The Health of Undocumented Latinx Immigrants: What We Know and Future Directions

Examining the Presence of Border Patrol Agents in Hospitals in South Texas

U.S. policy dictates that immigration enforcement should not take place in or near "sensitive locations," such as healthcare facilities, but Border Patrol agents are often required to accompany detained border crossers to hospitals for medical care. There is little understanding of the presence of Border Patrol agents within healthcare facilities. This study is the first to examine the presence of Border Patrol agents in healthcare settings and its possible impact on the willingness of undocumented individuals to access healthcare. We conducted interviews with 57 emergency medical services (EMS) personnel working in one county in South Texas. Interviews were held between November 2023- January 2024. Interview transcripts were coded using NVivo 14 and thematic analysis was performed on the transcript data. There is a regular, highly visible Border Patrol presence in healthcare settings in the community of study. In many cases, participants stated that they saw Border Patrol agents every time they brought a patient to the hospital. Hospitals are listed as sensitive locations for immigration enforcement, but policies that require agents to accompany detained border crossers result in a near constant presence of Border Patrol agents in hospitals. The regular, visible presence of Border Patrol agents at hospitals in the study community may deter community residents without legal status from seeking healthcare.

Exploring Rates of Functional Neurosurgery Procedures in the Hispanic Population: A Single-Institution Analysis From 2017 to 2024

INTRODUCTION

Racial and ethnic disparities in utilization of functional neurosurgical procedures have been extensively documented. However, few studies have focused on the differences between Hispanic and non-Hispanic White populations in regions with high representation of both groups. Given the large Hispanic population within our hospital's catchment area, we aimed to compare the utilization of functional neurosurgery between the Hispanic and White populations in our practice.

MATERIALS AND METHODS

We conducted a retrospective review of patients undergoing functional neurosurgery procedures from 2017 to 2024 at the University of Arizona in Tucson. Rates of epilepsy, pain, and movement disorder procedures were compared by ethnicity, focusing on Hispanic vs non-Hispanic White populations. Correlations with age, American Society of Anesthesiologists class, income, insurance status, distance from the treatment center, and complications were examined.

RESULTS

A total of 750 procedures were performed among 702 patients. Deep brain stimulation accounted for 27.73% of procedures, spinal cord stimulation for 35.87%, epilepsy surgery for 22.53%, and intrathecal pump placement for 13.7%. Among the included patients, 43.3% were treated for chronic pain, 22.5% for epilepsy, 18.1% for Parkinson's disease, 4.8% for essential tremor, 2.3% for spasticity, 0.9% for dystonia, and 8.0% for other/unknown diagnoses. Regarding ethnicity, 74.3% of our cohort identified as non-Hispanic White, 18.1% as Hispanic, and 7.6% as other or unknown ethnicity. Hispanic patients were significantly underrepresented relative to Southern Arizona demographics (χ2 [1, n = 693] = 280.38, p < 0.0001, ϕ=0.64). This disparity was consistent and significant across all procedure types. Significant differences in five-year median inflation-adjusted household income were observed between Hispanic and White non-Hispanic groups (Welch t-test [n = 693] = 5.79, p < 0.0001, Cohen d = 0.53). Cluster analysis revealed four distinct clusters based on multiple predictors, and multinomial regression identified several significant predictors of undergoing each procedure type.

DISCUSSION

Functional procedures are underutilized among Hispanic patients in Southern Arizona, with disparities associated with age, income, and distance from the treatment center.

Examining Emergency Department Utilization and Hospital Admissions Among Older Undocumented Immigrants: Insights From a Primary Care County Program

BACKGROUND AND OBJECTIVES

Limited access to preventive healthcare among undocumented immigrants may increase healthcare needs with age, leading to higher emergency department (ED) utilization and hospitalizations. Although county programs like My Health LA (MHLA) in Los Angeles County (LAC), California, provide primary care to older undocumented adults, our understanding of the group's specific health issues prompting ED visits and potential legal status (i.e., undocumented vs documented) differences in ensuing hospital admissions is limited.We compared legal status differences in the likelihood of an ED-originating hospital admission among older immigrant patients in LAC. We examined the top 10 diagnostic categories for undocumented (MHLA and non-MHLA participants) and documented patients to understand the health conditions that bring older immigrants to the ED and those that result in hospital admission.

RESEARCH DESIGN AND METHODS

This retrospective study analyzed 239,861 ED encounters from 2016 to 2020 across 3 LAC safety-net hospitals involving immigrant patients aged 50+. Multivariable mixed-effects models estimated the relationship between patient legal status and odds of ED-originating hospital admission.

RESULTS

Undocumented patient encounters, both MHLA (OR = 0.75, 95% CI: 0.71-0.78) and non-MHLA (OR = 0.88, 95% CI: 0.85-0.91), were less likely to result in ED-originating hospital admissions than documented patient encounters. The top clinical reasons for treat-and-release (i.e., ED visits discharged home) visits and ED-originating hospital admissions among undocumented immigrants were similar to those of their documented counterparts.

DISCUSSIONS AND IMPLICATIONS

Older undocumented patients in MHLA were less likely to be admitted following an ED visit. Health programs should be designed for both documented and undocumented patients to improve healthcare outcomes among immigrant communities.

Reviewing and Advocating for Data Disaggregation in Aging-Related Health Research: NIA Grants and Recommendations for Equity

Federal minimum standards for collecting and reporting race and ethnicity data implicitly categorize diverse individuals into broad, monolithic categories. Despite advancements in policy and practice and calls for inclusive research, data equity remains a significant issue in aging-related health research. Racially and ethnically diverse older adults are underrepresented in health research and rarely disaggregated by ethnicity in data collection, analysis, and reporting of aging-related health outcomes. Data disaggregation offers a promising approach to advancing data equity in aging research. We searched the National Institute on Health RePORT Expenditures and Results (NIH RePORTER) database to identify extramural National Institute on Aging (NIA) grants from 1985 to 2024 that proposed disaggregating race and ethnicity data for aging-related research. We found only 12 NIA-funded awards, visually demonstrating how understudied data disaggregation is within the field of aging. Most disaggregation-focused grants were awarded from 2015 onward (92%), with 42% being R01 grants. Enhancing methodological rigor in demographic data collection and reporting reflective of the diversifying aging population is crucial for data equity. We conclude with recommendations to advance aging health research and highlight considerations and ethical issues for data disaggregation for historically surveilled racial and ethnic minoritized communities.

Immigration Policy as a Social Determinant of Health among Brazilian Immigrants in the United States: A Narrative Review

The pervasive effects of increasingly restrictive migration policies on the health of immigrant populations in the U.S. have been well-documented, but not so much concerning the unique experiences of Brazilian immigrants, a subgroup of the Latino/a/x population. Considering that, this narrative review article employs a research design that is both conceptual and exploratory-to understand the possible connections and associations between restrictive immigration policies and negative health outcomes among Brazilian immigrants in the U.S. Findings indicate that Brazilian immigrants in the U.S. face an array of health and non-health related challenges, including racism and poor working conditions, with undocumented individuals experiencing worse outcomes. Studies highlight the complex relationship between immigration policies and health and emphasize the detrimental effects of deportation fear, healthcare access obstacles, and mental health repercussions due to hostile immigration policymaking and generalized anti-immigrant sentiment. More research is needed to understand the unique challenges faced by the Brazilian immigrant population concerning several mental and physical health outcomes.

