State-Level Immigration Policy Context and Health: How Are Latinx Immigrant Parents Faring?

Abstract

This study examined associations between perceived immigration policy effects and stress among Latinx immigrant parents living in Maricopa County, Arizona, which implemented a series of restrictive immigration policies. Three hundred Latinx immigrant parents participated in the study. A hierarchical regression model was used to examine the relationship between perceived immigration policy effects (that is, subscales include Discrimination, Social Exclusion, Threat to Family, and Children’s Vulnerability) on parents’ stress levels while controlling for demographics. The model also included protective factors (that is, familismo, social support, self-efficacy) and immigrant-specific indicators of health (that is, length of time in the United States and deportation of a family member). Findings revealed that threat to family and children’s vulnerability were associated with heightened stress levels among parents. There were no differences in stress levels by length of time in the United States or deportation of a family member, and protective factors were not associated with reduced stress levels. At a practice level, findings stress the need to work with families to address their fears of family separation and parents’ concerns for how the immigration policy context affects their children. At a policy level, advocacy is needed to secure access to care for immigrants and maintain families together.

Immigrants are exposed to high levels of stress throughout their migration experience that take a toll on their health. Immigrants are likely to experience heightened levels of stress at premigration, during the migration process, and postmigration (Coronado & Orrenius, 2007; Johnson & Marchi, 2009; Salas, Ayón, & Gurrola, 2013; Schwartz et al., 2014). At premigration, the choice to migrate is embedded within many uncertainties and decisions that will likely affect the migration and settlement process in the United States (Massey, Durand, & Malone, 2002). The migration process has become increasingly dangerous as border enforcement increases. Migration routes have changed and become more dangerous as individuals are exposed to harsh weather conditions, violence, and risk for human smuggling (Coronado & Orrenius, 2007; Fulginiti, 2008; Orrenius, 2004; Perez Foster, 2001). At postmigration, the focus of the present study, immigrants face difficulties associated with their immigration status, employment, housing, cultural shock, and a negative context of reception where individuals are faced with racism and discrimination (Schwartz et al., 2014). Latinx immigrants are also likely to experience financial hardships as they are often employed in low-wage jobs (Rosenblum & Brick, 2011). Although immigrants tend to be healthier on arrival compared with nonimmigrants (Johnson & Marchi, 2009), their health status may decline over time. Even after many years in the United States, immigrants continue to experience the hardships of discrimination and prejudice and increasingly hostile environments due to the anti-immigrant policy context (Ayón & Becerra, 2013). An emerging body of literature has examined the relationship between the presence of restrictive policies at a state level (that is, number of policies in each state) and access to care by mixed-status families (Vargas, 2015; Vargas & Ybarra, 2017) or mental health outcomes among Latinxs (Hatzenbuehler et al., 2017). This study elucidates how immigration policy and enforcement is experienced by Latinx immigrant parents and how their perception of the effects of the immigration policy context is associated with their health or stress levels. The purpose of this study is to examine the associations between immigrant parents’ perception of the immigration policy context and their health, while controlling for factors that are known to be protective and indicators of immigrants’ health. Findings have implications for practice, access to health care for undocumented immigrants, and immigration policy and enforcement strategies.

Arizona Immigration Policy Context

In 2016, immigrants in the United States constituted 13.5% of the total U.S. population, or 43.7 million (Zong, Batalova, & Hallock, 2018). Approximately 45% of immigrants are of Latinx origins, and specifically 26% are from Mexico (Zong et al., 2018). A large portion of immigrants reside in five states in the United States (Zong et al., 2018), including Arizona, the site of the present study. Arizona was at the forefront of passing state-level restrictive immigration policies, which aimed to deter undocumented immigrants from living and settling in the state. Policies passed in Arizona limited access to support services including health care (Proposition 200 required proof of citizenship to access services), restricted access to a driver’s license (ADOT, 2016), affected and limited access to education (Proposition 203 eliminated bilingual education; Proposition 300 prohibited in-state tuition rates, access to financial aid, and access to adult education classes; HR2281 aimed to eliminate ethnic studies programs), limited access to employment (Legal Arizona Workers Act), and ultimately aimed to criminalize immigrants (SB1070, Support Our Law Enforcement and Safe Neighborhoods Act). As these policies were passed, enforcement was at its height with Maricopa County’s Sheriff’s Office conducting community and workplace raids with an aim to detain undocumented immigrants and often targeted Latinx-dense or Spanish-speaking communities (Perez, 2011). Subsequently, fear of detainment and family separation was prevalent among families in Arizona. Immigrant families and their children may experience chronic fear that can take a toll on their health (Barajas-Gonzalez, Ayón, & Torres, 2018).

