SpringerLink
Log in

Order Keepers or Immigration Agents? Latine Immigrant Views of Law Enforcement in Healthcare Settings

  • Original Research: Qualitative Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Police and security presence in healthcare settings have grown. There are few studies exploring perceptions of these law enforcement agents among US Latine immigrants, who can be vulnerable to immigration enforcement actions due to past and ongoing criminalization and anti-immigrant policies.

Objective

To explore Latine immigrants’ perceptions of law enforcement in healthcare settings.

Design

Exploratory, semi-structured qualitative interviews asked participants about their perspectives of law enforcement in healthcare settings.

Participants

English- and Spanish-speaking adult patients (n = 19) from a Federally Qualified Health Center (FQHC) in Los Angeles, CA, serving predominantly low-income Latine immigrants.

Approach

We used the framework method for analysis to establish a codebook and inform our thematic interpretation.

Key Results

We identified three themes: (1) perceptions of safety offered by police officers are separated from the role of immigration officers; (2) perceptions of police officers are integrated into broader perceptions of the healthcare system; and (3) lived experiences, including immigration status, influenced valence response to officer uniforms and perceptions of officers. Most participants viewed police officers positively as maintaining order and safety, separating them from federal immigration enforcement actions, and reflecting on local, state, and organizational “sanctuary” or immigrant-friendly policies. Individuals with precarious immigration status more often saw officers as intimidating. Immigration enforcement remained a key concern.

Conclusions

Differentiating police and security roles from immigration enforcement in healthcare could improve Latine immigrant trust and access. Future studies should explore perspectives of Latine immigrants in localities without sanctuary laws or organizational immigrant-friendly policies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability:

The dataset analyzed during the current study is not publicly available due sensitivity of the data and populations. Researchers interested in access to the data may contact Dr. Altaf Saadi (asaadi@mgh.harvard.edu) who is able to field requests for use of this data on an individual basis.

References

  1. Gallen K, Sonnenberg J, Loughran C, et al. Health Effects of Policing in Hospitals: a Narrative Review. J Racial Ethn Health Disparities. 2023;10(2):870-882. https://doi.org/10.1007/s40615-022-01275-w

    Article  PubMed  Google Scholar 

  2. Schoenfisch AL, Pompeii LA. Security Personnel Practices and Policies in U.S. Hospitals: Findings From a National Survey. Workplace Health Saf. 2016;64(11):531-542. https://doi.org/10.1177/2165079916653971

    Article  PubMed  Google Scholar 

  3. Saadi A, Ray VE. Police Violence in Health Care Settings in US Media Coverage. JAMA Netw Open. 2023;6(11):e2342998. https://doi.org/10.1001/jamanetworkopen.2023.42998

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fatal police violence by race and state in the USA, 1980–2019: a network meta-regression. The Lancet. 2021;398(10307):1239-1255. https://doi.org/10.1016/S0140-6736(21)01609-3

  5. DeAngelis RT. Systemic Racism in Police Killings: New Evidence From the Map** Police Violence Database, 2013–2021. Race Justice. Published online October 19, 2021:21533687211047944. https://doi.org/10.1177/21533687211047943

  6. Diaz C, Nwadiuko J, Saadi A, Patler C. Advancing Research To Address The Health Impacts Of Structural Racism In US Immigration Prisons. Health Aff (Millwood). 2023;42(10):1448-1455. https://doi.org/10.1377/hlthaff.2023.00479

    Article  PubMed  PubMed Central  Google Scholar 

  7. Young MEDT, Tafolla S, Saadi A, Sudhinaraset M, Chen L, Pourat N. Beyond “Chilling Effects”: Latinx and Asian Immigrants’ Experiences With Enforcement and Barriers to Health Care. Med Care. 2023;61(5):306-313. https://doi.org/10.1097/MLR.0000000000001839

