PARENTAL LANGUAGE OF INTERVIEW AND PRIMARY LANGUAGE SPOKEN AT HOME: ASSOCIATIONS TO NATIONAL QUALITY FORUM (NQF) QUALITY MEASURES AMONG U.S. ASIAN AND HISPANIC CHILDREN, A CROSS-SECTIONAL STUDY USING NSCH 2007 Public

Abstract

Background. Limited English language proficiency (LEP) in the U.S. is increasing as the number of minority individuals from immigrant populations rise. LEP has been linked to child health status and access disparities. Several language metrics have been used to examine the association between language proficiency and child health disparities however no gold standard exists.
Objective. The primary objective of this study was to compare the strength of association between two measures of LEP (language of interview and primary language spoken at home) to Nationally validated child health quality indicators.
Methods. A cross-sectional study utilizing data from the 2007 National Survey of Children's Health compared select National Quality Forum (NQF) quality indicator performance based on both language metrics. Data were derived from Asian and Hispanic children in 9 states.
Results.Multivariable analysis demonstrated a significant association between history of physical activity for both language measures. Non-English language of interview had greater than 2 times the odds of lower physical activity (OR = 2.31, 95% CI: 1.15, 4.23) and non-English primary language spoken at home nearly 6 times the odds of lower physical activity (OR = 5.59, 95% CI: 2.48, 12.59). Of the remaining 8 NQF quality measures, including current or consistent insurance, the only significant association after multivariable analysis was between primary language spoken at home and receipt of family-centered care (OR = 2.09, 95% CI: 1.14, 3.83). In the secondary analysis both physical activity and lack of family-centered care remained significant in Hispanic children in multivariable models for both language metrics.
Conclusions. Our study does not provide data that leads to a strong preference of one metric over the other. Previous work comparing primary language spoken at home to level of English language proficiency found that parents providing an assessment of their English language ability was more useful than use of English language spoken at home. However the metrics and study population used were different from the current study and therefore further validation using similar quality measures and study population is warranted.

Table of Contents

Table of Contents Chapter I. Introduction...................................................................................................................... 1 Chapter II. Literature Evaluation........................................................................................................ 3 Population Characteristics Relative to Disparity Research........................................................................ 3 Asian and Hispanic Child Health Status, Access and Utilization Data......................................................... 5 Role of Language in Disparity Research................................................................................................ 7 Chapter III. Methods....................................................................................................................... 12 Population..................................................................................................................................... 12 Research Design............................................................................................................................ 13 Analysis........................................................................................................................................ 17 Chapter IV. Results.......................................................................................................................... 18 Socio-demographic Characteristics by language measure..................................................................... 18 Socio-demographic Characteristics by Race........................................................................................ 19 Association of Language Measure to NQF Indicators............................................................................ 20 Secondary Analysis.........................................................................................................................22 Chapter V. Discussion and Public Health Significance....................................................................... 22 Summary and Conclusion................................................................................................................. 22 Study Limitations............................................................................................................................ 29 Implications and Recommendations................................................................................................... 30 Tables.............................................................................................................................................. 32 Table 2. Characteristics of children based on Language of Interview......................................................32 Table 3. Characteristics of children based on Primary Language Spoken at Home................................... 34 Table 4. Characteristics of Children by Race, 9 States........................................................................ 36 Table 5. Association of Select NQF Child Health Quality Indicators to Language of Interview.....................38 Table 6. Association of Select NQF Child Health Quality Indicators to Primary Language Spoken at Home.. 39 Table 7. Select NQF Child Health Quality Indicators Performance by Race............................................. 40 Table 8. Association of Select NQF Child Health Quality Indicators to Language of Interview by Race........ 41 Table 9. Association of Select NQF Child Health Quality Indicators to Primary Language Spoken at Home by Race...........................................................................................................................42 Appendix I. NQF Quality Indicators.................................................................................................. 47 Appendix II. SAS Code..................................................................................................................... 48

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Mot-clé	Disparities Children Language Asian Hispanic
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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