Pima County Research Articles

Impeding Access to Asylum: Title 42 “Expulsions” and Migrant Deaths in Southern Arizona

Executive Summary Immigration at the US-México border has drastically changed since the mid-2010s. Instead of adult undocumented Mexican men, generally migrating for economic purposes, there are now large numbers of men, women, unaccompanied minors, and families from diverse countries seeking asylum in the United States, as they are allowed to do under US and international law. In response to these changes, the US federal government leveraged multiple strategies to impede access to the country’s asylum system, including relying on Title 42 “expulsions.” Title 42, a COVID-19-era health measure, prevented migrants from initiating an asylum claim. Instead, asylum-seekers were typically immediately expelled to the closest port of entry in México. The use of public health as a pretext to control the border placed these migrants at risk and led many to attempt repeat border crossings. Given this policy context, we ask: what, if any, is the association between Title 42 expulsions and migrant deaths in southern Arizona? We address this question by drawing on records of recovered undocumented border crosser (UBC) remains investigated by the Pima County Office of the Medical Examiner (PCOME) in Tucson, Arizona. We examined differences in the number and demographic characteristics of UBC remains recovered between what prior studies have characterized as the “Localized Funnel Effect” Era of border enforcement in southern Arizona (i.e., October 1, 2013–March 19, 2020; N = 851), and the “Title 42” Era (i.e., March 20, 2021–September 30, 2023; N = 709). We also assessed how, if at all, the geography of recovered UBC remains shifted between these eras. We found that migrant deaths rose from an annual mean of 133 during the Localized Funnel Effect (LFE) Era to 198 in the Title 42 (T42) Era, representing a 48 percent increase. Compared to the earlier era, remains recovered during the T42 Era clustered closer to the border and near the cities of Nogales and Agua Prieta, Sonora, having shifted from west to east in southern Arizona. Additionally, we found that Title 42 disproportionately affected Mexican and Guatemalan nationals both in terms of expulsions as well as deaths. We propose several policy recommendations based on our study’s findings intended to reduce unnecessary suffering and increase human security: • The US federal government should not impede or limit migrants’ access to the asylum system. Policymakers should instead create clear pathways and procedures that obviate the need for migrants to undertake dangerous journeys and overcome barriers to fair consideration of their claims. • The US government must expand its ability to address these claims, as continued attempts to block asylum seekers will result in additional loss of life and increased violence. It should increase its capacity to screen asylum seekers at the US-México border. We propose an increase in USCIS Asylum Officers to carry out this duty. US Customs and Border Protection agents should not screen asylum seekers, nor should they assume the responsibility of serving as asylum officers, given the agency’s extensively documented record of persistently dehumanizing and mistreating migrants. • The US federal government must take measures to eliminate the backlog of asylum cases in the immigration courts. These measures need to include reforms in the underlying immigration system and in the removal adjudication system, such as greater access to legal counsel and changes to the law that offer legal pathways to imperiled migrants who do not meet the narrow definition of asylum. Absent these reforms, the asylum case backlog will grow, and many asylum seekers with strong claims to remain will be removed after living for years in the United States.

Excessive Use of Force and Migrant Death and Disappearance in Southern Arizona

Executive Summary In this article, we present a qualitative analysis of the events surrounding death or disappearance in autopsy and missing person reports from the Pima County Office of the Medical Examiner (PCOME) in Arizona to highlight how interactions between border enforcement personnel and migrants can be deadly. We reviewed PCOME records of undocumented border crosser deaths between 2000 and 2023 and observed three main types of deadly U.S. Border Patrol (USBP) practices: reckless motor vehicle pursuits, aggressive strategies used to detain individuals who are on foot, and the use of lethal force. Our findings reveal that these tactics, which we argue constitute forms of “excessive use of force,” represent significant yet overlooked factors contributing to migrant death and disappearance in southern Arizona. We make the following policy recommendations: 1. Immediate measures to prevent the loss of life (A). The Department of Homeland Security (DHS) should mandate a ban on border enforcement methods that provoke fear, panic, or confusion. (B). DHS should take measures to substantially reduce the use of high-speed motor vehicle pursuits by USBP and other immigration enforcement officials. (C). DHS should ensure that USBP officers are compliant with Department of Justice (DOJ) standards on use of deadly force, in particular the policy that “Deadly force may not be used solely to prevent the escape of a fleeing suspect.” 2. Investigate Border Fatalities Involving Border Enforcement Officers (A). We call on the Government Accountability Office (GAO) to conduct an official review of all medical examiner and coroner records along the U.S.-Mexico border for fatality cases in which border enforcement personnel were involved in any way in the circumstances surrounding death. (B). We encourage the formation of civilian review boards in border regions to review medical examiner and coroner records of migrant fatalities involving immigration officials as well as immigration officials’ apprehension strategies immediately preceding fatal encounters with migrants.

