State variations in linguistic competency policies and the effects on immigrant a

描述（由申请人提供）：拟议的论文研究探讨了国家语言政策对移民获得医疗服务的影响，其中许多人英语水平有限（LEP），可能面临语言障碍。根据联邦公民权利法，各州必须确保其卫生系统可供LEP人员使用。然而，由于缺乏监督和执行，出现了广泛的国家政策“拼凑”。在文献中，已经做出努力来描述和编目广泛的国家政策，以及强调国家模式，如加州或华盛顿。然而，这些国家政策是否有效地改善了移民人口获得保健服务的机会，还没有经过实证检验，因此，仍然没有得到明确的理解。过去研究语言服务干预措施的有效性主要是基于一个单一的设置（如医院或诊所），并没有考虑到国家的变化。本研究的具体目的是：（1）检查不同语言政策的州的人口特征的变化;（2）确定移民和美国出生人口之间在获得医疗服务方面的差异是否因州而异;（3）确定移民和美国之间在获得医疗服务方面的差距是否-在有和没有特定语言政策的州之间，出生人口各不相同;（4）评估特定州语言政策在解决移民和美国出生者之间的差异方面的有效性。将评估三种类型的州语言政策，包括：语言服务的资金或报销，确保健康口译能力的努力，以及对医院或其他医疗保健提供者组织的要求。为了实现这些目标，本研究将利用二级数据源，美国家庭全国调查（NSAF）-城市研究所进行的大型代表性家庭调查。与其他国家调查不同的是，NSAF旨在提供各州的具体估计数，并允许在13个州的横截面之间进行比较。考虑到数据的层次性质（即个人嵌套在国家），多层次建模将用于测试移民获得卫生服务的国家与这些语言政策与国家没有这样的政策的差异。 公共卫生相关性：相关性和影响本研究评估了国家语言政策在改善移民人口获得卫生服务方面的有效性。各州在提供卫生服务方面发挥着重要作用，但在满足不断增长的移民群体的医疗保健需求方面面临着巨大挑战，其中许多人在英语口语或理解方面存在问题。目前，有相当大的国家差异的政策处理语言障碍的卫生系统和经验知识很少，这些政策是否工作。

DESCRIPTION (provided by applicant): The proposed dissertation study examines the effects of state language policies on the access to health services among immigrants-many of whom are limited English proficient (LEP) and likely to face language barriers. Under federal civil rights law, states are required to ensure that their health systems are accessible to LEP persons. However, due to the lack of oversight and enforcement, a broad "patchwork" of state policies has emerged. In the literature, efforts have been made to describe and catalogue the broad array of state policies as well as to highlight state models, such as California or Washington. However, whether these state policies are effective in improving access to health services among the immigrant population has not been empirically tested and thus, is still not clearly understood. Past studies examining the effectiveness of language service interventions have been largely based in a single setting (such as a hospital or clinic) and do not account for state variation. The specific aims of the study are to: (1) Examine the changes in demographic characteristics for states with differing language policies; (2) Determine whether the disparities in access to health services between the immigrant and US-born populations vary from state to state; (3) Determine whether the disparities in access to health services between the immigrant and US-born populations vary between states with and without specific language policies; and (4) Evaluate the effectiveness of specific state language policies in addressing the disparities in access between immigrants and US-born persons. Three types of state language policies will be assessed, including: funding or reimbursement for language services, efforts to ensure health interpreter competency, and requirements for hospitals or other health care provider organizations. To achieve these aims, this study will draw on a secondary data source, the National Survey of America's Families (NSAF)-a large representative survey of families conducted by the Urban Institute. Unlike other national surveys, the NSAF is designed to provide state-specific estimates and allows for comparisons between a cross-section of thirteen states. To account for the hierarchical nature of the data (i.e. individual nested in states), multi-level modeling will be used to test differences in immigrant access to health services in states with these language policies versus states without such policies. PUBLIC HEALTH RELEVANCE: Relevance and Impact This study evaluates the effectiveness of state language policies in improving access to health services for immigrant populations. States play an important role in the provision of health services, but face tremendous challenges in addressing the healthcare needs of their growing immigrant constituencies-many of whom have problems speaking or understanding the English language. Currently, there is considerable state variation in the policies dealing with language barriers in the health system and little empirical knowledge as to whether these policies work.