Undocumented Immigration Status Research Articles

The Transplant Experience for Undocumented Immigrant Patients Formerly Receiving Emergency Dialysis and Caregivers

Individuals of undocumented immigration status with kidney failure face barriers to receiving transplants due to lack of health insurance despite no regulatory barriers. Little is known about the perspectives on kidney transplant among individuals with undocumented immigration status with kidney failure who relied on emergency hemodialysis. To examine the overall experiences of transplant among transplant recipients of undocumented immigration status who previously relied on emergency hemodialysis and their family caregivers. In this qualitative study, semistructured 1-to-1 interviews were conducted with transplant recipients who had previously received emergency hemodialysis and transitioned to scheduled dialysis and their primary caregivers living in Denver, Colorado, between May 1, 2022, and March 31, 2023, in English or Spanish. Themes and subthemes regarding the experience of transplant as an undocumented immigrant previously receiving emergency hemodialysis were identified. Interview transcripts were translated, deidentified, and then analyzed using thematic analysis. A total of 25 participants including 15 transplant recipients (5 [33.3%] female and 10 [66.7%] male; mean [SD] age, 49.5 [9.8] years) and 10 caregivers (7 [70.0%] female and 3 [30.0%] male; mean [SD] age, 44.5 [22.3] years) participated. Six themes were reported: limited kidney replacement therapy education while receiving emergency hemodialysis (lack of awareness of kidney disease and treatment options and discriminatory kidney replacement therapy education due to immigration status), hope for transplant once receiving scheduled dialysis (prospect of transplant through scheduled dialysis, family and quality of life as transplant motivators), transplant education and health insurance after transition to scheduled dialysis (inadequate transplant education in dialysis clinic, peer-to-peer transplant education, and peer-to-peer communication regarding availability of private health insurance), uncertainty during transplant evaluation (difficulty navigating the evaluation and wait-listing process, lack of communication regarding timeline, and concern for family limiting living donation), posttransplant improvements (ability to work after transplant is critically important given immigration status, autonomy with transplant improves mental health, and vigilance in maintaining transplant), and transplant facilitators (self-advocacy, spirituality and optimism, and peer support). This qualitative study of transplant recipients of undocumented immigration status and their caregivers found that individuals formerly receiving emergency dialysis are excluded from education and access to transplant, and peer support throughout the transplant process helped with education and motivation to pursue transplant. These findings may be used to implement improvements in access to support and education for patients of undocumented immigration status with kidney failure, especially in areas where scheduled dialysis is not available.

A Lockean account of the moral status of undocumented immigrants

ABSTRACT This article aims to show that Locke’s discussion of tacit consent and the right to punish aliens in the Second Treatise of Government has important bearings on the moral status of undocumented immigrants. It argues that Locke conceptualized both friendly and hostile aliens, counting the former as tacit consenters to whom host states owed rights and protection. Moreover, it highlights how his approach, unlike theorists before and after him, was one that saw individuals as capable of shaping their own relationship with the host. The article also examines Locke’s discussion of the federative power of the state, which includes the power to vet aliens within the country. Seen through this Lockean lens, the article argues that the vast majority of undocumented immigrants can be understood as tacit consenters or potential citizens who should be judged by how they choose to relate to the host, and not by their country of origin. While noting that the Lockean approach is not incompatible with border control, the article also shows how it puts the onus on the host to justify the power it exercises and to engage in dialogue with undocumented immigrants about what their status should be in the country.

Incorporation and Utilization of an Additional Needs Screener by Surgical Trainees for Comprehensive Care of Underserved and Underinsured Surgical Patients

Comprehensive, socially-minded healthcare has historically been delivered in the primary care setting. For underserved patient populations, however, a surgical care episode may serve as the health care access point. To maximize patient wellbeing during the perioperative period, our surgical center developed the Additional Needs Screener (ANS). Operationalized into practice by GME and UME trainees, this tool screens surgical patients across 3 domains (social, emotional, and immigration needs) and connects patients to partner organizations if appropriate. This study describes the pilot utilization of the ANS among underserved and underinsured surgical patients. Clinical quality improvement and retrospective cohort study of patients completing the ANS from implementation in September 2021 to September 2022. The Hospital of the University of Pennsylvania, PA-a tertiary care center. One hundred and 10 underinsured and/or underserved patients completed at least 1 ANS domain. Patients were majority female (55F, 53M, 2 other) and Hispanic/Latinx (72%) with a median age of 38 (IQR = 34-48). Most patients spoke a primary language other than English (77%), and nearly all were either uninsured (82%) or received emergency medical assistance or Medicaid (14%) at referral. Patients demonstrated significant needs; 39% endorsed difficulty affording housing, 32% endorsed difficulty paying for food, 29% endorsed experiencing current life-interfering distress, and 75% had undocumented immigration status. Ultimately, 57% of screened patients accepted referrals to our needs response teams. Underserved and underinsured patients presenting for surgical care face significant challenges relating to social, emotional, and immigration needs. Through adoption of the ANS, trainees gained competency identifying and addressing these barriers in the perioperative period. Future works will focus on categorizing referral outcomes, developing interventions to increase patient trust, and improving screener dissemination.

