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Immigration enforcement and public health: disentangling governance levels in sanctuary policies and the impact on health outcomes
Dissertation

Immigration enforcement and public health: disentangling governance levels in sanctuary policies and the impact on health outcomes

Caroline C. Kravitz
Doctor of Philosophy (Ph.D.), Drexel University
Jun 2026
DOI:
https://doi.org/10.17918/00011415
pdf
Kravitz_Caroline_20266.01 MB
PDF Embargoed Access, Embargo ends: 01 Jul 2028

Abstract

Food access Health equity Immigration policy Legal epidemiology Quasi-experimental analysis
Background: Immigration enforcement -- affected by policies at the federal, state, and local levels -- has been widely associated with adverse health outcomes among immigrants and those socially proximate to them. Local policymakers can enact sanctuary policies to reduce immigration enforcement within their jurisdiction. These policies restrict local law enforcement's participation in immigration enforcement activities. States can also enact sanctuary policies, but more commonly enact anti-sanctuary policies, which increase law enforcement's participation in immigration enforcement. The causal impact of multilevel immigration policies on health outcomes, including household food access, remains understudied in public health literature. Objective: My project consists of three aims: (1) to describe the authority, implementation, and policy effects of state and local sanctuary and anti-sanctuary policies; (2) to quantify the impact of enacting a local sanctuary policy on household SNAP enrollment and food security, and how these relationships vary across state immigration policy environments; and (3) to quantify the impact of state sanctuary and anti-sanctuary policies on household SNAP enrollment and food security, and to assess whether this relationship changes after controlling for the local sanctuary policy environment. Methods: Aim 1 is a descriptive analysis of primary data on local sanctuary policies, state sanctuary policies, and state anti-sanctuary policies. Aims 2 and 3 are staggered difference-in-differences analyses using linear probability regression models. SNAP enrollment data are from the American Community Survey microdata (2005-2020), and food security data are from the Current Population Survey Food Security Supplement microdata (2005-2023). All models were adjusted for household, county, and state covariates. Results: Enacting a local sanctuary policy had no effect on household SNAP enrollment or food security. After stratifying by state immigration policy environment, enacting a local sanctuary policy in anti-sanctuary states was associated with a 3% lower probability of household SNAP enrollment [adjusted ATT (exponentiated) = 0.976; 95% CI: (0.956, 0.995)]. Enacting a state sanctuary policy did not affect household SNAP enrollment but, after controlling for the local sanctuary policy environment, was associated with a non-significant 2% higher probability of a household being food secure [adjusted ATT (exponentiated): 1.019; 95% CI: (0.994, 1.044)]. Enacting a state anti-sanctuary policy had no effect on household SNAP enrollment or food security, even after controlling for the local sanctuary policy environment. Conclusion: Local and state sanctuary and anti-sanctuary policies had a minimal impact on household SNAP enrollment and food security. Despite null effects, such policies remain an important legislative tool for signaling inclusion and ensuring that state and local resources are not used to enforce federal immigration law. Further research is needed to determine whether multilevel immigration policies causally affect health; information that may be important to policymakers interested in the externalities of immigration policy on health outcomes.

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