Centering Latinx immigrant knowledge for wellbeing, liberation, and justice in community-university research partnerships

Structural inequities impacting immigrant health in the United States were intensified during two recent time periods-the anti-immigrant socio-political context of 2017-2021 and the COVID-19 pandemic beginning in 2020. Our community-university research team adapted and implemented a community-based mental health intervention with Latinx immigrants during these periods, which allowed us to reflect on the role of our community-based participatory research (CBPR) partnership in addressing the disparate impacts of these events on Latinx immigrants. We documented the factors and processes that enabled our partnership to navigate crises, address immediate needs, and promote long-term social change. We analyzed focus groups with community-based organization staff, research team meetings, retreat notes, and interviews with Latinx immigrants. Exacerbated challenges included fear, uncertainty, limited resources, and restricted mobility and isolation. By prioritizing immigrant individual, community, and organizational knowledge and epistemologies, our team built upon immigrants' experiences of survival and resistance in the face of ongoing exclusion to navigate the difficulties of both periods. Instead of developing reactive processes, our partnership centered on immigrants' existing strategies, ensuring responses were rapid, effective, and aligned with community needs. These findings highlight that immigrant communities survive continual "crises" and engage in ongoing resistance and survival strategies that can provide the basis for effective CBPR and other social change efforts.

Centering equity through in-person data collection: short report

BACKGROUND

During the COVID-19 pandemic, data collection activities largely became tele-remote, excluding those who did not have the required technology or digital literacy.

METHODS

Between June and September 2020, we collected data in-person from people who use opioids in New York City. Participants were recruited via street intercept and outside four syringe service programs in the city. Surveys were conducted outdoors, with researchers and participants wearing masks and maintaining physical distance.

RESULTS

A total of 329 people participated in the survey. Participants reported an average age of 45.8 years, 69.6% identified as male, 32.6% identified as Hispanic/Latino/a and 22.3% identified as Black. Many experienced unstable housing/street homelessness (65.9%) and half did not have regular smartphone access (51.1%).

CONCLUSION

Many participants were struggling to meet their basic needs and did not have the resources to participate in tele-remote research or surveillance. In-person engagement may help researchers build trust, explain data security measures, and decrease technology and comprehension barriers. As data inform policies and programs, researchers must center equity by including under-engaged groups in data collection activities.

Global prevalence of loneliness in immigrants: A systematic review and meta-analysis

BACKGROUND

The feeling of loneliness is one of the global challenges for immigrants with adverse consequences on mental health. Also, no comprehensive meta-analysis study was found in this regard. Thus, this systematic review and meta-analysis study aimed to investigate the global prevalence of loneliness in immigrants.

METHODS

PRISMA guideline was followed to find eligible studies. PubMed, WoS, Scopus, Embase, ScienceDirect, and Google scholar databases were searched systematically using main keywords of Prevalence, Outbreak, Loneliness, Lonely, Immigration, and Immigrants. Following the exclusion of duplicates, primary and secondary screening processes were applied and the qualification of papers was assessed using the STROBE checklist. Random Effect Model was used for data analysis (CMA v.2). The heterogeneity was checked with the I2 index and publication bias was represented through Funnel Plot. P-value < 0.05 was considered significant and data were represented as CI95 %.

RESULTS

Following the review of 11 eligible studies with the sample size of 166,913 immigrants, the global prevalence of loneliness in immigrants was found 24.7 % (95 %CI:19.5-30.7). Meta-regression analysis also showed that following the increase in sample size and year of paper publication, the prevalence of loneliness in immigrants accelerates significantly (p < 0.05).

CONCLUSION

Loneliness among immigrants is an important mental health issue, globally; thus, according to the high rate of immigration in nations, comprehensive management seems necessary by the health care system.

Pandemic Times and Health Care Exclusion: Attitudes toward Health Care Exclusion of Undocumented Immigrants

CONTEXT

Most of the 11 million undocumented immigrants living in the United States are excluded from government health care programs. Yet, health care inequities pose significant dangers to all members of society during a pandemic. This project explores to what extent undocumented immigrants, in the context of a pandemic, can be seen as deserving of access to government health care programs.

METHODS

The project's first survey experiment explores whether work ethic can affect perceptions of undocumented immigrants as deserving of government health care programs. The second survey experiment tests to what extent appeals to fairness and self-interest, during a pandemic, shape health care deservingness attitudes.

FINDINGS

The results show that respondents view undocumented immigrants as less deserving of health care than citizens, even when undocumented immigrants have a solid work history. The second survey experiment, however, shows that appeals to fairness and self-interest trigger substantial increases in support for undocumented immigrants among both Republicans and Democrats.

CONCLUSIONS

The results suggest that while undocumented immigrants are seen as less deserving of access, appeals to fairness and self-interest can trigger increased support.

Experiences of Immigrants During Disasters in the US: A Systematic Literature Review

As a vulnerable population, immigrants can be disproportionately affected by disasters. Because of their legal and migratory status, immigrants may have different challenges, needs, and possibilities when facing a disaster. Yet, within disaster studies, immigrants are rarely studied alone. Instead, they are often considered part of the large heterogeneous group of racial and ethnic minorities in the United States. This racial classification points to a gap in the literature and in our understanding of how disadvantaged groups may cope with disasters. To address this gap, the current study hypothesizes that: (1) Immigrants have unique experiences and disaster impacts compared to the broader aggregated category of racial and ethnic minorities in the U.S. and (2) There are variations in disaster experiences and impacts across different types of immigrant subgroups beyond refugees. To explore these hypotheses, a study of the literature across six databases from 2018 to 2023was conducted. The review identified a total of 17 articles discussing immigrant experiences during disasters. Major cross-cutting themes on immigrant disaster experiences include fear of deportation, restrictive immigration status, excessive economic burden and labor exploitation, employment rigidity, adverse health outcomes, limited informational resources and limited social capital, selective disaster relief measures, and infrastructural challenges as regards to housing and transportation. Many of the themes identified are unique to immigrants, such as the fear of deportation, restrictive immigration status and visa policies, and selective disaster relief measures.

Healthcare Utilization and Chronic Disease Management for Non-Medicaid-Eligible Patients in a City-Wide Safety-Net Healthcare Access Program

BACKGROUND

In 2019, New York City (NYC) launched NYC Care (NYCC), a healthcare access program through NYC Health + Hospitals (H + H) for individuals who are ineligible for federally funded health insurance programs or cannot purchase insurance through the State Marketplace, predominantly undocumented individuals.

OBJECTIVE

To examine the sociodemographic characteristics, healthcare use patterns, and chronic disease quality measures for diabetes mellitus (DM) and hypertension among NYCC patients compared with Medicaid patients seen at NYC H + H.

DESIGN

Observational study.

PARTICIPANTS

Adults aged 18 years and older enrolled in NYCC (N = 83,003) or Medicaid (N = 512,012) as of January 1, 2022. Patients were included if they had at least one visit between January 1, 2021, and December 31, 2021.

MAIN MEASURES

Sociodemographic characteristics, healthcare use patterns, and quality measures for DM and hypertension.

KEY RESULTS

NYCC patients (n = 83,003) were, on average, older, more likely to be Hispanic with Spanish as their preferred language, had more comorbidities, and had more primary care (adjusted incidence rate ratio 2.75 [95% confidence interval 2.71, 2.80]) and specialty care (2.22 [2.17, 2.26]) visits compared to Medicaid patients (n = 512,012). Rates of emergency department visits were similar between the two groups (1.02 [1.00, 1.04]), but NYCC patients had relatively fewer hospitalizations (0.64 [0.62, 0.67]). NYCC patients with DM or hypertension had higher rates of having a documented hemoglobin A1c or blood pressure in 2022, respectively, and clinically similar rates of chronic disease control (mean difference in hemoglobin A1c - 0.05 [- 0.09, - 0.01] in patients with DM and mean difference in blood pressure - 0.38 [- 0.67, - 0.10]/ - 0.64 [- 0.82, - 0.46]) compared with Medicaid patients.

CONCLUSIONS

NYCC effectively enrolled a large number of uninsured participants and provided them with healthcare access similar to that of Medicaid patients. Future studies should evaluate the impact of NYCC enrollment on healthcare utilization and disease outcomes.

