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

描述（由申请人提供）：本研究的主要目的是测试在美国东部沿海地区对流动人口（农业劳动力移民的子女）实施基于人口的抽样策略的可行性。农业劳工移民的人数数以百万计，是美国最具流动性的人口之一。除了数量上的流动性增加外，它们还具有跨国家和国内的质量迁移模式。在一个州成功的试点研究的基础上，本研究将对三个州有孩子的家庭实施基于人口的抽样策略。抽样策略的关键在于劳动力迁移不是随机的。可以预见的是，劳动力移民会通过完善的移民门户，他们的住房地点是众所周知的。我们提出了一个多阶段聚类样本：1)识别每个状态下的迁移门户；2)按外来务工人口密度对各门户县进行分层；3)每个密度层随机抽取一部分县；4)在每个选定的县，随机抽取一部分移民居住的地址。我们创新的抽样策略将产生关于美国农业移民的代表性数据，这是一个高度脆弱和未充分研究的人群。我们的第二个目的是测试家庭迁移模式与儿童保健获取之间的独立关联，包括实现的（保健服务使用）和潜在的（保健障碍）保健获取结果。为了指导分析，我们增加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，在控制了迁移次数、健康需求、易感因素和有利资源之后，家庭迁移模式的类型（例如跨国或国内）是否与卫生服务的使用和保健障碍有关。该项目的重大贡献是：1)对流动人口采用可复制的基于人口的抽样策略，以及2)增进关于人口流动与儿童获得保健的关系的知识（PA-00-32）。这个项目对公共卫生很重要，因为这一人口中的许多父母和儿童都是无证移民，这是一个庞大且不断增长的美国人口，对他们知之甚少。项目说明：本项目的重大贡献是：1)对流动人口采用可复制的基于人口的抽样策略，以及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，因为这个人口中的很大一部分父母和孩子都是无证移民——这是一个庞大且不断增长的美国人口，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.