGROUND

The Deferred Action for Childhood Arrivals (DACA) program provides temporary relief from deportation and work permits for previously undocumented immigrants who arrived as children. DACA faced direct threats under the Trump administration. There is select evidence of the short-term impacts of DACA on population health, including on birth outcomes, but limited understanding of the long-term impacts.

METHODS

We evaluated the association between DACA program and birth outcomes using California birth certificate data (2009-2018) and a difference-in-differences approach to compare post-DACA birth outcomes for likely DACA-eligible mothers to birth outcomes for demographically similar DACA-ineligible mothers. We also separately compared birth outcomes by DACA eligibility status in the first 3 years after DACA passage (2012-2015) and in the subsequent 3 years (2015-2018) - a period characterized by direct threats to the DACA program - as compared to outcomes in the years prior to DACA passage.

RESULTS

In the 7 years after its passage, DACA was associated with a lower risk of small-for-gestational age (- 0.018, 95% CI: - 0.035, - 0.002) and greater birthweight (45.8 g, 95% CI: 11.9, 79.7) for births to Mexican-origin individuals that were billed to Medicaid. Estimates were consistent but of smaller magnitude for other subgroups. Associations between DACA and birth outcomes were attenuated to the null in the period that began with the announcement of the Trump U.S. Presidential campaign (2015-2018), although confidence intervals overlapped with estimates from the immediate post-DACA period.

CONCLUSIONS

These findings suggest weak to modest initial benefits of DACA for select birthweight outcomes during the period immediately following DACA passage for Mexican-born individuals whose births were billed to Medicaid; any benefits were subsequently attenuated to the null. The benefits of DACA for population health may not have been sufficient to counteract the impacts of threats to the program's future and heightened immigration enforcement occurring in parallel over time.

The association between Deferred Action for Childhood Arrivals, health access, and mental health: the role of discrimination, medical mistrust, and stigma

OBJECTIVE

There are approximately 11 million undocumented immigrants in the US, including 1.3 million young adults who are eligible for the Deferred Action for Childhood Arrivals (DACA) program. It is unclear how DACA influences engagement in healthcare or depressive symptoms, and the role of discrimination, medical mistrust, and stigma in healthcare settings. This study assesses the association of DACA on undocumented young adults' engagement with health care and depressive symptoms.

DESIGN

We conducted an internet-based survey examining the health-related experiences of undocumented Latino and Asians and Pacific Islander (API) young adults in California (n = 218) between June and August 2017. Multivariable logistic regressions were conducted to assess the influence of DACA, discrimination, medical mistrust, and stigma on healthcare engagement and depressive symptoms.

RESULTS

Approximately 78% of respondents had a gap in healthcare, and about 31% reported high levels of depressive symptoms. Controlling for demographic characteristics, compared to those without DACA, DACA-recipients had lower odds of reporting gaps in healthcare engagement (aOR = 0.270, p < 0.05) and depressive symptoms (aOR = 0.115, p < 0.01). Those facing discrimination, medical mistrust, and stigma in healthcare settings were less likely to have a healthcare visit and more likely to have higher depressive symptoms.

CONCLUSIONS

DACA is a potential strategy to improve healthcare access and address the mental health of undocumented populations. In particular, issues of discrimination, stigma by healthcare providers, and medical mistrust need to be addressed.

Immigrant-Related Policies and the Health Outcomes of Latinx Adults in the United States: A Systematic Review

BACKGROUND

US federal and subfederal immigrant-related policy activity has increased in recent years. We hypothesize that these policies are structural determinants of health for Latinx communities, operating through access to resources, discriminatory enforcement, and stress.

METHODS

We searched seven databases for quantitative studies, published as of September 2021, examining the association between the presence of federal, state, or local immigrant-related policy(ies), over time or cross-sectionally, and mental or physical health outcomes among immigrant or US-born Latinx adults. We rated studies on methodologic quality.

RESULTS

Eleven studies were included. Policies included federal and state policies. Health outcomes included mental health (seven studies), self-rated health (n = 6), and physical disability (n = 1). Among immigrant, noncitizen, or Spanish-preferring Latinx adults, exclusionary policies were associated with poor self-rated health, physical disability, and poor mental health. Inclusive policies were associated with better health, although null findings were more common than among studies of exclusionary policies. Only three studies separately examined policy effects on US-born or citizen Latinx adults and these findings were often null. All studies received a weak overall study quality rating; among quality domains, studies were strongest in confounding control and weakest in outcome information bias and reporting missing data approaches.

CONCLUSIONS

These results support the hypothesis that immigrant-related policies, especially exclusionary policies, are structural drivers of health for immigrant or noncitizen Latinx adults. However, evidence is scant among US-born or citizen Latinx adults. Studies of policies and physical health outcomes besides disability are lacking, as are results disaggregated by nativity and/or citizenship status.