Immigration Policy Context and Health

Restrictive immigration policies and anti-immigrant rhetoric subject immigrants to discrimination, racism, and exploitation. Immigrants experience discrimination at a micro level through their day-to-day interactions with others. For instance, immigrants report being discriminated against at restaurants, stores, and other community spaces on the basis of their skin tone or limited English-speaking ability (Ayón, 2017b; Cohen & Merino Chavez, 2013; Mendez Alarcón & Novak, 2010; Negi, 2013). Subsequently, individuals report limiting their social interactions to safe spaces or immigrant-friendly spaces (Ayón, 2017b; Negi, 2013). In addition, evidence suggests that Latinx immigrants face discrimination and exploitive practices in the workplace (Ayón, Gurrola, Moya-Salas, Androff, & Krysik, 2012; Ayón, Messing, Gurrola, & Valencia-Garcia, 2018; Harrison & Loyd, 2012). Following the passage of the Legal Arizona Workers Act, which mandated the use of an E-Verify program in Arizona, immigrants reported exploitive practices in the workplace. For instance, often participants were expected to work extra hours for free and received checks without funds, increasing their financial insecurity (Ayón et al., 2012). Immigrants may face name-calling, ridicule, and sexual harassment in their workplace with limited options for alternative employment (Ayón et al., 2012; Ayón et al., 2018; Harrison & Loyd, 2012; Waugh, 2010).

At a macro level, immigrants experience discrimination through the passage of immigration policies and enforcement strategies that unfairly target immigrants and Latinx people. For instance, in the state of Arizona, the U.S. Department of Justice Civil Rights Division found that the Maricopa County Sheriff’s Office engaged in patterns and practices of unconstitutional policing (Perez, 2011). These actions involved racially profiling Latinxs, through unlawful stops, detains, and arrests (Perez, 2011). Such policies and enforcement practices stigmatize immigrants and place their health at risk. Negi (2013) found that immigrant day laborers perceived that restrictive immigration policies unfairly targeted them, and these experiences of discrimination took a toll on their mental health. Using a national representative sample of Latinx adults in the United States, Almeida, Biello, Pedraza, Wintner, and Viruell-Fuentes (2016) examined the relationship between anti-immigrant policies and perceived discrimination. Findings indicated that 70% of the participants reported discrimination, more anti-immigrant policies were associated with higher rates of perceived discrimination, and the positive association between anti-immigrant policies and perceived discrimination was marginally strongest among third-generation (compared with second- and first-generation) Latinxs. Thus, the restrictive climate affects both Latinx immigrants and nonimmigrants (also see Vargas, Sanchez, & Juárez, 2017). These findings are critical in light of substantial evidence that links discrimination to a wide array of poor health outcomes among immigrants and Latinxs (Dawson & Panchanadeswaran, 2010; Ornelas, Perreira, Beeber, & Maxwell, 2009).

Enforcement practices leading to the detainment and deportation of individuals and family separation take a toll on the well-being of parents and their children. Within families, the effects of deportation are experienced by the deportee and those left behind. Specific to parents, mothers take on the short-term and long-term financial burden of forced separations. Dreby (2012) reported that mothers are stressed as they figure out how to best provide for their children while deported fathers are demoralized by their inability to provide for their children. Brabeck and Xu (2010) statistically examined the impact of deportation practices on families. They created a legal vulnerability measure based on participants’ documentation status, current or previous deportation, and familial experience of deportation. Legal vulnerability ranged from documented/citizen (low vulnerability) to undocumented with personal/familial history of deportation (high vulnerability). Families with higher legal vulnerability reported increased negative impacts on their family environment (that is, parent emotional well-being, financial strain, and parent–child relationship). Concomitantly, exposure to community raids has been linked to higher levels of stress and lower self-rated health (W. D. Lopez et al., 2017). Study participants who were immigrants and had children experienced higher levels of stress due to immigration enforcement activities. W. D. Lopez et al. (2017) argued that acute events, such as immigration raids, have immediate effects on communities. These experiences increase immigrants’ need for support services, which often go unmet, thus exacerbating health inequities among these populations (W. D. Lopez et al., 2017).