Risk factors associated with loneliness among mexican-origin adults in southern Arizona

This study examines factors associated with symptoms of loneliness among a sample (n = 213) of mostly Mexican-origin adults at risk of chronic diseases in Southern Arizona’s Pima, Yuma, and Santa Cruz counties. It uses baseline data from a community-based participatory research partnership and multinominal logistic regression models. Controlling for chronic diseases and sociodemographic characteristics, perceived social support and hope exhibit negative main effects on loneliness when comparing individuals who experienced loneliness for 5–7 days in the preceding week with those who did not encounter such feelings during the same period (adjusted odds ratio, AOR = 0.49 and 0.47; 95% confidence interval, CI = 0.34–0.73 and 0.29–0.75, respectively). However, when considered together, perceived social support and hope display a positive and statistically significant combined effect on loneliness (AOR = 1.03; 95% CI = 1.01–1.06). Holding all covariates constant, individuals reporting loneliness for 5–7 days exhibit a relative risk ratio of 1.24 (95% CI = 1.06–1.46) for a one-unit increase in physical problem severity compared to those who do not experience loneliness. Moreover, being 65 years old or older (AOR = 0.16, 95% CI = 0.03–0.84), and having been born in Mexico and lived in the US for less than 30 years (AOR = 0.12, 95% CI = 0.02–0.74) are associated with negative main effects on loneliness when comparing individuals who experienced loneliness 1–2, and 5–7 days in the preceding week with those who did not feel loneliness during the same timeframe, respectively. Recognizing the crucial role of loneliness in shaping health outcomes for Mexican-origin adults, our findings underscore the significance of fostering supportive environments that not only enhance well-being but also cultivate robust community bonds within the US-Mexico border region.

Pima County COVID-19 vaccine solutions dashboard project: lessons learned.

Recent improvements in the accessibility of mapping tools and an increased recognition of the importance of leveraging data to inform public health operations has led to enthusiasm among public health departments to rapidly evolve their ability to analyze and apply data to programs. As the COVID-19 pandemic made evident, many health department data systems have been neglected for decades and data literacy among staff low. Significant federal dollars have been allocated to local health departments to modernize health systems. This case study recounts the effort to equip the Pima County Health Department with a highly sophisticated "COVID-19 Vaccines Solutions Dashboard" in 2021-2022, quantifying community vulnerability in the midst of the COVID-19 pandemic and shares key successes and challenges in process and outcomes that can guide other such dashboard initiatives. The experience informed the development of Pima' County Health Department's Data & Informatics Team as well as efforts to cultivate a more robust data culture throughout the department. Many health departments around the United States are in a similar position, and these lessons learned are widely applicable.

Together We Thrive: Strengthen the Capability of AAPIs in Pima County in Dealing with COVID-19

Together We Thrive: Strengthen the Capability of AAPIs in Pima County in Dealing with COVID-19

Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023.

