At Risk: Latino Childrens Health

Children whose parents had resided in the United States for fewer than 8 years were at reduced odds odds ratio, 0. Language problems can result in adverse health consequences for some children, including poor medical care, misdiagnosis, and inappropriate medication and hospitalization. Low family income is an important independent risk factor among Latino children for suboptimal health and high utilization of health services. Mexico, Spain, Colombia, Peru, and Argentina. United States pediatricians are likely to encounter greater numbers of Latino children in their practices, given that Latinos have the greatest fertility rate of any ethnic group 3 and triple the growth rate of the overall American population.

Despite the size and rapid growth of the US Latino population, little is known about access barriers to health care for Latino children. In an extensive review of the literature on access barriers for Latino children, Flores and Vega 4 found no published studies that focused on barriers to care as perceived by Latino parents. Previous work has been limited by frequent reliance on secondary data sets, the rarity of analysis by pertinent major Latino subgroups, an emphasis on adults, and infrequent attention to the importance of barriers associated with language and culture.

We use the term Latino to aggregately denote all persons living in the United States whose origins can be traced to the Spanish-speaking regions of Latin America, including the Caribbean, Mexico, Central America, and South America. Although Hispanic is still the official designation used by the federal government, we agree with others 2 that this term places narrow and undue emphasis on the European influence of Spanish colonialism. Latino is a more inclusive term that does not de-emphasize the crucial roles in Latin American history of indigenous Indian cultures and African slaves, and is the term being used increasingly by communities and professional groups.

The goal of the clinic is to provide bilingual, bicultural pediatric primary care services to the Latino children of the greater Boston area.

Children are seen at the clinic regardless of their parents' ability to pay for services. The staff consists of bilingual attending physicians, nurses, and medical clerks. Most patients are self-referred, having found out about the clinic through relatives, friends, or medical receptionists. Several patients are also referred from physicians and nurses in other clinics at Boston Medical Center. The study population consisted of all parents bringing their children to the Pediatric Latino Clinic during a month period, from February 7, , until February 20, Parents were questioned only about their experiences with the American health care system prior to their first visit at the Pediatric Latino Clinic.

We thus excluded 1 newborns brought to the clinic for the first time, 2 children of recent immigrants who had never received health care in the United States, and 3 patients who had only been seen at the Pediatric Latino Clinic. Data collection was done by 2 bilingual Latina research assistants, so as to minimize linguistic, cultural, and gender problems. This study was approved by the institutional review board of Boston Medical Center.

Oral consent was obtained from all study participants.

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We interviewed parents using a survey consisting of 52 multiple-choice, open-ended, and Likert-scale questions. Surveys were administered orally in the language of the parent's choice, and the responses to each question were written down immediately. The Spanish version of the survey was a direct translation from the English version; the 3 bilingual authors G. The survey had been pilot tested shortly before the initiation of the study. The first part of the survey was composed of questions on background sociodemographics, including information about the family structure, parental employment, parental English proficiency, Latino subgroup equivalent to national origin , and years of residence in the United States.

Questions also were asked about the child's health status and use of health services. Results of the pilot study led us to place questions that were of a sensitive nature concerning family income and citizenship at the end of the survey. We found that participants were more likely to respond to these sensitive questions after a rapport with the interviewer was established, and if participants chose not to answer these questions, we at least were able to obtain other relevant survey information before having to terminate the interview.

The remainder of the survey consisted of questions on a wide variety of barriers experienced by parents in obtaining health care for their children, including problems with language, interpreters, finances, health insurance, cultural differences, clinic location, scheduling appointments, long waits to see physicians, inconvenient office hours, taking time off from work, discourteous staff, and not understanding explanations of illnesses or medications.

Questions about barriers were asked in several formats: We also asked whether the inability of the health care staff to speak Spanish had ever resulted in poor medical care, misdiagnosis, inappropriate medication, or inappropriate hospitalization. Data were entered and bivariate analyses were done with Epi Info version 6. Four outcome variables were examined by multiple logistic regression: Multiple linear regression was done to determine associations with the number of physician visits the child made in the past year for any reason.

The following independent variables were examined in multivariate analyses: Multivariate analyses for Latino subgroups were done only for Dominicans and Puerto Ricans, because sample sizes were too small for meaningful analyses of other subgroups. Multivariate analyses were done separately for each of these 2 subgroups dichotomized as Dominican vs not Dominican and Puerto Rican vs not Puerto Rican , because inclusion of both subgroups in the same model produced results that were too highly correlated.