Manoeuvering through the Multilayered Jurisdictional Policy Patchwork: DACA Recipients' Navigational Capital in the Washington, D.C. Metropolitan Region

During its almost-decade of existence, Deferred Action for Childhood Arrivals (DACA) has been a focal point of immigration policy debate. Liminally legal DACA recipients have endured a rollercoaster of lawsuits and court decisions, yet are simultaneously incorporating into local communities characterized by distinctive socio-legal contexts. Drawing from a longitudinal qualitative study of 30 DACA recipients in the Washington, D.C. Metropolitan region, we argue that DACA recipients draw from their legal-spatial consciousness and local knowledge to forge navigational capital that allows them to adeptly maneuver between different jurisdictions. Over time, they deploy this navigational capital to strategically access distinct yet interconnected educational, health care, housing, and employment sectors and expand their spatial mobility, underscoring their capacity for adaptation and resilience. As forms of collective knowledge, their navigational capital reverberates through their social networks as they broker on-the-ground forms of inclusion for themselves and their families and communities within these socio-legal contexts.

Deferred depression? Mediation analysis of Deferred Action for Childhood Arrivals and immigration enforcement among Undocumented Asian and Pacific Islander students

OBJECTIVES

Undocumented Asians and Pacific Islanders (UndocuAPI) comprise 25% of undocumented students. Yet few studies have examined UndocuAPI mental health in the context of the contradictory political environment which encompasses both inclusionary policies, such as Deferred Action for Childhood Arrivals (DACA), and exclusionary policies, like immigration enforcement.

METHODS

Using cross-sectional survey data collected in 2019 from UndocuAPI college students and recent alumni in California (n = 174), we used multiple logistic regression to estimate the effect of DACA status on clinical levels of depressive symptoms. We tested whether immigration enforcement experiences mediated this relationship using the Karlson, Holm, and Breen (KHB) method.

RESULTS

Adjusted logistic regression results revealed that UndocuAPI with DACA had significantly lower odds of depression (OR = 0.32, 95% CI: 0.13-0.79). Out of five immigration enforcement factors, limited contact with friends and family (OR = 2.36, 95% CI: 1.08, 5.13) and fearing deportation most or all of the time (OR = 3.62, 95% CI: 1.15, 11.34) were associated with significantly higher odds of depression. However, we did not detect a statistically significant mediation effect of immigration enforcement using KHB decomposition.

CONCLUSION

Findings suggest that the benefits of DACA protected UndocuAPI in California from depressive symptoms, even when accounting for immigration enforcement experiences. Because it was unclear whether immigration enforcement mediates DACA, future research should investigate the underlying mechanisms between immigration policies and mental health with larger samples. Practitioners should consider the short-term need for mental health support and legal services for UndocuAPI students as well as the long-term goal to decriminalize immigrant communities to advance racial health equity.

Differences in Barriers to Healthcare and Discrimination in Healthcare Settings Among Undocumented Immigrants by Deferred Action for Childhood Arrivals (DACA) Status

Undocumented immigrants face barriers to and discrimination in healthcare, but those with Deferred Action for Childhood Arrivals (DACA) status may fare better. This analysis uses the cross-sectional BRAVE Study of young undocumented Latinx and Asian immigrants to examine differences in barriers to and discrimination in healthcare by DACA status. A majority of respondents experienced financial, language, and cultural barriers, and up to half experienced documentation status barriers, discrimination when seeking healthcare or by a health provider, and negative experiences related to documentation status. In multivariable analyses, DACA recipients have over 90% lower odds of language and cultural barriers, approximately 80% lower odds of discrimination when seeking healthcare and by a health provider, and approximately 70% lower odds of documentation status barriers and negative experience related to documentation status compared to nonrecipients. These findings indicate that DACA recipients experience fewer barriers to healthcare and discrimination in healthcare compared to nonrecipients.

Immigrant Legal Status Disparities in Health Among First- and One-point-five-Generation Latinx Immigrants in California

Restrictive US immigration laws and law enforcement undermine immigrant health by generating fear and stress, disrupting families and communities, and eroding social and economic wellbeing. The inequality and stress created by immigration law and law enforcement may also generate disparities in health among immigrants with different legal statuses. However, existing research does not find consistent evidence of immigrant legal status disparities in health, possibly because it does not disaggregate immigrants by generation, defined by age at migration. Immigration and life course theory suggest that the health consequences of non-citizen status may be greater among 1.5-generation immigrants, who grew up in the same society that denies them formal membership, than among the 1st generation, who immigrated as adolescents or adults. In this study, we examine whether there are legal status disparities in health within and between the 1st generation and the 1.5 generation of 23,288 Latinx immigrant adults interviewed in the 2005–2017 waves of the California Health Interview Survey. We find evidence of legal status disparities in heart disease within the 1st generation and for high blood pressure and diabetes within the 1.5 generation. Non-citizens have higher rates of poor self-rated health and distress within both generations. Socioeconomic disadvantage and limited access to care largely account for the worse health of legally disadvantaged 1st- and 1.5-generation Latinx adults in California.

