Fear of Discovery Among Latino Immigrants Presenting to the Emergency Department
Fear of Discovery Among Latino Immigrants Presenting to the Emergency Department
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DOI：
10.1111/acem.12079
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发表时间：
2013-02-01
影响因子：
4.4
通讯作者：
Lovato, Luis M.
中科院分区：
文献类型：
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作者：
Maldonado, Cynthia Z.;Rodriguez, Robert M.;Lovato, Luis M.
最近立法要求报告无证移民的情况，这可能会使他们在接受急诊科服务时产生被发现的恐惧。本研究的目的是：1)表征无证拉丁裔移民（UDLI）对医疗工作者在ED中报告（或不报告）非法移民的知识和信念，2)确定UDLI在ED中是否害怕被发现，以及3)确定这种恐惧的性质和来源。方法本研究是2009年11月至2010年8月在加州两个县急诊室进行的UDLI和两个对照组的横断面研究。作者访问了成人UDLI，拉丁裔合法居民（LLR）和非拉丁裔合法居民（NLLR）的方便样本，使用结构化工具以他们的母语。主要的结果是UDLI害怕被发现以及这种恐惧的来源。结果在1224例患者中，1007例（82.3%）接受了访谈：314例UDLI， 373例LLR， 320例NLLR。年龄中位数为43岁（四分位数间距[IQR]=31 ~ 55岁），51%为男性。UDLIs不太可能说英语(14%,95%置信区间[CI] = 10%到18%),拥有医疗保险(39%,95%置信区间32%到44%),或有一个常规的初级保健提供者(卡式肺囊虫肺炎;39%,95% CI = 34%到45%),而LLR(英语56%、95% CI = 51%到61%;医疗保险50%,95% CI = 45%到55%;定期卡式肺囊虫肺炎51%,95% CI = 46%到57%)和NLLR(英语95%、95% CI = 92%到97%;医疗保险49%,95% CI = 43%到54%;定期卡式肺囊虫肺炎51%,95% CI = 45%到56%)。16%的UDLI表示护士和医生对待无证移民患者与对待公民不同，41% （95% CI=29%至54%）报告工作人员对UDLI的尊重较少。32%的UDLI听说过187号提案，13%的人相信医院工作人员向移民局报告了UDLI， 9%的人说他们被问及他们的公民身份。12% （95% CI=9%至16%）的UDLI患者表示害怕因为被发现而去医院，其中42% （95% CI=28%至58%）的患者认为是与朋友/家人的讨论，32% （95% CI=19%至47%）的患者认为是媒体，16% （95% CI=7%至30%）的患者认为两者都是恐惧的来源。向急诊科提出的UDLI中，有八分之一的人表示害怕被发现并因此被驱逐出境。认为医务人员报告UDLI和最近移民是造成这种恐惧的危险因素。家庭、朋友和媒体是这些担忧的主要来源。学术急诊医学2013；20:15 -161 (C) 2013，由学术急诊医学学会
Objectives Recent legislation mandating reporting of undocumented immigrants may instill fear of discovery when they access emergency department (ED) services. The objectives of this study were to: 1) characterize the knowledge and beliefs of undocumented Latino immigrants (UDLI) about health care workers' reporting (or nonreporting) of illegal immigrants in the ED, 2) determine whether UDLI fear discovery when presenting to the ED, and 3) determine the nature and sources of this fear.Methods This was a cross-sectional study of UDLI and two comparison groups conducted in two California county EDs, from November 2009 to August 2010. The authors interviewed a convenience sample of adult UDLI, Latino legal residents (LLR), and non-Latino legal residents (NLLR) using a structured instrument in their native language. The main outcome was fear of discovery among UDLI and the sources of that fear.Results Of 1,224 patients approached, 1,007 (82.3%) were interviewed: 314 UDLI, 373 LLR, and 320 NLLR. The median age was 43years (interquartile range [IQR]=31 to 55years), and 51% were male. UDLIs were less likely to speak English (14%, 95% confidence interval [CI]=10% to 18%), have health insurance (39%, 95% CI 32% to 44%), or have a regular primary care provider (PCP; 39%, 95% CI=34% to 45%), compared to LLR (English 56%, 95% CI=51% to 61%; health insurance 50%, 95% CI=45% to 55%; regular PCP 51%, 95%=CI 46% to 57%) and NLLR (English 95%, 95% CI=92% to 97%; health insurance 49%, 95% CI=43% to 54%; regular PCP 51%, 95% CI=45% to 56%). Of the 16% of UDLI who stated that nurses and doctors treat undocumented immigrant patients differently than citizens, 41% (95% CI=29% to 54%) reported less respect given to UDLI by staff. Thirty-two percent of UDLI had heard of Proposition 187, 13% believed hospital staff reported UDLI to immigration authorities, and 9% said they were asked about their citizenship status. Fear of coming to the hospital because of discovery was expressed by 12% (95% CI=9% to 16%) of UDLI, with 42% (95% CI=28% to 58%) citing discussions with friends/family, 32% (95% CI=19% to 47%) citing media and 16% (95% CI=7% to 30%) citing both as sources of this fear.Conclusions One in eight of UDLI presenting to the ED express fear of discovery and consequent deportation. Belief that medical staff report UDLI and recent immigration are risk factors for this fear. Family, friends, and media are the primary sources of these concerns. ACADEMIC EMERGENCY MEDICINE 2013; 20:155-161 (C) 2013 by the Society for Academic Emergency Medicine