    Article  PubMed  Google Scholar 

  8. Young MEDT, Chen L, Sudhinaraset M, Saadi A, Kietzman KG, Wallace SP. Cumulative Experiences of Immigration Enforcement Policy and the Physical and Mental Health Outcomes of Asian and Latinx Immigrants in the United States. Int Migr Rev. 2023;57(4):1537-1568. https://doi.org/10.1177/01979183221126726

    Article  Google Scholar 

  9. Rodriguez RM, Torres JR, Sun J, et al. Declared impact of the US President’s statements and campaign statements on Latino populations’ perceptions of safety and emergency care access. PLOS ONE. 2019;14(10):e0222837. https://doi.org/10.1371/journal.pone.0222837

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Miranda AR, Perez-Brumer A, Charlton BM. Latino? Latinx? Latine? A Call for Inclusive Categories in Epidemiologic Research. Am J Epidemiol. 2023;192(12):1929-1932. https://doi.org/10.1093/aje/kwad149

    Article  PubMed  Google Scholar 

  11. Saadi A, Ahmed S, Katz MH. Making a Case for Sanctuary Hospitals. JAMA. 2017;318(21):2079-2080. https://doi.org/10.1001/jama.2017.15714

    Article  PubMed  Google Scholar 

  12. Valentín-Cortés M, Benavides Q, Bryce R, et al. Application of the Minority Stress Theory: Understanding the Mental Health of Undocumented Latinx Immigrants. Am J Community Psychol. 2020;66(3-4):325-336. https://doi.org/10.1002/ajcp.12455

    Article  PubMed  Google Scholar 

  13. Perreira KM, Pedroza JM. Policies of Exclusion: Implications for the Health of Immigrants and Their Children. Annu Rev Public Health. 2019;40(1):147-166. https://doi.org/10.1146/annurev-publhealth-040218-044115

    Article  PubMed  PubMed Central  Google Scholar 

  14. Young MEDT, Payan DD, Guzman-Ruiz IY. The structural impacts of enforcement policy on Latino immigrant health. Front Public Health. 2022;10:928435. https://doi.org/10.3389/fpubh.2022.928435

    Article  PubMed  PubMed Central  Google Scholar 

  15. Center PR. Most unauthorized immigrants live with family members. Pew Research Center’s Hispanic Trends Project. Published November 27, 2018. Accessed March 20, 2024. https://www.pewresearch.org/hispanic/2018/11/27/most-unauthorized-immigrants-live-with-family-members/

  16. Menjívar C. The Racialization of “Illegality.” Daedalus. 2021;150(2):91-105. https://doi.org/10.1162/daed_a_01848

    Article  PubMed  PubMed Central  Google Scholar 

  17. Heard-Garris N, Johnson TJ, Hardeman R. The Harmful Effects of Policing-From the Neighborhood to the Hospital. JAMA Pediatr. 2022;176(1):23-25. https://doi.org/10.1001/jamapediatrics.2021.2936

    Article  PubMed  Google Scholar 

  18. Franco-Vásquez A, Lemus S, Castillo K, Isaac M, Saadi A. Integration of Waiting Room “Know Your Rights” Education into Medical Care of Immigrant Patients in a Federally Qualified Health Center: A Case Study. Health Equity. 2022;6(1):13-20. https://doi.org/10.1089/heq.2020.0145

    Article  PubMed  PubMed Central  Google Scholar 

  19. Budiman A. Key findings about U.S. immigrants. Pew Research Center. Published August 20, 2020. Accessed May 5, 2022. https://www.pewresearch.org/fact-tank/2020/08/20/key-findings-about-u-s-immigrants/

  20. Saadi A, Molina US, Franco-Vasquez A, Inkelas M, Ryan GW. Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States: A Qualitative Study. JAMA Netw Open. 2020;3(4):e203028-e203028. https://doi.org/10.1001/jamanetworkopen.2020.3028

