COVID-19's Unequal Toll: Differences in Health-Related Quality of Life by Gendered and Racialized Groups.

We examine whether the COVID-19 pandemic was associated with changes to daily activity limitations due to poor physical or mental health and whether those changes were different within and between gendered and racialized groups. We analyze 497,302 observations across the 2019 and 2020 waves of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System survey. Among White men and women, the COVID-19 pandemic was associated with fewer days of health-related activity limitations and decreased frequent activity limitation (≥14 days in the past month) compared to the prepandemic period. By contrast, Latina and Black women experienced increased days of activity limitation and greater likelihood of frequent activity limitation, and these changes were significantly different than for White women. These findings are robust to the inclusion of structural inequality measures and demonstrate how systemic racism and sexism likely exacerbate a myriad of pandemic-related health problems.

Advancing Research To Address The Health Impacts Of Structural Racism In US Immigration Prisons.

The US is the world leader in imprisoning immigrants. Its mass immigration detention system emerged as an extension of mass incarceration, rooted in a legacy of racist US immigration and criminal laws. Immigration policy is a structural determinant of health that negatively affects the health of imprisoned immigrants, their families, and their communities. The systemic harms of "detention facilities," which we refer to as "immigration prisons," have been extensively documented, yet incrementalist reforms have failed to result in improved outcomes for immigrants. We argue that ending the practice of immigrant imprisonment is the most effective solution to mitigating its harms. Community-based programs are safer and less expensive than imprisonment, while also being effective at ensuring compliance with government requirements. We identify several priorities for researchers and policy makers to tackle the health inequities resulting from this structurally racist system. These include applying a critical, intersectional lens to studying the policies and practices that drive imprisonment, engaging affected communities in research and policy development, and creating an accountable and transparent system of data collection and release to inform health interventions. The reliance of the US on immigrant imprisonment is a policy choice with immense social and economic costs; dismantling it is critical to advancing health equity.

Cumulative Risk of Immigration Prison Conditions on Health Outcomes Among Detained Immigrants in California.

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.

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

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

Risk of Poor Outcomes with COVID-19 Among U.S. Detained Immigrants: A Cross-Sectional Study.

Conditions in immigrant detention centers facilitate the spread of infectious diseases like COVID-19. However, there is no publicly-available data on detainees' health characteristics, making it difficult to estimate the prevalence of risk among detained people. We use cross-sectional survey data from the only survey of detained immigrants, conducted in California in 2013-2014, to assess the prevalence and health-related correlates of health conditions among detained immigrants. We calculated the proportion of detained immigrants with chronic conditions, their interruptions in care, and stratified by sociodemographic characteristics, evaluating differences using two-tailed tests. Among 529 detained immigrants, 42.5% had at least one chronic health condition; 15.5% had multiple chronic conditions. 20.9% experienced disruption in care upon entering detention. 95.6% had access to stable housing in the U.S. Many detained people face health conditions that confer greater risk for poor outcomes with COVID-19. Stable residence can facilitate release of detainees via Alternatives to Detention programs.

Understanding US Immigration Detention: Reaffirming Rights and Addressing Social-Structural Determinants of Health.

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.

Uncertainty About DACA May Undermine Its Positive Impact On Health For Recipients And Their Children.

Undocumented immigrants and their children have worse self-reported health than documented immigrants and US citizens do. Evidence suggests that the Deferred Action for Childhood Arrivals (DACA) program, which was created in 2012 by President Barack Obama and which granted some rights to undocumented immigrants who arrived as children, improved the well-being of recipients and their children in the first three years after the program's introduction. However, DACA is subject to executive discretion, and the US presidential campaign that began in 2015 introduced substantial uncertainty regarding the program's future. We examined whether DACA's health benefits persisted beyond 2015 using the 2007-17 waves of the California Health Interview Survey and dynamic treatment effects models. Our results show that self-reported health improved for Latina/o DACA-eligible immigrants and their children from 2012 to 2015 but worsened after 2015. Our results suggest that the political climate of the 2016 presidential election may have underscored the politically contingent nature of the DACA program and eroded the program's health benefits for eligible immigrants and their children.

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

Exclusionary immigration policies, as a form of structural racism, have led to a sizeable undocumented population that is largely barred from access to resources in the United States. Existing research suggests that undocumented immigration status detrimentally impacts mobility, yet few studies have tested the impacts of legal status on psychological wellbeing. Most importantly, we know little about how changes to legal status impact wellbeing. Announced in 2012, the Deferred Action for Childhood Arrivals (DACA) program allows eligible undocumented youth to apply for temporary lawful status. Drawing on cross-sectional survey data from 487 Latino immigrant young adults in California collected in 2014 and 2015, we analyze the predictors of three specialized outcomes related to immigrants' psychological wellbeing-distress, negative emotions, and deportation worry before and after a transition from undocumented to lawfully present status. Results show that retrospective reports of past psychological wellness, when all respondents were undocumented, are predicted primarily by socioeconomic status. However, reports of current psychological wellness are predicted by DACA status. Our results demonstrate, for the first time, the positive emotional consequences of transitioning out of undocumented status for immigrant young adults.