Migration and Access to Care: An Innovative Population-Based Sampling Strategy

描述(由申请人提供)：这项研究的主要目的是测试在多个州实施基于人口的抽样战略的可行性，该战略针对美国东部沿海农业劳动力移民的子女的流动人口。农业劳工移民人数数以百万计，是美国流动性最强的人口之一。除了更高的数量流动性，他们还拥有跨国和跨国的定性移民模式。在一个州的成功试点研究的基础上，这项研究将在三个州对有孩子的家庭实施基于人口的抽样战略。抽样策略的关键是劳动力迁移不是随机的。不出所料，劳工移民会通过完善的移民门户网站流动，他们的住房位置也是众所周知的。我们提出了一个多阶段的集群样本：1)确定每个州的移民门户；2)根据劳动力移民的密度对每个门户中的县进行分层；3)在每个密度层中随机抽取一部分县；以及4)在每个选定的县中，随机抽取一部分移民居住的地址。我们的创新抽样战略将产生有关美国农业移民的代表性数据，这是一个高度脆弱且未得到充分研究的人口。我们的次要目标是测试家庭移徙模式与儿童保健服务获取之间的独立关联，包括已实现的(保健服务使用)和潜在的(护理障碍)保健获取结果。为了指导分析，我们扩充了广泛使用的卫生服务使用行为模型(Andersen 1995)。一个关键问题是，在控制了迁徙次数、保健需求、诱因和有利资源之后，家庭移徙模式的类型，例如跨国或国内移徙模式，是否与卫生服务的使用和护理障碍有关。该项目的重大贡献是：1)为流动人口引入可复制的基于人口的抽样战略；2)增进关于人口流动如何与儿童获得保健服务相关联的知识(PA-00-32)。这个项目对公共卫生很重要，因为这一人群中的许多父母和孩子都是非法移民，这是一个庞大的、不断增长的美国人口，人们对他们知之甚少。项目说明：该项目的重大贡献是：1)为流动人口引入了可复制的基于人口的抽样战略，以及2)增进了关于人口流动与儿童获得保健服务的关系的知识(PA-00-32)。这个项目对公共卫生很重要，因为在这个人口中，有很大一部分父母和孩子是非法移民--这是一个庞大的、不断增长的美国人口，人们对他们知之甚少--这个项目的结果可以促进对这些家庭的了解。

DESCRIPTION (provided by applicant): The primary aim of this study is to test the feasibility of implementing, in multiple states, a population-based sampling strategy for a mobile population the children of agricultural labor migrants along the eastern United States seaboard. Agricultural labor migrants number in the millions and are one of the United States' most mobile populations. In addition to heightened quantitative mobility, they have qualitative migration patterns that are both trans- and intra- national. Building upon a successful pilot study in one state, this study will implement a population-based sampling strategy for families with children in three states. Key to the sampling strategy is the fact that labor migration is not random. Labor migrants predictably move across well-established migration portals, and their housing locations are well-known. We propose a multistage cluster sample to: 1) identify the migration portals in each state; 2) stratify counties in each portal by the density of labor migrants; 3) randomly sample a fraction of counties per density stratum; and 4) in each selected county, randomly sample a fraction of addresses where migrants live. Our innovative sampling strategy will yield representative data about agricultural U.S. migrants, a highly vulnerable and understudied population. Our secondary aim is to test the independent association between family migration patterns and child health care access, including both realized (health services use) and potential (barriers to care) health access outcomes. To guide the analysis, we augment the widely-used Behavioral Model of Health Services Use (Andersen 1995). One key question is whether or not the type of family migration pattern, e.g. whether trans- national or intra-national, is associated with health services use and barriers to care, after controlling for numbers of moves, health needs, predisposing factors, and enabling resources. The significant contributions of this project are: 1) introduction of a replicable population-based sampling strategy for a mobile population, and 2) advancement of knowledge about how population movement is associated with children's access to health care (PA-00-32). This project is important to public health because many parents and children in this population are undocumented immigrants a sizeable and growing U.S. population about whom little is known. Project Narrative: The significant contributions of this project are: 1) the introduction of a replicable population-based sampling strategy for a mobile population, and 2) advancement of knowledge about how population movement is associated with access to health care for children (PA-00-32). This project is important to public health because a large proportion of parents and children in this population are undocumented immigrants-a sizeable and growing U.S. population about whom little is known-results from this project can advance knowledge about these families.