    Article  PubMed  PubMed Central  Google Scholar 

  21. Saadi A, Sanchez Molina U, Franco-Vasquez A, Inkelas M, Ryan GW. Barriers and Facilitators to Implementation of Health System Interventions Aiming to Welcome and Protect Immigrant Patients: a Qualitative Study. J Gen Intern Med. Published online May 13, 2021. https://doi.org/10.1007/s11606-021-06788-4

  22. Knowles M, Crowley AP, Vasan A, Kangovi S. Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States. Annu Rev Public Health. 2023;44:363-381. https://doi.org/10.1146/annurev-publhealth-071521-031648

    Article  PubMed  Google Scholar 

  23. Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990;67(3 Pt 2):1091-1100. https://doi.org/10.2466/pr0.1990.67.3f.1091

    Article  CAS  PubMed  Google Scholar 

  24. Rose A, Peters N, Shea JA, Armstrong K. Development and testing of the health care system distrust scale. J Gen Intern Med. 2004;19(1):57-63. https://doi.org/10.1111/j.1525-1497.2004.21146.x

    Article  PubMed  PubMed Central  Google Scholar 

  25. Thompson HS, Valdimarsdottir HB, Winkel G, Jandorf L, Redd W. The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening. Prev Med. 2004;38(2):209-218. https://doi.org/10.1016/j.ypmed.2003.09.041

    Article  PubMed  Google Scholar 

  26. Corral ÁJ. Allies, Antagonists, or Ambivalent? Exploring Latino Attitudes about the Black Lives Matter Movement. Hisp J Behav Sci. 2020;42(4):431-454. https://doi.org/10.1177/0739986320949540

    Article  Google Scholar 

  27. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):117. https://doi.org/10.1186/1471-2288-13-117

    Article  PubMed  PubMed Central  Google Scholar 

  28. Alwan RM, Kaki DA, Hsia RY. Barriers and Facilitators to Accessing Health Services for People Without Documentation Status in an Anti-Immigrant Era: A Socioecological Model. Health Equity. 2021;5(1):448-456. https://doi.org/10.1089/heq.2020.0138

    Article  PubMed  PubMed Central  Google Scholar 

  29. Martínez-Schuldt RD, Martínez DE. Immigrant Sanctuary Policies and Crime-Reporting Behavior: A Multilevel Analysis of Reports of Crime Victimization to Law Enforcement, 1980 to 2004. Am Sociol Rev. 2021;86(1):154-185. https://doi.org/10.1177/0003122420978406

    Article  Google Scholar 

  30. Wong TK, Kang SD, Valdivia C, Espino J, Gonzalez M, Peralta E. How Interior Immigration Enforcement Affects Trust in Law Enforcement. Perspect Polit. 2021;19(2):357-370. https://doi.org/10.1017/S1537592719003943

    Article  Google Scholar 

  31. Saadi A, Cheffers ML, Taira B, et al. Building Immigration-Informed, Cross-Sector Coalitions: Findings from the Los Angeles County Health Equity for Immigrants Summit. Health Equity. 2019;3(1):431-435. https://doi.org/10.1089/heq.2019.0048

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kimball S, Maju M, Singh N, Sonis L. Embedding an Immigration Legal Navigator in a Primary Care Clinic. Ann Fam Med. 2019;17(2):177-177. https://doi.org/10.1370/afm.2360

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kim G, Molina US, Saadi A. Should Immigration Status Information Be Included in a Patient’s Health Record? AMA J Ethics. 2019;21(1):8-16. https://doi.org/10.1001/amajethics.2019.8.

    Article  Google Scholar 

  34. Kuczewski MG, Mejias-Beck J, Blair A. Good Sanctuary Doctoring for Undocumented Patients. AMA J Ethics. 2019;1(21):E78-85.

