Ninez A. Ponce

Linguistic Disparities in Health Care Access and Health Status Among Older Adults

AbstractBACKGROUND: English proficiency may be important in explaining disparities in health and health care access among older adults. SUBJECTS: Population-based representative sample (N=18,659) of adults age 55 and older from the 2001 California Health Interview Survey. METHODS: We examined whether health care access and health status vary among older adults who have limited English proficiency (LEP), who are proficient in English but also speak another language at home (EP), and who speak English only (EO). Weighted bivariate and multivariate survey logit analyses were conducted to examine the role of language ability on 2 aspects of access to care (not having a usual source of care, delays in getting care) and 2 indicators of health status (self-rated general health and emotional health). RESULTS: Limited-English proficient adults were significantly worse off (1.68 to 2.49 times higher risk) than EO older adults in 3 of our 4 measures of access to care and health status. Limited-English proficient older adults had significantly worse access to care and health status than EP older adults except delays in care. English proficient adults had 52% increased risk of reporting poorer emotional health compared with EO speakers. CONCLUSIONS: Provision of language assistance services to patients and training of providers in cultural competence are 2 means by which health care systems could reduce linguistic barriers, improve access to care, and ultimately improve health status for these vulnerable populations.

The California Health Interview Survey 2001: Translation of a Major Survey for California's Multiethnic Population

The cultural and linguistic diversity of the U.S. population presents challenges to the design and implementation of population-based surveys that serve to inform public policies. Information derived from such surveys may be less than representative if groups with limited or no English language skills are not included. The California Health Interview Survey (CHIS), first administered in 2001, is a population-based health survey of more than 55,000 California households. This article describes the process that the designers of CHIS 2001 underwent in culturally adapting the survey and translating it into an unprecedented number of languages: Spanish, Chinese, Vietnamese, Korean, and Khmer. The multiethnic and multilingual CHIS 2001 illustrates the importance of cultural and linguistic adaptation in raising the quality of population-based surveys, especially when the populations they intend to represent are as diverse as Californias.

A population-based study of colorectal cancer test use: Results from the 2001 California health interview survey

Recent research has supported the use of colorectal cancer (CRC) tests to reduce disease incidence, morbidity, and mortality. A new health survey has provided an opportunity to examine the use of these tests in Californias ethnically diverse population. The authors used the 2001 California Health Interview Survey (CHIS 2001) to evaluate 1) rates of CRC test use, 2) predictors of the receipt of tests, and 3) reasons for nonuse of CRC tests.

The Effects Of Unequal Access To Health Insurance For Same-Sex Couples In California

Inequities in marriage laws and domestic partnership benefits may have implications for who bears the burden of health care costs. We examined a recent period in California to illuminate disparities in health insurance coverage faced by same-sex couples. Partnered gay men are less than half as likely (42 percent) as married heterosexual men to get employer-sponsored dependent coverage, and partnered lesbians have an even slimmer chance (28 percent) of getting dependent coverage compared to married heterosexual women. As a result of these much lower rates of employer-provided coverage, partnered lesbians and gay men are more than twice as likely to be uninsured as married heterosexuals. The exclusion of gay men and women from civil marriage and the failure of domestic partnership benefits to provide insurance parity contribute to unequal access to health coverage, with the probable result that more health spending is pushed onto these individuals and onto the public.

Breast and Cervical Cancer Screening Rates of Subgroups of Asian American Women in California

Although breast and cervical cancer screening rates for Asian American (AA) women are the lowest of any ethnic group in California, few causes for this are known. The authors used the 2001 California Health Interview Survey, conducted in five Asian languages, to conduct the first evaluation of Pap and mammography screening rates for a representative sample of 2,239 AA women. Wide variations in screening rates were found among the seven different subgroups of AA women studied: adjusted Pap test use ranged from 81% (Filipina Americans) to 61% (Vietnamese Americans). Mammography rates ranged from 78% (Japanese Americans) to 53% (Korean Americans). Disaggregating the AA data and using separate multivariate logistic regressions revealed that different factors were independently associated with the low screening rates for each subgroup. The measurement of additional contextual information is needed to identify structural barriers and community resources to provide clearer guidance for the design of effective screening promotion programs for AA subpopulations.

