Stella M. Yu

Health Status and Health Service Access and Use Among Children in U.S. Immigrant Families

OBJECTIVES We examined the health status and patterns of health care use of children in US immigrant families. METHODS Data from the 1999 National Survey of Americas Families were used to create 3 subgroups of immigrant children: US-born children with noncitizen parents, foreign-born children who were naturalized US citizens, and foreign-born children with noncitizen parents. Chi-square and logistic regression analyses were used to examine relationships between immigrant status and health access variables. Subgroup analyses were conducted with low-income families. RESULTS Foreign-born noncitizen children were 4 times more likely than children from native families to lack health insurance coverage and to have not visited a mental health specialist in the preceding year. They were 40% and 80% more likely to have not visited a doctor or dentist in the previous year and twice as likely to lack a usual source of care. US-born children with noncitizen parents were also at a disadvantage in many of these aspects of care. CONCLUSIONS We found that, overall, children from immigrant families were in worse physical health than children from non-immigrant families and used health care services at a significantly lower frequency.

High Levels of Physical Inactivity and Sedentary Behaviors Among US Immigrant Children and Adolescents

OBJECTIVE To examine the prevalence and correlates of physical inactivity and sedentary behavior among immigrant and US-born children. DESIGN Cross-sectional analysis using data from the 2003 National Survey of Childrens Health, a telephone survey conducted between January 29, 2003, and July 1, 2004. SETTING United States. PARTICIPANTS Multivariate logistic and least squares regression models were used to analyze immigrant differentials among 68 288 children aged 6 through 17 years. Main Exposure Ethnic-immigrant status. MAIN OUTCOME MEASURES Prevalence and odds of regular physical activity, inactivity, television watching, and lack of sports participation. RESULTS Physical inactivity and sedentary behaviors varied widely among children in various ethnic-immigrant groups. For example, 22.5% of immigrant Hispanic children were physically inactive compared with 9.5% of US-born white children with US-born parents. Approximately 67% of immigrant Hispanic children did not participate in sports compared with 30.2% of native Asian children. Overall, immigrant children were significantly more likely to be physically inactive and less likely to participate in sports than native children; they were, however, less likely to watch television 3 or more hours per day than native children, although the nativity gap narrowed with increasing acculturation levels. Compared with native white children, the adjusted odds of physical inactivity and lack of sports participation were both 2 times higher for immigrant Hispanic children with foreign-born parents, and the odds of television watching were 1.5 and 2.3 times higher for native Hispanic and black children, respectively. CONCLUSIONS Immigrant children in each ethnic minority group generally had higher physical inactivity and lower sports participation levels than native children. To reduce disparities, health education programs need to promote physical activity among children in immigrant families.

Acculturation and the health and well-being of U.S. immigrant adolescents

PURPOSE To examine the association of acculturation, as measured by language spoken at home, with the health, psychosocial, school, and parental risk factors of adolescents of various racial/ethnic groups. METHODS Using the U.S. component of the 1997-98 World Health Organization Study of Health Behavior in School Children, bivariate and multiple logistic regression analyses were conducted of records for adolescents in four racial/ethnic groups to explore the relationship between the language spoken at home and outcome variables regarding health status and risks, psychosocial and school risk factors, and parental factors. Data were analyzed using Software for the Statistical Analysis of Correlated Data (SUDAAN). RESULTS Adolescents of all racial and ethnic groups who primarily speak a language other than English at home are at elevated risk for psychosocial risk factors such as alienation from classmates and being bullied, and parental risk factors such as feeling that their parents are not able or willing to help them. Those who speak a combination of languages are also at risk for being bullied and for high parental expectations. Language spoken at home is generally not associated with health and safety measures for adolescents across racial/ethnic groups. CONCLUSIONS Adolescents whose primary language at home is not English experience higher psychosocial, school, and parental risks than non-Hispanic white English-speakers. New immigrant youths of all races and ethnic groups would potentially benefit from preventive and risk-reduction services.

Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers.

