Understanding Mis- and Disinformation About Health Care Access and Their Impacts on Decision-Making Among Latino Immigrants

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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.