Living with(out) Citizenship: The Impact of Naturalization on Mortality Risk among U.S. Immigrants

In recent decades, naturalization rates among U.S. immigrants have surged as many seek citizenship to regain lost rights and protections. However, the impact of naturalization on immigrants' life outcomes, such as health, remains underexplored in academic research. Challenges arising from selection processes complicate the interpretation of any observed health disparities between naturalized citizens and noncitizens. To address this gap, we link restricted-use data from the 2000 U.S. census to individual Social Security records on citizenship change and death, enabling a 20-year observation of naturalization and mortality. Results from discrete-time hazard analysis of mortality risk reveals a significant protective health effect from naturalization, which increases in magnitude among long-term naturalized citizens. The effect is particularly strong across older ages and among groups with lower education, refugee entry status, Hispanic origin, and health limitations. These findings suggest that naturalization represents an important but stratifying source of institutional support for socially vulnerable immigrants.

Sanctuary policies and type 2 diabetes medication prescription trends among community health center patients

Immigrants in the United States are at increased risk of diabetes-related complications due to delayed diagnoses compared with US-born individuals. Immigration-related federal policies may support immigration enforcement activities and restrict some immigrants' access to health insurance and other publicly funded resources. Conversely, state and county-level sanctuary policies may reduce the fear of deportation and increase mobility in the community, improving the accessibility of essential pharmacological treatment for type 2 diabetes patients. This retrospective cohort study estimated the odds of receiving glucose-lowering medication prescriptions by the county's sanctuary policy environment for patients within a nationwide network of community health centers. We did not find statistically significant associations between sanctuary policies and annual prescription rates. The associations were not modified by nativity or race/ethnicity. Notably, compared to US-born patients, immigrants had higher odds of receiving prescriptions regardless of the sanctuary policy environment, emphasizing other potential influences on the receipt of anti-diabetes prescriptions for community health center patients.

Interventions to ensure access to and continuity of HIV care for international migrants: an evidence synthesis

International migrants, especially those belonging to key populations, face a considerable HIV burden. However, continuity of HIV care for this group is often challenged along the migration route. We assess the available evidence on the existing interventions that aim to strengthen community and health systems to ensure the continuity of HIV care for international migrants. We did a systematic search of PubMed for publications from 1989 until 2023 focused on different stages of the HIV care continuum regardless of the geographical region. The literature was reviewed with a thematic approach. Globally, legal regulations can restrict access to HIV care and fuel fear of deportation among undocumented migrants. The intersection of HIV-related and migration-related stigma creates further challenges for uninterrupted access to HIV care along the migration route, with negative clinical and public health consequences. Different potential interventions were identified including: provision of HIV care regardless of migration status; utilisation of mobile health, mobile units, and community-led initiatives to bring HIV care to migrants; and utilisation of participatory and co-creation methods to develop tailored and sustainable HIV-related interventions with migrant communities. Improving access to the continuity of care for migrants requires a shift towards intersectional policies rooted in co-creation approaches to address the underlying multiple and mutually reinforcing inequalities.

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.

Association of Intersectional Anticipated Discrimination with Mental Health Among Immigrant Latinos

Introduction

Anticipating discrimination can lead to increased vigilance, which acts as a potential stressor similar to actual discrimination experiences. However, there is limited understanding of how discrimination and anticipated discrimination affect Latinos with intersecting identities, particularly those who are immigrants. Using a cross-sectional survey, we examine the association between intersectional anticipated discrimination and mental health among immigrant Latinos.

Methods

We conducted a cross-sectional survey through the Rapid Acceleration of Diagnostics-Underserved Populations initiative (March 2022-May 2023). Participants were foreign-born adults who self-identified as Latino or Hispanic. The exposure measure used the Intersectional Anticipated Discrimination Scale, and outcomes measures included 2-item screens for anxiety (Generalized Anxiety Disorder screener [GAD-2]) and depression (Patient Health Questionnaire [PHQ-2]) and a 3-item screen for hazardous alcohol consumption (Alcohol Use Disorders Identification Test).

Results

A total of 810 participants completed the survey, of whom 66.7% were uninsured. Among them, 25.2% screened positive for anxiety, 18.1% for depression, and 20.2% for hazardous alcohol consumption. Positive screening for anxiety and depression was associated with higher levels of anticipated discrimination (GAD-2 adjusted odds ratio [AOR] = 1.05, 95% confidence interval [CI]: 1.03, 1.07; PHQ-2 AOR = 1.05, 95% CI: 1.03, 1.07). A dose-response relationship was observed with higher levels of anticipated discrimination and higher PHQ-2 and GAD-2 scores.

Conclusions

Anticipated intersectional discrimination was associated with symptoms of anxiety and depression in immigrant Latinos. Prioritizing culturally competent care that recognizes the heterogeneity of the Latino population, enhancing community support, and implementing targeted policy interventions are imperative steps toward promoting mental health equity among this population.

Barriers and Facilitators Along the PrEP Continuum of Care Among Latinx Sexual Minoritized Men and Transgender Women: A Systematic Review

Latinx cisgender sexually minoritized men (SMM) and transgender women (TW) in the U.S. are disproportionately affected by HIV. Although pre-exposure prophylaxis (PrEP) is a highly effective strategy for HIV prevention, rates of PrEP use among Latinx SMM and TW remain suboptimal. The main purpose of this systematic review was to (1) describe engagement in the various stages of the PrEP care continuum among Latinx SMM and TW, and (2) identify multilevel determinants that function as barriers or facilitators to engagement in the PrEP continuum of care for Latinx SMM and TW. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA). Five databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus) were searched to examine the available qualitative, quantitative, and mixed method studies relevant to the research question. A total of 56 studies were included, with the majority focusing on SMM and being cross-sectional in design. Barriers included PrEP knowledge, risk perception, intersecting stigma, and structural conditions. Community resources, social support, and PrEP navigation services facilitated engagement in the PrEP continuum of care. This review highlights the complex factors that influence PrEP care engagement among Latinx SMM and TW. These findings call for comprehensive, multilevel approaches to address inequities disparities in PrEP care engagement among these groups.

Using the Structural Influence Model to Explore U.S. Latina/O/X/E Undocumented Immigrants' COVID-19 Information Acquisition, Perceptions, and Prevention Behaviors

In the first year of the COVID-19 pandemic, U.S. undocumented immigrants were at heightened risk of contracting COVID-19, with many of them being "frontline essential workers" and residing in crowded living spaces. Given undocumented immigrants' elevated susceptibility to contracting COVID-19 at the peak of uncertainty surrounding the virus, we used the structural influence model of communication to explore: (1) how undocumented immigrants acquired information about COVID-19; (2) how they assessed information trustworthiness and accuracy; (3) their perceptions of COVID-19; and (4) how they prevented or managed COVID-19. Drawing from semi-structured interviews with 46 Latina/o/x/e undocumented immigrants residing in California, we found four key themes: (1) (dis)trust in traditional media as participants relied heavily on social media for COVID-19 information; (2) weak and strong ties played a crucial role in co-constructing health outcomes with different levels of organization; (3) learning about COVID-19 through (in)direct experiences; and (4) coping through health literacy and cultural beliefs. The study's findings can inform future efforts to reach highly-vulnerable immigrant communities during a crisis (or different outbreaks in COVID-19 variants), and hopefully, help reduce health inequities.

Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience

Anisman, H., Doubad, D., Asokumar, A. & Matheson, K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. NEUROSCI BIOBEHAV REV, XXXX. Immigration occurs between countries either to obtain employment, for family reunification or to escape violence and other life-threatening conditions. Refugees and asylum seekers are often obligated to overcome a uniquely challenging set of circumstances prior to and during migration. Settlement following immigration may pose yet another set of stressors related to acculturation to the host country, as well as financial insecurity, discrimination, language barriers, and social isolation. Here we discuss the multiple consequences of immigration experiences, focusing on the health disturbances that frequently develop in adults and children. Aside from the psychosocial influences, immigration-related challenges may cause hormonal, inflammatory immune, and microbiota changes that favor psychological and physical illnesses. Some biological alterations are subject to modification by epigenetic changes, which have implications for intergenerational trauma transmission, as might disruptions in parenting behaviors and family dysfunction. Despite the hardships experienced, many immigrants and their families exhibit positive psychological adjustment after resettlement. We provide information to diminish the impacts associated with immigration and offer strength-based approaches that may foster resilience.

