The effect of parental immigration authorization on health insurance coverage for migrant Latino children.

OBJECTIVE: To examine if immigration authorization among parents is associated with health insurance coverage for migrant Latino children. DATA SOURCE: A cross-sectional household survey of 300 migrant families for which one child, aged <13 years, was randomly selected. RESULTS: Most children lacked insurance (73%) and had unauthorized parents (77%). Having an authorized parent or parental stay of more than 5 years in the US were each positively associated with children's health insurance coverage [OR: 4.9; 95% CI: (2.7-8.7) and [OR = 6.7; 95% CI: (3.8-12.0), respectively]. The effect of parental authorization did not persist in multivariable logistic regression analysis; however, more than 5 years of parental stay in the US remained associated with children's insurance coverage [OR = 4.8; 95% CI (1.8-12.2)], regardless of parental authorization. CONCLUSION: Increased parental familiarity with US health and/or social services agencies, rather than parental authorization status, is important to obtaining health insurance for migrant children. Efforts to insure eligible migrant children should focus on recently arrived families.

Parental nativity is an important factor associated with where children usually go for health care.

PURPOSE: Few studies of children's access to care account for the independent effects of parental immigration characteristics. To address this gap in knowledge, we examine the association between parental nativity and where children usually obtain health care. DATA SOURCE: The 2002 National Survey of America's Families (N = 34,332). RESULTS: Fourteen percent of the sampled children had only foreign-born parents. Most of the sampled children used physician's offices or HMOs (69%) and clinics or other hospital outpatient settings (24%) as usual sites for health care; few used hospital emergency departments or other care providers (1.4%). After adjusting for confounders, using multinomial logistic regression, both citizen [OR = 1.92 (1.44-2.56)] and non-citizen [OR = 5.21 (3.33-8.15)] children with foreign-born parents were more likely to lack a usual site for health care, compared to children with at least one US-born parent-regardless of the mother's citizenship and duration of stay in the US. After accounting for parental nativity, lack of citizenship and shorter durations of US stay among mothers were associated with children's greater use of public clinics or other hospital outpatient settings, rather than physician's offices or HMOs. The effect of parental nativity persisted for minority, but not white, children; however, non-citizen children lacked a usual site for health care regardless of their race and ethnicity. CONCLUSION: The immigration characteristics of parents are important to disparities in where children usually go for health care. These results suggest that increasing the "biomedical acculturation" of immigrant mothers may improve access to care for their children.

Parental nativity affects children's health and access to care.

OBJECTIVE: To examine the effect of parental nativity on child health and access to health care. DATA SOURCE: The 2002 National Survey of America's Families. RESULTS: Among US children, 14% have foreign-born parents; 5% have one foreign- and one native-born parent ("mixed-nativity"). In multivariate logistic regression analyses, children with foreign-born parents were less likely than children with US-born parents to be perceived in "very good" or "excellent health" [OR = 0.68; 95% CI (0.56-0.82)] and to have a usual health care site [OR = 0.52 (0.38-0.69)]; having mixed-nativity parents is associated with better perceived child health. These effects persisted for minority, but not white, children. Regardless of race and ethnicity, non-citizen children have worse access to care. CONCLUSION: Efforts to improve children of immigrants' health and access to care should focus on families in which both parents are immigrants, particularly those who are ethnic or racial minorities. Efforts to increase use of health services should focus on non-citizen children.

Access to care for children of migratory agricultural workers: factors associated with unmet need for medical care.

OBJECTIVE: To assess the correlates of unmet need for medical care among migrant children. DESIGN AND SETTING: A cross-sectional household survey used multistage sampling to identify migrant families in eastern North Carolina. PARTICIPANTS: Three hundred adult caretakers of 1 (per household) randomly selected child <13 years old. RESULTS: Fifty-three percent of the children had an unmet medical need. The most common reasons for unmet medical need were lack of transportation (80%) and lack of knowledge of where to go for care (20%). Unmet medical need was associated inversely with less than very good health (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.16-0.61) and less than high school caretaker education (OR: 0.62; 95% CI: 0.39-0.98) and was associated directly with 1) having bed-days due to illness (OR: 2.46; 95% CI: 1.42-4.26), 2) lacking an annual well examination (OR:1.89; 95% CI: 1.12-3.20), 3) transportation dependence (OR:1.97; 95% CI: 1.24-3.13), 4) female gender (OR: 1.69; 95% CI: 1.07-2.67), 5) preschool age (OR: 2.24; 95% CI: 1.28-3.92), and 6) very high caretaker work pressure (OR: 5.01; 95% CI: 2.98-8.42). Adjustment using multiple logistic regression reveals unmet medical need to be independently associated with preschool age (OR: 2.08; 95% CI: 1.05-4.13) and very high caretaker pressure to work (OR: 5.93; 95% CI: 3.24-10.85). Of sampled children, 27% were preschool aged, and 40% had caretakers categorized with high work pressure. CONCLUSIONS: Medical-access barriers among migrant children are largely nonfinancial. Preschool-aged migrant children disproportionately experience unmet medical need. Decreasing forgone care among migrant children will likely require a combination of individual, health-system, and labor-policy modifications.

Health services use by children of migratory agricultural workers: exploring the role of need for care.

OBJECTIVE: For migrant children: 1). to assess the determinants of health services use among users and nonusers of health services; 2). to evaluate the association between health status and health services use, while controlling for potential confounders. DESIGN: A cross-sectional household survey using multistage, partially random sampling to identify migrant families in eastern North Carolina. PARTICIPANTS: Adult caretakers of 1 randomly selected child under 13 years old. RESULTS: Forty-four percent of children (N = 300) visited a doctor in the preceding 3 months. Those visiting a doctor disproportionately reported having less than very good health (29% vs 10%), insurance (46% vs 11%), interpreters (45% vs 27%), a family member receiving Special Supplemental Nutrition Program for Women, Infants, and Children (50% vs 16%), and a legal caretaker (30% vs 18%). Compared with those without a doctor visit, a larger proportion of children visiting a doctor were 6 years or younger in age (71% vs 35%), born in the United States (51% vs 15%), female (64% vs 45%), and had not moved in 6 or more months (19% vs 10%). Controlling for enabling resource and sociodemographic confounders, children with less than very good health were 2.4 times more likely than those in very good health to have visited a doctor (95% confidence interval [1.1-5.2]). CONCLUSIONS: Migrant children using health services are distinct from nonusers with regards to sociodemographic factors, enabling resources, and need for care. Health services use is associated with less than very good perceived health, despite resource barriers and sociodemographic disadvantages. More efforts are needed to improve access to health care for migrant children.