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1.
BMC Public Health ; 22(1): 804, 2022 04 22.
Article in English | MEDLINE | ID: covidwho-1862117

ABSTRACT

BACKGROUND: The health of undocumented immigrants is an important concern in most societies. However, there is no conclusive evidence that inclusive health care policies lead to better outcomes for this group of the population. The aim of this study is to analyse whether there is an association between inclusive health care policies and the mortality patterns of undocumented immigrants, or the distribution of different causes of death among those who have died. METHODS: We analyse individual data concerning the deceased in Switzerland between 2011 and 2017. We proceed in two steps. First, we estimate and compare the patterns of mortality of Swiss citizens, documented immigrants, and undocumented immigrants. Second, we test whether there is an association between cantonal authorities' policies and differing mortality patterns. We use logistic regressions and multinomial regressions to estimate the relationship between legal status and mortality patterns both in Switzerland and across different cantons. RESULTS: We find a difference in the patterns of mortality between undocumented immigrants and the other groups of the population. Specifically, death from circulatory system diseases is twice as frequent among undocumented immigrants compared to documented immigrants and Swiss citizens. However, this difference is smaller in the Swiss cantons that have more inclusive health care policies towards undocumented immigrants. CONCLUSIONS: We interpret these results as an indication that policies that expand access to health services lead to better outcomes for undocumented immigrants. This finding has implications for research on civic stratification and public health. Further analysis is needed to evaluate the effects of extending public health care for undocumented immigrants in different contexts.


Subject(s)
Emigrants and Immigrants , Undocumented Immigrants , Health Policy , Health Services Accessibility , Humans , Switzerland/epidemiology
2.
J Urban Health ; 99(1): 3-14, 2022 02.
Article in English | MEDLINE | ID: covidwho-1703665

ABSTRACT

Black and Hispanic Americans have been hardest hit with COVID-19 infections, hospitalizations, and deaths, yet during the first several months of vaccine roll-out they had the lowest level of vaccine uptake. Primarily, our research on vaccine hesitancy focused on skepticism around the vaccine itself and its roll-out. Our search strategy used PUBMED and Google with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during early period of roll-out and real-time perspectives were crucially needed. Literature searches occurred in April 2021and covered September 2020-April 2021. Analyses included expert opinion, survey results and qualitative summaries. Overall, for the general U.S. population, there was considerable hesitancy initially that remained high during the early roll-out. The general population expressed concerns over the speed of vaccine development ("warp speed"), confidence in the competence of government being involved in the development of vaccines and general mistrust of government. Among Black and Hispanic Americans, hesitancy was further expressed as mistrust in the medical establishment that was related to past and current medical mistreatment. Undocumented immigrants worried about access to insurance and possible deportation. These results on confidence in the vaccine early during vaccine roll-out suggest diverse reasons that influence a person's decision to vaccinate or not. Additional barriers to vaccine uptake include complacency and access. To ensure health equity, particularly to address disparities in morbidity and mortality, vaccine hesitancy needs to be acknowledged and addressed as COVID-19 vaccine roll-out continues, and these observations calls for conscious planning to address these issues early with future health crises.


Subject(s)
COVID-19 , Undocumented Immigrants , COVID-19 Vaccines , Humans , SARS-CoV-2
3.
J Community Health ; 47(3): 554-562, 2022 06.
Article in English | MEDLINE | ID: covidwho-1653622

ABSTRACT

There has been a dearth of reports that examine the effect of immigration status on COVID-19 vaccine hesitancy. While intention to be vaccinated has been higher among adults in immigrant families than non-immigrant adults, uptake of the vaccine has been lower among immigrants and especially those who are undocumented. Concerns raised by immigrants usually centered on the lack of access to information, language barriers, conflicts between work and clinic hours, and fears over their precarious status in the U.S. To perform a rapid review, our time frame was December 2020 through August 2021. Our search strategy used the PUBMED and Google search engines with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during the early period of roll-out and real-time perspectives were crucially needed. Strategies used to promote equity include the use of trusted leaders as well as direct communication styles. Other strategies centered informational messaging from government agencies and the medical community, with a strong emphasis on coalescing broad engagement of the community and being responsive to language and cultural needs. In addition to communication and messaging to educate about COVID-19 vaccines, another important aspect of COVID-19 vaccine uptake was overcoming multiple obstacles that affect ease of access. This report suggests that vaccine uptake, and more generally pandemic response, in vulnerable communities may be better able to launch when they build on existing, trusted, culturally intelligent community-based organizations and local sociocultural processes. These organizations need continued support to contribute to population health equity in emerging health crises.