Beyond the direct impact of enforcement strategies, the looming threat and fear of deportation also affects immigrants and their families. As a result of increased attention to immigration enforcement and anti-immigrant sentiment, Latinx immigrants expressed concern for family members and others in their social networks (Szkupinski Quiroga, Medina, & Glick, 2014). Qualitative data elucidate the emotional toll restrictive policies and enforcement strategies take on immigrants and their families. Salas et al. (2013) reported that immigrants experienced feelings of isolation, powerlessness, frustration, fear, stress, and chronic trauma in response to the restrictive immigration climate in Arizona. Similarly, Latinx immigrant parents reported “a loss of liberty—in an emotional sense through the constant experience of fear and, behaviorally, as they limit leaving their homes to prevent being detained and deported” (Ayón, 2017b, p. 9). In addition, a recent study (Martínez, Ruelas, & Granger, 2018) examined the relationship between household fear of deportation and a physiological health indicator, specifically oral inflammation, among mixed-status Mexican households in Arizona. Household fear of deportation and familial conflict were associated with pro-inflammatory cytokines. Such stressors have long-term implications as chronic inflammation in the oral mucosa is associated with risk of cardiovascular disease and diabetes (Martínez et al., 2018).

Latinx Immigrants and Protective Factors

Latinx immigrant families are resourceful, and a number of factors protect this community and promote their well-being. For instance, familismo has been associated with lower levels of depression among Latinx families (Ayón, Marsiglia, & Bermudez Parsai, 2010) and found to buffer the effects of acculturative stress on substance use (Gil, Wagner, & Vega, 2000). Familismo is a core cultural value for Latinxs that promotes strong cohesive ties characterized by loyalty among family members (Calzada, Tamis-LeMonda, & Yoshikawa, 2013).  Calzada et al. (2013) described the complexities associated with familismo through their ethnographic work with 23 low-income Latinx mothers. Family members are a valuable source of support for parents as they provide assistance with daily activities; child rearing; and emotional, financial, and instrumental social support in the event of deportations (Calzada et al., 2013). At the same time, family members may experience financial strain if expected to provide financial support to other family members, and they may experience overcrowding due to financial instability (Calzada et al., 2013).

Social support plays a protective role for immigrant families. Latinx immigrants’ social networks go beyond their families to include friends, fictive kin such as compadres, and neighbors or community members (Ayón & Bou Ghosn, 2013; R. A. López, 1999; Vega, 1990). Although immigrants have historically relied on their networks in the migration process (Massey et al., 2002), within the context of restrictive immigration policies, Latinx immigrants’ social support networks and access to resources have been severely limited (Ayón & Bou Ghosn, 2013; Negi, 2013). Immigrants reported that many members of their social networks experience similar challenges and consequently are unable to provide assistance as readily (Ayón & Bou Ghosn, 2013). In addition, immigration policies disrupt social networks as families may have to relocate to other states or return to their country of origin. Following the passage of restrictive policies, Latinx immigrant parents reported that their social networks were weakened and constantly changing (Ayón, 2017b). Strong social networks are critical, as social support has direct and buffering effects on the well-being of immigrants ( Jasinskaja-Lahti, Liebkind, Jaakkola, & Reuter, 2006). For instance, immigrant parents who report high levels of social support report feeling more effective as a parent (Izzo, Weiss, Shanahan, & Rodriguez-Brown, 2000).