Objectives: This report presents the national estimates of maternal depressive symptomatology prevalence and its socio-demographic correlates among major racial/ethnic-nativity groups in the United States. We also examined the relationship of mental health-seeking patterns by race/ethnicity and nativity. Methods: Using the Early Childhood Longitudinal Survey-Birth Cohort Nine-month data, we present the distribution of Center for Epidemiological Study-Depression (CES-D) score by new mothers’ nativity and race/ethnicity. The mental health-seeking pattern study was limited to mothers with moderate to severe symptoms. Weighted prevalence and 95% confidence intervals for depression score categories were presented by race/ethnic groups and nativity. Multi-variable logistic regression was used to obtain the adjusted odds ratios of help-seeking patterns by race/ethnicity and nativity in mothers with moderate to severe symptoms. Results: Compared to foreign-born mothers, mothers born in the U.S. were more likely to have moderate to severe depressive symptoms in every racial/ethnic group except for Asian/Pacific Islanders. These US-born mothers were also more likely to be teenagers, lack a partner at home, and live in rural areas. Among Asians, Filipina mothers had the highest rate of severe depressive symptoms (9.6%), similar to those of US-born black mothers (10.2%). Racial/ethnic minorities and foreign-born mothers were less likely to consult doctors (OR: 2.2 to 2.5) or think they needed consultation (OR: 1.9 to 2.2) for their emotional problems compare to non-Hispanic White mothers. Conclusion: Our research suggests that previous “global estimates” on Asian American mental health underestimated sub-ethnic group differences. More efforts are needed to overcome the barriers in mental health services access and utilizations, especially in minority and foreign-born populations.

Parent's Language of Interview and Access to Care for Children With Special Health Care Needs

OBJECTIVE To examine the association between the parents language of interview and the access to care for children with special health care needs (CSHCN). METHODS We used the 2001 National Survey of Children with Special Health Care Needs to compare socio-demographic characteristics and health care access variables among CSHCN with parents who interviewed in English and another language. Additional multivariate analyses explored the effect of language of interview on access to health care for the subgroup of Hispanic respondents. RESULTS CSHCN with non-English-speaking parents were from less-educated and lower-income families and were more likely to lack insurance and have conditions that greatly affected their activities. These children were also more likely to have inadequate insurance (odds ratio [OR]=11.29), have an unmet need for family support services (OR=1.88), lack a personal doctor or nurse (OR=1.98), lack a usual source of care (OR=1.89), and lack family-centered care (OR=1.74). Non-English-speaking parents were more likely to report having employment consequences (OR=1.94) and spending over

Periodontal disease and pregnancy outcomes : State-of-the-science

500 out-of-pocket annually on the childs health care needs (OR=1.49). The likelihood of Hispanic children experiencing health care access barriers compared with non-Hispanic children was reduced when language was controlled for and several disparities between Hispanic children and other children became insignificant. CONCLUSIONS CSHCN with non-English-speaking parents were more likely to be from disadvantaged families and to experience barriers to access than were CSHCN with English-speaking parents. Systems of care for CSHCN should consider the needs and challenges experienced by families whose primary language is not English.

Factors Associated with Smoking Cessation Among U.S. Pregnant Women

To examine the existing evidence on the relationship between periodontal disease and adverse pregnancy outcomes, we conducted a systematic review of studies published up to December 2006. Studies published in full text were identified by searching computerized databases (e.g., MEDLINE, EMBASE). A meta-analysis was performed to pool the effect size of the clinical trials. Forty-four studies were identified (26 case–control studies, 13 cohort studies, and 5 controlled trials). The studies focused on preterm low birth weight, low birth weight, preterm birth, birth weight by gestational age, miscarriage or pregnancy loss, preeclampsia, and gestational diabetes mellitus. Of the chosen studies, 29 suggested an association between periodontal disease and increased risk of adverse pregnancy outcome (odds ratios [ORs] ranging from 1.10 to 20.0) and 15 found no evidence of an association (ORs ranging from 0.78 to 2.54). A meta-analysis of the clinical trials suggested that oral prophylaxis and periodontal treatment may reduce the rate of preterm low birth weight (pooled risk ratio (RR): 0.53, 95% confidence interval [CI]: 0.30–0.95, P < 0.05), but did not significantly reduce the rates of preterm birth (pooled RR: 0.79, 95% CI: 0.55–1.11, P > 0.05) or low birth weight (pooled RR: 0.86, 95% CI: 0.58–1.29, P > 0.05). The authors conclude that periodontal disease may be associated with increased risk of adverse pregnancy outcomes. More methodologically rigorous studies are needed in this field. Currently, there is insufficient evidence to support the provision of periodontal treatment during pregnancy for the purpose of reducing adverse pregnancy outcomes. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to state that the published literature is not vigorous to clinically link periodontal disease and/or its treatment to specific adverse pregnancy outcomes, and explain that more rigorous studies with world-wide agreed-upon definitions are particularly needed before periodontal disease treatment can be recommended.