Subject(s)
COVID-19 , Emigrants and Immigrants , Undocumented Immigrants , Vaccines , Adult , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Humans
4.
J Immigr Minor Health ; 24(1): 1-9, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1616197

ABSTRACT

Immigration concerns can deter immigrants from utilizing healthcare services. We examined Latinx immigrants' immigration concerns related to COVID-19 testing and treatment. A multi-state sample of 336 US Latinx immigrants (documented and undocumented) completed a cross-sectional online survey in Spanish. Factor analysis informed the construction of a COVID-19 Immigration Concerns Scale. Multiple logistic regression was used to examine associations between the scale and indices of perceived immigration risk and healthcare access and utilization. Concerns clustered around two factors: (1) providers' release of information to immigration authorities and drawing government attention; and (2) eligibility for COVID-19 services and the immigration ramifications of using these. The regression equation highlighted strong associations between these and perceived instability of immigration laws and enforcement concerns after controlling for healthcare access and utilization. COVID-19-related immigration concerns were substantial and multifaceted. Perceived instability of laws was strongly related to concerns but remains understudied.


Subject(s)
COVID-19 , Emigrants and Immigrants , Undocumented Immigrants , COVID-19 Testing , Cross-Sectional Studies , Humans , SARS-CoV-2
6.
PLoS One ; 16(12): e0260467, 2021.
Article in English | MEDLINE | ID: covidwho-1551300

ABSTRACT

Patients often do not disclose domestic violence (DV) to healthcare providers in emergency departments and other healthcare settings. Barriers to disclosure may include fears and misconceptions about whether, and under what circumstances, healthcare providers report DV to law enforcement and immigration authorities. We sought to assess undocumented Latino immigrants (UDLI), Latino legal residents/citizens (LLRC) and non-Latino legal residents/citizens (NLRC) beliefs about disclosure of DV victimization to healthcare providers and healthcare provider reporting of DV to law enforcement and immigration authorities. From 10/2018-2/2020, we conducted this survey study at two urban emergency departments (EDs) in California. Participants, enrolled by convenience sampling, responded to survey questions adapted from a previously published survey instrument that was developed to assess undocumented immigrant fears of accessing ED care. Our primary outcomes were the proportions of UDLI, LLRC and NLRC who knew of someone who had experienced DV in the past year, whether these DV victims were afraid to access ED care, reasons DV victims were afraid to access ED care, and rates of misconceptions (defined according to current California law) about the consequences of disclosing DV to healthcare providers. Of 667 patients approached, 531 (80%) agreed to participate: 32% UDLI, 33% LLRC, and 35% NLRC. Of the 27.5% of respondents who knew someone who experienced DV in the past year, 46% stated that the DV victim was afraid to seek ED care; there was no significant difference in this rate between groups. The most common fears reported as barriers to disclosure were fear the doctor would report DV to police (31%) and fear that the person perpetrating DV would find out about the disclosure (30.3%). Contrary to our hypothesis, UDLI had lower rates of misconceptions about healthcare provider and law enforcement responses to DV disclosure than LLRC and NLRC. Fear of disclosing DV and misconceptions about the consequences of disclosure of DV to healthcare providers were common, indicating a need for provider, patient, and community education and changes that lower barriers to help-seeking.


Subject(s)
Disclosure , Adult , Domestic Violence , Emergency Service, Hospital , Emigration and Immigration , Humans , Undocumented Immigrants
7.
Int J Environ Res Public Health ; 18(23)2021 12 02.
Article in English | MEDLINE | ID: covidwho-1551597

