title: The impact of local immigration enforcement policies on the health of immigrant hispanics/latinos in the United States.
abstract: OBJECTIVE
  We sought to understand how local immigration enforcement policies affect the utilization of health services among immigrant Hispanics/Latinos in North Carolina.
  
  
  METHODS
  In 2012, we analyzed vital records data to determine whether local implementation of section 287(g) of the Immigration and Nationality Act and the Secure Communities program, which authorizes local law enforcement agencies to enforce federal immigration laws, affected the prenatal care utilization of Hispanics/Latinas. We also conducted 6 focus groups and 17 interviews with Hispanic/Latino persons across North Carolina to explore the impact of immigration policies on their utilization of health services.
  
  
  RESULTS
  We found no significant differences in utilization of prenatal care before and after implementation of section 287(g), but we did find that, in individual-level analysis, Hispanic/Latina mothers sought prenatal care later and had inadequate care when compared with non-Hispanic/Latina mothers. Participants reported profound mistrust of health services, avoiding health services, and sacrificing their health and the health of their family members.
  
  
  CONCLUSIONS
  Fear of immigration enforcement policies is generalized across counties. Interventions are needed to increase immigrant Hispanics/Latinos' understanding of their rights and eligibility to utilize health services. Policy-level initiatives are also needed (e.g., driver's licenses) to help undocumented persons access and utilize these services.
authors.affiliation: Scott D. Rhodes, Lilli Mann, Eunyoung Song, Jorge Alonzo, Mario Downs, and Christina J. Sun are with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC. Florence M. Simán is with El Pueblo, Inc., Raleigh, NC. Emma Lawlor is with the School of Geography and Development, University of Arizona, Tucson. Omar Martinez is with the HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY. Mary Claire O'Brien is with the Department of Emergency Medicine, Wake Forest School of Medicine. Beth A. Reboussin is with the Department of Biostatistical Sciences, Wake Forest School of Medicine. Mark A. Hall is with Wake Forest University School of Law.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Rhodes
authors.forename: Lilli
authors.initials: L
authors.lastname: Mann
authors.forename: Florence M
authors.initials: FM
authors.lastname: Simán
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Song
authors.forename: Jorge
authors.initials: J
authors.lastname: Alonzo
authors.forename: Mario
authors.initials: M
authors.lastname: Downs
authors.forename: Emma
authors.initials: E
authors.lastname: Lawlor
authors.forename: Omar
authors.initials: O
authors.lastname: Martinez
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Sun
authors.forename: Mary Claire
authors.initials: MC
authors.lastname: O'Brien
authors.forename: Beth A
authors.initials: BA
authors.lastname: Reboussin
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054242:Emigrants and Immigrants / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D004641:Emigration and Immigration / Q000331:legislation & jurisprudence; D017144:Focus Groups; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006630:Hispanic or Latino / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D035846:Law Enforcement; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011295:Prenatal Care / Q000706:statistics & numerical data; D011640:Public Policy; D014481:United States / Q000453:epidemiology; D055815:Young Adult