    Google Scholar 

  35. Byhoff E, Marchis EHD, Gottlieb L, Halperin-Goldstein S, Nokes K, LeClair AM. Screening for Immigration-Related Health Concerns in a Federally Qualified Health Center Serving a Diverse Latinx Community: A Mixed Methods Study. J Immigr Minor Health. Published online 2020. https://doi.org/10.1007/s10903-020-01005-6

    Article  Google Scholar 

  36. Alang S, McAlpine D, McCreedy E, Hardeman R. Police Brutality and Black Health: Setting the Agenda for Public Health Scholars. Am J Public Health. 2017;107(5):662-665. https://doi.org/10.2105/AJPH.2017.303691

    Article  PubMed  PubMed Central  Google Scholar 

  37. Alang S. Police Brutality and the Institutional Patterning of Stressors. Am J Public Health. 2020;110(11):1597-1598. https://doi.org/10.2105/AJPH.2020.305937

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lim H, Bontcheva-Loyaga N. Perceptions of the U.S. Police Among Latin-American Immigrants: A Bifocal Lens View. Race Justice. Published online October 9, 2022:21533687221130276.https://doi.org/10.1177/21533687221130277

  39. Wilson I, Antin TMJ, Hunt G. “Some are good, some are bad”: Perceptions of the Police from Black and Latina Women Living in the San Francisco Bay Area. Women Crim Justice. 2021;31(5):360-375. https://doi.org/10.1080/08974454.2020.1741489

    Article  PubMed  Google Scholar 

  40. Rafei L. This Deceptive ICE Tactic Violates the Fourth Amendment | ACLU. American Civil Liberties Union. Published April 12, 2023. Accessed March 18, 2024. https://www.aclu.org/news/immigrants-rights/this-deceptive-ice-tactic-violates-the-fourth-amendment

  41. Immigration Officers Could Be Banned from Wearing “Police” On Uniforms Under a Proposed Bill. Annenberg Media. Published April 10, 2017. Accessed March 18, 2024. https://www.uscannenbergmedia.com/2017/04/10/immigration-officers-could-be-banned-from-wearing-police-on-uniforms-under-a-proposed-bill/

  42. Eisenman DP, Gelberg L, Liu H, Shapiro MF. Mental Health and Health-Related Quality of Life Among Adult Latino Primary Care Patients Living in the United States With Previous Exposure to Political Violence. JAMA. 2003;290(5):627-634. https://doi.org/10.1001/jama.290.5.627

    Article  PubMed  Google Scholar 

Download references

Acknowledgements:

The authors would like to thank Stephanie Lemus, formerly Clínica Romero’s director of public policy and community affairs at the time of study recruitment, for her partnership; and attorney Jessica Vosburgh, for her input on an earlier version of the manuscript pertaining to legal expertise on immigration enforcement.

Funding

AS would like to thank Physicians for Human Rights for a seed grant that supported the parent project of this study, as well as institutional funds. Altaf Saadi is supported in part by grant number K23NS128164 from the National Institute of Neurological Disorders and Stroke.

Author information

Authors and Affiliations

  1. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Sara A. Snyder PsyD, MPH, MA, Margarita G. Velasco MA & Altaf Saadi MD, MSc

  2. Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA

    Sara A. Snyder PsyD, MPH, MA

  3. Departments of Biostatistics, Epidemiology, and Global Health, Boston University School of Public Health, Boston, MA, USA

    Krystal E. Kuan BHSN

Authors
  1. Sara A. Snyder PsyD, MPH, MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Krystal E. Kuan BHSN
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margarita G. Velasco MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Altaf Saadi MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Altaf Saadi MD, MSc.

Ethics declarations

Conflict of Interest:

The authors declare that they do not have a conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Prior presentations: None

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 17 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Snyder, S.A., Kuan, K.E., Velasco, M.G. et al. Order Keepers or Immigration Agents? Latine Immigrant Views of Law Enforcement in Healthcare Settings. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08767-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11606-024-08767-x

KEY WORDS

Search

Navigation