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), has had an unprecedented effect, especially among under-resourced minority communities. Surveillance of those at high risk is critical for preventing and controlling the pandemic. We must better understand the relationships between COVID-19-related cases or deaths and characteristics in our most vulnerable population that put them at risk to target COVID-19 prevention and management efforts. Population characteristics strongly related to United States (US) county-level data on COVID-19 cases and deaths during all stages of the pandemic were identified from the onset of the epidemic and included county-level socio-demographic and comorbidities data, as well as daily meteorological modeled observation data from the North American Regional Reanalysis (NARR), and the NARR high spatial resolution model to assess the environment. Advanced machine learning (ML) approaches were used to identify outbreaks (geographic clusters of COVID-19) and included spatiotemporal risk factors and COVID-19 vaccination efforts, especially among vulnerable and underserved communities. COVID-19 outcomes were found to be negatively associated with the number of people vaccinated and positively associated with age, the prevalence of cardiovascular disease, diabetes, and the minority population. There was also a strong positive correlation between unauthorized immigrants and the prevalence of COVID-19 cases and deaths. Meteorological variables were also investigated, but correlations with COVID-19 were relatively weak. Our findings suggest that COVID-19 has had a disproportionate impact across the US population among vulnerable and minority communities. Findings also emphasize the importance of vaccinations and tailored public health initiatives (e.g., mask mandates, vaccination) to reduce the spread of COVID-19 and the number of COVID-19 related deaths across all populations.


Subject(s)
COVID-19 , Undocumented Immigrants , COVID-19 Vaccines , Humans , SARS-CoV-2 , United States/epidemiology
9.
PLoS One ; 16(10): e0257912, 2021.
Article in English | MEDLINE | ID: covidwho-1463307

ABSTRACT

Dehumanization is a topic of significant interest for academia and society at large. Empirical studies often have people rate the evolved nature of outgroups and prior work suggests immigrants are common victims of less-than-human treatment. Despite existing work that suggests who dehumanizes particular outgroups and who is often dehumanized, the extant literature knows less about why people dehumanize outgroups such as immigrants. The current work takes up this opportunity by examining why people dehumanize immigrants said to be illegal and how measurement format affects dehumanization ratings. Participants (N = 672) dehumanized such immigrants more if their ratings were made on a slider versus clicking images of hominids, an effect most pronounced for Republicans. Dehumanization was negatively associated with warmth toward illegal immigrants and the perceived unhappiness felt by illegal immigrants from U.S. immigration policies. Finally, most dehumanization is not entirely blatant but instead, captured by virtuous violence and affect as well, suggesting the many ways that dehumanization can manifest as predicted by theory. This work offers a mechanistic account for why people dehumanize immigrants and addresses how survey measurement artifacts (e.g., clicking on images of hominids vs. using a slider) affect dehumanization rates. We discuss how these data extend dehumanization theory and inform empirical research.


Subject(s)
Dehumanization , Emigrants and Immigrants/psychology , Emigration and Immigration/statistics & numerical data , Adult , Emigrants and Immigrants/legislation & jurisprudence , Female , Humans , Male , Undocumented Immigrants/psychology , Undocumented Immigrants/statistics & numerical data , United States/epidemiology , Violence/legislation & jurisprudence , Violence/prevention & control
11.
Am J Public Health ; 111(8): 1497-1503, 2021 08.
Article in English | MEDLINE | ID: covidwho-1186643

ABSTRACT

Under international law, the United States is obligated to uphold noncitizens' fundamental rights, including their rights to health. However, current US immigration laws-and their enforcement-not only fail to fulfill migrants' health rights but actively undermine their realization and worsen the pandemic's spread. Specifically, the US immigration system's reliance on detention, which precludes effective social distancing, increases risks of exposure and infection for detainees, staff, and their broader communities. International agreements clearly state that the prolonged, mandatory, or automatic detention of people solely because of their migration status is a human rights violation on its own. But in the context of COVID-19, the consequences for migrants' right to health are particularly acute. Effective alternatives exist: other countries demonstrate the feasibility of adopting and implementing immigration laws that establish far less restrictive, social services-based approaches to enforcement that respect human rights. To protect public health and realize its global commitments, the United States must shift away from detaining migrants as standard practice and adopt effective, humane alternatives-both amid COVID-19 and permanently.