Another factor that can be protective of health is self-efficacy. Whereas social support speaks to strengths gained through one’s network, self-efficacy speaks to internal strengths used to overcome challenges (that is, to cope with and adapt to challenges). Self-efficacy refers to a person’s belief in their ability to perform tasks successfully (Bandura, 2004). That is, individuals who believe that their actions contribute to a given outcome are more likely to expect favorable outcomes and are more likely to view obstacles as manageable tasks (Bandura, 2004). Research has found that self-efficacy is associated with more positive parent–child interactions, such as acceptance, warmth, and consistent disciplining (Dumka, Stoerzinger, Jackson, & Roosa, 1996; Izzo et al., 2000). In a study among older Korean immigrants, self-efficacy was associated with healthpromoting behaviors (Sohng, Sohng, & Yeom, 2002). Furthermore, an intervention grounded on self-efficacy theory targeting Mandarin-speaking immigrants was effective in increasing knowledge of osteoporosis and improving the adoption of preventive behaviors (Qui, Resnick, Smeltzer, & Bausell, 2011). Thus, immigrants who have low levels of self-efficacy may find a restrictive immigrant policy context as more distressful compared with individuals who have higher levels of self-efficacy, as the latter group of individuals may be better equipped to find ways to maneuver in such contexts.

Current Study

Theories of integration identify structural forces that block or facilitate immigrants’ mobility. Menjívar and Abrego’s (2012) legal violence concept builds on integration theories to further illustrate how the violent effects of immigration laws affect immigrants’ integration process and short-term and long-term outcomes. Drawing on theories of structural and symbolic violence, Menjívar and Abrego (2012) argued that the convergence of immigration and criminal law constitutes a form of violence that becomes normalized in the quotidian life of immigrants. Whereas historically immigration law had fallen within the realm of civil or administrative law (Abrego & Lakhani, 2015), now immigration law is equated to criminal law, promoting a view of immigrants as criminals, which promotes dehumanizing acts against this population (Menjívar & Abrego, 2012). The integration process for immigrant families is hindered by restrictive policies as Latinx families are subjected to increased levels of discrimination, increased levels of social isolation, and chronic stress due to fear of detainment and deportation (Abrego & Lakhani, 2015; Androff & Tavassoli, 2012; Ayón & Becerra, 2013; Barajas-Gonzalez et al., 2018; Menjívar & Abrego, 2012). The legal violence framework illuminates how a restrictive immigration policy context increases immigrant families’ vulnerability, which has direct implications on parents’ health.

The legal violence framework informs our understanding of how hostile environments affect immigrants’ health through increased stress levels. The present study used a hierarchical regression model to examine the relationship between perceived immigration policy effects on health outcomes (or stress levels) while controlling for known protective factors (that is, familismo, social support, and self-efficacy) and known immigrant-specific indicators of health (that is, length of time in the United States and deportation of a family member). This study used the Perceived Immigration Policies Effects Scale (PIPES) to assess parents’ perception of immigration policy. The measure includes four dimensions of how parents experience immigration policy: discrimination, social exclusion, threat to family, and children’s vulnerability. On the basis of existing research, I anticipated that (a) protective factors would be associated with lower stress levels, (b) differences would be present based on how long participants have resided in the United States and if a family member had been deported, and (c) several dimensions of PIPES would be associated with increased stress levels, placing immigrants’ health at risk.

Method

Study Design and Procedure

This study is part of a larger mixed-methods study; the quantitative, cross-sectional component of the study consists of data on parenting practices, discrimination, immigration-related factors, protective factors, and demographic characteristics. Three hundred Latinx immigrants residing in the state of the Arizona participated in the study. Recruitments was completed through four community-based agencies that primarily serve Latinx immigrant families. The recruitment process involved brief presentations where team members described the study’s purpose, eligibility criteria, rights as participants, and procedures. Parents who were interested in participating in the study completed a recruitment form with their name, contact information, and best available days and times. Interviews were scheduled at a time that best fit the participant’s schedule, including weekends and evening hours. Interviews were completed in the participant’s home or a mutually agreed-on location. A structured interview format was used in which interviewers read the survey items to the participants and recorded the response. Interviews were completed in Spanish and ranged in duration between one hour and one hour and 15 minutes. Participants received a $30 remuneration. The study received institutional review board approval prior to data collection.

Measures

Participants completed a comprehensive self-report questionnaire including standardized measures and new measures that were developed as part of the larger study. Demographic information was also collected and was included in the analysis as control variables (that is, gender, age, marital status, number of children, and so on). Immigrant-specific demographics included age at migration, length of time in the United States (less than 10 years, 10 to 20 years, or 21 or more years), and deportation of a family member (yes/no).

