Objectives

The USA maintains the world's largest immigration detention system. This study examines the mechanisms by which detention serves as a catalyst for worsening health.

Methods

Using data from detained immigrants in California (n = 493) from 2013 to 2014, we assessed the prevalence of exposure to conditions of confinement hypothesized to negatively influence health; the extent to which conditions of confinement are associated with psychological stress, diagnosed mental health conditions, and/or declines in general health; and the cumulative impact of confinement conditions on these outcomes.

Results

We found that each condition increased the likelihood of one or more negative health conditions, but there was also a cumulative effect: for each additional confinement condition, the odds of worsening general health rose by 39% and reporting good health decreased by 24%.

Conclusions

Confinement conditions are associated with poor physical and mental health outcomes among immigrants detained in immigration prisons. Policies that seek to improve specific conditions in detention centers may remove some risks of harm, but alternatives to detention are likely to be most effective.

There has been a burst of research on immigrant health in the United States and an increasing attention to the broad range of state and local policies that are social determinants of immigrant health. Many of these policies criminalize immigrants by regulating the "legality" of their day-to-day lives while others function to integrate immigrants through expanded rights and eligibility for health care, social services, and other resources.Research on the health impact of policies has primarily focused on the extremes of either criminalization or integration. Most immigrants in the United States, however, live in states that possess a combination of both criminalizing and integrating policies, resulting in distinct contexts that may influence their well-being.We present data describing the variations in criminalization and integration policies across states and provide a framework that identifies distinct but concurrent mechanisms of deportability and inclusion that can influence health. Future public health research and practice should address the ongoing dynamics created by both criminalization and integration policies as these likely exacerbate health inequities by citizenship status, race/ethnicity, and other social hierarchies.

Background

Undocumented immigrants are expected to face increased risks related to COVID-19 due to marginalizing restrictive immigration policies. However, few studies have assessed the prevalence of direct encounters with the immigration enforcement system among the undocumented and its impacts on their COVID-related health behaviors and outcomes. In this study, we quantify undocumented immigrants' lifetime exposure to various immigration enforcement tactics and their association with delays in COVID-19 testing and healthcare behaviors.

Methods

This cross-sectional study included a non-random sample of 326 Asian and Latinx undocumented immigrants in California from September 2020 to February 2021. The primary exposure was immigration enforcement encounter scores ranging from 0-9, assessed through self-reports of direct experiences with the immigration system, immigration officials, and law enforcement. The main outcomes were positive test for COVID-19, had or suspected having COVID-19, and delayed or avoided testing and/or treatment for COVID-19 due to immigration status. We used multivariable logistic regression models to examine the association between the primary exposure and outcomes of interest.

Results

Among 326 participants, 7% had received a positive COVID-19 test result, while 43% reported having or suspected having COVID-19. Almost 13% delayed or avoided COVID-19 testing and/or treatment because of their immigration status. Overall, an increase in immigration enforcement encounters was associated with higher odds of suspecting having had COVID-19 (aOR = 1.13; 95% CI: 1.01,1.26). Reporting an additional enforcement encounter was associated with higher odds of delaying or avoiding testing and/or treatment because of immigration status (aOR = 1.53, 95% CI: 1.26,1.86). Compared to their Latino counterparts, Asian respondents were more likely to report higher odds of delaying or avoiding testing and/or treatment (aOR = 3.13, 95% CI: 1.17,8.42). There were no significant associations between the enforcement score and testing positive for COVID-19. Additionally, while Latinxs were more likely to report immigration enforcement encounters than Asians, there were no differences in the effects of race on COVID-19 testing and healthcare behaviors in models with race as an interaction term (p < 0.05).

Conclusions

Immigration enforcement encounters compound barriers to COVID-19 testing and treatment for undocumented immigrants.