Pharmacies are critical healthcare partners in community efforts to eliminate bloodborne illnesses. Pharmacy sale of sterile syringes is central to this effort. A mixed methods "secret shopper" syringe purchase study was conducted in the fall of 2022 with 38 community pharmacies in Maricopa and Pima Counties, Arizona. Pharmacies were geomapped to within 2 miles of areas identified as having a potentially high volume of illicit drug commerce. Daytime venue sampling was used whereby separate investigators with lived/living drug use experience attempted to purchase syringes without a prescription. Investigator response when prompted for purchase rationale was "to protect myself from HIV and hepatitis C." A 24-item instrument measured sales outcome, pharmacy staff interaction (hostile/neutral/friendly), and the buyer's subjective experience. Only 24.6% (n = 28) of 114 purchase attempts across the 38 pharmacies resulted in syringe sale. Less than one quarter (21.1%) of pharmacies always sold, while 44.7% never sold. Independent and food store pharmacies tended not to sell syringes. There emerged distinct pharmacy staff interactions characterized by body language, customer query, normalization or othering response, response to purchase request and closure. Pharmacy discretion and pharmacy policy not to sell syringes without a prescription limited sterile syringe access. Investigators reported frequent and adverse emotional impact due to pharmacy staff negative and stigmatizing interactions. Pharmacies miss opportunities to advance efforts to eliminate bloodborne infections by stringent no-sale policy and discretion about syringe sale. State regulatory policy facilitating pharmacy syringe sales,limiting pharmacist discretion for syringe sales, and targetingpharmacy-staff level education may help advance the achievement of public health goals to eliminate bloodborne infections in Arizona.

Ensuring an Equitable Response to the COVID-19 Pandemic in Pima County, Arizona, Through Local Political Support and Policy Action.

In the United States, persistent health disparities and preexisting gaps in local public health infrastructure led to disproportionate effects of COVID-19 across populations at high risk of COVID-19-related morbidity and mortality. In Pima County, Arizona, equity-centered local government engagement and policy action, multipronged community-based responses, and expansion of historically underfunded local public health infrastructure improved equitable outcomes and addressed multiple systemic factors. This case study examined Pima County's 3-pronged public health response to COVID-19 using an equity-based approach. As a result, COVID-19 was the third leading cause of death in Pima County in 2021, compared with being the leading cause of death in Arizona. Strong political support from local elected officials created the authorizing environment for the Pima County Health Department to advance health equity. Passage of a resolution in December 2020, which framed the racial and ethnic health and socioeconomic inequities as a public health crisis, supported innovation and fostered the creation of an Office of Health Equity, a public health policy program, and a data and informatics program. New structures for community engagement were formed, including an ethics committee and a community advisory committee, to ensure a formalized process for community participation in public health actions, during and after the pandemic response. Key lessons learned included (1) the importance of local government support, codified to allow implementation of creative strategies; (2) opening avenues for community voice and engagement in planning and implementation to respond in areas of greatest need; and (3) having flexible funding to sustain an equitable response.

COVID-19 Impact on the AAPI Population in Pima County

The Together We Thrive Project (TWT) goal was to increase the capability of the Asian American and Pacific Islanders (AAPI’s) to deal with COVID-19 and other respiratory infections in Pima County, Arizona, U.S.A. It is the second most populated county in the state. There was little published information available about the COVID-19 impact on the AAPI populations and the communities’ needs in the county. The TWT Project conducted a needs assessment. The assessment survey results assisted the project in producing strategies and activities that address the needs. Fifty-six percent of the AAPI respondents had gotten COVID-19 during the pandemic. A third of the those who gotten the virus had long-lasting effects. The COVID-19 pandemic had significantly impacted Pima County AAPI population socially, mentally, physically, and economically

Developing a small participant framework: An investigation of mode choice influential factors

An in-depth comprehension of the changing impact of mode choice influencing factors is essential in planning for behavior-adaptive mode shift policies. This study developed a framework to investigate a method of evaluation of the changes in mode choice using a small participation pool. A field application in Pima County, Arizona was developed to test the developed framework to evaluate the impact of a real transit experience. Twenty-two participants were recruited and repeated measurements were taken before and after their transit trip. The results revealed that people are less susceptible to their mental biases after a transit trip and consider more objective elements such as walking time. The developed framework resulted in successful evaluation methods that are reproducible for other application study designs. Thus, the results further present that low participant recruitment in application-based field studies can be accomplished using this developed methodology, for other regions and studies.

Infectious Diseases Telemedicine to the Arizona Department of Corrections During SARS-CoV-2 Pandemic. A Short Report.

