Elsevier

Journal of Adolescent Health

Volume 55, Issue 3, September 2014, Pages 323-328
Journal of Adolescent Health

Original article
“There Is No Help Out There and If There Is, It's Really Hard to Find”: A Qualitative Study of the Health Concerns and Health Care Access of Latino “DREAMers”

https://doi.org/10.1016/j.jadohealth.2014.05.012Get rights and content

Abstract

Purpose

Young immigrants without documentation who qualify for the Deferred Action for Childhood Arrivals (DACA) program are eligible for temporary legal status but excluded from the Affordable Care Act's Medicaid expansion and Health Care Exchanges. Little is known about this population's health or access to care.

Methods

Sixty-one DACA-eligible Latinos aged 18–31 years were recruited from community and Internet settings to participate in nine focus groups in California. An advisory board of immigration and health advocates assisted in the project's design and validation of results.

Results

Participants reported avoiding the health care system whenever possible, first turning to family members and unlicensed community healers, then seeking safety net providers if necessary. Barriers to care included cost, limited intergenerational knowledge about the health care system, lack of a driver's license, and mistrust of providers due to fear of discrimination and deportation. Mental health care was the greatest unmet health need. They wanted more information about their health care options and access to primary care, dental, and vision benefits. Participants reported refraining from high-risk behaviors to avoid associated financial and legal burdens that might threaten their immigration status.

Conclusions

As the first study to describe DACA-eligible young adults' health needs, these data demonstrate their profound mental health challenges and numerous barriers to health care access. Many barriers were attributed to their undocumented status and persisted even when they gained temporary legal status. This work provides a foundation for evidence-based policy changes to address the health needs of this and other undocumented populations.

Section snippets

Methods

An interdisciplinary research team from the University of California conducted a qualitative study utilizing community-based participatory methods [17], engaging a 10-member advisory board of immigration advocates and health policy stakeholders in study design, implementation, and validation of results. All procedures were approved by the University of California San Francisco Institutional Review Board.

Recruitment of this elusive population was guided by the advisory board and conducted by

Results

The 61 focus group participants were 18–31 years old. Fifty-nine percent were females, and 87% were from Mexico (Table 2). Participants identified barriers to care and described the ways in which they attempted to seek care despite their limited insurance and health care options. They also identified a variety of health care needs, ranging from mental health problems related to their immigration history and undocumented status to difficulty accessing primary and specialty care due to their

Discussion

This study is the first to describe the health concerns and barriers to care for DACA-eligible young adults. In general, young adults have lower health care utilization and higher rates of certain negative health outcomes, such as sexually transmitted diseases and unintentional injury, than adolescents and older adults in the US [6]. This study indicates that for DACA-eligible young adults, many of whom have experienced trauma and long-term stress associated with their undocumented status,

Acknowledgments

The authors thank the following people for their contributions for this project: Laurel Lucia, M.P.P. (UC Berkeley Center for Labor Research and Education), Efrain Talamantes, M.D., M.B.A. (UCLA Center for Health Policy Research), and Max Hadler, M.P.H., M.A. (UCLA Center for Health Policy Research), our interns Arlette Lozano and Kathy Latthivongskorn, our advisory board members, the community-based organizations that assisted with focus groups, and the many participants who shared their

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    Conflicts of Interest: The authors have no conflicts of interest to disclose.

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