Impact of Anti-Immigrant Rhetoric and Policies on Perceived Safety and Emergency Department Utilization

Prior research demonstrated that 2016 anti-immigrant presidential campaign rhetoric induced fear and delayed emergency care among Latino populations. Anti-immigrant rhetoric escalated during the 2024 campaign, followed by sweeping anti-immigrant executive orders and policies in 2025. We sought to assess how these anti-immigrant statements and policies have affected perceptions and emergency department (ED) utilization among Latino populations.

We conducted a cross-sectional survey of adult patients at three EDs in California and Texas from June-December 2025. Eligible patients spoke English or Spanish and were excluded for major trauma, critical illness, altered mental status, temporary visitor status, incarceration, or psychiatric hold. We adapted a 2016 survey instrument assessing demographics, knowledge, and perceptions of anti-immigrant rhetoric and policies. Outcomes included awareness of anti-immigrant rhetoric and policies, perceived likelihood of policies being implemented, feelings of safety and fear, and delays in seeking emergency care. We compared outcomes across three groups—Spanish-speaking Latino (SL), English-speaking Latino (EL), and English-speaking non-Latino (ENL) participants—to determine whether perceptions varied by language and ethnicity.

Of 319 participants, 40.7% were female, 54.3% Latino, 21.7% Black, 36.7% Non-Latino White, 7% Asian, 33.7% Spanish-speaking only, and 41.3% insured by Medicaid or Medicare; 31.3% were SL participants, 21.9% EL, and 46.7% ENL. Most SL (99%, 95% CI [94.6–99.8]%), EL (95.7%, [88.1–98.5]%), and ENL ([90.6%, [84.8-94.3]%) participants were aware of anti-immigrant rhetoric and policies. The majority of SL (58%, 95% CI 48.2–67.2%) participants reported feeling unsafe living in the US, while 44.3% (95% CI 33.2–55.9%) EL and 34.9% (95% CI 27.7-42.8%) ENL participants reported feeling unsafe. Fear of seeking emergency care was more common in SL participants (31%, [22.8-40.6]%) than EL (4.29%, [1.47–11.9]%) or ENL (2.68%, [10.5–6.70]%) participants. Among SL participants reporting fear, 43.3% delayed emergency care by a median (standard deviation) of 22.3 (25.4) days.

Rhetoric and actions of the 2025 presidential administration have had substantial impact on safety concerns in Latino populations and fear of accessing the ED in SL populations.