Glenn Flores

Background. Lack of health insurance adversely affects children’s health. Eight million US children are uninsured, with Latinos being the racial/ethnic group at greatest risk for being uninsured. A randomized, controlled trial comparing the effectiveness of various public insurance strategies for insuring uninsured children has never been conducted.

Background. A total of 196000 hospitalizations occur each year among the 9 million US children who have been diagnosed with asthma. Not enough is known about how to prevent pediatric asthma hospitalizations.

Background.: Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. Objectives.: Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. Methods.: We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. Results.: Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. “Dose-response” relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar “dose-response” relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. Conclusions.: Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP categories are associated with different risks of adverse outcomes in children's health and health care. Consistent data collection on parental English proficiency and referral of LEP parents to English classes by pediatric providers have the potential to contribute toward reduction and elimination of health care disparities for children of LEP parents.

Background Little is known about whether racial/ethnic differences exist in household family activities, safety practices, and educational opportunities known to impact young children’s healthy development and school success. Objective To examine whether racial/ethnic disparities exist in early childhood home routines, safety measures, and educational practices/resources. Methods The 2000 National Survey of Early Childhood Health is a telephone survey of a nationwide sample of parents of 2608 children aged 4 to 35 months. Differences in family activities, safety measures, and educational practices/resources were examined for white, black, and Hispanic children. Results Minority children are less likely than white children to have consistent daily mealtimes and bedtimes, and more frequently never eat lunch or dinner with their family. Minority parents are less likely to install stair gates or cabinet safety locks and to turn down hot water settings. Minority parents less often read daily to their child, Hispanic parents more often never read to their child, and minority households average fewer children’s books. Black children average more hours watching television daily. Disparities persisting in multivariate analyses included: minority children having increased odds of never eating lunch or dinner with their family, black children not having regular mealtimes (odds ratio, 1.8; 95% confidence interval, 1.2-2.7) and watching 1 more hour of television daily, black parents not installing cabinet locks, minority parents having twice the odds of not installing stair gates and not reading to their child daily, and minority homes having fewer children’s books (black homes, −30; and Hispanic homes, −20). Children whose parents completed surveys in Spanish also experienced several disparities. Conclusions Young minority children experience multiple disparities in home routines, safety measures, and educational practices/resources that have the potential to impede their healthy development and future school success. Such disparities might be reduced or eliminated through targeted education and intervention by pediatric providers.

Background. Racial/ethnic disparities in health care have received much national attention recently, but few studies have focused on disparities among children. We studied disparities in early childhood health and health care.

Managed care is the dominant form of health insurance in the United States, covering millions of children. Little is known about whether inner-city parents adequately understand managed care's complex definitions and rules. The objective of this study was to examine managed care knowledge and practices among inner-city parents. We conducted a cross-sectional survey of parents at inner-city community sites in Boston, including supermarkets, hair salons, and laundromats. Participants were asked 74 questions on access, insurance, and managed care. The 1100 participants were mostly poor, minority (82% Latino, 10% black) and covered by public health insurance. Although 55% of insured children were covered by managed care, 45% of the managed care-covered children's parents were unaware of their children's managed care coverage. When asked “What is managed care?,” 88% of parents did not know it was a type of insurance, and 94% did not identify a specific feature; Latino parents were significantly more likely to provide a wrong/do not know answer to this question, and there was no significant association with whether the child was covered by managed care. Latino parents and parents with children not covered by managed care were significantly more likely to provide a wrong/do not know answer for all 11 questions about specific features of managed care, but the proportion of parents with managed care-covered children who gave wrong/do not know answers for these 11 questions ranged from 41% to 84%. More than half of parents gave wrong/do not know answers to 10 of the 11 questions about specific managed care features, regardless of whether their child was covered by managed care. Most parents reported that if their child were covered by managed care, they would bring the child to the emergency department without prior approval for 4 minor childhood illnesses. For each of these illnesses, at least two thirds of parents said that they would bring their child in without prior approval, ranging from 72% of parents for a child with diarrhea to 90% for a child with a sprained ankle. Latino ethnicity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2–3.1), having a nonmanaged care-covered child (OR, 2.3; 95% CI, 1.5–3.7), and having a managed care-covered child but being unaware of the managed care coverage (OR, 2.9; 95% CI, 1.6–5.2) were associated with greater adjusted odds of incorrect/do not know parental definitions of managed care. Low family income and limited English proficiency were consistently associated with a significantly higher adjusted odds of wrong/do not know answers about specific managed care features. In multivariable analyses, Latino parents were significantly more likely to bring a managed care-covered child with a minor illness to the emergency department without prior approval. Regardless of whether their children have managed care coverage, most inner-city parents interviewed in this study do not know what managed care is, have insufficient knowledge of managed care rules and practices, and believe that prior approval for emergency department visits for mild childhood illnesses is unnecessary. These findings indicate that many urban parents may need better, more comprehensible information about managed care, particularly those who are poor, Latino, and have limited English proficiency.