Undocumented Immigrant Status: Implications for Music Education

Although issues concerning immigration have been debated for decades, the results of the 2016 U.S. presidential election ignited additional politicization, particularly regarding undocumented immigration. Dominant narratives of undocumented persons continue to be framed in damaging and deficit perspectives that position individuals as unhuman (“alien”) and criminal (“illegal”). Considering the ongoing anti-immigrant climate, it is imperative to learn from undocumented student experiences and how citizenship status might impact access to and participation in music classes. Importantly, learning from undocumented students’ experiences could help educators and administrators better support a significant population in school communities. In this review of literature, I explore research relevant to undocumented immigrant students in the United States and offer implications for working with undocumented students and families.

Immigration Policy and the Health of Latina Mothers and Their Infants.

Restrictive immigration policies may adversely affect the health of Latina mothers and their infants. We hypothesized that undocumented Latina mothers and their US born children would have worse birth outcomes and healthcare utilization following the November 2016 election. We used a controlled interrupted time series to estimate the impact of the 2016 presidential election on low birth weight (LBW), preterm birth, maternal depression, well child visit attendance, cancelled visits, and emergency department (ED) visits among infants born to Latina mothers on emergency Medicaid, a proxy for undocumented immigration status. There was a 5.8% (95% CI: -0.99%, 12.5%) increase in LBW and 4.6% (95% CI: -1.8%, 10.9%) increase in preterm births immediately after the 2016 election compared to controls. While these findings were not statistically significant at p < 0.05, the majority of our data suggest worsened birth outcomes among undocumented Latina mothers after the election, consistent with larger prior studies. There was no difference in well child or ED visits. While restrictive policies may have contributed to worse birth outcomes among undocumented Latina mothers, our findings suggest that Latino families still attend infants' scheduled visits.

The Racialized Dimensions of Contemporary Immigration and Border Enforcement Policies and Practices

AbstractImmigration policies in the United States have not been explicitly race‐based since the mid‐20th Century. Nevertheless, the effects of contemporary US immigration enforcement practices are highly racialized. The further development of a “race conscious” approach in public policy and administration will help expand our understanding of the racialized dimensions of these policies and practices. Specifically, I call attention to how current approaches to immigration control disproportionately negatively affect non‐White immigrants from the so‐called “Global South,” contribute to racialization processes, and perpetuate racial inequality in the United States. Examples include the ways that undocumented immigration status is leading to the emergence of a new “underclass” in the United States, the separation and dissolution of Latino families through mass deportation, and the systematic criminalization of non‐White undocumented immigrants from Mexico, Guatemala, Honduras, and El Salvador.

A Novel Application of Non-Negative Matrix Factorization to the Prediction of the Health Status of Undocumented Immigrants.

Introduction: Undocumented immigrants (UIs) in the United States are less likely to be able to afford health insurance. As a result, UIs often lack family doctors and are rarely involved in annual screening programs, which makes estimating their health status remarkably challenging. This is especially true if the laboratory results from limited screening programs fail to provide sufficient clinical information.Methods: To address this issue, we have developed a machine learning model based on the non-negative matrix factorization technique. The data set we used for model training and testing was obtained from the 2004 cost-free hepatitis B screening program at the Omni Health Center located in Plano, Texas. Total 300 people were involved, with 199 identified as UIs.Results: People in the UIs group have higher cholesterol (219.6 mg/dL, p=0.038) and triglycerides (173.2 mg/dL, p=0.03) level. They also have a lower hepatitis B vaccination rate (38%, p=0.0247). No significant difference in hepatitis B(+) was found (p=0.8823). Using 16 individual clinical measurements as training features, our newly developed model has a 67.56% accuracy in predicting the ratio of cholesterol to high-density lipoprotein; in addition, this newly developed model performs 9.1% better than a comparable multiclass logistic regression model.Conclusions: Elderly UIs have poorer health status compared with permanent residents and citizens in the United States. Our newly developed machine learning model demonstrates a powerful support tool for designing health intervention programs that target UIs in the United States.