Subject(s)
COVID-19/prevention & control , Emigration and Immigration/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Social Determinants of Health/statistics & numerical data , Transients and Migrants/statistics & numerical data , Undocumented Immigrants/statistics & numerical data , COVID-19/epidemiology , Emigration and Immigration/legislation & jurisprudence , Health Services Accessibility/legislation & jurisprudence , Human Rights/statistics & numerical data , Humans , Right to Health/statistics & numerical data , Social Determinants of Health/legislation & jurisprudence , Social Justice , Transients and Migrants/legislation & jurisprudence , Undocumented Immigrants/legislation & jurisprudence , United States
14.
J Immigr Minor Health ; 23(5): 885-894, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1146068

ABSTRACT

The mounting evidence highlighting the disproportionate impact of the COVID-19 pandemic in ethnic minority communities underscores the need to understand how distress and healthcare access impacts the well-being of undocumented Latino/a immigrants (ULIs), one of the most marginalized and vulnerable ethnic minority communities in the U.S. We used existing data from a cross sectional study (Proyecto Voces) of 252 ULIs to conduct path analyses that explored the relations among distress due to immigration legal status, healthcare access difficulties, and the health of ULIs. Results demonstrated that distress due to immigration legal status is related to the physical and mental health of ULIs, and that difficulties in accessing healthcare explained these relations. These data support the importance of immediate, targeted efforts for increasing access to healthcare among undocumented immigrants and highlight the long-term importance of a much-needed healthcare reform for improving access to marginalized populations.


Subject(s)
Emigrants and Immigrants , Health Services Accessibility , Undocumented Immigrants , COVID-19 , Cross-Sectional Studies , Humans , Minority Groups , Pandemics
16.
JAMA Netw Open ; 4(3): e210684, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1126326

ABSTRACT

Importance: Latinx individuals, particularly immigrants, are at higher risk than non-Latinx White individuals of contracting and dying from coronavirus disease 2019 (COVID-19). Little is known about Latinx experiences with COVID-19 infection and treatment. Objective: To describe the experiences of Latinx individuals who were hospitalized with and survived COVID-19. Design, Setting, and Participants: The qualitative study used semistructured phone interviews of 60 Latinx adults who survived a COVID-19 hospitalization in public hospitals in San Francisco, California, and Denver, Colorado, from March 2020 to July 2020. Transcripts were analyzed using qualitative thematic analysis. Data analysis was conducted from May 2020 to September 2020. Main Outcomes and Measures: Themes and subthemes that reflected patient experiences. Results: Sixty people (24 women and 36 men; mean [SD] age, 48 [12] years) participated. All lived in low-income areas, 47 participants (78%) had more than 4 people in the home, and most (44 participants [73%]) were essential workers. Four participants (9%) could work from home, 12 (20%) had paid sick leave, and 21 (35%) lost their job because of COVID-19. We identified 5 themes (and subthemes) with public health and clinical care implications: COVID-19 was a distant and secondary threat (invincibility, misinformation and disbelief, ingrained social norms); COVID-19 was a compounder of disadvantage (fear of unemployment and eviction, lack of safeguards for undocumented immigrants, inability to protect self from COVID-19, and high-density housing); reluctance to seek medical care (worry about health care costs, concerned about ability to access care if uninsured or undocumented, undocumented immigrants fear deportation); health care system interactions (social isolation and change in hospital procedures, appreciation for clinicians and language access, and discharge with insufficient resources or clinical information); and faith and community resiliency (spirituality, Latinx COVID-19 advocates). Conclusions and Relevance: In interviews, Latinx patients with COVID-19 who survived hospitalization described initial disease misinformation and economic and immigration fears as having driven exposure and delays in presentation. To confront COVID-19 as a compounder of social disadvantage, public health authorities should mitigate COVID-19-related misinformation, immigration fears, and challenges to health care access, as well as create policies that provide work protection and address economic disadvantages.


Subject(s)
COVID-19/ethnology , Emigration and Immigration , Employment , Fear , Help-Seeking Behavior , Hospitalization , Public Health , Adult , COVID-19/therapy , California , Colorado , Communication , Deportation , Economic Status , Female , Financial Stress , Health Expenditures , Humans , Male , Middle Aged , Poverty Areas , Qualitative Research , SARS-CoV-2 , Sick Leave , Social Class , Social Norms , Teleworking , Undocumented Immigrants
17.
New Solut ; 31(1): 9-15, 2021 05.
Article in English | MEDLINE | ID: covidwho-1058188

