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.
