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OBJECTIVES: We examined the association between children's state of residence and their access to health care among specific types of immigrant families: foreign-born children, US-born children with 1 foreign-born parent, US-born children with both foreign-born parents, and nonimmigrant families. METHODS: We analyzed data from 12 400 children from the 2003 National Survey of Children's Health in the 6 states with the highest proportion of immigrants (California, Florida, Illinois, New York, New Jersey, and Texas). RESULTS: Multivariable analyses indicated that among foreign-born children, those living in California, Illinois, and Texas were more likely to lack access to health care compared with those living in New York. Among foreign-born children with 1 or 2 US-born parents, Texas children were most likely to lack health insurance. Within nonimmigrant families, children from California, Florida, and Texas had significantly more access and use problems. CONCLUSIONS: Our findings document differential health care access and use among states for specific immigrant family types. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We examined the relation between parents' level of English proficiency and their children's access to health care. METHODS: Using the 2001 California Health Interview Survey, we conducted bivariate and multivariate analyses of several measures of children's access to health care (current health insurance status, usual source of care, emergency room visits, delayed or forgone care, traveling to another country for health care, and perceived discrimination in health care) and their association with parents' English proficiency. RESULTS: Compared with English-speaking households, children in non-English-speaking households were more likely to lack health insurance, to not have doctor contact, and to go to other countries for health care and were less likely to use emergency rooms. Their parents were less likely to report their children's experiencing delayed or forgone care or discrimination in health care. CONCLUSION: English proficiency is a strong predictor of access to health insurance for children, and children in non-English-speaking families are especially likely to rely on other countries for their health care. English proficiency may mitigate the effects of race/ethnicity commonly observed in health care access and utilization studies. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study examined whether there were significant differentials between US-born and foreign-born women in risks of infant mortality, low birthweight, and preterm birth and whether these differentials, if they existed, varied across major US racial/ethnic groups. METHODS: Multivariate logistic regression was applied to national linked birth/infant death records for 1985 through 1987 to estimate overall and ethnic-specific maternal nativity effects on pregnancy outcomes. RESULTS: Substantial maternal nativity differences in risks of infant mortality and low birthweight were found, with the magnitude of the nativity effect varying significantly across racial/ethnic groups. Overall, foreign-born status was associated with 7% and 20% lower risks of low birthweight and infant mortality, respectively. However, the reduced risk of adverse pregnancy outcome associated with immigrant status tended to be substantially larger for Blacks, Cubans, Mexicans, and Chinese than for other ethnic groups. CONCLUSIONS: Maternal nativity status, along with ethnicity, may serve as an important axis of differentiation in birth outcome studies. Further research needs to be conducted to assess the effects of behavioral, cultural, and psychosocial factors in explaining the nativity differentials observed here. [ABSTRACT FROM AUTHOR]

Objectives: We examined the association between the joint effects of children's immigrant family type and race/ethnicity on parenting aggravation., Methods: We analyzed data on a nationally representative sample of 101 032 children aged birth through 17 years from the 2003 National Survey of Children's Health., Results: Analysis of the Aggravation in Parenting Scale showed that 26% of foreign-born parents with foreign-born children were highly aggravated, followed by 22% of foreign-born parents with US-born children and 11% of US-born parents. Multivariable analyses indicated that all minority parents experienced high parenting aggravation compared with non-Hispanic White US-born parents; the odds of reporting parenting aggravation were 5 times higher for Hispanic foreign-born parents. All foreign-born parents, regardless of race/ethnicity, reported significantly elevated parenting aggravation. Parents of adolescents, children with special health care needs, and nontraditional and lower-income households were also more likely to report high parenting aggravation., Conclusions: Our findings clearly document significantly elevated levels of parenting aggravation among immigrant and minority families. Public health programs and clinicians should target referrals and interventions for these families to avoid potential health problems for both children and their families.

Objectives: We examined health status and health services access and utilization of Chinese, Filipino, Japanese, Korean, South Asian, Vietnamese, and non-Hispanic White children in California., Methods: We analyzed aggregated data from the 2003 and 2005 California Health Interview Survey (648 Chinese, 523 Filipino, 235 Japanese, 308 Korean, 314 South Asian, 264 Vietnamese, and 8468 non-Hispanic White children aged younger than 12 years), examining the relationship between Asian ethnicities and outcomes., Results: Compared with non-Hispanic White children, Korean children were 4 times more likely to lack health insurance; Filipino children were twice as likely to not have had recent contact with a doctor; Chinese, Korean, and Vietnamese children were less likely to have visited an emergency room in the past year; and Chinese, Korean, and Vietnamese children were more likely to be in fair or poor health. Age, gender, poverty, citizenship-nativity status, health insurance, and parental marital and child health statuses were related to most outcomes., Conclusions: Asian ethnicities have heterogeneous health care access and utilization patterns, suggesting the need for targeted outreach to different Asian ethnic groups.

