Abstract
Statements about building walls, deportation and denying services to undocumented immigrants made during President Trump’s presidential campaign and presidency may induce fear in Latino populations and create barriers to their health care access. To assess how these statements relate to undocumented Latino immigrants’ (UDLI) and Latino legal residents/citizens’ (LLRC) perceptions of safety and their presentations for emergency care, we conducted surveys of adult patients at three county emergency departments (EDs) in California from June 2017 to December 2018. Of 1,684 patients approached, 1,337 (79.4%) agreed to participate: 34.3% UDLI, 36.9% LLRC, and 29.8% non-Latino legal residents/citizens (NLRC). The vast majority of UDLI (95%), LLRC (94%) and NLRC (85%) had heard statements about immigrants. Most UDLI (89%), LLRC (88%) and NLRC (87%) either thought that these measures were being enacted now or will be enacted in the future. Most UDLI and half of LLRC reported that these statements made them feel unsafe living in the US, 75% (95% CI 70–80%) and 51% (95% CI 47–56%), respectively. More UDLI reported that these statements made them afraid to come to the ED (24%, 95% CI 20–28%) vs LLRC (4.4%, 95% CI 3–7%) and NLRC (3.5%, 95% CI 2–6%); 55% of UDLI with this fear stated it caused them to delay coming to the ED (median delay 2–3 days). The vast majority of patients in our California EDs have heard statements during the 2016 presidential campaign or from President Trump about measures against undocumented immigrants, which have induced worry and safety concerns in both UDLI and LLRC patients. Exposure to these statements was also associated with fear of accessing emergency care in some UDLIs. Given California’s sanctuary state status, these safety concerns and ED access fears may be greater in a nationwide population of Latinos.
Highlights
The Pew Research Center estimates that approximately 8 million undocumented Latino immigrants (UDLI) lived in the United States in 2016 [1]
We categorized participants after the surveys into UDLI, legal residents/citizens’ (LLRC), and non-Latino legal residents/citizens (NLRC) groups by the following direct questions: Do you identify as being of Latino origin? Are you a legal resident/citizen of the United States? Our three primary outcomes were 1) the proportions of UDLI, LLRC and NLRC who had heard statements about measures against immigrants from the president or during the campaign; 2) whether these statements made them worry or feel unsafe living in the US; and 3) whether these statements made them afraid to come to the emergency departments (EDs) for care
Spanish was the primary language of 97% of UDLI with 78% of them reporting little to no English proficiency; 22% stated that they were brought to the US as children
Summary
The Pew Research Center estimates that approximately 8 million undocumented Latino immigrants (UDLI) lived in the United States in 2016 [1]. Given the lack of availability of other health care options including primary care, emergency departments (EDs) serve as the primary health care access point and safety net for UDLI [2,3,4]. The effects of the president’s statements and policy shift on attitudes of US citizens and voters have been well documented by traditional news media surveys and polling organizations [13,14], very little is known about the impact on immigrants themselves. Threats of deportation may induce safety concerns, anxiety and other mental health problems in UDLI. Statements about denying health care (and other) services may generate misconceptions that increase their fear of emergency care access and thereby compromise the public health and safety net function of EDs
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