The University of Arizona infectious diseases provides telemedicine clinics to the Arizona Department of Corrections (DOC) and Pima County Jail. Beginning in January 2020 there was a sharp drop in the number of monthly consultations following the public health emergency regarding the SARS-CoV-2 pandemic. Only since ending the emergency have the number of consults risen each month to pre-pandemic numbers. However, the nature of consult requests has changed. In this report we document the change from predominately human immunodeficiency virus (HIV) consults to a broader spectrum of infectious-related issues, most noteworthy being infective endocarditis, osteomyelitis, and chronic hepatitis B and C infection, the majority of cases due to intravenous drug injection. Although the DOC and jail underwent major upheavals intramurally due to the pandemic, medical outcomes with the diseases listed above, were excellent. The telemedicine infectious diseases clinics continued to provide timely, effective care for inmates.

School health systems under strain: an example of COVID-19 experiences & burnout among school health staff in Pima County, Arizona

BackgroundSchool health staff lead and provide a variety of care for children in schools. As school districts have navigated the COVID-19 pandemic, school health staff have faced unprecedented challenges in protecting the health of students and school staff. Our objective was to qualitatively characterize these pandemic challenges and experiences of school health staff in Pima County, Arizona to identify gaps in school health staff support for improving future emergency preparedness.MethodsWe conducted two focus group discussions (FGDs) with 48 school health staff in Pima County, Arizona in two school districts using a discussion guide including ten open-ended questions. The FGDs were audio recorded and transcribed verbatim. We used the socioecological model (SEM) to organize the thematic analysis and generate codes and themes; data were analyzed using Atlas.ti software.FindingsThe pandemic has significantly challenged school health staff with new pandemic-related job tasks: managing isolation, vaccination, and developing/implementing new and evolving COVID-19 guidelines. School health staff also reported increased stress related to interactions with parents and school administration as well as frustrations with rapid changes to guidance from the health department and policy makers. A common issue was not having enough staff or resources to complete regular job responsibilities, such as providing care for students with non-COVID-19 related health issues.ConclusionsIncreased workload for school health staff resulted in physical burnout, mental distress, and disruption of core functions with long term implications for children’s health. These focus groups highlight the need for improved emergency preparedness in schools during pandemics or infectious disease outbreaks. These include basic infrastructure changes (e.g., personnel support from health departments for tasks such as contact tracing to enable school nurses to continue core functions), and increased funding to allow for hazard pay and more school health personnel during emergency situations. In addition, basic school health infrastructure is lacking, and we should include a licensed school health nurse in every school.

Health Characteristics and Birth Outcomes for "Starting Out Right," a Teen Pregnancy Program.

To evaluate differences in health characteristics and birth outcomes for participants of a prenatal education and support program for pregnant teens, "Starting Out Right" (SOR) compared to nonparticipant pregnant teens in Pima, Maricopa, and Gila counties in Arizona to gauge benefits of program participation. The SOR program is a community education and support program for pregnant teens based on a structured curriculum. All pregnant teens living in the service area are eligible to participate. Vital statistics birth data from 2014 to 2019 were obtained from three counties in Arizona that identified SOR and non-SOR program participants. Logistic regression was used to calculate multivariable -adjusted odds ratios (aOR) for specific health characteristics (smoking, hypertensive disorders, overweight and obesity, gestational diabetes, sexually transmitted infections) and birth outcomes (C-section, preterm birth, NICU admission, birthweight, and breastfeeding) for SOR participants compared with nonparticipants. Variables in the adjusted models included age, BMI, smoking, gestational diabetes, race, ethnicity, county, WIC participation, insurance type, plurality, and month and year prenatal care began. These results suggest that participation in SOR was associated (p ≤ 0.06) with a reduced odds for low birthweight [aOR 0.7(95% CI 0.5,1.0)] and increased odds (p ≤ 0.05) of breastfeeding [aOR 1.3(95% CI 1.0,1.7)] compared to nonparticipants. These results provide evidence that the education components in the SOR program support improved pregnancy and breastfeeding outcomes for pregnant teens.