Protective factors included familismo, social support, and self-efficacy. The Attitudinal Familism Scale is an 18-item measure that reflects the main components of familismo (Lugo Steidel & Contreras, 2003). Sample items include “A person should always be expected to defend his/her family’s honor no matter what the cost” and “A person should respect his or her older brothers and sisters regardless of their differences in views.” The scale was scored on a five-point Likert-type scale ranging from 1 = strongly disagree to 5 = strongly agree. The reliability score for this sample was good (α = .892). Perceived social support by family and friends was measured by the Multidimensional Scale of Perceived Social Support, a 12-item scale (Canty-Mitchell & Zimet, 2000). Sample questions include “your family tries to help you,” “you can talk about your problems with your family,” and “you can count on your friends when things go wrong.” A four-point Likert-type scale ranging from 1 = not at all true to 4 = very true was used. The reliability score for this sample was good (α = .889). Self-efficacy was measured with the General Self-Efficacy Scale (α = .901), a 10-item scale. This scale was created to assess a general sense of perceived self-efficacy with the aim to predict an individual’s coping with daily hassles and adaptation after stressful life events (Schwarzer & Jerusalem, 1995). Sample items include “I can always manage to solve difficult problems if I try hard enough” and “When I’m confronted with a problem, I can usually find several solutions.” A five-point Likert-type scale ranging from 1 = strongly disagree to 5 = strongly agree was used.

The policy context was assessed with PIPES (Ayón, 2017a), which comprehensively measures the perceived impact of immigration policies on Latinx immigrant parents and their families. It includes 24 items composing four subscales: Discrimination (α = .889), Social Exclusion (α = .908), Threat to Family (α = .898), and Children’s Vulnerability (α = .824). Sample questions include, for Discrimination, “Were you treated like a criminal based on who you are?” and “Did others treat you like they had the right to treat you unfairly or poorly?”; for Social Exclusion, “Did you avoid certain locations like parks and neighborhoods because you did not feel safe?” and “Did you feel that you had no liberty and needed to stay home?”; for Threat to Family, “Did you fear being deported or detained?” and “Did you fear that you or a family member would be reported to immigrant officials?”; and for Children’s Vulnerability, “Have you been concerned that your children were having emotional problems due to immigration policies?” and “Have your children feared authorities due to immigration policies?” Items are measured on a five-point scale ranging from 1 = never to 5 = always. A higher score on each subscale is indicative of higher levels of perceived discrimination, social exclusion, fear of family separation, and risk to their children.

The outcome variable is an Immigrant Stress scale. The scale consists of four items measured on a Likert-type scale ranging from 1 = never to 5 = always. The measure assesses individuals’ perceptions of their stress due to the effects of immigration policies (confirmatory factor analysis = .997, Tucker–Lewis index = .992, root mean square error of approximation = .052, standardized root mean square residual = .004). These questions followed PIPES in the survey. The measure items were as follows: (1) How much have you felt there was no hope that the immigration situation would improve? (2) How much have these problems caused you to feel depressed or helpless? (3) How much do these problems upset you? (4) How much have these problems caused you to feel paralyzed by fear? Cronbach’s alpha was good, at .831.

Analysis

I performed bivariate correlation to examine the relationship between the dependent variable and independent variables (see Table 1). I used hierarchical regression analyses to determine the influence of variables on immigrants’ report of stress. The analysis was completed in four models: demographics, immigration indicators of health, protective factors, and predictor of interest (that is, PIPES). Demographics variables (gender, age, number of children, marital status, education, and financial strain) were entered in the first model. The second model included immigrant-specific indicators related to health (years in the United States and deportation of a family member). The following model added known protective factors (that is, familismo, social support, and self-efficacy). The final model added the predictors of interest—immigration policy effects, measured by reports of discrimination, social exclusion, threat to family, and children’s vulnerability. Including the variables in sequential blocks allowed for an evaluation of the contribution of each set of variables as they were added to the model. I ruled out multicollinearity by examining the tolerance and variance inflation of factor values. I conducted these analyses with IBM SPSS 24.