NYC Care: A Large Health Care Access Program for Uninsured New York City Residents

CONTEXT

Millions of people living in the United States are excluded from health insurance due to income or immigration status. These 2 groups are more likely to lack access to health care or a regular source of care.

PROGRAM

NYC Health + Hospitals is addressing this need with NYC Care, a health care access program. The program is designed to be the single point of access for uninsured care citywide and includes a membership card, a 24-hour customer service line, and direct access to primary care medical homes. Health care is coordinated across NYC Health + Hospitals using integrated electronic referrals and a medical record system.

IMPLEMENTATION

The program uses a single enrollment process across safety net health care resources of NYC Health + Hospitals. A 24-hour call center was established to answer questions, make primary care appointments, and make warm handoffs to enrollment staff. Once eligibility is confirmed and patients are enrolled, they are mailed a membership card, a member handbook, and offered a primary care appointment. A multipronged public awareness campaign including citywide, multilingual marketing and outreach via community-based organizations was essential to build trust.

OUTCOMES

NYC Care had 119 203 members at the end of June 2023. Fifty-eight percent had not seen a primary care doctor in the NYC Health + Hospitals system in the prior 36 months. In total, 76 439 had completed 1 or more primary care visits; 53.1% of enrollees with diabetes had improved hemoglobin A 1c , and 73.4% of enrollees with hypertension had improved blood pressure control after 6 months of enrollment.

DISCUSSION

NYC Care demonstrates that municipalities can improve access to care for the uninsured by simplifying steps to affordable health care services, connecting patients directly to patient-centered medical homes, and improving the patient experience. A comprehensive public awareness campaign is also crucial.

Patients' Perspectives on the Acceptability and Effectiveness of a Community Health Worker-Led Intervention to Increase Chronic Kidney Disease Knowledge and Screening among Underserved Latine Adults: The CARE 2.0 Study

In the United States, Chronic Kidney Disease (CKD) affects approximately 1 in 7 adults. Despite its significant impact, CKD awareness, education, and screening are often lacking among underserved Latine populations, leading to poorer health outcomes and higher mortality rates. Various studies highlight the crucial role of Community Health Workers (CHWs) in improving health outcomes within minority communities both domestically and globally. However, there remains a gap in research on the acceptance and effectiveness of CHW-led interventions targeting CKD. This prospective intervention study employed a pre-post quasi-experimental design to evaluate a CHW-led educational program aimed at enhancing CKD knowledge, screening, and monitoring among Latines with low health literacy and English proficiency. CHWs utilized a culturally tailored CKD Flipchart, and 100 underserved patients received the intervention. Feedback from 85 participants who completed post-intervention surveys indicated high satisfaction with the program's relevance and the professionalism of the CHWs. Importantly, 85% expressed a positive intention to seek kidney care following the intervention. Preliminary analysis of medical records before and after the intervention showed improvements in glycemic control (median change = -18.0, p = 0.014) and triglyceride levels (median change = -29.0, p = 0.035), suggesting the program's effectiveness in managing CKD risk factors. These findings highlight the potential of CHW-led interventions to reduce kidney health disparities among underserved communities.

Understanding the Experiences of Latinx LGBTQ Texans at the Beginning of the COVID-19 Pandemic

Marginalized communities have been disproportionately affected by COVID-19, including both racial/ethnic minority and sexual minority populations. To date, there has been little research examining the impact of the COVID-19 pandemic at the intersections of marginalized identities. Furthermore, available national data on COVID-19 outcomes may obscure our understanding of region-specific outcomes, particularly in the U.S. South. Using an intersectional approach, we explore differences in worries over COVID-19, preventative behaviors, and COVID-19 outcomes in the early months of the pandemic in a diverse sample of LGBTQ people (N = 1076) living in Texas. Our findings indicated that LGBTQ Latinx people in Texas reported more COVID-19 related worries and adverse outcomes than non-Latinx LGBTQ people. These findings are in line with previous research that found that the increased risk to Latinx and LGBTQ populations in public health crises is often overlooked and can be attributed to many factors such as socioeconomic status, occupational propensity, disparities in physical health, and barriers to healthcare access. Furthermore, our findings suggest the necessity of utilizing an intersectional approach when examining the disproportionate burden marginalized communities face in public health crises.

Posttraumatic stress and probable post traumatic stress disorder as it relates to smoking behavior and beliefs among trauma exposed hispanic persons who smoke

There has been little scientific effort to evaluate the associations between cigarette smoking and cessation-related constructs and exposure to traumatic events, posttraumatic stress, and Posttraumatic Stress Disorder (PTSD) symptoms among Hispanic persons who smoke in the United States (US). Such trauma-related factors may pose unique difficulties for Hispanic persons who smoke and possess a desire to quit. As such, the present investigation sought to fill this gap in the literature and examine posttraumatic stress and probable PTSD in terms of their relations with several clinically significant smoking constructs among trauma-exposed Hispanic persons who smoke from the United States. Participants included 228 Spanish-speaking Hispanic persons who endorsed prior traumatic event exposure and smoked combustible cigarettes daily (58.3% female, Mage= 32.1 years, SD = 9.65). Results indicated that posttraumatic stress symptoms were related to increased cigarette dependence, perceived barriers for smoking cessation, and more severe problems when trying to quit with effect sizes ranging from small to moderate in adjusted models. Additionally, Hispanic persons who smoke with probable PTSD compared to those without probable PTSD showcased a statistically effect for perceived barriers for cessation (p < .008) and a severity of problems when trying to quit (p < .001). No effect was evident for cigarette dependence after alpha correction. Overall, the present study offers novel empirical evidence related to the role of posttraumatic stress symptoms and PTSD among Hispanic persons who smoke in the US. Such findings highlight the need to expand this line of research to better understand the role of posttraumatic stress and PTSD among Hispanic persons who smoke which can inform smoking cessation treatments for Hispanic persons who smoke experiencing trauma-related symptomology.

Evaluating enrollment and representation in COVID-19 and HIV vaccine clinical trials

Background

Vaccine clinical trials should strive to recruit a racially, socioeconomically, and ethnically diverse range of participants to ensure appropriate representation that matches population characteristics. Yet, full inclusion in research is often limited.

Methods

A single-center retrospective study was conducted of adults enrolled at Brigham and Women's Hospital (Boston, MA) between July 2020 and December 2021. Demographic characteristics, including age, race, ethnicity, ZIP code, and sex assigned at birth, were analyzed from both HIV and COVID-19 vaccine trials during the study period, acknowledging the limitations to representation under these parameters. We compared the educational attainment of vaccine trial participants to residents of the Massachusetts metropolitan area, geocoded participants' addresses to their census block group, and linked them to reported median household income levels from publicly available data for 2020. Frequency and quartile analyses were carried out, and spatial analyses were performed using ArcGIS Online web-based mapping software (Esri).

Results

A total of 1030 participants from four COVID-19 vaccine trials (n = 916 participants) and six HIV vaccine trials (n = 114 participants) were included in the analysis. The median age was 49 years (IQR 33-63) and 28 years (IQR 24-34) for the COVID-19 and HIV vaccine trials, respectively. Participants identifying as White were the majority group represented for both the COVID-19 (n = 598, 65.3%) and HIV vaccine trials (n = 83, 72.8%). Fewer than 25% of participants identified as Hispanic or Latin. Based on ZIP code of residence, the median household income for COVID-19 vaccine clinical trial participants (n = 846) was 102,088 USD (IQR = 81,442-126,094). For HIV vaccine clinical trial participants (n = 109), the median household income was 101,266 USD (IQR 75,052-108,832).

Conclusion

We described the characteristics of participants enrolled for HIV and COVID-19 vaccine trials at a single center and found similitude in geographical distribution, median incomes, and proportion of underrepresented individuals between the two types of vaccine candidate trials. Further outreach efforts are needed to ensure the inclusion of individuals from lower educational and socioeconomic brackets. In addition, continued and sustained efforts are necessary to ensure inclusion of individuals from diverse racial and ethnic backgrounds.