As evidence of the negative health impact of immigration enforcement policy continues to mount, public health research has focused primarily on the psychosocial health mechanisms, such as fear and stress, by which immigration enforcement may harm health. We build on this research using structural vulnerability theory to investigate the structural processes by which enforcement policy may shape Latino immigrants' health. We conducted qualitative analysis of testimonios from a purposive sample of Latino immigrants (n=14) living in Southern California in 2015, a period of significant federal, state, and local enforcement policy change. Testimonios are a narrative methodology used across the social sciences and humanities to center the voices of marginalized people. Through unstructured testimonio interviews, we sought to understand Latino immigrants' experiences with immigration enforcement and identify specific structural factors by which those experiences may influence health. Respondents' narratives revealed that singular enforcement experiences were not viewed as the sole manifestation of enforcement, but as part of a system of intersecting physical, legal, institutional, and economic exclusions which shaped the social and economic conditions that influence health. These exclusions reinforced respondents' marginalization, produced instability about the future, and generated a sense of individual responsibility and blame. We discuss how physical, legal, institutional, and economic processes may influence health and propose a framework to inform population health research on intersecting structural health mechanisms.

U.S. food insecurity rates rapidly increased during the COVID-19 pandemic, with disproportionate impacts on Latino immigrant households. We conducted a qualitative study to investigate how household food environments of rural Latino immigrants were affected during the COVID-19 pandemic. Thirty-one respondents (42% from low food security households) completed interviews (July 2020-April 2021) across four rural counties in California. A rural household food security conceptual framework was used to analyze the data. Early in the pandemic, food availability was impacted by school closures and the increased consumption of meals/snacks at home; food access was impacted by reduced incomes. Barriers to access included limited transportation, excess distance, and lack of convenience. Key resources for mitigating food insecurity were the Supplemental Nutrition Assistance Program (SNAP), the Pandemic Electronic Benefits Transfer (P-EBT), school meals, charitable food programs, and social capital, although the adequacy and acceptability of charitable food distributions were noted issues. Respondents expressed concern about legal status, stigma, and the public charge rule when discussing barriers to government nutrition assistance programs. They reported that food pantries and P-EBT had fewer access barriers. Positive coping strategies included health-promoting food substitutions and the reduced consumption of meals outside the home. Results can inform the development of policy and systems interventions to decrease food insecurity and nutrition-related health disparities among rural Latino immigrants.

While immigrants in the US suffer poor access to healthcare in general, access within immigrant populations varies notably by legal status and employment. Intersections between immigration, employment, and healthcare policy have shaped immigrants access or exclusion from healthcare; however, little research has examined how immigrants experience and navigate these intersections. Drawing on social exclusion theory and the theory of bounded agency, we aimed to investigate Mexican and Chinese immigrants experiences of exclusion from healthcare as one key dimension of social exclusion-and how this was shaped by interactions with the institutions of immigration and employment. The examination of two ethnic immigrant groups who live under the same set of policies allows for a focus on the common impacts of policy. We selected Mexican and Chinese immigrants as the two largest subgroups in Californias Latinx and Asian immigrant population. We use a policy lens to analyze qualitative data from the mixed-methods Research on Immigrant Health and State Policy (RIGHTS) Study, involving 60 in-depth interviews with Mexican and Chinese immigrants in California between August 2018-August 2019. We identified two primary themes: pathways of social exclusion and access, and strategies used to address social exclusion. Findings show that immigrants exclusion from healthcare is fundamentally linked to legal status and employment, and that immigrants navigate difficult choices between opportunities for improved employment and changes in legal status. We argue that multiple categories of legal status affect immigrants employment opportunities and social position, which, in turn, translates to stratified healthcare access. Our findings support the literature establishing legal status as a mechanism of social stratification but challenge legal-illegal binary paradigms.

A crisis of mass immigration detention exists in the United States, which is home to the world's largest immigration detention system. The immigration detention system is legally classified as civil, rather than criminal, and therefore non-punitive. Yet it mimics the criminal incarceration system and holds detained individuals in punitive, prison-like conditions. Within immigration detention centers, there are increasing reports and recognition of civil and human rights abuses, including preventable in-custody deaths. In this paper, we propose understanding the health impacts of detention as an accumulation of mental and physical trauma that take place during the entirety of a detained immigrant's experience, from migration to potential deportation and removal. Further, we explore the social-structural determinants of health as they relate to immigration detention, contextualize these determinants within a human rights framework, and draw parallels to the larger context of US mass incarceration. Realizing the right to health requires addressing these social-structural determinants of health. For the care of immigrant patients to be effective, clinicians and public health professionals must incorporate an awareness of the health risks of the immigration detention system into trauma- and human rights-informed models of care during and after detention.

