Angie Denisse Otiniano, MPH CityMatCH Promising Practice Presentation September 22, 2008
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Transcript of Angie Denisse Otiniano, MPH CityMatCH Promising Practice Presentation September 22, 2008
Preconception Insurance Status and Preconception Care Utilization Among
Latinas in Los Angeles
Findings from the 2007 Los Angeles Mommy and Baby (LAMB) Survey
Angie Denisse Otiniano, MPH
CityMatCH Promising Practice Presentation
September 22, 2008
Overview
• Significance• Research Questions• Methods• Results• Public Health Implications
Significance
• 2006 Census estimated 9,744,896 people residing in Los Angeles County– 56.3% speak a language other than English at
home
Significance
• In 2005, 63% of the live births were to Latina mothers
• Growing interest in preconception health and health care among Latinas
Research Questions
• Does preconception care use vary by race/ethnicity?
• Does preconception care use vary by acculturation factors among Latinas in Los Angeles?
• Does preconception care use vary by socioeconomic factors among Latinas in Los Angeles?
Methods:Study Design
• Data collection– Mailed questionnaire with multiple follow-up
attempts and by telephone
• Multistage clustered design– cross-sectional, population-based survey of a
stratified random sample of mothers who recently delivered a liveborn infant in Los Angeles County
• Data collected for the 2007 birth cohort
Methods:Population
LAMB Respondents by Race/Ethnicity
48.4
18.215.4
17.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Latina Black Asian White
Pe
rce
nta
ge
NTotal= 1135
NLatina= 543
NBlack= 204
NAsian= 173
NWhite= 201
Methods:Variables
Acculturation factorsLanguage preference
Language in which the mother preferred to answer the survey Nativity
“Were you born in the United States?”
Socioeconomic factorsIncome
“What was your family income in 2006 before taxes?”Insurance
“Just before your last pregnancy, did you have health insurance?”
Preconception care use“During the six months before you got pregnant with your new baby, did
you talk to a doctor, nurse or other health care worker about how to prepare for a healthy pregnancy and baby?”
Methods:Data Analysis
• Pearson’s chi square tests used to determine if:– Preconception care use varied by
race/ethnicity among all LAMB respondents– Preconception care use varied by
acculturation factors among Latinas in Los Angeles
– Preconception care use varied by socioeconomic factors among Latinas in Los Angeles
Results:Race/Ethnicity
Preconception Care Utilization by Race/Ethnicity
23.2
29.9
35.8
40.8
0
5
10
15
20
25
30
35
40
45
Latina Black Asian White
Per
cen
tag
e
*p<0.001
Results:Language Barrier
*p<0.001
Language Barrier to Preconception Care by Language Preference Among Latinas
1.6
26.7
0
5
10
15
20
25
30
English preference Spanish preference
Pe
rce
nta
ge
Results:Acculturation Factors
*p = 0.87
Preconception Care Utilization by Language Preference Among Latinas
23.5 22.9
0
5
10
15
20
25
English preference Spanish preference
Per
cen
tag
e
Results:Acculturation Factors
*p=0.5685
Preconception Care Utilization by Nativity Among Latinas
24
22
0
5
10
15
20
25
US Born Foreign Born
Per
cen
tag
e
Results:Socioeconomic Factors
*p=0.0001
Preconception Care Utilization by Income Among Latinas
19.916.94
37.72
0
5
10
15
20
25
30
35
40
<$20,000 $20,000-$40,000 >$40,000
Per
cen
tag
e
Results:Socioeconomic Factors
Preconception Care Utilization by Insurance Status Among Latinas
27.8
17.8
0
5
10
15
20
25
30
Insured Uninsured
Per
cen
tag
e
*p=0.0063
Results:Race/Ethnicity
*p<0.001
Uninsured Status by Race/Ethnicity of LAMB Respondents
44.8
25.6
12.1 11.5
05
10
1520253035
404550
Latina Black Asian White
Pe
rce
nta
ge
Results:Acculturation Factors
*p<0.001
Insurance Status Among Latinas by Language Preference
31.9
72.1
0
10
20
30
40
50
60
70
80
English preference Spanish preference
Pe
rce
nta
ge
Results:Acculturation Factors
Insurance Status by Nativity Among Latinas
66.1
39.5
0
10
20
30
40
50
60
70
US Born Foreign Born
Per
cen
tag
e
*p<0.0001
Results:Summary
• Preconception care use did vary by race/ethnicity.
• Preconception care use did not vary by acculturation factors among Latinas in Los Angeles.
• Preconception care use did vary by socioeconomic factors among Latinas in Los Angeles.
• Insurance status varied by acculturation factors.
Public Health Implications
• Additional research among Latinas– Improvement of measures of acculturation
• Address language barrier– Assure quality care through linguistically competent
health care providers and promotoras (community health workers)
• Address lack of health insurance– Policies ensuring access to care throughout the life
course
• Address overall low rates of preconception care use among Latinas
Acknowledgements
Los Angeles County Public Health Department Margaret Chao, Cindy Harding, Gina Donnatoni,
Yvonne Lau, Chandra Higgins, Marian Eldahaby, Karen Coller
University of California, Los Angeles
Michael Lu, Eunice Muthengi, Fathima Wakeel,
Erin Rains, Luu Cortes Doan