Results

Descriptive Statistics

All participants were immigrants (N = 300). See Table 2 for a summary of the demographics. The majority of the participants were of Mexican origin (94%, n = 282). Most participants were mothers (83%, n = 248); the remaining participants were fathers (17.3%, n = 52). Eighty-six percent of the participants were married and had three children (SD = 1.12). On average, participants were 38 years old (SD = 6.68). Education levels ranged from less than a high school education (57%) to high school graduate (17%) and some college education to a bachelor’s degree (26%). Nearly 60% of the participants reported family incomes of $25,000 or less. The average length of time in the United States was 15.8 years (SD = 6.422), and the average age at time of migration was 21 years (SD = 6.79). Nearly 60% of the participants had never returned to their country of origin since migration. A majority of the participants reported that they originally migrated to the United States to find good jobs or earn a better income (42%, n = 126), or to provide their children with an education and better opportunities (27%, n = 82). Over a third of the participants reported experiencing the deportation of a family member (40%, n = 118).

Hierarchical Regression

The analysis revealed factors associated with parents’ report of stress (see Table 3). The first model, including the demographic variables, accounted for 9% of the variance [R² = .09, F(8, 281) = 3.47, p < .001]. In this model, gender was significant, with women reporting higher levels of stress; and financial strain was also associated with higher levels of stress. The second model added the immigration-related variables to the control variables [R² = .12, F(11, 278) = 3.20, p < .001]. Although this model was statistically significant, the additional variables did not account for a significant percentage of the variance (ΔR² = .02, p > .05), and the immigration variables were not statistically significant. That is, there were no differences in stress levels by time in the United States or having experienced the deportation of a family member. The third model added the protective factors familismo, social support, and self-efficacy. The third model accounted for 12% of the variance [R² = .12, F(13, 275) = 2.75, p < .001]. The addition of the protective factors did not account for a significant percentage of the variance (ΔR² = .01, p < .05), and the protective factors were not significant in the model; that is, protective factors were not associated with changes in the level of stress experienced by immigrants. Financial strain remained significant in the third model. The final model added the variables measuring the effects of immigration policy. The final model accounted for 41% of the variance [R² = .41, F(18, 271) = 10.64, p < .001; ΔR² = .29, p < .001]. When the effects of immigration policy were included in the model, financial strain was no longer significant. The subscales Threat to Family and Children’s Vulnerability were significant, accounting for 2% and 5% of the variance in the model, respectively.

Discussion

Immigrants are faced with many challenges throughout the migration and adaptation process that place them at high risk for stress (Perez Foster, 2001). Findings from this study highlight that various dimensions of how immigration policy is experienced by immigrants can take a toll on immigrants’ health by increasing their stress levels. Specifically, threat to family or the fear of family disintegration and children’s vulnerability or risk to children were statistically significant predictors of increased stress levels among immigrant parents. The hypotheses for the study were partially supported.

Financial strain was a significant predictor in the first three models, before adding the immigration policy contextual variables. Anti-immigrant policies often serve to limit work opportunities for immigrants. In Arizona, the site of the study, the Legal Arizona Workers Act mandated the use of an E-Verify program, which prevents undocumented individuals from obtaining employment. This policy reduced access to employment and led to exploitive practices where immigrants reported that they did not receive paychecks on time, were being paid less for more work, or were receiving paychecks that would bounce (Ayón et al., 2012). Consequently, immigrant household may face financial instability and hardships, increasing stress levels experienced by this population. Although financial insecurity was a significant predictor in the model, it did not remain significant once the immigration policy contextual factors were included. This change in the model indicates that although financial strain increases levels of stress among immigrants, the immigration policy context, specifically the risk to children and increased fear of family separation, plays a stronger role.

Model 3 adds factors that have previously been found to protect the health and well-being of immigrants. In this study, familismo, social support, and self-efficacy were not significantly associated with immigrant stress, and the findings do not support the “protective” nature of these variables. As a result of the policy context in Arizona, many immigrant families relocated, and support networks were constantly changing (Ayón, 2017b). It is possible that the strength in social support systems is weaker due to changing networks. At the same time, immigrants are a vulnerable population; particularly if they are undocumented, they may feel that they lack power to change restrictive policies. Participants continue to have strong ties with family members, which may heighten their concern for the safety and stability of their family. Within a restrictive immigration policy context, the protective elements of familismo may be outweighed by the fear of deportation. In sum, known protective factors of health among immigrants were not statistically associated with changes in stress levels among this sample.