While a growing body of research has examined immigrants’ health generally, less is known specifically about the impact of immigration policy on the health of Chinese immigrants, the second-largest foreign-born population in the United States. This is due, in part, to the lack of methodologically well-trained, cross-cultural researchers who have both the cultural and linguistic expertise and health knowledge to engage with Chinese immigrant populations. This paper addresses this gap by examining Chinese cross-cultural researchers’ roles in the qualitative phase of the Research on ImmiGrant HealTh and State policy (RIGHTS) project, which sought to assess how immigration policies shaped Chinese and other immigrants’ experiences in healthcare and other related sectors in California. We used reflexivity to assess Chinese cross-cultural researchers’ positionality of insiderness and outsiderness and its influence on the process of data collection (i.e., recruitment, conducting interviews, transcription, and translation). Our reflexivity guides the assessment of the opportunities (e.g., expanding the recruitment pool, engaging participants more effectively in interviews, ensuring data integrity, and discussing heterogeneity within the Chinese immigrant community) and challenges (e.g., the difficulty of recruiting low-income and undocumented immigrants, addressing participants’ in-depth thoughts, the time-consuming nature of transcription and translation, and the assessment of power dynamics) in conducting immigrant health research with the Chinese community. These results highlight the need for cross-cultural researchers to help build trusting relationships with ethnic-minority communities, thus gaining new insights and advancing knowledge within the field of ethnic minority health research. These insights can guide future investigations of Chinese and other immigrant communities as research on immigration policy and health expands.

The mental health of the United States' Latino population significantly deteriorated during the SARS-CoV-2 (COVID-19) pandemic, and Latino immigrants living in rural areas faced unique vulnerabilities. However, few studies have specifically examined the mental health burden and experiences of rural Latino immigrants during the COVID pandemic. To understand the mental health experiences of first- and second-generation Latinos in rural areas, we conducted semi-structured interviews with 35 Latino residents of rural California counties during July 2020-February 2021 and screened all respondents for major depression and generalized anxiety symptoms using the Patient Health Questionnaire [PHQ]-2 and Generalized Anxiety Disorder [GAD]-2 screeners. We explored the prevalence of symptoms of depression and anxiety in our sample, iteratively analyzed participants' narratives regarding the mental health impact of the pandemic, and used their mental health screener status to contextualize these narratives. Results indicated that nearly all respondents viewed mental health as a major concern, and 34% (n ​= ​12) of respondents screened positive for major depression or generalized anxiety disorder. Respondents connected their mental health concerns to experiences of financial precarity, fear of contracting COVID-19, social isolation, and the challenges of remote schooling. Additional themes emerged around problems accessing the mental health care system, the utility of pre-pandemic mental health services, and using healthy coping mechanisms to alleviate psychological problems. Respondents' narratives tended to focus on the mental health challenges facing their family members, particularly their children. Our findings suggest that mental health intervention models that engage with multiple family members, policies that support infrastructure for encouraging exercise and outdoor activity, and ensuring access to culturally and linguistically appropriate mental health care for Latino communities may be important for protecting population mental health.

Policy Points There is growing attention to the role of immigration and immigrant policies in shaping the health and well-being of immigrants of color. The early 21st century in the United States has seen several important achievements in inclusionary policies, practices, and ideologies toward immigrants, largely at subnational levels (e.g., states, counties, cities/towns). National policies or practices that are inclusionary toward immigrants are often at the discretion of the political parties in power. Early in the 21st century, the United States has implemented several exclusionary immigration and immigrant policies, contributing to record deportations and detentions and worsening inequities in the social drivers of health.