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.
