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

项目概要/摘要 美国有超过1800万18岁以下的拉美裔人，占青年总数的四分之一 人口有一致和严格的证据表明，拉丁美洲青年历史上有最糟糕的模式 任何青年群体获得和利用卫生保健的机会，即使在控制了诸如 保险和家庭收入。对于超过50%的拉丁裔青年来说，获得医疗服务的机会更糟， 移民父母这些差异可能是青年和家庭、社区、 政策和社会因素。然而，缺乏证据表明，个人的影响和 这些层面的共同影响。加州是研究获得医疗服务的复杂性的理想州 因为它拥有全国最大的拉丁裔和移民人口， 家庭公民身份和文件组成的可变性。州和国家健康调查不 通常衡量家庭公民身份和文件状态以及医疗保健的许多方面 资格，这些调查通常对青年人获得和利用保健的措施有限， 家庭层面。加州健康访谈调查（CHIS）是全州最大的年度代表性调查， 在全国进行健康调查，收集关于青年和父母公民身份及证件状况的数据， 这使得有独特的机会来审查家庭公民身份的可变性的影响， 关于青年获得和利用保健服务的文件状况。我们计划进行一项后续研究 在2021年和2022年的CHIS浪潮中，有1,000名拉丁裔青年及其家庭。我们的方法将使我们能够 将联合收割机基线CHIS数据与从后续访谈和县级数据中新收集的数据相结合， 审查青年在获得和利用保健方面的差距。我们还将确定差异如何 不同的青年，父母和兄弟姐妹的公民身份和文件的组成和程度，青年 家庭、社区、政策和社会因素影响着他们。使用NIMHD研究框架， Warnecke等人的人口健康和健康差距模型，我们将在 家庭公民身份和证件状况构成的背景：1）估计获得方面的差距 根据青年和家庭层面的因素，拉丁美洲青年对卫生保健的接受和利用; 2）了解 增加拉丁美洲青年获得和使用服务的可能性的过程和促进者; 3） 确定父母对卫生系统和机构的信任如何影响卫生保健的决定因素 拉丁美洲青年的获取和利用;以及4）了解县级政策和社会政策的变化 背景影响拉丁美洲青年的卫生服务使用。该项目将提供关键信息， 多层次的影响影响了拉丁美洲青年获得和利用护理的机会， 证据指导政策和实践干预措施，以改善拉丁美洲青年获得护理的机会。

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.