Migration Policies As Social Determinants of Health Among International Graduate Students in the United States

Background and Purpose: The U.S. remains a primary destination for international students, with over one million of them enrolled in the 2022/2023 academic year, a number projected to rise. Similar to other visa-holding groups, international students are influenced by the nation's evolving and increasingly restrictive immigration policies. This study aimed to investigate the impact of immigration policies on the quality of life of international graduate students and to examine how these policies may act as social determinants of health.

Methods: In this qualitative research study, we employed inductive reasoning and a phenomenological approach to report on the lived experiences of international graduate students in the U.S. in the context of migration policies. Participants were recruited through convenience sampling. They completed an online demographic survey and an informed consent form agreeing to be contacted for an interview following the advertisement of the study in two online immigration forums. Data for the study were collected through 36 semi-structured interviews conducted between April 2021 and April 2022. Interviews were conducted and audio recorded via Zoom. The research team transcribed all interviews verbatim, and coded and analyzed them using reflexive thematic analysis with the assistance of the Dedoose application. Themes were generated from the common codes following discussions among the research team members.

Results: Participants were from fifteen different countries including China, India, and Iran. Around half of the sample (N=19) self-identified as female and the other half as male. Participants were all young adults between the ages of 22 and 38. Close to one-third of the participants were married (N=11) while the rest of the sample chose single as their marital status. Three major themes emerged from the qualitative data analysis: 1. Adverse health impacts of restrictive migration policies: Participants referred to physical and mental health challenges, such as sleep disturbance, stress, anxiety, depression, pre-diabetes, and unwanted weight gain, in relation to restrictive migration policies. 2. Internalized vulnerabilities: A considerable number of participants blamed themselves or their luck for the stress they reported experiencing concerning restrictive migration policies, rather than attributing it to policy restrictions. 3. Coping strategies and forced choices: Participants reported facing multiple barriers, including travel restrictions, financial stress, limited rights to work legally, and challenges related to lengthy visa processing times. To cope with these challenges, they seem to rely on their limited social support system including international friends, family members who may not fully understand their situation, classmates, and resources at their respective universities. Many participants told us that they had to make unwanted decisions, such as starting a new degree, to navigate the challenging immigration system.

Conclusions and Implications: Participants recommended changes to migration policies, specifically in terms of expanding work rights and improving consistency, transparency, and efficiency in adjudicating immigration petitions, work authorization requests, and visa applications. This study emphasizes the substantial impact of restrictive migration policies on the health and well-being of international students in the U.S., underscoring the need for policy reform to promote their health and success and create a more equitable society.