U.S. immigrants have faced a changing landscape with regard to immigration enforcement over the last two decades After the passage of the Illegal Immigration Reform and Immigrant Responsibility Act (IRRIRA) of 1996, detention of illegal immigrants increased and the categories for persons subject to detention expanded along with the types of crimes for which noncitizens could be deported (Miller, 2005
). With the creation of Immigration and Customs Enforcement (ICE), a new division within the Department of Homeland Security, following the attacks of September 2011, the growth of detention and deportation activities accelerated (U.S. Immigration and Customs Enforcement, 2009
). Now, with the advent of section 287(g) agreements which allow local police officers to carry out enforcement of federal immigration law ( Rodriguez, Chishti, Capps, & St. John, 2010
) even longtime documented immigrants are being targeted for deportation for minor offenses ( Miller, 2005
Simultaneously, there has been a progressive shift in responsibility for immigration policy and enforcement from the federal government to states and locales (Fix & Tumlin, 1997
; Suarez-Orozco & Suarez-Orozco, 2009
). Communities where immigrant populations are most concentrated are struggling to address the strains associated with the influx of diverse and, at times, undocumented populations. Local institutions, including police departments, schools, and health systems, are developing their own de-facto policies to accommodate these new populations (Steinberg, 2008
). At times, these local policies directly conflict with federal ICE mandates. For example, the 2007 ICE raids in New Haven, CT occurred within days of the city adopting a “resident identification card” that allowed documented and undocumented immigrants to open bank accounts and use other municipal services (www.Eyewitness News 3, 2007
The contextual factors present in receiving communities greatly influence the assimilation patterns of new immigrants. According to segmented assimilation theory, immigrants follow divergent assimilation paths based in part on the characteristics of the host community (Portes, Fernandez-Kelly, & W., 2005
; Portes & Rumbaut, 2006
; Zhou, 1997
). Community context includes socio-economic conditions and governmental policies which may support or impede assimilation including discrimination, bifurcated labor markets, poverty and crime (Portes et al., 2005
; Xie & Greenman, 2005
). Immigration enforcement policies related to detention and health care access are important contextual factors influencing the integration process. For example, the negative effect of detention and temporary status on the mental health of asylum seekers has been well documented in Australia, Japan, and Europe (Ichikawa, Nakahara, & Wakai, 2006
; Keller, Rosenfeld, Trinh-Shevrin, Meserve, Sachs, Leviss et al., 2003
; Silove, Steel, & Mollica, 2001
). Sequelae of policies that limit immigrants access to health care have been documented in Germany, Spain and Canada among others (Castaneda, 2009
; Magalhaes, Carrasco, & Gastaldo, 2010
; Torres & Sanz, 2000
The daily threat of discovery and deportation is likely to create fear and emotional distress for both documented and undocumented immigrants, thus impeding integration (K. E. Miller & Rasmussen, 2010
; Silove et al., 2001
; Steinberg, 2008
). So too, the loss of loved ones who are detained or deported may create unexpected economic challenges and new responsibilities for children left behind (Chaudry, Capps, Pedroza, Castaneda, Santos, & Scott, 2010
). According to Viruell-Fuentes (2007)
, immigrants’ experience of stigmatization translates to stress, isolation, and marginalization. This may lead to depression and anxiety, as well as lack of personal empowerment and self-advocacy (Viruell-Fuentes, 2007
). Thus, this chronic fear may have a deep negative impact on integration as well as health outcomes.