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 America's 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.

Objectives: This study examined trends and differentials in US childhood mortality from 1950 through 1993 according to sex, race/ethnicity, education, family income, and cause of death., Methods: Log-linear, multiple regression, and Cox proportional hazards regression models were applied to the data from the National Vital Statistics System, the National Longitudinal Mortality Study, and the Area Resource File., Results: Substantial declines in US childhood mortality have occurred in the past 4 decades, primarily due to decreases in mortality from unintentional injuries, cancer, pneumonia and influenza, and congenital anomalies. The overall declining trend, however, has been dampened by a twofold to threefold increase in the suicide and homicide rates among children since 1968. Male, Black, American Indian, Hawaiian, and Puerto Rican children and those in the lower socioeconomic strata were at an increased risk of death., Conclusions: Increasing trends in mortality from violence, firearm injuries, and human immunodeficiency virus/acquired immunodeficiency syndrome pose a major obstacle to continued declines in US childhood mortality. Reducing socioeconomic disparities and improving access to and use of health care may bring about further declines in overall and injury-related childhood mortality.

Using data from the National Vital Statistics System and the National Longitudinal Mortality Study, this study examined mortality trends and differentials from 1950 through 1993 among US adolescents and young adults according to sex, race/ethnicity, education, family income, marital status, and cause of dealth. No appreciable reduction in youth mortality has occurred, especially among men. Declines in youth mortality from accidents have been nearly ofset by increases in death rates from homicide, suicide, and firearm injuries. American Indians, Blacks, males, and those with least education and income were at increased risk of both overall and injury-specific youth mortality.

This paper examines the prevalence of multivitamin-mineral supplement use before and during pregnancy, as well as predictors of nonuse, in 9953 women who delivered live infants in the 1988 National Maternal and Infant Health Survey. Ninety-seven percent of the women were advised to take multivitamin-mineral supplements in prenatal care. Sixty-seven percent of Black mothers took supplements during pregnancy, as compared with 84% of White mothers. Multivariate analysis revealed that Black mothers; mothers who are less educated, younger, unmarried, and non-smokers; and mothers who participate in Women, Infants, and Children programs are at elevated risk for nonuse. These data help identify groups in need of supplementation guidance.

Objectives: This study examined long-term trends and differences in infant mortality in the United States from 1950 through 1991 according to race and ethnicity, education, family income, and cause of death. Forecasts are made through the year 2010., Methods: Log-linear regression models were applied to data from the National Vital Statistics System, National Linked Birth and Infant Death files, the National Maternal and Infant Health Survey, the National Natality Survey, and the National Infant Mortality Survey to model and forecast infant mortality., Results: Dramatic declines in the US infant mortality rate have occurred in the past 4 decades, largely as a result of declines in mortality from pneumonia and influenza, respiratory distress syndrome, prematurity and low birthweight, congenital anomalies, and accidents. Despite the overall reductions, however, substantial racial/ethnic, educational, and income differences in infant mortality still exist., Conclusions: The long-term downward trend in US infant mortality has not benefited Blacks and Whites equally. The Black/White disparity in infant mortality has not only persisted but increased over time and is not expected to diminish in the near future. Educational inequalities have also widened, and racial disparities have generally increased across all educational levels.

Objectives: This study examines differentials in mean birthweight and the risk for low birthweight among various Asian-American groups in New York State (n = 499,377)., Methods: Using resident singleton live-birth records from New York State for 1985 and 1986, Asian-American births were compared with Black, American Indian, and White births. Multivariate ordinary least squares and logistic regression models were used to analyze ethnic differences., Results: Compared with White births, the expected mean difference in birthweight was -115 g for Chinese, -235 g for Japanese, -164 g for Filipinos, -120 g for Blacks, and 74 g for American Indians. The risk for low birthweight was 45% higher for Filipinos and 49% higher for Blacks as compared with Whites., Conclusions: Results of this study suggest substantial heterogeneity in mean birthweight and risk for low birthweight among ethnic groups in general and the major Asian-American groups in particular. Interestingly, after controlling for ethnic differences in sociodemographic risk factors, Filipinos appear to resemble Blacks much more closely than they do their Japanese and Chinese counterparts with respect to risk for low birthweight.