title: "There is no help out there and if there is, it's really hard to find": a qualitative study of the health concerns and health care access of Latino "DREAMers".
abstract: OBJECTIVE
  Young immigrants without documentation who qualify for the Deferred Action for Childhood Arrivals (DACA) program are eligible for temporary legal status but excluded from the Affordable Care Act's Medicaid expansion and Health Care Exchanges. Little is known about this population's health or access to care.
  
  
  METHODS
  Sixty-one DACA-eligible Latinos aged 18-31 years were recruited from community and Internet settings to participate in nine focus groups in California. An advisory board of immigration and health advocates assisted in the project's design and validation of results.
  
  
  RESULTS
  Participants reported avoiding the health care system whenever possible, first turning to family members and unlicensed community healers, then seeking safety net providers if necessary. Barriers to care included cost, limited intergenerational knowledge about the health care system, lack of a driver's license, and mistrust of providers due to fear of discrimination and deportation. Mental health care was the greatest unmet health need. They wanted more information about their health care options and access to primary care, dental, and vision benefits. Participants reported refraining from high-risk behaviors to avoid associated financial and legal burdens that might threaten their immigration status.
  
  
  CONCLUSIONS
  As the first study to describe DACA-eligible young adults' health needs, these data demonstrate their profound mental health challenges and numerous barriers to health care access. Many barriers were attributed to their undocumented status and persisted even when they gained temporary legal status. This work provides a foundation for evidence-based policy changes to address the health needs of this and other undocumented populations.
authors.affiliation: Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California. Electronic address: Marissa.Raymond-Flesch@ucsf.edu.
authors.forename: Marissa
authors.initials: M
authors.lastname: Raymond-Flesch
authors.affiliation: Joint Medical Program of the University of California Berkeley and the University of California San Francisco, Berkeley, California.
authors.forename: Rachel
authors.initials: R
authors.lastname: Siemons
authors.affiliation: Department of Health Services, University of California Los Angeles School of Public Health, Los Angeles, California.
authors.forename: Nadereh
authors.initials: N
authors.lastname: Pourat
authors.affiliation: Center for Labor Research and Education, University of California Berkeley, Berkeley, California.
authors.forename: Ken
authors.initials: K
authors.lastname: Jacobs
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, Department of Pediatrics, and Department of Obstetrics, Gynecology, and Reproductive Health, University of California San Francisco, San Francisco, California.
authors.forename: Claire D
authors.initials: CD
authors.lastname: Brindis
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D003144:Communication Barriers; D054242:Emigrants and Immigrants / Q000523:psychology*; D017144:Focus Groups; D015438:Health Behavior; D057220:Health Literacy; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D036301:Qualitative Research; D014481:United States
keywords: Health literacy; Health services accessibility; Immigrants; Immigration; Latino; Undocumented