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
60.0
Percentage
50.0
48.4
40.0
30.0
NTotal= 1135
18.2
20.0
15.4
17.9
NLatina= 543
10.0
NBlack= 204
0.0
NAsian= 173
Latina
Black
Asian
White
NWhite= 201
Methods:
Variables
Acculturation factors
Language preference
Language in which the mother preferred to answer the survey
Nativity
“Were you born in the United States?”
Socioeconomic factors
Income
“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
45
40.8
40
35.8
35
29.9
Percentage
30
25
23.2
20
15
10
5
0
Latina
*p<0.001
Black
Asian
White
Results:
Language Barrier
Language Barrier to Preconception Care by
Language Preference Among Latinas
30
26.7
Percentage
25
20
15
10
5
1.6
0
*p<0.001
English preference
Spanish preference
Results:
Acculturation Factors
Preconception Care Utilization by Language Preference
Among Latinas
25
23.5
22.9
English preference
Spanish preference
Percentage
20
15
10
5
0
*p = 0.87
Results:
Acculturation Factors
Preconception Care Utilization by Nativity Among Latinas
25
24
22
Percentage
20
15
10
5
0
*p=0.5685
US Born
Foreign Born
Results:
Socioeconomic Factors
Preconception Care Utilization by Income Among Latinas
40
37.72
35
Percentage
30
25
19.9
20
16.94
15
10
5
0
<$20,000
*p=0.0001
$20,000-$40,000
>$40,000
Results:
Socioeconomic Factors
Preconception Care Utilization by Insurance Status
Among Latinas
30
27.8
25
Percentage
20
17.8
15
10
5
0
Insured
*p=0.0063
Uninsured
Results:
Race/Ethnicity
Percentage
Uninsured Status by Race/Ethnicity
of LAMB Respondents
*p<0.001
50
45
40
35
30
25
20
15
10
5
0
44.8
25.6
Latina
Black
12.1
11.5
Asian
White
Results:
Acculturation Factors
Insurance Status Among Latinas by Language
Preference
80
72.1
70
Percentage
60
50
40
31.9
30
20
10
0
*p<0.001
English preference
Spanish preference
Results:
Acculturation Factors
Insurance Status by Nativity Among Latinas
70
66.1
60
Percentage
50
39.5
40
30
20
10
0
US Born
*p<0.0001
Foreign Born
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
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