Post-immigration factors affecting retention in HIV care and viral suppression in Latin American and Caribbean immigrant populations in the United States: a systematic review

ABSTRACT Objectives To reduce disparities in HIV care outcomes among Latin American and Caribbean (LAC) immigrants living with HIV in the U.S., it is necessary to identify factors influencing HIV care in this population. A systematic review that provides a comprehensive understanding of factors influencing retention in HIV care and viral suppression among LAC immigrants living with HIV in the U.S. is lacking. This systematic review used the Immigrant Health Services Utilization theoretical framework to provide an understanding of these factors. Design We searched for peer-reviewed publications in MEDLINE, EMBASE, CINAHL, PsycINFO, and ASSIA, from January 1996 to June 2020. Results A total of 17 qualitative (n = 10) and quantitative (n = 7) studies were included in the review. The most commonly reported general and immigrant-specific factors appearing in studies were undocumented immigration status, HIV stigma, homophobia, cultural norms, values and beliefs, family and social support, language barriers, structure, complexity and quality of the U.S. healthcare delivery system, and patient-provider relationship. Conclusion These findings highlight the importance of considering immigrant-specific factors along with general factors to improve the provision of HIV care services and HIV care outcomes among LAC immigrant populations.

Assessment of COVID-19–Related Immigration Concerns Among Latinx Immigrants in the US

Despite the contentious immigration environment and disproportionate rates of COVID-19 infection among Latinx individuals in the US, immigrants' concerns about engaging in COVID-19-related testing, treatment, and contact tracing have been largely unexplored. To examine the proportions of Latinx immigrants who endorse statements about the potential negative immigration ramifications of seeking and using COVID-19-related testing and treatment services and engaging in contact tracing. In this cross-sectional survey study, 25 COVID-19-related items were incorporated into the online Spanish-language survey of an ongoing study. Data were collected between July 15 and October 9, 2020, in Chicago, Illinois; Los Angeles, California; and Phoenix, Arizona. A nonrandom sample of 379 adult, Spanish-speaking, noncitizen Latinx immigrants (with either documented or undocumented immigration status) were sent surveys. Of those, 336 individuals (88.7% participation rate) returned surveys, and 43 individuals did not. An additional 213 individuals were screened but ineligible. Descriptive statistics were computed, and mean comparisons and bivariate correlations between sociodemographic variables, indices of immigration risk, and COVID-19-related survey items were conducted. Items elicited agreement or disagreement with statements about immigrants' access to COVID-19-related testing and treatment services and the potential immigration ramifications of using these services. Willingness to identify an undocumented person during contact tracing was also assessed. A total of 336 Latinx immigrants completed surveys. The mean (SD) age of participants was 39.7 (8.9) years; 210 participants (62.5%) identified as female, and 216 participants (64.3%) had undocumented immigration status. In total, 89 participants (26.5%) agreed that hospital emergency departments were the only source of COVID-19 testing or treatment for uninsured immigrants, and 106 participants (31.6%) agreed that using public testing and health care services for COVID-19 could jeopardize one's immigration prospects. A total of 96 participants (28.6%) and 114 participants (33.9%), respectively, would not identify an undocumented household member or coworker during contact tracing. Reluctance to identify an undocumented household member or coworker was associated with having had deportation experiences (r = -0.17; 95% CI, -0.06 to 0.27; P = .003) but not with the number of years lived in the US (r = 0.07; 95% CI, -0.16 to 0.17; P = .15) or immigration status (r = 0.03; 95% CI, -0.07 to 0.13; P = .56). In this cross-sectional survey study, a substantial number of immigrants endorsed statements about immigrants' restricted access to COVID-19-related testing and treatment services and the potential negative immigration ramifications of using these services. These results suggest that programs for COVID-19-related testing, contact tracing, and vaccine administration that are designed to allay immigration concerns are needed.