Immigrant health indicators that have been found to be associated with differences in outcomes—length of time in the United States ( Johnson & Marchi, 2009) and deportation of a family member (Vargas, 2015)—were not significant in this study. That is, stress levels were similar regardless of how long immigrants resided in the United States. Similar to Szkupinski Quiroga et al. (2014), who found that Latinx immigrants worry about the deportation of family members, findings in the current study reveal the complexity in the role of deportation on immigrants’ health. Although deportation of a family member was not a significant predictor in the model, the threat of family separation was significant. That is, previous deportation of a family member did not elevate stress levels, but the looming threat of family separation was associated with increased stress levels. Concomitantly, risk to children due to the immigration policy context was also associated with increased stress levels among parents. The policy context variables assessing discrimination and social exclusion were not significant.

Limitations

This study was based on a convenience sample of Latinx immigrant parents and on cross-sectional data. Thus, the findings cannot be generalized beyond the study’s participants, and causality of immigrant stress cannot be determined. Within the restrictive immigration policy climate, immigrants can be classified as a “hard to reach population” as many fear that revealing their status or sharing personal information can lead to detainment or deportation. Thus, recruiting through nonprofits that are trusted entities is one way to overcome recruitment barriers. However, doing so limited the sample to individuals who have an established relationship with support services. Thus, this further limits the generalizability of findings, as immigrants who are not linked to support services may perceive the effects of immigration policies differently. In addition, the present sample is composed mostly of mothers. Future studies should aim to include more fathers in the sample as their experiences of the immigration policy context vary (for example, see Dreby, 2012). Yet, the study makes an important contribution to our understanding of how immigration policies are experienced by immigrant parents and how such policies can take a toll on their health through heightened stress levels.

Implications for Practice, Policy, and Research

Immigrant families are in need of support and health services. Findings from this study shed light on factors that service providers need to consider when working with immigrant families. Providers need to be prepared to discuss parents’ and family members’ fears around the threat of deportation and parents’ concerns regarding the impact of restrictive policies on children, with the specific aim of helping parents build coping strategies and linking them to resources so that their fear is not self-consuming. Efforts to create opportunities for mutual support groups to strengthen social networks and support structures for immigrants are needed. Practitioners can also encourage parents to seek out support through religious institutions and parent groups in school settings. Access to care is a critical step to alleviating the stress experienced by immigrant parents. Evidence suggests that following Donald Trump’s election, immigrant families were more likely to miss appointments and change their health care–seeking behaviors (Shore & Ayón, 2018). The current proposal to expand the public charge rule (National Immigration Law Center, 2019) is likely to reduce service-seeking behaviors, as families with undocumented members will not want to risk their chances of being ineligible for residency or to adjust their status. Community-based approaches such as promotoras (community leaders) models may support the dissemination of information to families and help parents identify organizations that are “immigrant friendly.”

At a policy level, advocacy work is needed to inform policymakers about the impact of restrictive immigration policy and enforcement strategies on families and immigrants’ health. Efforts to maintain the integrity of the family unit is critical. Several states have passed state-level policies that are restrictive or pro-integration. Future research is necessary to examine whether states with pro-integration policies protect immigrants’ health and improve access to care or whether the national climate supersedes any protections offered by states. Although this study was focused on the health of parents, additional research is needed on the health of children within immigrant families. Emerging evidence suggests that children whose parents are deported experience many challenges to their health and mental health (Flores Rojas, 2017). How does the threat of parental deportation affect the health status of children? What are the long-term consequences of being exposed to a restrictive immigration policy climate? Studies that examine the health of families (with multiple informants) are also needed as the health and mental health needs of a family member can take a toll on the well-being of other family members (for example, caregivers). Within a restrictive immigration policy context where multiple families members are affected, what does that mean for the health of a whole family or household?

The immigration policy context has placed immigrant parents’ health at risk. This study identifies dimensions of the immigration policy context that affect parents’ health through increased stress levels. Although this study is focused on the experiences of Latinx immigrant parents in a state that passed multiple restrictive immigration policies, the findings can inform practice with immigrants across the United States given the current national climate. Social workers and other providers are positioned to support this vulnerable population.

Cecilia Ayón, PhD, is professor, School of Public Policy, University of California Riverside, 900 University Avenue, Riverside, CA 92521; e-mail: [email protected].

References