Redefining communities: The association between deferred action, online and offline social capital and depressive symptoms among undocumented young adults

An explosion in Internet use, social networking sites, and COVID-19 has promoted a new concept in health - online social capital, defined as linkages to online social networks that promote trust and group norms. Particularly for the 1.3 million undocumented young adult immigrants who "live in the shadows," the Internet may serve as a place of support and information. This study examines the association between documentation status (defined as Deferred Action for Childhood Arrivals (DACA) status), offline social capital, online social capital, and depressive symptoms among foreign-born Latino and Asian and Pacific Islander young adults in California (N = 208) using data from an internet-based survey conducted in 2017. This study found that those without DACA status had higher online social capital (p < 0.001) and increased depressive symptoms (p = 0.01) than those with DACA status. Using linear regression, we found evidence of online social capital potentially mediating the relationship between DACA status and depressive symptoms. This study also found that as offline social capital increases, the association between online social capital on depressive symptoms decreases. This study points to the power of offline communities and the importance of increasing access to community resources, particularly to those without documentation status who may only have online social networks.

A Comparison of Psychological Stress and Sleep Problems in Undocumented Students, DACA Recipients, and U.S. Citizens

Amidst the uncertainty of a shifting political landscape, our study examined stress and sleep problems experienced by both Deferred Action for Childhood Arrivals (DACA) undergraduates and non-DACA undocumented immigrants in an undergraduate population, in relation to students who were US citizens. We surveyed 969 students (93% Hispanic; 69% female) in 2017 or 2019 using established measures of stress, sleep quality, and insomnia. Collapsed across years, undocumented students reported significantly greater stress than citizens and DACA students, but DACA students did not differ from citizens. No differences were found in sleep for either quality or insomnia. Additionally, DACA student stress was significantly higher in 2019 than 2017, rising to a level similar to that of undocumented students and that differed significantly from citizens. Undocumented students appear to experience greater stress than students who are U.S. citizens, but these differences do not extend to sleep quality or insomnia.

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

Immigrant health research has often noted an "immigrant health paradox", the observation that immigrants are "healthier" compared to their native-born peers of similar demographic and socioeconomic profile. This paradox disappears as immigrants stay longer in the host country. Multiple arguments, including migrant selectivity and cultural and behavioral factors have been proposed as reasons for the apparent paradox. Recently, the field has focused on immigrant legal status, especially its racialization. We review the literature on the immigrant health paradox, legal status, and racialized legal status to examine how this debate has taken a more structural approach. We find that immigrant health research has taken a needed intersectional approach, a productive development that examines how different markers of disadvantage work concurrently to shape immigrants' health. This approach, which factors in immigration enforcement practices, aligns with explanations for poor health outcomes among other racialized groups, and promises a fruitful avenue for future research.

Chilling Effects: US Immigration Enforcement And Health Care Seeking Among Hispanic Adults

Aggressive deportation policy enforcement in the US may make undocumented immigrants and those close to them reluctant to seek medical care. With 68 percent of undocumented immigrants coming from Mexico or Central America, US deportation policies particularly affect Hispanic residents. To examine how deportation enforcement relates to health care use in the Hispanic population in general, we matched survey data from the 2011-16 Behavioral Risk Factor Surveillance System to measures of Immigration and Customs Enforcement (ICE) activity. Quasi-experimental analyses demonstrated that Hispanic respondents were less likely to report having had a regular provider or annual checkup following increased ICE activity in their state. In contrast, these behaviors were unchanged among non-Hispanic adults, a group less likely to be affected by deportation enforcement. Parallel results were found among Hispanic and non-Hispanic adults with diabetes, for whom lapses in care may confer significant health risks.

An ecological expansion of the adverse childhood experiences (ACEs) framework to include threat and deprivation associated with U.S. immigration policies and enforcement practices: An examination of the Latinx immigrant experience

The Adverse Childhood Experiences (ACEs) framework has contributed to advances in developmental science by examining the interdependent and cumulative nature of adverse childhood environmental exposures on life trajectories. Missing from the ACEs framework, however, is the role of pervasive and systematic oppression that afflicts certain racialized groups and that leads to persistent threat and deprivation. In the case of children from immigrant parents, the consequence of a limited ACEs framework is that clinicians and researchers fail to address the psychological violence inflicted on children from increasingly restrictive immigration policies, ramped up immigration enforcement, and national anti-immigration rhetoric. Drawing on the literature with Latinx children, the objective of this conceptual article is to integrate the ecological model with the dimensional model of childhood adversity and psychopathology to highlight how direct experience of detention and deportation, threat of detention and deportation, and exposure to systemic marginalization and deprivation are adverse experiences for many Latinx children in immigrant families. This article highlights that to reduce bias and improve developmental science and practice with immigrants and with U.S.-born children of immigrants, there must be an inclusion of immigration-related threat and deprivation into the ACEs framework. We conclude with a practical and ethical discussion of screening and assessing ACEs in clinical and research settings, using an expanded ecological framework that includes immigration-related threat and deprivation.