Disrupted Education?: A Latent Profile Analysis of Immigration-Related Distractions and Academic Engagement among Undocumented College Students

ABSTRACT Prior research has established that legal vulnerability affects undocumented students’ educational experiences. Building on this work, we examine how undocumented immigration status may disrupt academic performance through students’ behavioral engagement in their coursework. Drawing on a survey of nearly 1,277 undocumented college students in California, we use latent profile analysis to identify student profiles based on their experiences of immigration-related distractions. We then assess the role of self and family demographics on profile membership, and the relationship between immigration-related distraction profiles and students’ behavioral engagement outcomes. We identify five distraction profiles that indicate a wide variation in frequency of immigration-related distractions and suggest that these distractions result from both students’ own and their parents’ immigration-related issues. These distractions are consequential as students with more frequently distracted profiles are more likely to report negative behavioral engagement outcomes. Ultimately, we argue that academic distractions and behavioral disengagement are key ways in which legal vulnerability disrupts the academic success and educational experiences of undocumented students.

Life after College: Liminal Legality and Political Threats as Barriers to Undocumented Students’ Career Preparation Pursuits

ABSTRACT Prior research has established that undocumented immigration status disrupts students’ transition into life after college, but limited research has examined their preparatory experiences in college. Drawing on interviews with 154 undocumented college students and 32 alumni, we examine how immigration status impacts undocumented students’ career planning and preparation. We find that professional development opportunities and college social networks facilitate successful career transitions for both those who received DACA and those who did not. Although DACA facilitates access to a wider variety of professional development opportunities in college, a lack of permanent legal status continues to pose barriers. Yet, both those with and without DACA identify persistent feelings of uncertainty that constrain their career planning, particularly in the face of ongoing political threats to the DACA program. In all, we contend that DACA has supported the post-college transitions of undocumented young adults, but its effects are substantially constrained because it is an increasingly compromised form of liminal legality. We assert that experiences of liminal legality are shifting due to the increasingly temporary and threatened nature of contemporary immigration policy making.

An Assessment of the Social Determinants of Health in an Urban Emergency Department.

IntroductionSocial determinants of health (SDOH) have significant impacts on patients who seek care in the emergency department (ED). We administered a social needs screening tool and needs assessment survey to assess SDOH and evaluate for trends in the population of patients visiting our ED.MethodsA survey was distributed via convenience sampling to adult ED patients to capture self-reported demographic information and data about social needs. We categorized the questions related to SDOH based on the International Classification of Diseases, Tenth Revision, Clinical Modification coding format and created a composite variable called “SDOH Strata” based on the SDOH Index scores (0–5-low, 6–10-middle, or ≥11-high). We conducted bivariate analyses using the sociodemographic characteristics of the patients and their SDOH Strata using Fisher’s exact test. We then conducted multinomial logistic regression to examine the association between the patients’ sociodemographic characteristics and the SDOH Strata.ResultsA total of 269 surveys were collected. We observed that Hispanic/Latino patients were more than two times as likely (odds ratio: 2.04, 95% confidence interval [CI], 1.12,−6.51) to be in the higher impact stratum than in the lower impact stratum. Those who were undocumented had 3.43 times increased adjusted odds (95% CI, 1.98, 9.53) of being in the higher than the lower impact stratum compared to US citizens. Additionally, people speaking Spanish as their primary language were 5.16 times as likely to be in the higher impact stratum compared to the reference (English-speaking and lower impact stratum).ConclusionIn our patient population, patients noted to have the highest impact burden of the SDOH were those who identified as Hispanic/Latino, Spanish-speaking, and undocumented immigrant status.

Discovering One’s Undocumented Immigration Status through Family Disclosures: The Perspectives of U.S. College Students with Deferred Action for Childhood Arrivals (DACA)

ABSTRACT Many undocumented youths who come to the United States as children are unaware of their status until family disclosure; this likely has identity implications for youth. Through 40 semi-structured interviews with deferred action for childhood arrivals (DACA) college students, we explored how youth discovered their undocumented status, the type of information that was discussed during family disclosures, and how these youth perceived their identity changed after discovering their undocumented status. Most youths learned through direct parental disclosure, although several learned accidentally. Others reported always knowing, due in part to memories of crossing the U.S.–Mexico border. During disclosures, youth’s family helped youth make sense of what being undocumented meant. After disclosure, many youths felt cautious, experienced identity confusion, and felt dehumanized; however, some felt empowered. Our findings extend Communication Privacy Management Theory by highlighting environmental contextual features’ (e.g. political and legal systems) role in learning about and interpreting private information.