Foreign-born parents had lived in the United States for a median of 8 years. The highest levels of parental educational attainment were low: In this article we reviewed the status of three major health conditions affecting Latino youth living in the U. We focused on obesity, asthma, and mental health because the high burden, the interconnectedness between these conditions, the consequences for adult health, and common challenges in their control. Each of these sections pointed out to the multi-factorial causes explaining the burden of obesity, asthma, and mental health conditions in this population.

From biological to environmental influences, research shows that this complexity of multiple causes affects not only the high burden, but also the success of interventions and access to care. Furthermore, longitudinal studies with a life course perspective are research gaps in all three of these health conditions. In the absence of longitudinal studies that examine trajectories of health, most of what we know of the factors increasing risks or protecting from disease are based on evidence that have limited causal inference, as temporal relationship cannot be inferred.

In recent years, there has been significant progress in the understanding of genetic factors in obesity, asthma, and mental health functioning, but there is still a paucity of studies examining the interaction between genetic and environmental influences, an important step for a translating genomics research to clinical and public health practice. National Center for Biotechnology Information , U. Author manuscript; available in PMC May 1. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at J Lat Psychol.

See other articles in PMC that cite the published article. Abstract This review focuses on obesity, asthma and mental health functioning as salient health issues affecting Hispanic youth.

Hispanic, children, asthma, mental health, obesity, cardiometabolic risk. Risk Factors for Obesity and Cardiometabolic Risk Lifestyle behaviors among children of immigrants are a mix of obesogenic and protective behaviors. Childhood Asthma Asthma is one of the most common chronic diseases among children residing in the U.

Risk Factors Asthma is a multifactorial disease in which environmental exposures play a prominent role von Mutius E, Implications for Adult Health There is evidence to suggest that development of wheeze early in life may not always evolve into asthma. Conclusions In this article we reviewed the status of three major health conditions affecting Latino youth living in the U. American Journal of Public Health. Do Puerto Rican youth with asthma and obesity have higher odds for mental health disorders?

National Center for Health Statistics; NCHS data brief, no Racial and ethnic differences in asthma diagnosis among children who wheeze. Ethnic differences in body mass index trajectories from adolescence to adulthood: Obesity in Mexican-American preschool children--a population group at risk.

Disparities in adequate mental health care for past-year major depressive episodes among Caucasian and Hispanic youths. Psychiatric disorder, impairment, and service use in rural African American and white youth. Archives of General Psychiatry. From awareness to acknowledgement: The development of concern among Latina mothers of children with disruptive behaviors.

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National Health Interview Survey, Health disparities beginning in childhood: Lower bronchodilator responsiveness in Puerto Rican than in Mexican subjects with asthma. Understanding psychopathology among the adult and child Latino population from the United States and Puerto Rico: Developmental and Community-Based Perspectives.

Sage Publications, Inc; Prevalence, correlates, service use, and the effects of impairment. Influence of race, ethnicity, and culture on childhood obesity: Asthma intervention program prevents readmissions in high healthcare users. Obesity-related behaviors of US-and non-US-born parents and children in low-income households. J Dev Behav Pediatr. Novel genetic loci identified for the pathophysiology of childhood obesity in the Hispanic population. Genetic ancestry modifies pharmacogenetic gene-gene interaction for asthma.

Prevalence and development of psychiatric disorders in childhood and adolescence. The metabolic syndrome in children and adolescents. Changes in body mass during elementary and middle school in a national cohort of kindergarteners. Severe obesity among children in New York City public elementary and middle schools, school years —07 through — Common variants in the LAMA5 gene associate with fasting plasma glucose and serum triglyceride levels in a cohort of pre-and early pubertal children.

Ethnic differences in the link between insulin resistance and elevated ALT. Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation. J Allergy Clin Immunol. A genome-wide association study of bronchodilator response in Latinos implicates rare variants. J Allergy Clin Immmunol.

Individual, family, and community environmental correlates of obesity in Latino elementary school children. Translating developmental genetic findings into obesity-related clinical practice: Arch Pediatr Adolesc Med. Genetic influences in childhood obesity: Int J Obes Lond ; 36 4: Genetic admixture and obesity: Polymorphism of the ADRB2 gene and response to inhaled beta-agonists in children with asthma: The Health of Latino Children: Factors predicting severe childhood obesity in kindergarteners. Int J Obes Lond ; 37 1: Decreased response to inhaled steroids in overweight and obese asthmatic children.

Genetic epidemiology of cardiometabolic risk factors and their clustering patterns in Mexican American children and adolescents: Latino youth on discrimination in the United States. National Council of La Raza; Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med. Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: The contribution of childhood obesity to adult carotid intima-media thickness: Int J Obes Lond ; 32 5: Perinatal and early childhood environmental factors influencing allergic asthma immunopathogenesis.

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