National Center for Education in Maternal and Child Health

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November 26, 2003

1. Report Examines Health Insurance Coverage Among Low-Income Citizen Children

2. Study Assesses Association Between Adolescents' Level of Linguistic Acculturation and Their Well-Being

3. Authors Explore Risk Factors Associated with Pregnancy in Mothers Ages 50 and Older

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1. REPORT EXAMINES HEALTH INSURANCE COVERAGE AMONG LOW-INCOME CITIZEN CHILDREN

"Public health insurance coverage increased--and rates of uninsurance decreased--between 1999 and 2002 among two groups of low-income, U.S. citizen children: those with parents who are native or naturalized U.S. citizens and those with at least one immigrant parent who is not a U.S. citizen (referred to as mixed-status families)," state the authors of Health Insurance Coverage of Children in Mixed-Status Immigrant Families, a report published by the Urban Institute. The authors of this report used data from the 1999 and 2002 National Survey of America's Families to examine the health insurance coverage of low-income citizen children. The report compares differences in coverage between citizen children whose parents are native or naturalized U.S. citizens and those in mixed-status families, and it compares differences in coverage between children whose parents or caregivers responded to the survey in English and those whose parents or caregivers responded in Spanish.

The authors found that

• Uninsurance rates dropped 6.0% for children with citizen parents and 7.1% for children in mixed-status families; however, 12.4% of children with citizen parents and 21.6% of children in mixed-status families were uninsured in 2002.
• Public health insurance coverage increased by 13.0% for children with citizen parents and 11.6% for those in mixed-status families.
• Employer-sponsored coverage of low-income children with citizen parents dropped by 6.5%; for children in mixed-status families such coverage dropped by 4%.
• Gains in public coverage among children whose parents or caregivers responded to the survey in Spanish were equivalent to gains among those whose parents or caregivers responded in English; however, children whose parents or caregivers responded in Spanish were significantly more likely to have public (vs. employer-sponsored) health insurance coverage than those whose parents or caregivers responded in English (47.7% vs. 36.3%).

"Policies designed to reduce language barriers and legal immigrants' fears of receiving health benefits were successful during the period examined here," the authors conclude. However, they caution, "figures recently released by the U.S. Census Bureau . . . suggest that most of the progress we see here occurred between 1999 and 2001, and that this progress may have already ended."

Capps R, Kenney G, Fix M. 2003. Health insurance coverage of children in mixed-status immigrant families. Snapshots of America's Families, No. 12. Washington, DC: Urban Institute. Available at http://www.urban.org/UploadedPDF/310886_snapshots3_no12.pdf.

Readers: For more information, see the MCH Library bibliography, Children's Health Insurance, at http://www.mchlibrary.info/databases/bibmenu.html and the MCH Library knowledge path, Child and Adolescent Health Insurance and Access to Care, at http://www.mchlibrary.info/KnowledgePaths/kp_insurance.html.

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2. STUDY ASSESSES ASSOCIATION BETWEEN ADOLESCENTS' LEVEL OF LINGUISTIC ACCULTURATION AND THEIR WELL-BEING

"Adolescents of all racial and ethnic groups from a non-English [speaking] home environment are at higher risk of a range of psychosocial and parental risk factors than the majority population of non-Hispanic white English-speakers," state the authors of an article published in the December 2003 issue of the Journal of Adolescent Health. The authors of this article sought to assess the influence of adolescents' level of acculturation on their health and psychosocial risks. The article examines the association of linguistic acculturation (as measured by the language spoken at home) with measures of adolescent well-being.

Data for the study were drawn from the 1997-1998 Health Behavior in School-Aged Children survey, which asked a nationally representative sample of 15,220 adolescents in grades 6 to 10 in 386 U.S. schools to report on several measures of child well-being (health behaviors, psychosocial and school risk factors, and parental influence). Students were also asked to report on the language spoken at home all or most of the time (categorized as exclusively or mostly English, exclusively or mostly another language, or a mixture of the two). Researchers compared students' self-reported measures of well-being for all racial and ethnic groups who did not report speaking English at home with those of the majority population of white non-Hispanic English speakers.