Comparing Direct Demand Models for Estimating Pedestrian Volumes at Intersections and Their Spatial Transferability to Other Jurisdictions

Direct demand (DD) models are used to estimate pedestrian volumes at intersections as a function of readily available variables, such as land use and socioeconomic features. The objectives of this paper are: (1) to identify and qualitatively assess existing DD models in the literature; and (2) to evaluate the spatial transferability of DD models for estimating annual average daily pedestrian traffic (AADPT) at signalized intersections. Six DD models developed from jurisdictions with varying characteristics were selected for spatial transferability assessment. The models were applied to three jurisdictions (Milton, Canada; Pima County, U.S.; and Downtown Toronto, Canada) that had notable differences in the level of pedestrian activity, land use, and socioeconomics. Observed pedestrian volumes were obtained for sites in each jurisdiction. The DD models performed considerably differently across jurisdictions. Five of the models performed reasonably well for Milton, a jurisdiction that is comparable to those considered in the calibration of the selected DD models and that shares characteristics with many suburban Canadian and U.S. jurisdictions. Overall, the applications for Pima County and Downtown Toronto, which have extremely low and high pedestrian volumes, respectively, provided poor accuracy. This paper demonstrated the potential for transferring existing DD models to other jurisdictions; but also identified the clear need for further research to improve the spatial transferability of DD models.

Modeling red-light running behavior using high-resolution event-based data: a finite mixture modeling approach

To effectively reduce the number of red-light violations and crashes, it is crucial to explore RLR behavior at local intersections, understand the contributing factors, and identify the riskiest intersections by estimating RLR frequency. In this study, a finite mixture modeling method was utilized to understand the contributing factors to RLR behavior and estimate this violating behavior. To develop the RLR estimation models, performance metrics and signal phasing data were collected from the Automated Traffic Signal Performance Measures (ATSPMs) system in two jurisdictions in Arizona: Pima County and the Town of Marana. The results from calibrated models showed that an increase in traffic flow, intersection delay, number of approach lanes, and split failure is associated with an increase in the likelihood of observing red-light violations. In addition, it was found that an increase in cycle length is associated with a decrease in the likelihood of observing the red-light violation. The results of comparing the proposed RLR estimation method with several conventional methods, the Poisson Generalized Linear Model (PGLM), Zero-inflated Poisson Regression Model (ZIPM), and Zero-inflated Negative Binomial Regression Model (ZINB) showed the proposed method outperforms all the models in terms of both model fit and accuracy. The application of the proposed method could be used to analyze the intersections with the highest number of red-light violations. Furthermore, the presented transferability results can be advantageous to transportation agencies within Arizona and urban areas with similar characteristics by providing insight into which model specifications may provide the best RLR estimation accuracy.

Qualitative assessment of COVID-19 vaccination acceptance among healthcare workers in Pima County

ABSTRACT In the Spring of 2021, the COVID-19 vaccination was authorized for emergency use by the Food and Drug Administration. Healthcare workers (HCWs) are one of the most trusted sources of information for vaccination choices. However, HCWs at this time appeared to continue to have lower rates of COVID-19 vaccination uptake than expected in Arizona. The objective of this study was to examine factors that play a role in the vaccination decision-making process among Arizona HCWs. Between January and April 2021, 18 semi-structured interviews were conducted among physicians, emergency medical technicians and long-term care nurses in Pima County. The informed consent process was completed for each participant. The interview guide was informed by the Increasing Vaccination model to collect information on vaccination decision-making. A codebook was developed using an inductive approach. Coding and analysis was conducted using the software MAXQDA. Participants were primarily male (11/18, 61%) and white (11/18, 61%). Three participants identified as Hispanic. Initial themes that emerged included: mixed opinions concerning the innovations in COVID-19 vaccine development, access-related barriers, issues related to distribution inequities, concerns about misinformation and conspiracy theories, and dialogue concerning the benefits of requiring mandatory vaccination. The results gathered from this study indicate that there continues to be hesitancy among some healthcare professionals in Pima County. These results will be used to help Arizonan Health Departments promote rollout of novel vaccines more effectively through targeting relevant vaccination decision-making factors among HCWs.