Self-rated health among undocumented and newly regularized migrants in Geneva: a cross-sectional study

Background

In Europe, knowledge about the social determinants of health among undocumented migrants is scarce. The canton of Geneva, Switzerland, implemented in 2017–2018 a pilot public policy aiming at regularizing undocumented migrants. We sought to test for associations between self-rated health, proven eligibility for residence status regularization and social and economic integration.

Methods

This paper reports data from the first wave of the Parchemins Study, a prospective study whose aim is to investigate the effect of residence status regularization on undocumented migrants’ living conditions and health. The convenience sample included undocumented migrants living in Geneva for at least 3 years. We categorized them into those who were in the process of receiving or had just been granted a residence permit (eligible or newly regularized) and those who had not applied or were ineligible for regularization (undocumented). We conducted multivariate regression analyses to determine factors associated with better self-rated health, i.e., with excellent/very good vs. good/fair/poor self-rated health. Among these factors, measures of integration, social support and economic resources were included.

Results

Of the 437 participants, 202 (46%) belonged to the eligible or newly regularized group. This group reported better health more frequently than the undocumented group (44.6% versus 28.9%, p-value < .001), but the association was no longer significant after adjustment for social support and economic factors (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.67–1.87). Overall, better health was associated with larger social networks (OR: 1.66; 95% CI: 1.04–2.64). This association remained significant even after adjusting for health-related variables.

Conclusion

At the onset of the regularization program, access to regularization was not associated with better self-rated health. Policies aiming at favouring undocumented migrants’ inclusion and engagement in social networks may promote better health. Future research should investigate long-term effects of residence status regularization on self-rated health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11239-0.

Undocumented immigrants and mental health: A systematic review of recent methodology and findings in the United States

This study reviewed the methodology and findings of 44 peer-reviewed studies on psychosocial risk factors associated with mental health outcomes among undocumented immigrants (UIs) in the United States. Findings showed a considerable advancement over the past seven years in the methods and measures used in the included studies. Nonetheless, there is a need for continued methodological rigor, innovative study designs, greater diversity of samples, and in-depth exploration of constructs that facilitate resilience. Identifying avenues to reduce risk in this population is essential to inform intervention and advocacy efforts aimed at overcoming distress from the current U.S. anti-immigrant and socio-political climate.

DACA's Association With Birth Outcomes Among Mexican-Origin Mothers in the United States

The 2012 Deferred Action for Childhood Arrivals (DACA) program granted work authorization and protection from deportation to more than 800,000 young undocumented immigrants who arrived to the United States as minors. We estimate the association between this expansion of legal rights and birth outcomes among 72,613 singleton births to high school-educated Mexican immigrant women in the United States from June 2010 to May 2014, using birth records data from the National Center for Health Statistics. Exploiting the arbitrariness of the upper age cutoff for DACA eligibility and using a difference-in-differences design, we find that DACA was associated with improvements in the rates of low birth weight and very low birth weight, birth weight in grams, and gestational age among Mexican immigrant mothers.

Somatic, Anxiety, and Depressive (SAD) Symptoms in Young Adult Latinx Immigrants: Prevalence and Predictors

Certain immigration factors may increase somatic, anxiety, and depressive (SAD) symptoms in Latinx immigrants. Our study examined prevalence of SAD symptoms in Latinx immigrants 18-29 presenting to primary care with correlates of acculturation, immigration, and legal status. SAD symptoms were measured using the PHQ-14, GAD-7 and PHQ-8. Moderate somatization (37%), anxiety (20%), and depression (25%) were common. Multivariable analysis found five immigration factors predicted a higher composite SAD score and the presence of each additional factor increased likelihood of a SAD score ≥ 20 (OR  1.7; 95% CI, 1.1 to 2.5). SAD scores increased in a dose-response fashion (8.3, 10.5, 14.8, 17.1, 21.7, 29.3) with the added presence of each factor. Elevated SAD scores were not associated with gender, marital status, education, income, country of origin, or acculturation. Screening with our five factor immigration distress index may help identify patients at risk for higher SAD scores during a primary care visit.

Mental health of undocumented migrants and migrants undergoing regularization in Switzerland: a cross-sectional study

BACKGROUND

Undocumented migrants live and work in precarious conditions. Few studies have explored the mental health consequences of such environment. The objective of this study is to describe the mental health of migrants at different stages of a regularization program.

METHODS

This cross-sectional study included migrants undocumented or in the process of regularization. We screened for symptoms of anxiety, depression and sleep disturbance using validated tools. We created a composite outcome of altered mental health including these components plus self-report of a recent diagnosis of mental health condition by a health professional.