In the U.S., the effects of ICE activity on immigrant stress levels and health status have only recently been examined (Capps, Castañeda, Chaudry, & Santos, 2007
; Massachusetts Immigrant and Refugee Advocacy Coalition, 2010
; Steinberg, 2008
). Studies on the impact of Proposition 187, a 1994 California state ballot initiative which prevented undocumented immigrants from accessing publicly funded health care, found that immigrants feared obtaining medical care and delayed or discontinued care as a result (Asch, Leake, Anderson, & Gelberg, 1998
; Asch, Leake, & Gelberg, 1994
; Berk & Schur, 2001
; Fenton, Catalano, & Hargreaves, 1996
). Deportation fear has also been associated with poorer self-perceived health, and activity limitation following ICE raids (Cavazos-Rehg, Zayas, & Spitznagel, 2007
; Steinberg, 2008
In the last fifteen years, Massachusetts cities have become home to increasing numbers of immigrant residents. In 2007, over 14% percent of Massachusetts residents were immigrants (Clayton-Mathews, Karp, & Watanabe, 2009
). Everett, Massachusetts, with a population of 38,037, is an exampleof a city that has experienced rapid diversification, with immigrants predominantly coming from Haiti, Central America, Brazil and North Africa (U.S. Census Bureau, 2010
). Today, Everett hosts the fourth largest concentration of immigrants in the state (34.8%) (Clayton-Mathews et al., 2009
; U.S. Census Bureau, 2010
Rising concerns about the impact of ICE activities on immigrant health emerged in 2009 as Everett community members reported immigrants missing health appointments due to their fear of being stopped en route by ICE or local police and deported. This concern was validated with a brief questionnaire of local health providers. As a result, members of the Everett community representing local organizations, churches and immigrant led advocacy groups approached researchers at the Institute for Community Health to examine this issue in depth using a community-based participatory research (CBPR) approach.
The goal of this CBPR project was to determine whether increased ICE activity was affecting the health and health care of immigrants in Everett. Specifically, the project sought to: 1) Learn more about the impact of ICE activities on immigrant health through a series of focus groups with a diverse population of immigrants, and 2) Develop a set of recommendations for community action. The data described herein provide insight into the concerns and fears of immigrants and the factors contributing to them. The analysis of these perspectives provides information that can be used to inform local policies here and abroad in communities that are experiencing rapid diversification through immigration.
As a community, Everett has attempted to integrate newly arriving immigrants into the fabric of the city. The Multicultural Affairs Commission (MAC) was created in 2005 and included immigrant and non-immigrant members. MAC efforts included: monthly Everett Dialogues with immigrants and city leaders, community forums to assess and improve immigrant access to health care services, a “Welcome To Everett” guide on city services and regulations for all newcomers to Everett and other projects including a youth/elder oral history project that paired recently arrived immigrant youth with older long term residents. Such channels of communication also allowed immigrant communities to voice their concerns about ICE activities in Everett.
Six Everett community agencies, many members of the MAC, who had been actively involved in addressing immigrant issues in Everett, were involved in the research project: the Joint Committee for Children’s Health Care in Everett (JCCHCE), the Everett Literacy Program, the Muslim American Civic and Cultural Association (MACCA), Immaculate Conception and St. Anthony’s Catholic churches, La Comunidad, Inc., and the Everett police department. The JCCHCE focuses its efforts on improving access to health care and is actively involved in enrollment in both insurance and in the state Health Care Safety Net program (“Health Safety Net-HSN (Free Care): An Overview,” 2010
). The two Catholic churches’ congregations include large numbers of Haitians and Brazilians. La Comunidad and MACCA are emerging immigrant service organizations focused on Latinos and the Arab and Muslim population respectively and both are led by immigrants. The Everett Literacy Program provides the majority of English Second Language courses in Everett. Representatives from these groups had extensive experience in coalition building, community organizing, and addressing immigrant concerns. Representatives also participated from the Everett Community Health Partnership; a collaborative of the Cambridge Health Alliance, the Everett Police Department, the Everett Public Schools and the City of Everett.
Research support included scientists from the Institute for Community Health, health care providers from the Cambridge Health Alliance, and researchers from the Harvard School of Public Health and Tufts Medical School. They contributed diverse expertise in clinical issues, qualitative and quantitative methods, CBPR, immigrant health, and demography.