The authors found that

• Language spoken at home was generally not significantly associated with health and safety measures for adolescents across the racial/ethnic groups, with the exceptions of seatbelt and helmet use among black and Hispanic adolescents who spoke a language other than English at home.
• Among non-Hispanic whites, those who spoke a mixture of languages at home were at higher risk for feeling low. Those who spoke another language at home were at higher risk for being bullied because of their religion or race, reporting that their parents were not willing to talk to their teachers and that students in their class did not enjoy being together and feeling that their parents expected too much of them at school.
• Black adolescents were at significantly higher risk in terms of psychosocial and school factors and parental influence, regardless of the language spoken at home.
• Hispanic English speakers did not show any significant difference in risk compared with non-Hispanic white English speakers; however, those who spoke Spanish (either exclusively or in addition to English) at home were more likely to report not feeling confident, to feel that their teachers' expectations were too high, to be bullied at school because of race or religion, to report that their parents were not willing to talk to their teachers, and to feel that their parents expected too much of them at school.
• Asians who spoke a mixture of languages at home were at significantly higher risk only for feeling that their parents were not willing to talk to their teachers and feeling that their parents expected too much of them at school, whereas those who spoke another language exclusively at home were at significantly higher risk in several areas.

The authors conclude that "these findings emphasize the need to design risk-reduction interventions for adolescents that take the vulnerabilities of immigrant youth into account, and to implement preventive mental health services for youth that are targeted toward new immigrants of all races and ethnic groups."

Yu SM, Huang ZJ, Schwalberg RH, Overpeck M, Kogan MD. 2003. Acculturation and the health and well-being of U.S. immigrant adolescents. Journal of Adolescent Health 33(6):479-488.

Readers: For more information, see the MCH Library bibliography, Adolescent Mental Health, at http://www.mchlibrary.info/databases/bibmenu.html and the MCH Library organization list, Culturally Competent Services, at http://www.mchlibrary.info/databases/orgmenu.html.

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3. AUTHORS EXPLORE RISK FACTORS ASSOCIATED WITH PREGNANCY IN MOTHERS AGES 50 AND OLDER

"[Our] findings suggest that pregnancy beyond age 50 may represent a distinct obstetrical entity with a risk pattern that differs from that observed for mature [ages 30-39] and very mature [ages 40-49] mothers," state the authors of an article published in the November 2003 issue of Obstetrics and Gynecology. The purpose of the study described in this article was to determine whether older mothers (ages 50 and above) constitute a specific and unique risk group distinct, in terms of magnitude of risk, from their younger counterparts. The main outcomes of interest were fetal mortality rate, low and very low birthweight, preterm and very preterm delivery, and small size for gestational age. Maternal complications were also examined.

For the study, the authors used 1997-1999 National Center for Health Statistics public-access natality files and fetal death files. Expanded reporting of maternal age from 49+ to individual years of age from 49 to 54 was initiated in 1997, so the 1997-1999 period represented the years for which relevant U.S. data were available at the time of the study. Maternal age was grouped into the following four cohorts: 20-29 (young), 30-39 (mature), 40-49 (very mature), and 50 and older (older).

The authors found that

• Of the 12,066,854 deliveries that resulted in live births or fetal deaths in the United States between 1997 and 1999, 539 were to women ages 50 and older.
• Compared with singleton infants of young mothers, those of older mothers had higher risks for low and very low birthweight, preterm and very preterm delivery, small size for gestational age, and fetal mortality.
• Compared with singleton infants of very mature mothers, those of older mothers had increased risk for low birthweight, preterm and very preterm delivery, small size for gestational age, and fetal mortality.
• For mothers with multiple gestations, the differences in the risk between older and young mothers was smaller than that noted for those with singleton gestations, but older mothers still had significantly higher risk for low and very low birthweight, very preterm delivery, and small size for gestational age.
• Rates for cardiac disease, diabetes, chronic hypertension, placenta previa, and abruptio placentae showed a positive association with maternal age; for these risk factors, with the exception of abruptio placentae, the rates were higher among older mothers than among very mature mothers.

The authors conclude that "there is a need to offer older women special counseling both before and after conception so that they become informed about the risks involved."

Salihu HM, Shumpert N, Slay M, et al. 2003. Childbearing beyond maternal age 50 and fetal outcomes in the United States. Obstetrics and Gynecology 102(5):1006-1014.

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MCH Alert © 2003 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by MCH Library Services at the National Center for Education in Maternal and Child Health under its cooperative agreement (6U02 MC 00001) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.

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EDITORS: Jolene Bertness, Tracy Lopez

COPYEDITOR: Ruth Barzel

National Center for Education in Maternal and Child Health
Georgetown University
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