Sociopolitically and Trauma-Informed Public Health Practice With Latinx Families: Conceptual Framework and Best Practices

Public health practitioners working with Latinx families in the United States must consider the historical contexts of colonization and slavery that have created conditions of violence, displacement, and social and economic marginalization throughout Latin America. Although shared experiences of colonization, dispossession, and migration affect all Latinxs, diverse national histories and sociopolitical contexts, migration patterns, and intersecting identities (e.g., gender, social class, race) complicate efforts to develop a uniform approach to this heterogeneous population. We provide a critical analysis of (1) how past experiences contribute to collective trauma and motivate migration, and (2) how these experiences are replicated in the United States through immigration-related adversities that deprive and threaten children and families through marginalization, fear of detention and deportation, and family separation brought on by a parent's deportation. This knowledge is imperative to advance research, practice, and policymaking with US Latinx populations. We provide best practice recommendations for a sociopolitically and trauma- informed public health workforce interfacing with Latinxs in the United States. (Am J Public Health. 2024;114(S6):S485-S494. https://doi.org/10.2105/AJPH.2024.307589) [Formula: see text].

Dignity of Work and at Work: The Relationship between Workplace Dignity and Health among Latino Immigrants during the COVID-19 Pandemic

Latino immigrants living in the United States were highly vulnerable to the health and economic consequences brought on by the COVID-19 pandemic. We use the conceptual framing of workplace dignity, worth that is acknowledged based on performance of job responsibilities, to explore Latino immigrants' experiences during the early months of the pandemic. A qualitative study was conducted with La Clínica del Pueblo (La Clínica), a community health center serving low-income Latino immigrants. From June to December 2020, we conducted in-depth video interviews with 29 Latino immigrant clients to explore pandemic-related challenges, including workplace changes, discriminatory experiences, and effects on health. We conducted thematic analysis using Dedoose software. Nearly half of participants were undocumented immigrants. Most participants were unemployed or underemployed due to the pandemic and 26-49 years of age; one-third were still working, and one-quarter were 50 years or older. About half were cisgender women and two were transgender women. Employed participants experienced a lack of dignity through being socially isolated and stigmatized at work; receiving no compensation for their extra labor or for sick leave; and experiencing discriminatory labor practices. Unemployed participants experienced a lack of dignity in being the first to lose their jobs without government support; losing self-esteem; and not being rehired. Participants associated denial of dignity with worsening health conditions and increased anxiety and depression. Our study suggests that denial of workplace dignity-through job loss, underemployment, and poor working conditions-is linked to adverse health outcomes for Latino immigrants. More research should recognize workplace dignity as an important social determinant of health.

Perspectives from the pandemic epicenter: Sexual and reproductive health of immigrant women in New York City

CONTEXT

The United States' response to COVID-19 created a policy, economic, and healthcare provision environment that had implications for the sexual and reproductive health (SRH) of racialized and minoritized communities. Perspectives from heterogenous immigrant communities in New York City, the pandemic epicenter in the United States (US), provides a glimpse into how restrictive social policy environments shape contraception, abortion, pregnancy preferences, and other aspects of SRH for marginalized immigrant communities.

METHODS

We conducted in-depth interviews in 2020 and 2021 with 44 cisgender immigrant women from different national origins and 19 direct service providers for immigrant communities in New York City to explore how immigrants were forced to adapt their SRH preferences and behaviors to the structural barriers of the COVID-19 pandemic. We coded and analyzed the interviews using a constant comparative approach.

RESULTS

Pandemic-related fears and structural barriers to healthcare access shaped shifts in contraceptive use and preferences among our participants. Immigrant women weighed their concerns for health and safety and the potential of facing discrimination as part of their contraceptive preferences. Immigrants also described shifts in their pregnancy preferences as rooted in concerns for their health and safety and economic constraints unique to immigrant communities.

CONCLUSION

Understanding how immigrant women's SRH shifted in response to the structural and policy constraints of the COVID-19 pandemic can reveal how historically marginalized communities will be impacted by an increasingly restrictive reproductive health and immigration policy landscape.

Social determinants of the healthcare needs of undocumented migrants living with non-communicable diseases: a scoping review

Objectives

We aimed to map the social determinants of meeting the healthcare needs of undocumented migrants living with non-communicable diseases (NCDs) throughout their migration journey (from the country of origin to the country(/ies) of transit and destination).

Design

We conducted a scoping review.

Data sources

We searched literature in Medline, Embase, Web of Science and Google Scholar.

Eligibility criteria

We included articles that describe interventions, programmes or policies for undocumented migrants living with cardiovascular diseases, cancer, chronic respiratory disease, or diabetes. There were no restrictions by setting (eg, hospital, community or mobile clinic) or country. We included articles published in English, Spanish, or French between 2000 to 2022.

Data extraction and synthesis

The data were structured according to the Commission on Social Determinants of Health framework, differentiated along the migration journey (country of origin, transit, departure and integration, and country of destination). A new conceptual model emerged from data synthesis.

Results

We included 22 studies out of 953 identified articles. They reported data from Italy, the USA, Spain, Switzerland, The Netherlands, France, Austria, and Sweden. They show that individual determinants (material, biological, psychosocial and behavioural) evolve throughout the migration journey and influence healthcare needs. The satisfaction of these needs is conditioned by health system-related determinants such as availability and accessibility. However, the individual and health-system determinants depend on the political and legal context of both the country of origin and the country(/ies) of destination, as well as on the socioeconomic position of undocumented migrants in the destination country.

Conclusions

Migrant health policies should aim at better responding to NCDs-related healthcare needs of undocumented migrants throughout their migration journey, taking into account the social, economic and legal factors that underlie their health vulnerability.

The Toxic Stress of Racism and Its Relationship to Frailty

Significant morbidity and mortality from COVID-19-related illnesses have been observed among people of color within the United States. While theories involving healthcare inequity and political division have emerged to explain this observation, the role of chronic stress and inflammation is also being explored. Toxic stress is experienced disproportionately by race, ethnicity, and socioeconomic status and increases frailty and vulnerability to diseases such as COVID-19. C-reactive protein (CRP) is a biomarker associated with the inflammatory response that is typically elevated due to exposure to acute or chronic traumatic stress, as well as COVID-19. This study explored the relationship between CRP and Hispanic/non-Hispanic ethnicity among adults hospitalized with COVID-19 via a secondary analysis of retrospective electronic health record (EHR) data collected from a community healthcare system in Southern California. A total of 1,744 cases representing hospitalized adults with COVID-19 were reviewed. Data were extracted from the EHR to reflect demographics, medical diagnoses, medications, CRP, and comorbidity burden. Frequencies, percentages, and measures of central tendency were assessed to understand the distribution of data. Associations were conducted using Pearson's r and the chi-square test of independence. Differences between groups were examined via independent samples t-tests. The sample was 52% Hispanic, 56% male, and the mean age was 62 years (SD = 16.1). The mean age of Hispanic cases was younger than non-Hispanic cases (p < .001, η = 0.289). Serum CRP was significantly higher in the Hispanic cases, with a high degree of association (p < .001, η = 0.472). In addition, higher CRP levels were significantly associated with the need for mechanical ventilation (p < .001, φc = 0.216). No significant relationships were found between CRP and age, body mass index (BMI), or comorbidity burden. Findings challenge the assumption that the disproportionate morbidity and mortality suffered by the Hispanic population due to COVID-19 was due to age, BMI, or comorbidities such as metabolic syndrome or heart disease. CRP in the Hispanic population should be further investigated to understand its relationship to chronic stress, frailty, and risk for COVID-19 in this population.