Childbirth education classes: sociodemographic disparities in attendance and the association of attendance with breastfeeding initiation.

Objectives: This study examines smoking and smoking cessation behaviors among U.S. pregnant women and seeks to identify the sociodemographic correlates of smoking cessation in pregnancy. Methods: The 1998 NHIS Pregnancy and Smoking supplement was analyzed, including 5288 U.S. women (weighted to represent 13,714,358 women) who gave birth to a live-born infant in the past 5 years. Four categories of smoking behavior were analyzed: nonsmoking at last pregnancy, persistent smoking throughout pregnancy, attempting unsuccessfully to quit during pregnancy, and successfully quitting during pregnancy. Logistic regression was used to isolate risk factors for each of the smoking behaviors and to examine factors associated with attempted and successful cessation. Results: The women most likely to attempt to quit smoking in pregnancy were Hispanic women (OR = 3.09) and women who have smoked for less than 10 years (OR = 2.75 for women aged 18–24.) In general, for the groups at highest risk of smoking at the start of pregnancy, the odds of being a persistent smoker were higher than the odds of being an unsuccessful quitter, which in turn were higher than the odds of quitting successfully. The factors associated with attempts to quit included Hispanic ethnicity, higher education, above-poverty income, and shorter duration of smoking, while the combined effect of age and smoking duration was the only one significantly associated with successful quitting. In every age group, longer smoking duration was associated with lower likelihood of attempting to quit as well as successful quitting. Conclusions: The factors most strongly associated with attempts to quit smoking were Hispanic ethnicity and the combined effect of age and smoking duration. Future smoking cessation and relapse prevention programs should be developed, taking into consideration the critical factors of age, ethnicity, income, geography, and addiction.

Prenatal Care Use Among Selected Asian American Groups

Objectives: To examine sociodemographic disparities in attendance at childbirth classes, and to evaluate the association of attendance with breastfeeding initiation. Methods: Parents of a nationally representative, cross-sectional sample of 2068 children ages 4–35 months were surveyed by telephone. The responses of 1540 mothers were included in the analysis. They were asked whether they had attended a childbirth class before giving birth. Disparities in attendance at childbirth classes and the association between attendance and breastfeeding initiation were examined using bivariate and multivariate logistic regression analyses. Results: Two thirds (66%) of the childrens mothers had ever attended a childbirth class. White mothers were twice as likely (OR 2.15, CI 1.39, 3.31) as African American mothers to have ever attended. Attendance also varied by education, household income, and marital status. Attendance at childbirth classes was associated with a 75% increase in the odds that a child will be breastfed (OR 1.75, CI 1.18, 2.60). Conclusions: Significant sociodemographic disparities exist in attendance at childbirth classes. Further research is needed to determine whether improving utilization of childbirth education classes reduces sociodemographic disparities in breastfeeding initiation.

Parental awareness of health and community resources among immigrant families.

OBJECTIVES This study examined the predictors of 3 patterns of prenatal care use (no care, late initiation of care, and inadequate use after early initiation) for 4 Asian American ethnic groups in the United States. METHODS Single live births to US resident mothers of Chinese, Japanese, Korean, and Vietnamese ancestry (n = 273 604) were selected from the 1992-1996 US natality files. Logistic regression was used to analyze the effects of maternal characteristics on the 3 use measures. RESULTS Korean Americans and Vietnamese Americans had the lowest levels of prenatal care use. Young or single motherhood, high parity for age, and low educational attainment were the main risk factors for low use. CONCLUSIONS Considerable variability exists in prenatal care use among Asian American ethnic groups.