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.

项目摘要/摘要 移民约有4500万人占美国人口的14％。之中 移民，1050万是无证移民，其中80％是拉丁裔。加利福尼亚，该地点 拟议的研究有1100万移民，这是该国所有移民的四分之一。加利福尼亚也是如此 拥有最大的无证件移民人口，该州有230万或22％的移民。 与美国总体类似，加利福尼亚的大多数移民是拉丁裔，有71％的无证移民是 出生于墨西哥。有一致的证据表明，拉丁美洲人的健康状况最糟糕的模式 与任何其他种族或族裔相比 特别是对于无证移民。即使是为了增加安全网计划以增加访问权限 照顾移民，他们并不总是最佳地吸引他们。在加利福尼亚州，最近的州政策有 允许26岁以下和49岁以上的符合收入的无证件移民入学 在其医疗补助计划中。然而，最近的研究表明，即使符合条件，许多人也没有注册 因为他们担心驱逐出境或不信任政府。这种恐惧和不信任在2019年加剧了 当特朗普政府更改“公共指控”规则的定义时，该规则允许拒绝 签证或永久居住如果移民依赖或可能取决于公共利益 包括医疗补助。加利福尼亚的大约有193,000名合格的无证拉丁裔移民没有注册 由于这种变化，在医疗补助中，即使拜登政府在2021年推翻了定义。 研究将提供一个独特的机会，以了解拉丁裔的错误和虚假信息的病因 移民和相关的“冷酷效果”，这是行使公共福利权利的决定， 包括政府法律或行动，包括参加医疗补助并寻求医疗保健。当前的 了解拉丁裔移民的寒冷效果的原因大多是轶事，并且仅限于框架 作为“恐惧”和/或“不信任”，而没有了解遗漏和虚假信息的机制 寒冷效果。我们设计了一项多方法，多层研究，以确定沟通方式 访问，评估，解释，传播和采取行动，以及这些访问，这些文档和 拉丁美洲人的公民身份。该研究将使用组织和社区的主要线人访谈 领导者，在2025年和2026年加利福尼亚健康访谈调查中对1,100名拉丁裔成年人的后续研究 （CHI）和社交媒体数据的机器学习分析。使用NIMHD研究的改编版 框架和关于沟通基础设施作为健康的社会决定者的新兴研究，这 研究将提供有关错误和虚假信息的新证据，并产生可用于的宝贵见解 告知政策和计划，以减少拉丁裔移民的医疗保健不平等。