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

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

Immigrant Perspectives of Social Connection in a Nontraditional Migration Area

Social connection is a core dimension of health and wellness among all populations, yet the experience of moving to and living in a new country makes social and community-level influences particularly salient for immigrants. We interviewed 38 Latino immigrants living in a nontraditional migration area to explore the social and community foundations of health and wellness. Using hybrid (inductive/deductive) qualitative analysis, we identified seven domains of social connection from the perspective of the interviewed participants: (1) lens of the individual; (2) immigrant experience; (3) interpersonal support; (4) community belonging; (5) community capital; (6) community navigation; and (7) social acceptance. Social connection domains generated by participants are consistent with the scientific literature, but this study identifies the specific social factors that immigrants describe as most salient to their own health and wellness. Our community-generated understanding of social connection can be used by healthcare providers to reduce risks and build on assets that will improve the health of immigrants living in nontraditional migration areas. Additionally, these results might serve as a foundation for a quantitative measure that can be used by providers to more accurately and comprehensively assess the social connection of their patients and by researchers to evaluate the effectiveness of community-level interventions for immigrants.

Understanding uptake of COVID-19 testing, vaccination, and boosters among Spanish-speaking Latines in the United States: Qualitative insights from Spanish speakers and key informants

BACKGROUND

Latine communities in the United States have been disproportionately affected by COVID-19. It is critical to gain a better understanding of the sociocultural determinants that challenge and facilitate COVID-19 testing, vaccination, and booster uptake within these vulnerable communities to inform culturally congruent strategies and interventions.

METHODS

In summer 2022, our community-based participatory research partnership conducted 30 key informant interviews and 7 focus groups with 64 Spanish-speaking Latine participants in North Carolina. Interviewees consisted of representatives from health and service organizations, most of whom were engaged with direct service to Spanish speakers. Interviews were conducted in either English or Spanish, depending on the preference of the participant; all focus groups were conducted in Spanish. Interviews and focus groups were conducted in person or by videoconference.

RESULTS

Twenty themes emerged that we organize into four domains: general perceptions about COVID-19; barriers to COVID-19 testing, vaccination, and booster uptake; facilitators to COVID-19 testing, vaccination, and booster uptake; and recommendations to promote testing, vaccination, and booster uptake.

DISCUSSION

Results underscore important sociocultural determinants of ongoing COVID-19 testing, vaccination, and booster uptake to consider in developing interventions for Spanish-speaking Latines in the United States. Based on this formative work, our partnership developed Nuestra Comunidad Saludable (Our Healthy Community). We are implementing the intervention to test whether trained peer navigators can increase COVID-19 testing, vaccination, and booster uptake among Spanish-speaking Latines through blending in-person interactions and mHealth (mobile health) strategies using social media.

The Intersectional Impact of Disability and Immigration on Health: A Health Needs Assessment of Immigrants Living With Spinal Cord Injury in Houston, Texas

BACKGROUND

Immigrants with spinal cord injury (SCI) experience challenges with co-morbidities and lack of access to medical supplies and equipment. Much of the current disability and SCI literature does not include Latinx immigrants with SCI. To address this gap in knowledge, the present study explores the intersectional impact of disability and immigration on health as well as the health status and health needs of immigrants living with SCI.

METHODS

This community-partnered study is a secondary analysis of needs assessment data collected in February 2019 with 24 of the members of Living Hope Wheelchair Association, a nonprofit organization serving Latinx immigrants living with SCI in Houston, Texas.

RESULTS

Participants shared challenges with accessing healthcare, comorbidities, mental illness, transportation, and discrimination by healthcare professionals. They also shared difficulties accessing medical supplies, medical equipment, and the need for adaptations in their homes and vehicles.

CONCLUSION

The findings corroborate those of previous studies with people with SCI, but highlights additional layers of marginalization and challenges faced by immigrants living with SCI. More research is needed to understand the health needs and health status of this population, including their access to care and management of chronic diseases such as diabetes and heart disease. Findings support the need for public health and immigration policies to promote inclusion and equitable access to services as well as improve the health and quality of life of immigrants.

Lessons from Two Latino Communities Working with Academic Partners to Increase Access to COVID-19 Testing

OBJECTIVE

We sought to examine the experiences of community partners in a community-academic partnership to promote COVID-19 testing in two majority Latino communities.

METHODS

We conducted semistructured, in-depth interviews in English and Spanish with community-based organization leaders and community health workers/promotoras (n = 10) from June to July 2021. Interviews focused on identifying partner roles in planning and testing implementation and evaluating communication among partners. Interviews were transcribed and analyzed in ATLAS.ti version 8.4.5. Analyses involved deductive and inductive approaches to identify key themes.

RESULTS

Participants described both strengths and challenges to the collaborative approach within each of three core themes: building relationships in the time of COVID-19; uplifting existing community leadership; and commitment of the academic partners and community-based organizations to conduct partnership activities in Spanish.

CONCLUSION

Community-academic partnerships that invest in strong relationships, community leadership, and a commitment to the community's preferred language offer a promising approach to addressing COVID-19 testing barriers. Findings provide direction for future research on how community members and academic partners can come together to inform strategies to continue addressing the COVID-19 pandemic.

Facing a dual threat: Pandemic stress and immigration policy vulnerability on mental health among Latinx immigrant parents

BACKGROUND

Exclusionary immigration policies rooted in structural racism threaten the wellbeing of Latinx families, increasing stress, anxiety, depression, and distress among immigrant parents. The COVID-19 pandemic has had devastating and disproportionate impacts on communities of color with unique impacts on Latinx immigrant parents in mixed-status families.

AIMS

From a syndemic theory lens, we explored the convergence of structural racism and the COVID-19 pandemic to explore if the stress of the COVID-19 pandemic may compound harmful immigration-related policies.

METHODS

Our community-based participatory research cross-sectional study administered 145 surveys among Latinx immigrant parents in mixed-status families in Georgia. We examined the relationship of pandemic stress and perceived statewide immigration policy vulnerability to depressive, anxiety, and PTSD symptoms. We conducted multiple linear regression analyses to test these relationships and their interaction.

RESULTS

We found that that greater perceived policy immigration vulnerability and reported pandemic stress were associated with higher symptoms of depression. Increased PTSD symptoms were also associated with immigration policy vulnerability, but not pandemic stress. Tests to assess if pandemic stress strengthened the relationship between policy vulnerability on depressive, anxiety, and PTSD symptoms revealed no statistically significant interactions.

CONCLUSION

Our findings suggest that stress of the COVID-19 pandemic and longstanding anti-immigrant policies in Georgia were salient for and related to the mental health of these Latinx immigrant parents.

Community-Engaged Research (CEnR) to Address Gaps in Chronic Kidney Disease Education among Underserved Latines-The CARE Study

Ensuring equitable chronic kidney disease (CKD) education for Latine patients with low health literacy and low English proficiency stands as a critical challenge, and the "Caridad Awareness and Education" (CARE) initiative represents our ongoing effort to address this imperative issue. In collaboration with twenty-three patients living with CKD, diabetes and/or hypertension and twelve trained Community Health Workers (CHWs) from diverse Latine subgroups, we conducted a research initiative funded by the National Kidney Foundation. Our primary objective was to co-design and test culturally tailored patient education materials (PEMs) for underserved Latine adults at risk for or diagnosed with CKD. We effectively integrated Community-Engaged Research (CEnR) principles with a Human-Centered Design (HCD) approach to create a range of CKD-PEM prototypes in Spanish. Patient preferences for printed educational materials were clear. They favored printed materials that incorporated visual content with concise text over digital, email, texts, or online resources and personalized phone outreach and the involvement of CHWs. Additionally, patients identified their unwavering commitment to their families as a forceful motivator for caring for their kidney health. Currently, a culturally and linguistically tailored CKD flipchart for one-on-one education, led by CHWs, is undergoing a pilot testing phase involving a sample of one hundred Latine patients at risk for or diagnosed with CKD. This innovative approach signifies a commitment to amplifying the insights and expertise of the Latine community afflicted by kidney health disparities, effectively embracing a CEnR to forge meaningful and impactful CKD-PEMs.