RESULTS

We enrolled 456 participants of whom 246 (53.9%) were undocumented. They were predominantly women (71.9%) with a median age of 43.3 (interquartile range: 15.5) years, from Latin America (63.6%) or Asia (20.2%) who had lived in Switzerland for 12 (IQR: 7) years. Overall, 57.2% presented symptoms of altered mental health. Prevalence of symptoms of anxiety, depression and sleep disturbance were 36% (95% confidence interval: 31.6-40.6%), 45.4% (95% CI: 40.8-50.1%) and 23% (95% CI: 19.2-27.2), respectively. Younger age (adjusted odd ratio: 0.7; 95% CI: 0.5-0.9 for each additional decade), social isolation (aOR: 2.4; 95% CI: 1.4-4.2), exposure to abuse (aOR: 1.9; 95% CI: 1.1-3.5), financial instability (aOR: 2.2; 95% CI: 1.4-3.7) and multi-morbidity (aOR: 3.2; 95% CI: 1.7-6.5) were associated with increased risk of having altered mental health while being in the early stages of the process of regularization had no effect (aOR: 1.3: 95% CI: 0.8-2.2).

CONCLUSIONS

This study highlights the need for multi-pronged social and health interventions addressing the various domains of undocumented migrants living difficulties as complement to legal status regularization policies. Protection against unfair working conditions and abuse, access to adequate housing, promoting social integration and preventive interventions to tackle the early occurrence of chronic diseases may all contribute to reduce the burden of altered mental health in this group. More research is needed to assess the long-term impact of legal status regularization on mental health.

Immigration status as a health care barrier in the USA during COVID-19

In the context of the United States of America (U.S.), COVID-19 has influenced migrant experiences in a variety of ways, including the government's use of public health orders to prevent migration into the country and the risk of immigrants contracting COVID-19 while in detention centers. However, this paper focuses on barriers that immigrants of diverse statuses living in the U.S.—along with their families—may face in accessing health services during the pandemic, as well as implications of these barriers for COVID-19 prevention and response efforts. We report findings from a scoping review about immigration status as a social determinant of health and discuss ways that immigration status can impede access to health care across levels of the social ecology. We then develop a conceptual outline to explore how changes to federal immigration policies and COVID-19 federal relief efforts implemented in 2020 may have created additional barriers to health care for immigrants and their families. Improving health care access for immigrant populations in the U.S. requires interventions at all levels of the social ecology and across various social determinants of health, both in response to COVID-19 and to strengthen health systems more broadly.

The Gendered Effects of Local Immigration Enforcement: Latinas' Social Isolation in Chicago, Houston, Los Angeles, and Phoenix

The 2017 revitalization of the controversial Security Communities program, which requires local law enforcement to cooperate with federal immigration officials in the United States, has made it urgent to better understand such enforcement programs' effects on the well-being of Latinas/os, especially the foreign-born. Social isolation from increased immigration enforcement can have significant impacts on economic, social, and health outcomes among Latina/o immigrants and non-immigrants. This article analyzes the gendered impacts of different levels of increased local involvement in immigration enforcement on social isolation, using a survey of over 2000 Latinas/os in four large US cities, all considered to be traditional destinations. Unsurprisingly, respondents reported increased social isolation resulting from local law enforcement's involvement in immigration enforcement. In contrast to results from previous research, our analysis found that women and men were equally likely to feel socially isolated and that having children led to more social isolation for both women and men. Personal and vicarious experiences with immigration enforcement, as well as living in Phoenix and Houston - two urban areas with the strictest enforcement regimes - were strongly related to social isolation. Our results indicate that local authorities' increased involvement in immigration enforcement can lead to more social isolation for Latina immigrants, particularly those who have children, aligning their experiences with men's and, thus, undermining Latinas' previously recognized role as bridges between their families and social institutions and as community builders.

Psychological distress in middle eastern immigrants to the United States: A challenge to the healthy migrant model?

RATIONALE AND OBJECTIVE

Research has documented a robust mental health advantage among Asian and Latino immigrants to the United States relative to the native-born. The current investigation extended this line of research, asking whether Middle Eastern immigrants to the United States enjoy a similar mental health advantage.

METHODS

Drawing on pooled cross-sections from the 2007-2018 National Health Interview Surveys, we used OLS regression to examine psychological distress in Middle Eastern immigrants relative to both native-born Whites and immigrants from other global regions. We used statistical interactions to assess whether gender and period differences are contingent on region of birth.

RESULTS

Findings reveal that the average level of psychological distress is higher among Middle Eastern immigrants than among both U.S.-born Whites and immigrants from other regions. Despite changing circumstances of migration for Middle Easterners and implementation in the United States of anti-immigrant policies, we see no evidence that distress increased more among immigrants compared to native-born Whites. Results point to greater psychological distress among Middle Eastern women than their native-born White counterparts and women from other immigrant groups, as well as Middle Eastern men. In contrast, psychological distress levels for Middle Eastern and native-born White men were indistinguishable, suggesting that the Middle Eastern mental health disadvantage in the United States is borne solely by women.

CONCLUSIONS

Results show that the mental health advantage enjoyed by some immigrant groups does not extend to Middle Eastern women, contradicting the healthy migrant model and challenging the assumption of a uniform mental health advantage across immigrant groups.

