Pediatricians Awakened: Addressing Family Immigration Status as a Critical and Intersectional Social Determinant of Health

The concept of intersectionality in bioethics: a systematic review

BACKGROUND

Intersectionality is a concept that originated in Black feminist movements in the US-American context of the 1970s and 1980s, particularly in the work of feminist scholar and lawyer Kimberlé W. Crenshaw. Intersectional approaches aim to highlight the interconnectedness of gender and sexuality with other social categories, such as race, class, age, and ability to look at how individuals are discriminated against and privileged in institutions and societal power structures. Intersectionality is a "traveling concept", which also made its way into bioethical research.

METHODS

We conducted a systematic review to answer the question of where and how the concept of intersectionality is applied in bioethical research. The PubMed and Web of Science databases were systematically searched and 192 articles addressing bioethical topics and intersectionality were finally included.

RESULTS

The qualitative analysis resulted in a category system with five main categories: (1) application purpose and function, (2) social dimensions, (3) levels, (4) health-care disciplines and academic fields, and (5) challenges, limitations, and critique. The variety of academic fields and health-care disciplines working with the concept ranges from psychology, through gynaecology to palliative care and deaf studies. Important functions that the concept of intersectionality fulfils in bioethical research are making inequities visible, creating better health data collections and embracing self-reflection. Intersectionality is also a critical praxis and fits neatly into the overarching goal of bioethics to work toward social justice in health care. Intersectionality aims at making research results relevant for respective communities and patients, and informs the development of policies.

CONCLUSIONS

This systematic review is, to the best of our knowledge, the first one to provide a full overview of the reference to intersectionality in bioethical scholarship. It creates a basis for future research that applies intersectionality as a theoretical and methodical tool for analysing bioethical questions.

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.

Legal Relief for Children in Immigrant Families: A Mixed-Methods Study

Objective: Immigration status is a known social driver of health. Little research exists on addressing concerns about immigration status in primary care. The objective of this study is to understand the experiences of immigrant families that received a clinical-community intervention to address immigration-related concerns. Methods: We conducted a mixed-methods study: an embedded experimental design study. We implemented an immigration-focused legal needs screening tool and referral intervention at one academic primary care clinic in January 2018. Caregivers who screened positive for immigration-related concerns and were referred to a local immigration law firm were invited to participate in a semi-structured interview. Interviews were recorded, de-identified, transcribed, and systematically coded using an inductive content analysis approach. A modified constant comparative method was used to iteratively review codes, identify emerging themes, and resolve differences through consensus. Results: Nineteen caregivers reported immigration-related legal concerns, seven of whom were interviewed. Most (84.2%) were mothers, identified as Hispanic (94.7%), were from Mexico (52.6%), and reported persecution and fear of returning to their country of origin (57.9%). In interviews, we identified three major themes: (1) families were motivated to immigrate due to mental health trauma and persecution; (2) families sought legal services for several immigration-related concerns; and (3) families experienced challenges in navigating the legal system, with which clinics may assist. Conclusion: This study demonstrates the need for immigration-related services in primary care settings and the feasibility and potential benefits of implementing a legal screening and referral intervention.

Screening for Immigration-Related Health Concerns in a Federally Qualified Health Center Serving a Diverse Latinx Community: A Mixed Methods Study

Immigration-related concerns can impact health and are an important consideration while caring for a multinational Latinx immigrant community. Patients and caregivers waiting for a non-urgent clinic appointment were randomly screened with one of two social risk screening tools. One tool included a question about "any health or stability concerns related to immigration status." The other tool did not include an immigration health question. Immediately following, respondents were invited to participate in a semi-structured interview regarding their social risk screening experience. 201 screens were completed, and 20 patients agreed to an interview. There were no significant sociodemographic differences between groups. Of those screened for immigration, 11% reported a concern. In both arms, interviewees felt that social risk screening was acceptable in a clinic setting. Questions about immigration are timely, important, and relevant, and can be considered when implementing social assessments in communities where there are high levels of trust in providers.