India Ornelas from the University of Washington School of Public Health has been analyzing and studying the effect United States legal status has on the mental health of undocumented Latinx immigrants and is now looking at how COVID-19 is impacting them.

“Our society and economy rely on this population, from agriculture to caregiving,” said Ornelas, who is an associate professor in the Department of Health Services where she teaches in the department’s MPH program. “Although we rely on them, they don’t have the same access to health and social services because of their legal status.”

In a recent publication, Ornelas analyzed multiple studies around undocumented Latinx immigrants in this country, establishing the significant influence migration and legal status have on the population’s mental health and risk for communicable diseases like HIV. While Ornelas was able to find several studies that included data about legal status, she was surprised by the limited number.

“I think, in the past, researchers might have been afraid to collect this data because they feared people wouldn’t want to participate in the study or collecting this data could be harmful,” she said. 

That doesn’t have to be the case, as Ornelas points out in her publication. Researchers can and should ask questions around legal status in ways that protect participants, respect their confidentiality and build trust through community-based organizations that work with undocumented Latinx community members.

“They want their stories to be told,” Ornelas said. “Some have even said we can’t really understand the full picture of their health without understanding the barriers that legal status creates for them.”

Ornelas has heard this firsthand from community members in Seattle and King County, Washington, where she is testing a program — Amigas Latinas Motivando el Alma (ALMA) — aimed at helping improve access to mental health services and reducing stress for Latina immigrants. The program name translates to “Latina Friends Motivating the Soul.” The intervention trial is in its third year of the five-year study, which is funded by the National Institutes of Health. Ornelas credits the community partnerships she and the research team have fostered to make the study possible.

“Community engagement is essential, and it’s important to work with community partners to build trust and collect data around legal status,” she said. “Community-based organizations can give me, and other researchers, advice on how best to ask questions around legal status. They also provide proxy trust within communities. For example, if we conduct community surveys at those partnering organizations, people are going to feel more comfortable.”

Ornelas also noted that researchers can give participants the option to not answer questions when they don’t feel comfortable.

These lessons and partnerships will be key to Ornelas’ continued work in better understanding the health of Latinx immigrants.

UW recently awarded her a rapid-response Population Health Initiative grant for a four-month project to study the impact COVID-19 is having on this population in King County. Ornelas will reach out to participants from the ALMA program and ask them how the disease is impacting them and members of their household. She knows that communities of color across the country are facing higher rates of death and negative health outcomes because of the virus. Hispanic people in King County have died from COVID-19 at a rate nearly two-and-a-half times higher than that of white, non-Hispanic people, as reported by the Seattle Times. And it’s not just King County that is facing this issue. The New York Times recently reported coronavirus was twice as deadly for Black and Latinx people than white, non-Hispanic community members in New York City.

Understanding the impact coronavirus has along legal status, racial and ethnic lines will help public health professionals support healthier communities. But first, the right questions have to be asked and the data has to be collected.

“We want to encourage more researchers to look at questions around legal status,” Ornelas said. “We need this data if we want to help improve health outcomes for everyone in our community.”