Understanding Mis- and Disinformation About Health Care Access and Their Impacts on Decision-Making Among Latino Immigrants

了解有关医疗保健获取的错误和虚假信息及其对拉丁裔移民决策的影响

• 批准号: 10740251
• 负责人: Arturo Vargas Bustamante
• 金额: $ 59.02万
• 依托单位: UNIVERSITY OF HAWAII AT MANOA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-19 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10740251
• 关键词: Adult; Age; Age Years; Attitude; Authorization documentation; California; Charge; Chills; Communication; Communities; Confusion; Consumption; Country; Data; Decision Making; Documentation; Eligibility Determination; Enrollment; Ethnic Origin; Ethnic Population; Etiology; Exercise; Follow-Up Studies; Fright; Funding; Government; Green Card; Health; Health Care Seeking Behavior; Health Services Accessibility; Healthcare; Home; Housing; Human Rights; Immigrant; Immigration; Income; Inequity; Infrastructure; Institution; Interview; Knowledge; Latino; Latino Population; Laws; Legal; Legal Status; Life; Link; Machine Learning; Medicaid; Medicaid eligibility; Medicare; Methods; Mexican; Misinformation; National Institute on Minority Health and Health Disparities; Pattern; Perception; Persons; Policies; Politics; Population; Race; Research; Residencies; Resources; Rights; Site; Social Security; Source; Structure; Surveys; Taxes; Time; Trust; United States; Work; authority; care seeking; community organizations; design; disinformation; distrust; follow-up; health care availability; health care disparity; health care service utilization; health organization; informant; insight; nutrition; programs; racial population; safety net; social; social health determinants; social media; welfare

PROJECT SUMMARY/ABSTRACT At 45 million people, immigrants compose approximately 14% of the United States population. Among immigrants, 10.5 million are undocumented immigrants and 80% of them are Latino. California, the site of the proposed study, has 11 million immigrants, which is a quarter of all immigrants in the country. California also has the largest undocumented immigrant population, with 2.3 million or 22% of the immigrants in the state. Similar to the US overall, most immigrants in California are Latino, and 71% of undocumented immigrants are Mexican-born. There is consistent evidence that Latinos have the worst patterns of access to and use of health care compared to any other racial or ethnic group, and these inequities are even worse for Latino immigrants, especially for undocumented immigrants. Even when safety net programs are designed to increase access to care for immigrants, they do not always optimally engage them. In California, recent state policies have allowed income-eligible undocumented immigrants under the age of 26 and over the age of 49 years to enroll in its Medicaid program. Recent studies, however, have shown that even when eligible, many do not enroll because they fear deportation or distrust the government. This fear and distrust were exacerbated in 2019 when the Trump administration changed the definition of the “public charge” rule, which allows for the denial of a visa or permanent residency if immigrants are dependent or likely to become dependent on public benefits including Medicaid. Approximately 193,000 eligible undocumented Latino immigrants in California did not enroll in Medicaid because of this change, even after the Biden administration reversed the definition in 2021. This study will provide a unique opportunity to understand the etiology of mis- and disinformation among Latino immigrants and the related “chilling effects,” which are a deterrent to exercising one’s rights to public benefits, including enrolling in Medicaid and seeking health care, because of government laws or action. Current understanding of the causes of chilling effects for Latino immigrants is mostly anecdotal and limited to framing as “fear” and/or “distrust” without the knowledge of the mechanisms that connect mis- and disinformation and chilling effects. We have designed a multi-methods, multi-level study to determine how communication is accessed, assessed, interpreted, spread, and acted upon and how these vary by documentation and citizenship status for Latinos. The study will use key informant interviews of organizational and community leaders, a follow-up study of 1,100 Latino adults in the 2025 and 2026 California Health Interview Survey (CHIS), and machine learning analyses of social media data. Using an adapted version of the NIMHD research framework and emerging research on the communication infrastructure as a social determinant of health, this study will provide new evidence on mis- and disinformation and yield valuable insights that can be used to inform policies and programs to reduce health care inequities for Latino immigrants.

项目概要/摘要 移民人数为 4500 万，约占美国人口的 14%。 移民中，有 1050 万无证移民，其中 80% 是加州的拉丁裔。 拟议的研究显示，加州有 1100 万移民，占该国所有移民的四分之一。 拥有最多的无证移民人口，有 230 万人，占该州移民的 22%。 与美国整体情况相似，加州的大多数移民是拉丁裔，71% 的无证移民是拉丁裔。 墨西哥出生的人有一致的证据表明拉丁裔获得和利用健康的方式最差。 与任何其他种族或族裔群体相比，这些不平等对于拉丁裔移民来说更加严重， 特别是对于无证移民来说，即使安全网计划的目的是增加获得机会的机会。 在加州，最近的州政策已经改变了对移民的照顾。 允许26岁以下和49岁以上有收入资格的无证移民注册 然而，最近的研究表明，即使符合资格，许多人也没有参加。 因为他们害怕被驱逐出境或不信任政府，这种恐惧和不信任在 2019 年加剧了。 当特朗普政府改变了“公共负担”规则的定义，允许否认 如果移民依赖或可能依赖公共福利，则可获得签证或永久居留权 包括医疗补助计划在内，加州约有 193,000 名符合资格的无证拉丁裔移民没有参加。 由于这一变化，即使在拜登政府于 2021 年扭转了定义之后，医疗补助也被纳入医疗补助计划中。 研究将为了解拉丁美洲人中错误和虚假信息的病因提供一个独特的机会 移民和相关的“寒蝉效应”，阻碍人们行使公共福利的权利， 包括因政府法律或现行行动而参加医疗补助和寻求医疗保健。 对拉丁裔移民产生寒蝉效应的原因的理解大多是轶事且仅限于框架 在不了解将错误和虚假信息与 我们设计了一项多方法、多层次的研究来确定沟通的效果。 访问、评估、解释、传播和采取行动，以及这些如何因文档和内容而异 该研究将使用对组织和社区的关键知情人访谈。 领导人，对 2025 年和 2026 年加州健康访谈调查中的 1,100 名拉丁裔成年人进行的跟踪研究 (CHIS)，以及使用 NIMHD 研究的改编版本对社交媒体数据进行机器学习分析。 关于通信基础设施作为健康社会决定因素的框架和新兴研究，这 研究将为错误和虚假信息提供新的证据，并产生可用于 为减少拉丁裔移民医疗保健不平等的政策和计划提供信息。