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

项目摘要/摘要 移民有4500万人，约占美国人口的14%。其中 移民，1050万是非法移民，其中80%是拉丁裔。加利福尼亚州，世界上最大的 建议研究，有1100万移民，占全国移民总数的四分之一。加利福尼亚州也 拥有最多的非法移民人口，有230万，占该州移民总数的22%。 与美国整体情况类似，加州的大多数移民是拉丁裔，71%的非法移民是拉丁裔 墨西哥出生的。有一致的证据表明，拉美裔人在获得和使用卫生保健方面的模式最差 与任何其他种族或民族相比，这些不平等对拉美裔移民来说更加严重， 尤其是对非法移民来说。即使安全网计划被设计为增加对 关心移民，他们并不总是以最佳方式让他们参与进来。在加利福尼亚州，最近的州政策已经 允许26岁以下和49岁以上符合收入条件的无证移民登记 在其医疗补助计划中。然而，最近的研究表明，即使符合条件，许多人也没有注册 因为他们害怕被驱逐出境或不信任政府。这种恐惧和不信任在2019年加剧 当特朗普政府改变了“公共指控”规则的定义时，该规则允许否认 移民依赖或可能依赖公共福利的签证或永久居留权 包括医疗补助。加利福尼亚州约有193,000名符合条件的无证拉美裔移民没有登记 由于这一变化，即使在拜登政府在2021年推翻了这一定义之后，医疗补助计划也是如此。这 这项研究将提供一个独特的机会来了解拉丁裔中错误和虚假信息的原因 移民及其相关的“寒蝉效应”，这是对行使公共利益权利的威慑， 包括参加医疗补助和寻求医疗保健，因为政府的法律或行动。当前 对拉美裔移民产生寒蝉效应的原因的了解大多是轶事，仅限于框定。 在不知道连接错误和虚假信息和 令人不寒而栗。我们设计了一个多方法、多层次的研究来确定沟通是如何进行的 访问、评估、解释、传播和操作，以及这些内容如何随文档和 拉丁裔的公民身份。这项研究将使用组织和社区的关键线人访谈 领袖，在2025年和2026年加州健康访谈调查中对1100名拉丁裔成年人进行的跟踪研究 (CHIS)和对社交媒体数据的机器学习分析。使用NIMHD研究的改编版本 关于通信基础设施作为健康的社会决定因素的框架和新出现的研究，这 研究将提供关于错误和虚假信息的新证据，并产生可用于 为政策和计划提供信息，以减少拉美裔移民在医疗保健方面的不平等。

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.