(Il)legality and psychosocial well-being: Central Asian migrant women in Russia

Legal status has shown far-reaching consequences for international migrants' incorporation trajectories and outcomes in Western contexts. In dialogue with the extant research, we examine the implications of legal status for subjective well-being of Central Asian migrant women in the Russian Federation. Using survey data collected through respondent-driven sampling in two large cities, we compare migrants with regularized and irregular legal statuses on several interrelated yet distinct dimensions of subjective well-being. We find that, regardless of other factors, regularized status has a strong positive association with migrants' perception of their rights and freedoms but not with their feeling of being respected in society. Regularized status is positively associated with self-efficacy and negatively with depression. Yet, no net legal status difference is found in migrants' views on their relations with other migrants or on treatment of migrants by native-borns. The findings are situated within the cross-national scholarship on the ramifications of racialized immigrant (il)legality and its implications for membership and belonging.

Race and ethnic variation in college students' allostatic regulation of racism-related stress

Racism-related stress is thought to contribute to widespread race/ethnic health inequities via negative emotion and allostatic stress process up-regulation. Although prior studies document race-related stress and health correlations, due to methodological and technical limitations, they have been unable to directly test the stress-reactivity hypothesis in situ. Guided by theories of constructed emotion and allostasis, we developed a protocol using wearable sensors and daily surveys that allowed us to operationalize and time-couple self-reported racism-related experiences, negative emotions, and an independent biosignal of emotional arousal. We used data from 100 diverse young adults at a predominantly White college campus to assess racism-related stress reactivity using electrodermal activity (EDA), a biosignal of sympathetic nervous system activity. We find that racism-related experiences predict both increased negative emotion risk and heightened EDA, consistent with the proposed allostatic model of health and disease. Specific patterns varied across race/ethnic groups. For example, discrimination and rumination were associated with negative emotion for African American students, but only interpersonal discrimination predicted increased arousal via EDA. The pattern of results was more general for Latinx students, for whom interpersonal discrimination, vicarious racism exposure, and rumination significantly modulated arousal. As with Latinx students, African students were particularly responsive to vicarious racism while 1.5 generation Black students were generally not responsive to racism-related experiences. Overall, these findings provide support for allostasis-based theories of mental and physical health via a naturalistic assessment of the emotional and sympathetic nervous system responding to real-life social experiences.

Disentangling contributions of demographic, family, and socioeconomic factors on associations of immigration status and health in the United States

BACKGROUND

In the United States, immigration policy is entwined with health policy, and immigrants' legal statuses determine their access to care. Yet, policy debates rarely take into account the health needs of immigrants and potential health consequences of linking legal status to healthcare. Confounding from social and demographic differences and lack of individual-level data with sensitive immigration variables present challenges in this area of research.

METHODS

This article used the restricted California Health Interview Survey (CHIS) to assess differences in self-rated health, obesity, and severe psychological distress. Between US-born citizens, naturalised citizens, lawful permanent residents (LPR), undocumented immigrants, and temporary visa holders living in California.

RESULTS

Results show that while immigrant groups appear to have poorer health on the surface, these differences were explained predominantly by older age among naturalised citizens and by lower-income and education among LPRs and undocumented immigrants. Favourable family characteristics acted as protective factors for immigrants' health, especially among disadvantaged immigrants.

CONCLUSION

Immigration policy that limits access to healthcare and family support may further widen the health disadvantage among immigrants with less legal protection.

Heterogeneity in the Association of Citizenship Status on Self-Rated Health Among Asians in California

Citizenship is considered an egalitarian legal identity but may function differently among minorities because of racial/ethnic stratification and historical context. Using Asians, I examine whether the association between citizenship and self-rated health differs by ethnicity. I examine the moderating effect of Asian ethnic group (Chinese, Filipino, Korean, Vietnamese, and Other Asian) on citizenship and self-rated health using the 2012-2016 California Health Interview Survey (n = 11,084). Models account for demographics, socioeconomic status, healthcare, and English proficiency. Adjusting for demographics, naturalized citizens and non-citizens were statistically significantly more likely to report fair/poor health compared to U.S.-born citizens. Naturalized and non-citizen Vietnamese reported statistically significantly poorer health to all U.S.-born groups. These trends largely disappear when controlling for all covariates. Citizenship status can be useful in considering structural barriers for immigrants. Future work should interrogate the non-citizen category and why trends are seen among Vietnamese, but not others.

Undocumented immigration in the United States: Historical and legal context and the ethical practice of school psychology

Anti-immigrant sentiment, policy, and practice are deeply rooted in the US tradition. Because of this, a series of laws have been passed to restrict immigration, which has resulted in millions of children and families being designated as “undocumented”. These individuals reside in the US, yet do not receive the same protections as citizens. Schools, however, have historically been supportive institutions for undocumented children because of various laws and court decisions that uphold their access to a free and appropriate education. Various barriers exist to the successful implementation of these laws and they are often not followed. School psychologists, as professionals with an ethical responsibility to advocate for the well-being of all students and families—regardless of their immigration status—can help overcome these barriers. This article first reviews the historical and legal context surrounding undocumented immigration in the US as it impacts public K-12 education. Second, it details how ethical standards influence the applied practice of school psychology when working with undocumented students and families. Finally, it concludes with a brief discussion on resolving legal and ethical dilemmas.

