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
About this Master's Thesis
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