Associations Between Racial Discrimination, Limited English Proficiency, and Health-Related Quality of Life Among 6 Asian Ethnic Groups in California

OBJECTIVES We examined the association of racial discrimination and limited English proficiency with health-related quality of life among Asian Americans in California. METHODS We studied Chinese (n = 2576), Filipino (n = 1426), Japanese (n = 833), Korean (n = 1128), South Asian (n = 822), and Vietnamese (n = 938) respondents to the California Health Interview Survey in 2003 and 2005. We assessed health-related quality of life with the Centers for Disease Control and Preventions measures of self-rated health, activity limitation days, and unhealthy days. RESULTS Overall, Asians who reported racial discrimination or who had limited English proficiency were more likely to have poor quality of life, after adjustment for demographic characteristics. South Asian participants who reported discrimination had an estimated 14.4 more activity limitation days annually than South Asians who did not report discrimination. Results were similar among other groups. We observed similar but less consistent associations for limited English proficiency. CONCLUSIONS Racial discrimination, and to a lesser extent limited English proficiency, appear to be key correlates of quality of life among Asian ethnic groups.

Is there a language divide in pap test use

Objective:We sought to determine whether primary language use, measured by language of interview, is associated with disparities in cervical cancer screening. Data sources:We undertook a secondary data analysis of a pooled sample of the 2001 and 2003 California Health Interview Surveys. The surveys were conducted in English, Spanish, Cantonese, Mandarin, Korean, and Vietnamese. Study Design:The study was a cross-sectional analysis of 3-year Pap test use among women ages 18 to 64, with no reported cervical cancer diagnosis or hysterectomy (n = 38,931). In addition to language of interview, other factors studied included race/ethnicity, marital status, income, educational attainment, years lived in the United States, insurance status, usual source of care, smoking status, area of residence, and self-rated health status. Data Collection/Extraction Methods:We fit weighted multivariate logit models predicting 3-year Pap test use as a function of language of interview, adjusting for the effects of specified covariates. Principal Findings:Compared with the referent English interview group, women who interviewed in Spanish were 1.65 times more likely to receive a Pap test in the past 3 years. In contrast, we observed a significantly reduced risk of screening among women who interviewed in Vietnamese (odds ratio [OR] 0.67; confidence interval [CI] 0.48–0.93), Cantonese (OR 0.44; 95% CI 0.30–0.66), Mandarin (OR 0.48; 95% CI 0.33–0.72), and Korean (OR 0.62; 0.40–0.98). Conclusions:Improved language access could reduce cancer screening disparities, especially in the Asian immigrant community.

A population‐based survey of prostate‐specific antigen testing among California men at higher risk for prostate carcinoma

Despite the lack of evidence demonstrating a survival benefit from prostate‐specific antigen (PSA) screening, its use has become widespread, organizations have encouraged physicians to discuss early detection of prostate carcinoma, and two higher risk groups have been recognized. In the current study, the authors examined whether African‐American men and men who had a family history of prostate carcinoma underwent PSA testing preferentially, and patterns of test use were examined according to age, race, and other factors.

Comparing Racial/Ethnic Differences in Mental Health Service Use Among High-Need Subpopulations Across Clinical and School-Based Settings

Racial/ethnic differences in mental health service use among adolescents in clinic and school settings for three high-need populations are examined. Results indicate no racial/ethnic differences in school-based use contrasted with significant differences in clinical settings. Schools may be critical avenues for reduction of unmet mental health need among racial/ethnic minorities.

MEASURING EVERYDAY RACIAL/ETHNIC DISCRIMINATION IN HEALTH SURVEYS

While it is clear that self-reported racial/ethnic discrimination is related to illness, there are challenges in measuring self-reported discrimination or unfair treatment. In the present study, we evaluate the psychometric properties of a self-reported instrument across racial/ ethnic groups in a population-based sample, and we test and interpret findings from applying two different widely-used approaches to asking about discrimination and unfair treatment. Even though we found that the subset of items we tested tap into a single underlying concept, we also found that different groups are more likely to report on different aspects of discrimination. Whether race is mentioned in the survey question affects both frequency and mean scores of reports of racial/ethnic discrimination. Our findings suggest caution to researchers when comparing studies that have used different approaches to measure racial/ethnic discrimination and allow us to suggest practical empirical guidelines for measuring and analyzing racial/ethnic discrimination. No less important, we have developed a self-reported measure of recent racial/ethnic discrimination that functions well in a range of different racial/ethnic groups and makes it possible to compare how racial/ethnic discrimination is associated with health disparities among multiple racial/ethnic groups.