The Higher Educational Trajectories of Undocumented Youth in the United States

Despite growth in the number of Latino students enrolled in U.S. colleges, foreign-born Latinos are less likely than both native-born Latinos and other immigrant groups to graduate. However, it is difficult to understand the lower educational attainment of Latino immigrants without considering variation in enrollment by legal status. After all, until recently, undocumented immigrants have been blocked from higher education in the United States. Drawing upon the education and immigrant illegality literature, as well as longitudinal administrative data on 35,400 college students, we examine the association between students' legal status and their educational achievement, or GPA-an important predictor of educational attainment. We find that, despite high achievement in high school and upon first enrolling in college, undocumented students do not experience upward achievement over time, otherwise known in the education literature as educational progression. Rather, their growth is flat, and their level of achievement declines slightly, what we call an educational regression, relative to their documented and foreign-born citizen Latino peers. We identify several individual- and structural-level factors that help explain the pattern and timing of undocumented student regression. The results have implications for studies of immigrant inequality, incorporation, and immigration law in the U.S. and globally.

Provider Perspectives on Stressors, Support, and Access to Mental Health Care for Latinx Youth

Despite risk for mental health difficulties, Latinx youth have among the lowest rates of mental health care utilization. With this study, we contribute to our ongoing community-based participatory research (CBPR) efforts to explore stressors and protective factors experienced by low-socioeconomic status (SES) Latinx youth, and how these factors influence mental health care utilization. We interviewed community providers and stakeholders (N = 11) from organizations serving low-SES Latinx youth. Coded data yielded seven categories of specific stressors, protective factors, and processes by which these factors influence service utilization. Across categories, providers emphasized how combined family and socioeconomic risk contributed to disengagement from services and described schools and community programs as buffering this risk. Findings suggest that the unique experiences of low-SES Latinx youth contribute to low rates of service utilization, and that intervention should address specific factors at the family, school, and community level to improve access to care.

Intergenerational Mobility and Goal-Striving Stress Among Black Americans: The Roles of Ethnicity and Nativity Status

Goal-striving stress refers to the psychological consequences of seeking but failing to reach upward mobility and is more common among low-income and people of color. Intergenerational mobility-or improved socioeconomic standing relative to one's parents-may be an important predictor of goal-striving stress for Blacks. We used the National Survey of American Life to investigate the association between intergenerational mobility and goal-striving stress among U.S.-born African Americans, U.S.-born Caribbean Blacks, and foreign-born Caribbean Blacks. Intergenerational mobility was associated with lower goal-striving stress and U.S.-born African Americans and Caribbean Blacks reported lower goal-striving stress than foreign-born Caribbean Blacks. Goal-striving stress was relatively high among foreign-born Blacks, regardless of level of intergenerational mobility attained. Goal-striving is an important stressor for foreign-born Caribbean Blacks, regardless of their level of educational success. Given increasing Black migration, future studies should disaggregate the Black racial category based on ethnicity and nativity.

The Health of Children Who Are Immigrants and Refugees: A Review for the General Pediatrician

The United States is home to many immigrants and refugees; therefore, pediatricians who care for these vulnerable patients must be familiar with their unique medical, developmental, and psychosocial needs. Thankfully, there are resources that describe the recommended components of the medical visit for newly arrived immigrants and refugees. In this article, we review these resources while focusing on the resettlement process, mental health, trauma-informed care resources, and other important psychosocial needs such as legal and educational resources that are available for this patient population. [Pediatr Ann. 2019;48(11):e455-e460.].

Association of Perceived Immigration Policy Vulnerability With Mental and Physical Health Among US-Born Latino Adolescents in California

IMPORTANCE

Current US immigration policy targets immigrants from Mexico and other Latin American countries; anti-immigration rhetoric has possible implications for the US-born children of immigrant parents.

OBJECTIVE

To assess whether concerns about immigration policy are associated with worse mental and physical health among US citizen children of Latino immigrants.

DESIGN, SETTING, AND PARTICIPANTS

This study of cohort data from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), a long-term study of Mexican farmworker families in the Salinas Valley region of California, included a sample of US-born adolescents (n = 397) with at least 1 immigrant parent. These adolescents underwent a health assessment before the 2016 presidential election (at age 14 years) and in the first year after the election (at age 16 years). Data were analyzed from March 23, 2018, to February 14, 2019.

EXPOSURES

Adolescents aged 16 years self-reported their concern about immigration policy using 2 subscales (Threat to Family and Children's Vulnerability) of the Perceived Immigration Policy Effects Scale (PIPES) instrument.