Paths to Mobility: A Longitudinal Evaluation of Earnings Among Latino/a DACA Recipients in California

Undocumented immigration status is a structural barrier to socioeconomic mobility. The regularization of legal status may therefore promote the socioeconomic mobility of formerly undocumented immigrants. The 2012 Deferred Action for Childhood Arrivals (DACA) program provided protection against deportation and access to work authorization for eligible undocumented immigrants who came to the United States as children. While studies using cross-sectional data find that DACA led to improved socioeconomic status, no studies have examined the socioeconomic status of DACA recipients over time and few have disaggregated among groups of DACA recipients. Drawing from one of the only longitudinal studies of DACA recipients, we use growth curve models to estimate individuals’ wage trajectories from the year prior to DACA receipt up to 77 months post-DACA receipt among Latino/a DACA participants in California. In this sample, DACA is associated with improved earnings trajectories for recipients, compared with nonrecipients. Among DACA recipients, there is variation in earnings growth by stage of the life course, as measured by age and educational attainment. Notably, DACA tenure appears to be particularly beneficial for individuals who attain DACA at earlier ages and who earn college degrees. This study contributes to our understanding of the role of immigration laws and policies in structuring immigrant integration and socioeconomic mobility in the United States.

Intimate Partner Violence Help-Seeking for Latina Undocumented Immigrant Survivors: Feminist Intersectional Experiences Narrated Through Testimonio

In addressing the grand challenge to build healthy relationships to end violence, social workers continue to engage in helping individuals affected by intimate partner violence (IPV). IPV often results in negative mental health and physical health outcomes. This qualitative study explored Latina immigrant women’s experiences of IPV by using an intersectional Chicana feminist approach. Twenty Latina undocumented immigrants who experienced IPV shared their testimonio interviews to denounce the injustices they experienced when seeking help. A narrative analysis is presented to illustrate some of the ineffective responses the participants experienced when seeking help as well as effective responses that provided them support. The analysis of the survivors’ testimonios also offered detailed stories to help us understand the intersectional experiences related to the survivors’ gender, ethnicity, social class, and undocumented immigration status when seeking help. Providing support to Latina immigrant survivors requires a better understanding of the unique help-seeking barriers they encounter in the United States. Implications from this study suggest that in order to effectively support the health of undocumented survivors of IPV, social workers need to consider trust building and be prepared to respond to the current political climate and institutional barriers when providing services for undocumented immigrant survivors.

Selective Disclosure as a Self-Protective Process: Navigating Friendships as Asian and Latino Undocumented Young Adults

Abstract Drawing on in-depth interviews with sixty-three undocumented, 1.5-generation Korean-origin and Mexican-origin young adults in the United States, I bring attention to the deep-seated effects of immigration status that extend into the most intimate aspects of undocumented immigrants’ lives. Findings show that the stigma of being undocumented leads undocumented young adults to be selective about whom they befriend and to whom they decide to disclose their status, feeling safer with those of shared immigrant descent. Furthermore, ethnoracial background shapes pathways of selective disclosure. Korean undocumented young adults in the study were more likely to be prompted to disclose their status to justify another personal circumstance, whereas Mexican respondents primarily sought empathy and community in times of distress. Moreover, Korean respondents more often created a distinction between individuals with whom they discussed the intimate details of their legal situation and those they deemed close but from whom they hid their status. This work demonstrates the ways in which undocumented immigrants engage in selective status disclosure as one of myriad strategies to mitigate the harmful affective and material effects of undocumented immigration status. By using a comparative qualitative approach, this study points to the nuanced and very personal ways in which ethnoracial background shapes everyday experiences of illegality.

The Life-Course Timing of Legalization: Evidence from the DACA Program

The Deferred Action for Childhood Arrivals (DACA) program was created to mitigate some of the harmful consequences of undocumented immigration status. Although research shows that the DACA program promoted employment outcomes for the average DACA recipient, life-course theory and immigrant integration theory suggest that the program may differentially affect younger and older recipients. Using data from the American Community Survey, the authors test whether DACA was associated with different education and employment outcomes for younger and older Mexican immigrants. The results indicate that DACA was associated with increases in the likelihood of working among younger but not older DACA-eligible individuals and with greater decreases in the likelihood of school enrollment among younger DACA-eligible individuals. These results suggest that policy makers should ensure that opportunities to permanently legalize status are available to immigrants as early as possible in the life course.