ABSTRACT

The Covid-19 pandemic has greatly impacted frontline workers' health in 2020. The objective of this commentary is to evaluate some of the challenges faced by undocumented farmworkers in the context of the current global pandemic and possible risk mitigation strategies. Undocumented farmworkers make considerable contributions to the U.S. economy and food production, but they are at an elevated risk for contracting Covid-19. Their risk is compounded by their employment and legal status, as well as their poor working and living conditions which makes it difficult for them to observe Covid-19 precautionary measures. U.S. immigration policy disincentivizes undocumented farmworkers from seeking healthcare services. Contact tracing challenges could be overcome by gaining trust with subsequent increased testing and care. Extending eligibility of safety net programs for undocumented farmworkers will help to ease the burden of Covid-19, thereby improving their overall health and productivity.


Subject(s)
COVID-19/ethnology , Farmers , Undocumented Immigrants , COVID-19/prevention & control , COVID-19/transmission , Contact Tracing , Health Services Accessibility , Humans , Occupational Health , Pandemics , SARS-CoV-2 , Socioeconomic Factors , Trust , United States
18.
Front Public Health ; 8: 596887, 2020.
Article in English | MEDLINE | ID: covidwho-1005630

ABSTRACT

Introduction: Undocumented migrants are at high risk of adverse consequences during crises because of a lack of access to essential securities and sources of support. This study aims to describe the impact of the COVID-19 crisis on the health and living circumstances of precarious migrants in Switzerland and to assess whether those undergoing legal status regularization fared better than undocumented migrants. Materials and methods: This cross-sectional mixed methods study was conducted during the COVID-19 lockdown in April-May 2020. Undocumented and recently regularized migrants taking part in an ongoing cohort study were asked to respond to an online questionnaire. A subsample was selected to undergo semi-directed phone interviews. Results: Overall, 117 of the 379 (30.9%) cohort study participants responded to the questionnaire. Seventeen interviews were conducted. Migrants faced cumulative and rapidly progressive difficulties in essential life domains. As a consequence, they showed high prevalence of exposure to COVID-19, poor mental health along with frequent avoidance of health care. Moreover, the loss of working hours and the related income overlapped with frequent food and housing insecurity. Around one participant in four had experienced hunger. Despite these unmet needs, half of the participants had not sought external assistance for reasons that differ by legal status. Both groups felt that seeking assistance might represent a threat for the renewal or a future application for a residency permit. While documented migrants were less severely affected in some domains by having accumulated more reserves previously, they also frequently renounced to sources of support. Conclusions: The cumulated difficulties faced by migrants in this period of crisis and their limited search for assistance highlight the need to implement trust-building strategies to bridge the access gap to sources of support along with policies protecting them against the rapid loss of income, the risk of losing their residency permit and the exposure to multi-fold insecurities.


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Pandemics/statistics & numerical data , Quarantine/psychology , Transients and Migrants/psychology , Transients and Migrants/statistics & numerical data , Undocumented Immigrants/psychology , Adult , Aged , Aged, 80 and over , Cohort Studies , Cross-Sectional Studies , Humans , Longitudinal Studies , Male , Middle Aged , Quarantine/statistics & numerical data , SARS-CoV-2 , Switzerland/epidemiology , Undocumented Immigrants/statistics & numerical data
19.
Eur J Public Health ; 30(6): 1186-1188, 2020 Dec 11.
Article in English | MEDLINE | ID: covidwho-915870

ABSTRACT

Despite concern on the impact of coronavirus disease 2019 (COVID-19) pandemic on undocumented immigrants, quantitative evidence on the issue is scant. We analyze socioeconomic and health conditions of 1590 undocumented immigrants in Milan, Lombardy, one of the regions with the highest COVID-19 clinical burden in the world that does not guarantee access to primary care for these individuals. We document a sharp reduction in visit number after lockdown, with 16% frequency of acute respiratory infections, compatible with COVID-19. Moreover, housing conditions make it difficult to implement public health measures. Results suggest the need to foster primary care by undocumented immigrants to face COVID-19 emergency.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility/statistics & numerical data , Undocumented Immigrants/statistics & numerical data , Adult , Age Factors , Health Status , Housing/standards , Humans , Italy/epidemiology , Middle Aged , Pandemics , Primary Health Care/organization & administration , SARS-CoV-2 , Sex Factors , Socioeconomic Factors
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