James S. Griffith: Remembering “Big Jim” (1935–2021)

James S. Griffith: Remembering “Big Jim” (1935–2021)

Racial/ethnic disparities in influenza risk perception and vaccination intention among Pima County residents in Arizona

ABSTRACT While influenza cases in Arizona have nearly tripled since 2018, vaccination rates continue to lag. Statewide, Hispanics and African Americans had the lowest vaccination rates despite having higher influenza infection rates than Whites. Given Arizona’s racial influenza vaccination disparity and the general increase in vaccination hesitancy due to COVID-19, the purpose of this study was to better understand the influences of seasonal influenza vaccination in Arizona during the COVID-19 pandemic using qualitative methods. Findings from this study revealed that many participants were motivated to get the influenza vaccine to protect their family and close friends. The heightened concern for COVID-19 prompted some Hispanic/Latino focus group discussion participants to consider getting vaccinated. However, many Hispanic/Latino participants also expressed that they stopped getting influenza vaccine due to negative vaccination experiences or concern about sickness following immunization. African American participants primarily discussed receiving the vaccine as part of their routine health visit. Compared to other races, more White participants believed that vaccination was unimportant because they were healthy, and the people they interacted with never got sick. Distinct factors influence risk perception and vaccination intention across different racial/ethnic groups. Effective interventions can account for these factors and be tailored to the target population to maximize vaccination uptake.

Performance of Existing and Novel Symptom- and Antigen Testing-Based COVID-19 Case Definitions in a Community Setting.

Point-of-care antigen tests are an important tool for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection, yet are less clinically sensitive than real-time reverse-transcription polymerase chain reaction (RT-PCR), affecting their efficacy as screening procedures. Our goal in this analysis was to see whether we could improve this sensitivity by considering antigen test results in combination with other relevant information, namely exposure status and reported symptoms. In November 2020, we collected 3,419 paired upper respiratory specimens tested by RT-PCR and the Abbott BinaxNOW (Abbott Laboratories, Abbott Park, Illinois) antigen test at 2 community testing sites in Pima County, Arizona. We used symptom, exposure, and antigen-testing data to evaluate the sensitivity and specificity of various symptom definitions in predicting RT-PCR positivity. Our analysis yielded 6 novel multisymptom case definitions with and without antigen test results, the best of which overall achieved a Youden's J index of 0.66, as compared with 0.53 for antigen testing alone. Using a random forest as a guide, we show that this definition, along with our others, does not lose the ability to generalize well to new data despite achieving optimal performance in our sample. Our methodology is broadly applicable, and our code is publicly available to aid public health practitioners in developing or fine-tuning their own case definitions.

Death and disappearance at border crossings: factualization devices and truth(s) accounts

ABSTRACT In this article, we analyze three forensic and counter-forensic devices that go beyond the strictly medico-legal realm to show which concrete practices and truth-spots contribute to (re)constructing a public account of migrant deaths and disappearances along border zones. Drawing on written documents and semi-structured interviews, we examine operations led by the International Committee of the Red Cross (ICRC) in Europe and Africa, the work of the Pima County Office of the Medical Examiner (PCOME) together with the NGO Colibrí Center for Human Rights in Arizona, and Forensic Oceanography's (FO) open-source investigations of shipwrecks of migrants in the Central Mediterranean Sea and the structural violence embedded in militarized border regimes. We argue that these practices constitute factualization devices, namely practices that transform lived experience of death and disappearance into an objectified reality that can be visibilized and mobilized in the public sphere as part of a counter-narrative. We demonstrate how these factualization practices are imbricated in valuation practices, i.e. practices that ascribe not only an epistemological but also an ethical, aesthetic and political value to the work of objectification, which inform the production of truth narratives.

Making Vaccines Equitably Available to All Persons in Pima County, Arizona, 2020-2021.

We review the Pima County (Arizona) Health Department's efforts to achieve equitable COVID-19 vaccine distribution in a county with a social vulnerability index of 0.88. We expedited vaccine distribution, focusing on equitable distribution, implementing a multi-point of dispensing approach, and using a periurban and rural strategy. Pima County has one of the highest vaccine distribution percentages among the highest social vulnerability index quartiles and is more than 10 percentage points ahead of other large counties in Arizona in vaccine uptake. (Am J Public Health. 2022;112(11):1560-1563. https://doi.org/10.2105/AJPH.2022.307040).