Understanding the Multiple-levels of Influence on Access to Care for Latino Youth

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PROJECT SUMMARY/ABSTRACT There are over 18 million Latinos under the age of 18 in the US, and they make up one-fourth of the total youth population. There is consistent and rigorous evidence that Latino youth have historically had the worst patterns of health care access and utilization of any group of youth, even after controlling for variables such as insurance and family income. Access to care is even worse for the over 50% of Latino youth who have immigrant parents. These disparities are likely the result of multiple levels of youth and family, community, policy and societal factors. There is a dearth of evidence, however, on both the individual influence and the joint influence of these levels. California is an ideal state in which to study the complexities of access to care for Latino youth because it has the largest Latino and immigrant populations in the country with considerable variability in family citizenship and documentation compositions. State and national health surveys do not commonly measure the many dimensions of family citizenship and documentation statuses and health care eligibility, and these surveys generally have limited measures of health care access and utilization at the youth- and family-levels. The California Health Interview Survey (CHIS) is the largest annual representative statewide health survey in the country and collects data on youth and parent citizenship and documentation statuses, which allows for the unique opportunity to examine the effects of variabilities in family citizenship and documentation statuses on health care access and utilization for youth. We plan to conduct a follow-up study of 1,000 Latino youth and their families in the 2021 and 2022 CHIS waves. Our approach will allow us to combine baseline CHIS data with newly collected data from follow-up interviews and county-level data to examine disparities in youth's access to and utilization of health care. We will also determine how disparities vary by youth, parent and sibling citizenship and documentation compositions and the extent to which youth and family, community, policy and societal factors influence them. Using the NIMHD Research Framework and Warnecke et al.'s model for population health and health disparities, we will address 4 specific aims in the context of families' citizenship and documentation status compositions: 1) estimating the disparities in access to and utilization of health care for Latino youth according to youth- and family-level factors; 2) understanding the processes and facilitators that increase the likelihood that Latino youth access and use services; 3) identifying how parental trust in health systems and institutions influence the determinants of health care access and utilization for Latino youth; and 4) understanding how variations in county-level policy and societal contexts influence health services use for Latino youth. The project will provide critical information on how the effects of multiple levels of influence affect access and utilization of care for Latino youth and will offer evidence to guide policy and practice interventions to improve access to care for Latino youth.