MAIN OUTCOMES AND MEASURES

Resting systolic blood pressure, diastolic blood pressure, and mean arterial pressure; body mass index; maternal- and self-reported depression and anxiety problems (using Behavioral Assessment System for Children, 2nd edition); self-reported sleep quality (using Pittsburgh Sleep Quality Index [PSQI]); and maternal rating of child's overall health. All measures except sleep quality were assessed at both the aged-14-years and aged-16-years visits. Health outcomes at age 16 years and the change in outcomes between ages 14 and 16 years were examined among youth participants who reported low or moderate PIPES scores vs high PIPES scores.

RESULTS

In the sample of 397 US-born Latino adolescents (207 [52.1%] female) and primarily Mexican American individuals, nearly half of the youth participants worried at least sometimes about the personal consequences of the US immigration policy (n = 178 [44.8%]), family separation because of deportation (177 [44.6%]), and being reported to the immigration office (164 [41.3%]). Those with high compared with low or moderate PIPES scores had higher self-reported mean anxiety T scores (5.43; 95% CI, 2.64-8.23), higher maternally reported anxiety T scores (2.98; 95% CI, 0.53-5.44), and worse PSQI scores (0.98; 95% CI, 0.36-1.59). Youth participants with high PIPES scores reported statistically significantly increased levels of anxiety over the 2 visits (adjusted mean difference-in-differences, 2.91; 95% CI, 0.20-5.61) and not significantly increased levels of depression (adjusted mean difference-in-differences, 2.63; 95% CI, -0.28 to 5.54).

CONCLUSIONS AND RELEVANCE

Fear and worry about the personal consequences of current US immigration policy and rhetoric appear to be associated with higher anxiety levels, sleep problems, and blood pressure changes among US-born Latino adolescents; anxiety significantly increased after the 2016 presidential election.

Policies of Exclusion: Implications for the Health of Immigrants and Their Children

Public policies play a crucial role in shaping how immigrants adapt to life in the United States. Federal, state, and local laws and administrative practices impact immigrants' access to education, health insurance and medical care, cash assistance, food assistance, and other vital services. Additionally, immigration enforcement activities have substantial effects on immigrants' health and participation in public programs, as well as effects on immigrants' families. This review summarizes the growing literature on the consequences of public policies for immigrants' health. Some policies are inclusive and promote immigrants' adaptation to the United States, whereas other policies are exclusionary and restrict immigrants' access to public programs as well as educational and economic opportunities. We explore the strategies that researchers have employed to tease out these effects, the methodological challenges of undertaking such studies, their varying impacts on immigrant health, and steps that can be undertaken to improve the health of immigrants and their families.

Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis

BACKGROUND

Government policies can strongly influence migrants' health. Using a Health in All Policies approach, we systematically reviewed evidence on the impact of public policies outside of the health-care system on migrant health.

METHODS

We searched the PubMed, Embase, and Web of Science databases from Jan 1, 2000, to Sept 1, 2017, for quantitative studies comparing the health effects of non-health-targeted public policies on migrants with those on a relevant comparison population. We searched for articles written in English, Swedish, Danish, Norwegian, Finnish, French, Spanish, or Portuguese. Qualitative studies and grey literature were excluded. We evaluated policy effects by migration stage (entry, integration, and exit) and by health outcome using narrative synthesis (all included studies) and random-effects meta-analysis (all studies whose results were amenable to statistical pooling). We summarised meta-analysis outcomes as standardised mean difference (SMD, 95% CI) or odds ratio (OR, 95% CI). To assess certainty, we created tables containing a summary of the findings according to the Grading of Recommendations Assessment, Development, and Evaluation. Our study was registered with PROSPERO, number CRD42017076104.

FINDINGS

We identified 43 243 potentially eligible records. 46 articles were narratively synthesised and 19 contributed to the meta-analysis. All studies were published in high-income countries and examined policies of entry (nine articles) and integration (37 articles). Restrictive entry policies (eg, temporary visa status, detention) were associated with poor mental health (SMD 0·44, 95% CI 0·13-0·75; I2=92·1%). In the integration phase, restrictive policies in general, and specifically regarding welfare eligibility and documentation requirements, were found to increase odds of poor self-rated health (OR 1·67, 95% CI 1·35-1·98; I2=82·0%) and mortality (1·38, 1·10-1·65; I2=98·9%). Restricted eligibility for welfare support decreased the odds of general health-care service use (0·92, 0·85-0·98; I2=0·0%), but did not reduce public health insurance coverage (0·89, 0·71-1·07; I2=99·4%), nor markedly affect proportions of people without health insurance (1·06, 0·90-1·21; I2=54·9%).

INTERPRETATION

Restrictive entry and integration policies are linked to poor migrant health outcomes in high-income countries. Efforts to improve the health of migrants would benefit from adopting a Health in All Policies perspective.

FUNDING

Swedish Council for Health, Working Life, and Social Research; UK Medical Research Council; Scottish Government Chief Scientist Office.