Immigration policy and immigrants’ sleep. Evidence from DACA

Stress is associated with sleep problems and poor sleep is linked to mental health and depression symptoms. The stress associated with immigrant status and immigration policy can directly affect mental health. While previous studies have documented the significant relationship between immigration policy and the physical and mental health of immigrants, we know little about the effects of immigration policy on immigrants’ sleep patterns. Exploiting the approval of the Deferred Action for Childhood Arrivals (DACA) program in 2012, we study how immigrants’ sleep behavior responds to a change in immigration policy. Consistent with the findings of previous research documenting the positive effects of DACA on mental health, we find evidence of a significant improvement in immigrants’ sleep in response to this policy change. However, the estimated effects of the policy disappear rapidly after 2016. While temporary authorization programs such as DACA may have beneficial impacts on immigrants’ sleep in the short term, the effects of such temporary programs can be rapidly undermined by uncertainty about their future. Thus, permanent legalization programs may be more effective at achieving long-term effects, thereby eliminating uncertainty around the legal status of undocumented immigrants.

Reimagining the Convoluted Plights of Refugee, Immigrant and Undocumented Immigrant Women: Implications for the Reauthorizations of the Violence Against Women's Act of 1994 in the United States

Background: Violence against women exists, is entrenched and shares commonalities among all cultures and societies, regardless of their level of civilization or the lack thereof. This act, which in some societies has now been recognized, therefore currently perceived, defined and interrogated as socially problematic is committed mostly by men, especially intimate partners and significant others, regardless of demography. Violence Against Women as an aberrant type of relationship interaction exists as a phenomenon that has largely been socially constructed, perpetrated, sustained and reproduced mostly by men. Although, and as a gender discourse, all women are recipients or potential recipients of violence perpetrated predominantly by men, however, new immigrant and refugee women remain at the apex as recipients of all sorts of violence, especially Intimate Partner Violence (IPV). Method: This study applied phenomenological interviews to explore how violence, particularly IPV against refugee women, including how the risk and propensities are further heightened and complicated by subjectivity labels. These labels include gender, race, socioeconomic, including undocumented immigrant status and language in host countries and continents, such as the United States, Canada and Europe. Results: The study found that IPV has serious ramifications for the physical and mental health of all affected women and their children, but presents a specially complicated problem for refugee and undocumented immigrant women as they strive to adapt to their host countries and environments. The study further evaluated new and existing policies, including the Violence Against Women Act of 1994 and its various reauthorizations, as well as evidence-based modalities that attempt to interrogate and attenuate this aberrant interactional process. Conclusion/Recommendations: It also explored policy recommendations that can be engaged in the sustainable protection of women, already victims of violence and those at high risk, but especially new immigrant, refugee and undocumented immigrant women, who have been socially, economically, culturally and linguistically deracinated by migration and refugee creating events.

Association of Documentation of Legal Residency Status with Nonprescribed Hormone Use Among Hispanic/Latina Trans Women in San Francisco.

Undocumented immigrant trans Latinas face significant barriers to attaining gender-affirming health care and may use nonprescribed feminizing hormones. Without medical supervision, nonprescribed hormone use may lead to adverse health outcomes. This study aimed to determine if a history of being an undocumented immigrant was associated with nonprescribed hormone use among trans Latinas. We conducted a secondary analysis using baseline data from the 2016 Trans National study done in the San Francisco Bay Area. Two hundred five trans Latinas participated in the study, of whom 75 (37%) reported a history of being undocumented. We fitted a multivariable logistic regression model to determine whether having a history of being an undocumented immigrant was associated with nonprescribed hormone use while controlling for age, income, time living in San Francisco, history of sex work, and history of problems with accessing health care. The prevalence of nonprescribed hormone use was 55.9% among trans Latinas overall; however, for trans Latinas with a history of undocumented immigration status, the prevalence was 68%. There was a significant, independent association between nonprescribed hormone use and undocumented status (adjusted odds ratio [aOR]=3.20; 95% confidence interval [CI]=1.47–6.97). We also found that having a history of sex work was associated with nonprescribed hormone use (aOR=5.72; 95% CI=2.69–12.18). The prevalence of nonprescribed hormone use among trans Latinas was high and is associated with a history of undocumented status and sex work. These associations may indicate health care avoidance related to concerns of being criminalized due to their documentation status or source of income (i.e., sex work) among trans Latinas. These findings underscore the need to reduce barriers in gender-affirming care to increase access to medically supervised hormone use, particularly among individuals with a history of undocumented status and engaged in sex work.