Sex Trafficking in New York City and Vulnerabilities to Re-Trafficking

Human trafficking occurs in a cycle of coercion and exploitation of vulnerable people; yet, little is known about those who are trafficked more than one time (re-trafficked). Our study sought to describe the trafficking experiences and explore vulnerabilities to re-trafficking in an urban, majority immigrant, population. This study is part of a parent cohort study that enrolls patients at the EMPOWER Center in New York City, which provides trauma-informed obstetric and gynecologic services to victims of sexual- and gender-based violence. Retrospective chart review was conducted on patients with a history of sex trafficking who were evaluated at the EMPOWER Center from February 2013 to January 2021. A total of 87 patients were enrolled in this study, 23 (26.4%) of whom had been re-trafficked. All were women. Most (88.5%) were victims of international trafficking, most often from Mexico or the Caribbean/Central America. Nine (10.3%) reported contraceptive use and six (6.9%) experienced forced substance use while trafficked. The most reported barriers that women faced in escaping trafficking were threat of violence (28.7%) and financial dependence (19.5%). Re-trafficked patients were more likely to have a history of being undocumented (odds ratio [OR] = 5.29; 95% confidence intervals [CI] [1.34, 20.94]) and experienced childhood sexual abuse (OR = 2.99; 95% CI [1.10, 8.16]), experienced childhood physical abuse (OR = 3.33; 95% CI [1.18, 9.39]), and lived with a non-parent family member (OR = 6.56; 95% CI [1.71, 25.23]). Although these vulnerabilities were no longer significant when analyzed in a parsimonious multivariate logistic regression model adjusting for the other significant variables, likely due to the limited sample size. Almost half (46.0%) reported ongoing emotional effects from being trafficked, which did not vary by re-trafficking status. Our study highlights potential pre-trafficking vulnerabilities, illustrates the complexity of the trafficking experience, and presents potential risk factors for being re-trafficked.

Mental Health Stigma Among Spanish-Speaking Latinos in Baltimore, Maryland

To assess mental health-related stigma in an emerging Latino immigrant community and explore demographic characteristics associated with stigma. We surveyed 367 Spanish-speaking Latino adults recruited at community-based venues in Baltimore, Maryland. The survey included sociodemographic questions, the Depression Knowledge Measure, Personal Stigma Scale, and the Stigma Concerns about Mental Health Care (SCMHC) assessment. Multiple regression models examining associations between personal stigma and stigma concerns about mental health care, respectively, were constructed using variables that were statistically significant in bivariate analyses. Being male, having less than high school education, reporting high importance of religion, and having lower depression knowledge contributed to higher personal stigma. When controlling for other variables, only depression knowledge contributed unique variance to the prediction of higher SCMHC. Efforts to improve access to and quality of mental health care must be paralleled by ongoing efforts to reduce depression stigma within emergent immigrant Latino communities.

Building an Infectious Disease Diversity, Equity, and Antiracism (ID2EA) Curriculum: A Single Center's Experience and Reflections

In response to longstanding healthcare inequities unmasked by the Coronavirus Disease 2019 pandemic, the infectious diseases (ID) section at the Yale School of Medicine designed and implemented a pilot curriculum integrating Infectious Disease Diversity, Equity, and Antiracism (ID2EA) into ID educational training and measured program outcomes. We herein describe a mixed-methods assessment of section members on whether the ID2EA curriculum affected their beliefs and behaviors regarding racism and healthcare inequities. Participants rated the curriculum as useful (92% averaging across sessions) and effective in achieving stated learning objectives (89% averaging across sessions), including fostering understanding of how inequities and racism are linked to health disparities and identifying strategies to effectively deal with racism and inequities. Despite limitations in response rates and assessment of longer-term behavioral change, this work demonstrates that training in diversity, equity, and antiracism can be successfully integrated into ID physicians' educational activities and affect physicians' perspectives on these topics.

Utilizing Community Based Participatory Research Methods in Black/African American and Hispanic/Latinx Communities in the US: The CDC Minority HIV Research Initiative (MARI-Round 4)

The Centers for Disease Control and Prevention Minority HIV Research Initiative (MARI) funded 8 investigators in 2016 to develop HIV prevention and treatment interventions in highly affected communities. We describe MARI studies who used community-based participatory research methods to inform the development of interventions in Black/African American and Hispanic/Latinx communities focused on sexual minority men (SMM) or heterosexual populations. Each study implemented best practice strategies for engaging with communities, informing recruitment strategies, navigating through the impacts of COVID-19, and disseminating findings. Best practice strategies common to all MARI studies included establishing community advisory boards, engaging community members in all stages of HIV research, and integrating technology to sustain interventions during the COVID-19 pandemic. Implementing community-informed approaches is crucial to intervention uptake and long-term sustainability in communities of color. MARI investigators' research studies provide a framework for developing effective programs tailored to reducing HIV-related racial/ethnic disparities.

Disruptions in Sexual and Reproductive Health Care Service Delivery for Immigrants During COVID-19

Purpose

To provide perspectives from heterogenous cisgender immigrant women and service providers for immigrants in New York City (NYC) on how restrictive sexual and reproductive health (SRH) care delivery environments during COVID-19 shape immigrant's access to health care and health outcomes to generate insights for clinical practices and policies for immigrant women's health care needs.

Methods

A qualitative study was conducted in 2020 and 2021, including in-depth interviews with 44 immigrant women from different national origins and 19 direct service providers for immigrant communities in NYC to explore how immigrants adapted to and were impacted by pandemic-related SRH care service delivery barriers. Interviews were coded and analyzed using a constant comparative approach.

Results

Pandemic-related delays and interrupted health care, restrictive accompaniment policies, and the transition from in-person to virtual care compounded barriers to care for immigrant communities. Care delays and interruptions forced some participants to live with untreated health conditions, resulting in physical pain and emotional distress. Participants also experienced challenges within the health care system because of changes to visitor policies that restricted the accompaniment of family members or support persons. Some participants experienced difficulties accessing telehealth and technology, while others welcomed the flexibility given the demands of frontline work and childcare.

Conclusions

To mitigate the health and social implications of increasingly restrictive immigration, reproductive, and social policies, clinical practices like expanding access to care for all immigrants, engaging immigrant communities in health care institutions policies and practices, and integrating immigrant's support networks into care play an important role.

Linkages Between Childhood Maltreatment, Intimate Partner Violence, and Posttraumatic Stress Disorder Symptoms in Pregnant Hispanic Women: A Network Analysis

Pregnant Hispanic women are at increased risk for posttraumatic stress disorder (PTSD) in part due to greater risk of childhood maltreatment, intimate partner violence (IPV), and pregnancy-related vulnerabilities. However, PTSD, is a highly heterogenous diagnosis with numerous presentations. Individual PTSD symptoms may be differentially associated with specific types of maltreatment, IPV. Determining how IPV exposure across the lifespan is associated with specific symptoms of PTSD in pregnant Hispanic women is necessary to develop group-relevant models of this disorder and targeted interventions. The present study examined a network model of PTSD symptoms, childhood maltreatment, and adulthood IPV in a sample of pregnant Hispanic women (N = 198). Childhood emotional abuse and adulthood psychological distress had the highest bridge centrality. These types of exposures were most strongly associated with social isolation. Childhood emotional abuse was associated with more individual PTSD symptoms than any IPV type. These findings suggest that associations between PTSD symptoms and different types of IPV exposure vary. In addition, robust associations between childhood emotional abuse and PTSD symptoms suggest that this domain may be particularly important for the clinical assessment and intervention for pregnant women.

