May Sudhinaraset

There is growing evidence that Asian and Latinx immigrants' health and health care access is shaped by immigrant policies that determine their rights, protections, and access to resources and the extent to which they are targeted by policing or deportation based on citizenship/legal status and other immigration-related social categories. However, there is limited population-based evidence of how immigrants experience the direct consequences of policies, nor of the impact of such consequences on their health.

Between 2018 and 2020, researchers conducted the Research on Immigrant Health and State Policy (RIGHTS) Study, developing a population-based survey of Asian and Latinx immigrants in California that measured 23 exclusionary experiences under health care and social services, education, labor/employment, and immigration enforcement policies. Applying Ruth Wilson Gilmore's concept of "disproportionate costs," authors conducted a latent class analysis (LCA) and regression models of the RIGHTS data to 1) describe patterns of immigrant policy exclusion experienced by Asian and Latinx immigrants and 2) test relationships between patterns of policy exclusion and health care access and health status.

LCA analyses identified six classes of distinct combinations of policy exclusions. In regression analyses, respondents in the class with cumulative exclusions across all policy sectors had the worst health care access and highest level of psychological distress, but the best self-rated health, while those in the class with employment and enforcement exclusions also had poor health care access. Respondents in the other three classes experienced combinations of health and social services exclusions, but these alone were not associated with worse outcomes.

Findings: Results show that the consequences of immigrant policies harm health through both cumulative exposure to and intersections of exclusions across policy sectors. Labor/employment and immigration enforcement policies, specifically, likely drive health inequities within immigrant populations. The RIGHTS study highlights the need to measure the cumulative and intersecting "disproportionate costs" of immigrant policy within diverse immigrant populations.
 

Summary: This study examines how legal status and past undocumented status are associated with health care access and health outcomes. Data were collected between 2018 and 2020 as a follow-on, cross-sectional survey to the California Health Interview Survey (CHIS). Researchers assess associations between past and current legal status and usual source of care, delayed medical care and psychological distress.

Findings: Overall, 26.2% of the sample had ever been undocumented. Compared with citizens who have always held lawful status (CLS), noncitizens who were previously undocumented and noncitizens who have always held lawful status (NLS) were less likely to have a usual source of care. Citizens who were previously undocumented were more likely to delay medical care compared with CLS. NLS were more likely to have moderate and above distress compared with CLS.

Public health efforts are needed to address the burden of trauma and disadvantage among those experiencing persistent effects of undocumented status.

Read the Publication:

• Journal Article: Persistent Effects of Legal Status on Healthcare Access and Outcomes: Findings from a State-Wide Representative Cross-Sectional Survey in California

In 2023, an estimated 32,000 women in California will be diagnosed with breast cancer, and approximately 4,680 will die from it. For birthing women, both the initiation of breastfeeding and the duration of it can reduce the risk of breast cancer. Therefore, it is important to understand the barriers to a woman’s decision to start breastfeeding and to continuing its practice for as long as desired. Professional lactation services can have a significant and positive impact on both.

In this policy note, authors present the findings from their recent study on the perceived benefits of lactation services, barriers to connecting to services, and recommendations for improving access to lactation consultants.

This is one key finding in a larger study of 33 participants — including mothers of recent newborns, maternal care providers (including physicians, nurses, lactation consultants, and doulas), and community advocates for child and maternal health — in which the authors learned about the barriers to initiating and maintaining breastfeeding in accordance with a mother’s breastfeeding plan. All participants represent or work with Black, Asian American, or Native Hawaiian or Pacific Islander (NHPI) communities.

Read the Publications

• Policy Note: Reducing Breast Cancer Risk Through Access to Lactation Specialists
• Related Policy Note: Reducing Breast Cancer Risk Through Improved Workplace Accommodation
• Related Policy Note: Reducing Breast Cancer Risk Through Better Family Leave Policies
• Related Policy Research Report: Reducing Barriers to Breastfeeding in Disadvantaged Communities 
   

Summary: Breastfeeding can reduce breast cancer risk, both in the practice of breastfeeding and the duration of time a person breastfeeds, with longer durations associated with increased benefits. However, several racial/ethnic communities with higher rates of breast cancer are also those with lower rates of breastfeeding. 

One strategy for reducing racial/ethnic inequities in breast cancer rates centers on improving breastfeeding rates, particularly among Asian, Black, and Native Hawaiian and Pacific Islander (NHPI) populations.  

To improve rates of breastfeeding, we seek to understand the attitudes toward breastfeeding within these communities, perceived barriers to breastfeeding, and resources that are available to help people effectively breastfeed, as well as recommendations that can positively impact the number of people who choose to breastfeed and the duration of time that they engage in breastfeeding their children.  Specifically, we seek to answer the following research questions, particularly as they apply to the Asian-American, Black and Native Hawaiian and Pacific Islander (NHPI) communities.

1. What policy interventions could increase awareness of breastfeeding as a way to reduce breast cancer risk among the public and medical community? 
2. What policy interventions could state or local governments adopt to increase support for breastfeeding where women live, work, learn, worship and play? 
3. Are there roles for community health clinics and other non-governmental organizations to support new policy interventions or implement existing or potential policies?

Our approach to this study included three main tasks: (1) Literature and Legislation Review, (2) Recruitment of Advisory Board and Key Informants, and (3) Interviews with Key Informants: providers, community advocates and breastfeeding people. 

Read the Publications:

• Policy Research Report: Reducing Barriers to Breastfeeding in Disadvantaged Communities
• Policy Note: Reducing Breast Cancer Risk Through Improved Workplace Accommodation
• Policy Note: Reducing Breast Cancer Risk Through Better Family Leave Policies
• Policy Note: Reducing Breast Cancer Risk Through Access to Lactation Specialists