Anti-immigrant Rhetoric and the Experiences of Latino Immigrants in the Emergency Department

Abstract

Introduction Anti-immigrant rhetoric and increased enforcement of immigration laws have induced worry and safety concerns among undocumented Latino immigrants (UDLI) and legal Latino residents/citizens (LLRC), with some delaying the time to care. 1 In this study, we conducted a qualitative analysis of statements made by emergency department (ED) patients – a majority of whom were UDLI and LLRC – participating in a study to better understand their experiences and fears with regard to anti-immigrant rhetoric, immigration enforcement, and ED utilization. Methods We conducted a multi-site study, surveying patients in three California safety-net EDs serving large immigrant populations from June 2017–December 2018. Of 1684 patients approached, 1337 (79.4%) agreed to participate; when given the option to provide open-ended comments, 260 participants provided perspectives about their experiences during the years immediately following the 2016 United States presidential election. We analyzed these qualitative data using constructivist grounded theory. Results We analyzed comments from 260 individuals. Among ED patients who provided qualitative data, 59% were women and their median age was 45 years (Interquartile range 33–57 years). Undocumented Latino immigrants comprised 49%, 31% were LLRC, and 20% were non-Latino legal residents. As their primary language, 68% spoke Spanish. We identified six themes: fear as a barrier to care (especially for UDLI); the negative impact of fear on health and wellness (physical and mental health, delays in care); factors influencing fear (eg, media coverage); and future solutions, including the need for increased communication about rights. Conclusion Anti-immigrant rhetoric during the 2016 US presidential campaign contributed to fear and safety concerns among UDLI and LLRC accessing healthcare. This is one of the few studies that captured firsthand experiences of UDLI in the ED. Our findings revealed fear-based barriers to accessing emergency care, protective and contributing factors to fear, and the negative impact of fear. There is a need for increased culturally informed patient communication about rights and resources, strategic media campaigns, and improved access to healthcare for undocumented individuals.

Barriers and facilitators to healthcare for people without documentation status: A systematic integrative literature review

“…Most studies were conducted in California ( n = 17; 56%), followed by Arizona ( n = 2), Texas ( n = 2), New York ( n = 2), eight other states and the District of Columbia. Four studies were multisite (El‐Banna et al, 2022; Keller & Alishio‐Caballero, 2021; Olukotun et al, 2021; Ornelas et al, 2021). All 30 studies reported barriers to healthcare experienced by PWDS, and 24 (80%) reported facilitators.…”

“…Some PWDS believed that hospitals collaborated with immigration authorities and reported PWDS; and among those who held this belief, 52.6% were afraid to come to the ED, compared with only 7.8% of those who did not (Maldonado et al, 2013). Mistrust of healthcare workers due to beliefs that they would be reported to immigration authorities (Ornelas et al, 2021; Raymond‐Flesch et al, 2014) and internalized stigma or feeling “undeserving” of care were related to fear (Gómez & Castañeda, 2019, p. 5; Keller & Alishio‐Caballero, 2021; Ornelas et al, 2021).…”

“…PWDS were required to complete lengthy intake forms and provide copies of their government‐issued identification and income documents, which they often lacked (Armenta & Sarabia, 2020; El‐Banna et al, 2022; Lopez‐Sanders, 2017; Pacheco et al, 2012). Extended wait times for appointments at safety‐net clinics, sometimes requiring several months for an appointment to see a provider, significantly impeded access to care (El‐Banna et al, 2022; Ornelas et al, 2021; Wallace et al, 2013). Anti‐immigrant rhetoric, portrayed in mass and social media heightened PWDS' fear of deportation (Cleaveland & Ihara, 2012; Olukotun et al, 2021; Ornelas et al, 2021), and the presence of law enforcement deterred PWDS from seeking services (Kline, 2017; Ornelas et al, 2021).…”

Structural Inequities and Barriers to Accessing Kidney Healthcare Services in the United States: A Focus on Uninsured and Undocumented Children and Young Adults

“…Public anti-immigrant rhetoric limits access to healthcare by instilling fear of deportation, anxiety, and even depression in undocumented immigrants. This scenario frequently results in significant delays in seeking and receiving healthcare services, greater risk for more rapid progression of the disease and an earlier need for initiation of renal replacement therapy in patients with kidney disease ( 65 ).…”

Assessing Mental Health Vulnerability Among First- and Second-Generation Immigrants During the Trump Administration

“…Research suggests that stress endured by immigrant families under the Trump administration correlates with elevated physical and mental health concerns (Becerra et al, 2020; Benavides et al, 2021; Morey, 2018; Ornelas et al, 2021; Perreira & Pedroza, 2019). For example, multiple studies have found stress associated with Trump-era policies to predict greater depression and anxiety among diverse immigrant adults, both documented and undocumented, including those from South and South East Asia, Africa, the Middle East, and Latin America (Becerra et al, 2020; Held et al, 2022b).…”