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

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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.