Associations Between Perceptions Of U.s. Immigration Enforcement Policies, Physical Health, Psychological Distress, And Health Care Utilization In A Hispanic Border Community

Since the beginning of the current U.S. federal administration, immigration policies have become more restrictive and immigration enforcement has been strengthened. This cross-sectional survey study examines associations between perceptions of and experiences with current immigration enforcement policies and self-rated physical health, psychological distress, and health care utilization among Hispanic adults with different residency statuses in the U.S. Paso del Norte region. This study further investigates moderating effects of collective efficacy and engaged coping strategies on associations between policy perceptions and psychological distress. The study sample included 211 Hispanic adult residents of the U.S. Paso del Norte Region (i.e., El Paso, Hudspeth, Doña Ana, Luna, and Otero counties) who were enrolled via convenience (N=184) and web-based respondent-driven (N=27) sampling (RDS) between April and July 2019. An original bilingual survey was completed on paper by two-thirds and electronically by one-third of the sample. Quantitative survey data were analyzed using univariate analyses, bivariate analyses, and multiple linear and logistic regression with statistical analyses software SPSS Version 23 and STATA Version 15. The significance level for analyses was set at alpha \u3c .05. Among 198 participants with reported residency status, 97 (49%) were U.S.-born citizens, 37 (19%) were foreign-born U.S. citizens, 34 (17%) were legal permanent residents (LPRs), 15 (8%) were legal temporary residents (LTRs), and 15 (8%) were undocumented. Bivariate analyses demonstrated respondents with a more protected residency status experienced lower fear of deportation and fewer issues with immigration enforcement than participants with a more vulnerable residency status (p=.007 and p=.003, respectively). Participants with a less protected residency status were less likely to have received medical check-ups for blood pressure, blood glucose, and cholesterol in the past three years (p=.003). Multiple regression analyses revealed fear of deportation and experiences of issues with immigration enforcement were significantly associated with greater psychological distress in regression models adjusted for age, sex, education, income, insurance status, length of U.S. residency, and survey language (p= .007 and p \u3c.001, respectively). Participants who experienced issues with immigration enforcement were also marginally statistically more likely to have delayed or avoided medical care (p=.059). Participants who experienced issues with immigration enforcement who engaged in positive thinking reported significantly lower psychological distress compared to those who did not report this coping strategy (p=.001). Collective efficacy was not associated with psychological distress. Limitations of this study include the limited generalizability of findings, inability to assess causality, and minimal success with RDS to reach more hidden members of the community. Future research is needed to examine effects of recent changes to immigration policies and enforcement approaches (e.g., the public charge rule change, zero tolerance , and remain in Mexico policies) on physical and mental health as well as access to essential health care services for immigrants, refugees, and asylum seekers. Implications from this study include a need for policy- and decision makers to consider spillover effects of current immigration enforcement policies on community well-being, including in the form of adverse mental health effects and avoidance of health care services. Furthermore, health care providers ought to be aware of the potential for mental health problems and avoidance of services among their patients and clients related to immigration enforcement policies, especially among individuals with a vulnerable residency status. With a global rise in nationalism and strengthened immigration enforcement, it is crucial for governments to consider the impacts of corresponding policies on community well-being