Documentation Status and Self-Rated Physical Health Among Latinx Young Adult Immigrants: the Mediating Roles of Immigration and Healthcare Stress

Previous research has demonstrated that undocumented Latinx immigrants in the USA report worse physical health outcomes than documented immigrants. Some studies suggest that immigration-related stress and healthcare related-stress may explain this relationship, but none have tested it empirically. The purpose of this study was to determine if immigration-related stress and healthcare-related stress in the USA explain the relationship between documentation status and physical health among Latinx immigrants in North Carolina. The conceptual model was tested utilizing baseline data from a longitudinal, observational, community-engaged research study of young adult (18-44 years) Latinx immigrants residing in North Carolina (N = 391). Structural equation modeling was used to determine relationships among documentation status, healthcare, and immigration stress in the past six months, and self-rated physical health. Goodness-of-fit measures indicated that data fit the model well (RMSEA = .008; CFI = 1.0; TLI = .999; SRMR = .02; CD = .157). Undocumented individuals were more likely to experience immigration stress than their documented counterparts ([Formula: see text] = - 0.37, p < 0.001). Both immigration stress ([Formula: see text] = - 0.22, p < 0.01) and healthcare stress ([Formula: see text] = - 0.14, p < 0.05) were negatively related to physical health. Additionally, immigration stress was positively related to healthcare stress ([Formula: see text] = 0.72, p < 0.001). Results demonstrate that documentation status is an important social determinant of health. Passage of inclusive immigration and healthcare policies may lessen the stress experienced by Latinx immigrants and subsequently improve physical health.

Economic and Psychosocial Impact of COVID-19 in the Hispanic Community Health Study/Study of Latinos

Objectives

To examine the prevalence and correlates of economic hardship and psychosocial distress experienced during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic in a large cohort of Hispanic/Latino adults.

Methods

The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), an ongoing multicenter study of Hispanic/Latino adults, collected information about COVID-19 illness and psychosocial and economic distress that occurred during the pandemic (N=11,283). We estimated the prevalence of these experiences during the initial phase of the pandemic (May 2020 to May 2021) and examined the prepandemic factors associated with pandemic-related economic hardship and emotional distress using multivariable log linear models with binomial distributions to estimate prevalence ratios.

Results

Almost half of the households reported job losses and a third reported economic hardship during the first year of the pandemic. Pandemic-related household job losses and economic hardship were more pronounced among noncitizens who are likely to be undocumented. Pandemic-related economic hardship and psychosocial distress varied by age group and sex. Contrary to the economic hardship findings, noncitizens were less likely to report pandemic-related psychosocial distress. Prepandemic social resources were inversely related to psychosocial distress.

Conclusions

The study findings underscore the economic vulnerability that the pandemic has brought to ethnic minoritized and immigrant populations in the United States, in particular noncitizens. The study also highlights the need to incorporate documentation status as a social determinant of health. Characterizing the initial economic and mental health impact of the pandemic is important for understanding the pandemic consequences on future health. Clinical Trial Registration Number: NCT02060344.

Unauthorized Mexican-Born Immigrants, Occupational Injuries, and the use of Medical Services in the United States

This article examines how unauthorized immigrant status is associated with the risk of suffering a work-related accident or illness and with the use of medical services after experiencing an injury among Mexican immigrants in the United States. Using individual-level data on 81,004 Mexican immigrants who previously worked in the United States and were interviewed when they returned to Mexico in the Survey of Migration in the Northern Border of Mexico from 2010 to 2018, we estimate a series of probit models and nonlinear decompositions to analyze legal status differences in the incidence of occupational injuries among immigrant workers. The results show that among Mexican immigrants in the United States unauthorized status was associated with a greater probability of experiencing an occupational injury. The higher injury rate among unauthorized immigrants was partly driven by the fact that they worked more hours per day, more days per week, and were employed in riskier occupations than authorized immigrants. If unauthorized immigrants were older and had higher levels of English-language ability, the injury gap would have been even larger. Unauthorized status was also associated with a lower likelihood of using medical services after suffering an occupational injury because unauthorized workers had less access to medical care. The findings show that the right to legal work has important implications for the health of immigrants by setting a higher risk level for injury on the job and limiting access to health care following such an injury.

Understanding the Relationship Between Social Stressors, Trauma, and Somatic Symptoms Among Latina Immigrant Women

BACKGROUND

Latina immigrant women are at increased risk for poor mental health. Little is known about factors associated with somatic symptoms, the physical manifestation of distress, in this population. This study examined associations between social stressors, trauma, and somatic symptoms.

METHODS

This study used survey data from a community-based sample of Latina immigrant women (n = 154). We determined the frequency of somatic symptoms and used linear regressions to estimate associations of stressors and trauma with physical symptoms.

RESULTS

Most participants reported mild or moderate levels of somatic symptom severity. In univariate models, all social stressors and trauma types were significantly associated with higher levels of somatic symptoms. A multivariate model suggested perceived stress was associated with increased somatic symptoms after accounting for other stressors and trauma.

DISCUSSION

Future research should examine whether stress and trauma lead to higher levels of somatic symptoms among Latina immigrants.

Addressing health inequities for children in immigrant families: Psychologists as leaders and links across systems

What can psychologists do to address social determinants of health and promote health equity among America's approximately 20 million children in immigrant families (CIF)? This article identifies gaps in current research and argues for a stronger role for psychologists. Psychologists can advocate for and enact changes in institutional systems that contribute to inequities in social determinants of health and promote resources and services necessary for CIF to flourish. We consider systemic exclusionary and discriminatory barriers faced by CIF, including a heightened anti-immigrant political climate, continued threat of immigration enforcement, restricted access to the social safety net, and the disproportionate health, economic, and educational burden of the COVID-19 pandemic. We highlight the potential role of psychologists in (a) leading prevention that addresses stressors such as poverty and trauma; (b) changing systems to mitigate risk factors for CIF; (c) expanding workforce development across multiple disciplines to better serve their needs; (d) identifying mechanisms, such as racial profiling, that contribute to health inequity, and viewing them as public health harms; and (e) guiding advocacy for resources at local, state, and federal levels, including by linking discriminatory policies or practices with health inequity. A key recommendation to increase psychologists' impact is for academic and professional institutions to strengthen relationships with policymakers to effectively convey these findings in spaces where decisions about policies and practices are made. We conclude that psychologists are well positioned to promote systemic change across multiple societal levels and disciplines to improve the well-being of CIF and offer them a better future. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

State and local integrationist policies and the physical and psychological health of undocumented immigrants

Protracted daily preoccupation with the federal immigration policing infrastructure, restrictive policy, and antagonistic rhetoric take a substantial toll on the psychological and physical health of undocumented immigrants and their families. A growing network of states and municipalities are adopting policies to promote immigrant wellbeing through integration. Recent advances in research suggest subfederal healthcare access, sanctuary, and ID policies increase access to healthcare and health resources and decrease fear and stress. However, health impacts of these policies are modulated by national socio-political forces that spur misinformation, distrust, and fear. To help overcome this, states and municipalities should layer integrationist actions. Critically, more policy impact research is needed to support understanding, uptake, and renewal of state and local policymaking promoting immigrant health.

Health Care During Incarceration: A Policy Position Paper From the American College of Physicians

The American College of Physicians (ACP) has a long-standing commitment to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services. ACP is committed to working toward fully understanding and supporting the unique needs of the incarcerated population and eliminating health disparities for these persons. In this position paper, ACP offers recommendations to policymakers and administrators to improve the health and well-being of persons incarcerated in adult correctional facilities.

State Immigration Policy Contexts and Racialized Legal Status Disparities in Health Care Utilization Among U.S. Agricultural Workers

Research links restrictive immigration policies to immigrant health and health care outcomes. Yet most studies in this area focus on the impact of single policies in particular years, with few assessing how broader state-level immigration policy contexts affect groups by nativity, race/ethnicity, and legal status. Linking data from the National Agricultural Workers Survey (2005-2012) with information on state immigration policies, we use an intersectional approach to examine the links between policy contexts and health care utilization by nativity, race/ethnicity, and legal status. We also assess the associations between two specific types of state immigration policies-those governing immigrant access to Medicaid and driver's licenses-and health care utilization disparities. We find that state-level immigration policy contexts are associated with health care utilization among U.S.-born and naturalized U.S. citizen non-White Latinx agricultural workers, who report lower levels of health care utilization and greater barriers to care-seeking in more restrictive policy contexts. By contrast, we find little evidence that state policies shaped health care utilization among undocumented workers. These findings advance understanding of the impact of "policies of exclusion" on the lives of marginalized groups and underscore the importance of racialized legal status in considering the links between sociopolitical contexts and health and health care disparities.