The Impact of Multiple Levels of Immigrant Policy on Rural Latino Mental Health and Health Care Access

项目摘要/摘要 城乡之间持续存在心理健康和医疗保健服务的获取差距 社区。在农村社区，在外国和美国出生的拉丁裔经历了更糟糕的精神状况 健康和获得保健的机会比农村白人或城市拉美裔人更多。而社会决定因素 农村健康一直被认为是健康的一个主要潜在原因，但存在着有限的 改善心理的结构性因素和社区因素的调查和数据 拉丁美洲农村人获得保健和保健的机会。拟议研究的首要目标是 调查心理健康和卫生保健服务可获得性与移民之间的关系 通过对农村地区的拉美裔美国人的政策进行多层次的横断面研究 政策背景、社会气候和拉美裔人与 落实政策。本研究的具体目的是：1)调查排他性政策的影响 关于农村拉丁裔心理健康和保健机会的县政策背景和社会气候； 2)调查农村拉美裔遇到排他性移民政策对他们的影响 心理健康和保健服务的可获得性；以及3)调查县政策在多大程度上 背景、社会气候和政策接触共同影响拉美裔农村人的心理健康和 医疗保健服务。为实现这些目标，我们将首先收集县级地方政策数据 并将实施分层回归模型来测试其 与心理健康和卫生保健获取的关系，协变量净值。我们还将进行 一项以人口为基础的调查，对象是加利福尼亚州和美国农村县在外国和美国出生的拉美裔美国人 亚利桑那州。我们将使用调查数据来构建受访者排外程度的衡量标准 遇到策略，并将实施分层回归模型以测试其 与心理健康和医疗保健服务相关。最后，我们将对 县级政策背景、社会环境、政策接触和政策行为之间的相关性 调停和缓和测试，以评估他们的关系如何有助于心理健康 和医疗保健服务。这项研究的多层次方法将有助于了解 影响拉丁裔和移民健康的机制。这项研究将产生新的数据来 在农村社区宣传卫生政策和以拉丁裔为重点的干预措施，旨在促进 精神健康和增加获得保健和安全网服务的机会。

Project Summary/Abstract There are persistent mental health and health care access disparities between rural and urban communities. Within rural communities, foreign- and US- born Latinos experience worse mental health and access to care than rural Whites or urban Latinos. While the social determinants of rural health have been recognized as a major underlying cause of health, there is limited investigation of and data on the structural and community factors specific to improving mental health and health care access of rural Latinos. The overarching goal of the proposed study is to investigate the association between mental health and health care access and immigrant policies among Latinos in rural regions by conducting a multilevel, cross-sectional study of the impact of policy contexts, social climates, and Latinos’ direct encounters with institutions that implement policy. The specific aims of this study are to: 1) investigate the impact of exclusionary county policy contexts and social climates on rural Latino mental health and health care access; 2) investigate the impact of rural Latinos’ encounters with exclusionary immigrant policy on their mental health and health care access; and 3) investigate the extent to which county policy contexts, social climates, and policy encounters jointly influence rural Latino mental health and health care access. To achieve these aims we will, first, collect county-level data on local policy contexts and social climates and will implement hierarchical regression models to test their associations with mental health and health care access, net of covariates. We will also conduct a population-based survey of foreign- and US-born Latinos in rural counties in California and Arizona. We will use survey data to construct a measure of respondents’ level of exclusionary encounters with policies and will implement hierarchical regression models to test their association with mental health and health care access. Finally, we will conduct analyses of the correlations between county policy contexts, social climates, and policy encounters and conduct tests of mediation and moderation to assess how their relationships contribute to mental health and health care access. The study’s multi-level approach will contribute to knowledge on the mechanisms that influence Latino and immigrant health. The study will produce new data to inform health policy and Latino-focused interventions in rural communities aimed at promoting mental health and increasing access to health care and safety net services.