Date

5-1-2008

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Background: There are significant health and health care disparities between Hispanic and white children in the United States. Hispanic children are a heterogeneous group by nationality, level of acculturation and immigrant status. Prescription medications are key to the management of many childhood conditions, and disparities in the use of prescription medications have been found between Hispanic and white children. It is not known whether these disparities are the same or different across different groups of Hispanic children. Objectives: This study examined how Hispanic children, stratified by language of interview to indicate level of acculturation, differ in socio-demographic characteristics and both overall and specific classes of medication use. We also examined which factors are associated with the use of different classes of prescription medications. Methods: We used data from the 2004 Medical Expenditure Panel Survey linked to the National Health Interview Survey to analyze children's use of medications in 2004. Independent variables were grouped as predisposing characteristics, enabling factors, perceived need, and evaluated need. Multivariable logistic regression was used to assess the impact of independent variables on the outcomes of overall and specific types of medication use.Results: Spanish-interviewed Hispanics were less likely to have a usual source of care than English-interviewed Hispanics (79.4% versus 90.7%), and Spanish-interviewed Hispanic children were twice as likely to be uninsured all year than English-interviewed Hispanic children (18.6% versus 8.9%). Both groups of Hispanic children had lower odds of using any prescription medication compared to White children, which was largely explained by enabling factors such as having a usual source of care but also by perceived need characteristics such as perceived health status. The lower use of psychiatric medications in the Spanish-interviewed group compared to white children was not explained by the independent variables (final model odds ratio = 0.28, 95% confidence interval: 0.10, 0.79) while the use of antibiotics was (final model odds ratio = 1.07, 95% confidence interval: 0.76, 1.51). There was no significant difference in the use of any respiratory medication among the groups of children, but Hispanic, Spanish-interviewed children were less likely to have reported active asthma (p-value = 0.007). Conclusions: There are significant differences between Hispanic children by acculturation as indicated by language of interview, and acculturation impacts prescription medication use. Hispanic children from more acculturated backgrounds do not experience a disparity compared to white children in their use of psychiatric medications while Hispanic children from less acculturated backgrounds do. These findings may be used to more specifically address disparities and the medical needs of Hispanic children.

Identifier

doi:10.6083/M4VM4975

School

School of Medicine

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