Poverty, insurance, and well-baby care among mainland Puerto Rican children

An explanatory model of factors related to well baby visits by age three years for Medicaid-enrolled infants: a retrospective cohort study

BACKGROUND

Well baby visits (WBVs) are a cornerstone of early childhood health, but few studies have examined the correlates of WBVs for socioeconomically vulnerable infants. The study objective was to identify factors related to the number of WBVs received by Medicaid-enrolled infants in the first three years of life and to present a preliminary explanatory model.

METHODS

We analyzed Iowa Medicaid claims files and birth certificate data for infants born in calendar year 2000 (N = 6,085). The outcome measure was the number of well baby visits (WBVs) received by Medicaid-enrolled infants between age 1 and 41 months (range: 0 to 10). An ecological health model and existing literature were used to evaluate 12 observed factors as potential WBV correlates. We ran multiple variable linear regression models with robust standard errors (α = 0.05).

RESULTS

There were a number of infant, maternal, and health system factors associated with the number of WBVs received by Medicaid-enrolled infants. Infants whose mothers had a greater number of prenatal healthcare visits (ß = 0.24 to 0.28; P = .001) or were married (ß = 0.20; P = .002) received more WBVs. Having a chronic health condition (ß = 0.51; P < .0001) and enrollment in a case management program (ß = 0.48; P < .0001) were also positively associated with WBVs. Eligibility for Medicaid through the Supplemental Security Income Program (ß = -0.70; P = .001), increased maternal age (ß = -0.27 to -0.35; P = .004), higher levels of maternal education (ß = -0.18; P = .005), maternal smoking (ß = -0.13; P = .018), and enrollment in a health maintenance organization plan (ß = -1.15; P < .0001) were negatively associated with WBVs. There was a significant interaction between enrollment in a health maintenance organization plan and enrollment in a Medicaid case management program (P = .015). Maternal race, maternal alcohol use during pregnancy, and rurality were not significantly related to the number of WBVs.

CONCLUSIONS

Multiple infant, maternal, and health system variables were related to the number of WBVs received by Medicaid-enrolled infants. Additional research is needed to develop strategies to optimize access to WBVs for Medicaid-enrolled infants at risk for poor use of preventive medical care services.

Lower early neonatal mortality among singletons in transnational marriage families: Taiwan Birth Registry

The nativity composition of the Taiwan population has changed substantially since 1980, which resulted in one in six children being born to foreign-born mothers in 2004. The purpose of this study was to compare the early neonatal mortality rates among babies of foreign-born and Taiwan-born mothers. Data was obtained from the Taiwan Birth Registry Database in 2004 by the Bureau of Health Promotion, Department of Health, Taiwan. Multivariate analysis was used to examine the influence of the different maternal nationalities on early neonatal mortality after adjusting for important maternal and infant variables. Infants born to foreign-born mothers had a lower early neonatal mortality rate (5.6 per thousand) compared to those born to Taiwan-born mothers (9.4 per thousand). Even after adjusting for important maternal and infant variables, newborns of foreign-born mothers still had a lower risk of early neonatal death compared to newborns of Taiwan-born mothers (odds ratio = 0.68, 95% CI = 0.57-0.80). Foreign-born status may serve as an important index of differentiation in early neonatal mortality among the current Taiwan population. Selection, economic and non-economic aspects may explain the paradox of favorable early neonatal mortality outcomes.

Nonresponse in follow-back surveys of ethnic minority groups: an analysis of the Puerto Rican Maternal and Infant Health Study

OBJECTIVES

This study documents the levels and sources of nonresponse in the first large-scale maternal-infant health survey administered to representative samples of Puerto Rican mothers on both the U.S. mainland and the island of Puerto Rico.

METHODS

The data source is the Puerto Rican Maternal and Infant Health Study, which was administered to a vital records-based sample of 2763 mothers of infants. An additional 805 women were nonrespondents. Nonresponse is examined as a function of several characteristics measured from vital records using logistic regression.

RESULTS

The response rate for this survey compares favorably to response rates for similar surveys. Although nonresponse is not associated with most characteristics measured from vital records, it is higher among mainland residents and mothers of infants who died. The absence of significant associations is due to opposite relationships between several covariates and the failure to locate and refusal. For example, nonresponse in the birth sample is not associated with migration, despite the difficulty of locating migrants. The lower likelihood of locating migrants is offset by their willingness to participate.

CONCLUSIONS

Selectivity due to nonresponse is minimal. Nevertheless, researchers who design "binational" surveys should be aware of setting-specific circumstances that affect the ability to locate sampled individuals and secure their cooperation.