Ill health and use of medical care. Community-based assessment of morbidity in children

How health status affects progress and performance in school: a population-based study

OBJECTIVE

To assess the effects of health status at birth and health status in the preschool years on educational outcomes to age 9 in a population-based birth cohort.

METHODS

Administrative data were used to follow all children born to Winnipeg mothers in 1990, and remaining in Manitoba until September 2004 (N = 5,873). A structural equation model was used, incorporating latent variables to represent Health Status at Birth, Major Illness and Minor Illness during the preschool years. The model also included the child's sex and exact age, along with a number of social, economic, and demographic characteristics of the child's family. The outcome was a combination of marks on Grade 3 Standards Tests and enrollment in the appropriate grade for age.

RESULTS

Major Illness in the preschool years had a significant influence on progress and performance in school (p = 0.0003), predicting 1.26% of the variation in the outcome. Minor Illness was weaker but still significant (p < 0.01). Health Status at Birth was not directly related to the outcome; its effect was mediated by Major and Minor Illness in childhood. Overall, the strongest predictors were the child's age and the area-level income, followed by the mother's age, family receipt of income assistance, the sex of the child, breastfeeding initiation (all p < 0.0001), and Major Illness.

CONCLUSIONS

Health status plays a statistically significant but substantively small role in explaining progress and performance in school among a population-based cohort. Major Illness was more important than Minor Illness, and these two factors completely mediated the influence of Health Status at Birth on the outcome. The strength of the social, economic, and demographic variables underscores the importance of the broader factors that affect both health and educational outcomes.

Health services use by children of migratory agricultural workers: exploring the role of need for care

OBJECTIVE

For migrant children: 1). to assess the determinants of health services use among users and nonusers of health services; 2). to evaluate the association between health status and health services use, while controlling for potential confounders.

DESIGN

A cross-sectional household survey using multistage, partially random sampling to identify migrant families in eastern North Carolina.

PARTICIPANTS

Adult caretakers of 1 randomly selected child under 13 years old.

RESULTS

Forty-four percent of children (N = 300) visited a doctor in the preceding 3 months. Those visiting a doctor disproportionately reported having less than very good health (29% vs 10%), insurance (46% vs 11%), interpreters (45% vs 27%), a family member receiving Special Supplemental Nutrition Program for Women, Infants, and Children (50% vs 16%), and a legal caretaker (30% vs 18%). Compared with those without a doctor visit, a larger proportion of children visiting a doctor were 6 years or younger in age (71% vs 35%), born in the United States (51% vs 15%), female (64% vs 45%), and had not moved in 6 or more months (19% vs 10%). Controlling for enabling resource and sociodemographic confounders, children with less than very good health were 2.4 times more likely than those in very good health to have visited a doctor (95% confidence interval [1.1-5.2]).

CONCLUSIONS

Migrant children using health services are distinct from nonusers with regards to sociodemographic factors, enabling resources, and need for care. Health services use is associated with less than very good perceived health, despite resource barriers and sociodemographic disadvantages. More efforts are needed to improve access to health care for migrant children.

Psychosocial influences on the use of health care by children

A prospective cohort study examined the influence of psychosocial factors on the use of general practitioners over a six-month period by 271 children (aged four to nine years) and their mothers. The study was conducted in 10 general practices in the metropolitan area of Perth. The influences of psychosocial factors on use, nonuse and frequency of use by the children were examined, taking into account sociodemographic and morbidity factors. Physical health status, maternal use and financial factors were directly associated with the children's use or nonuse of general practitioners, while maternal stress, a mother's attitude towards her child and the child's psychosocial morbidity were indirectly related. Physical health status, doctor-initiated consultations, maternal stress, children's ages and birth order were directly associated with the children's frequency of use of general practitioners. Depression and anxiety in the mothers, measured with standardised instruments, were not associated with use by the children nor was a mother's level of social support. The results point to the importance of family relationships and illness behaviour in the family when considering use of general practitioners and the importance of using standardised measuring instruments and multivariate designs when studying such complex behaviours as the use of health care.

Utilization of ambulatory health services by urban adolescents

PURPOSE

To describe adolescents' utilization of ambulatory health services and its association with sociodemographic and health status characteristics.

METHODS

Adolescents (N = 199) were selected from a larger group of urban middle and high school students who had previously participated in a health risk survey. Subjects were surveyed about their health status and use of ambulatory medical services. Subjects' parents/guardians were also surveyed about sociodemographic information. Bivariate and multivariate analyses using Chisquare statistics and logistic regression techniques assessed the contribution of hypothesized variables to use of routine medical, illness-related medical, and dental services.

RESULTS

Most adolescents reported having seen a physician (70%) or a dentist (79%) within the past year. Subjects reported using a wide variety of practitioners and settings, with family/general practitioners (29%), and the private office setting (23%) most commonly reported. Subjects having a regular source of care and those perceiving their health as "excellent" or "very good" were 2.4 and 3.4 times more likely to have used routine medical services than those without a regular source of care and those reporting their health as "fair" or "poor." In contrast, the strongest predictors of having received illness-related care in the past year were the presence of a current medical problem and an age by gender interaction factor. Those reporting a current medical problem were twice as likely as those not reporting a problem and older females were 6.6 times as likely as younger males to have received illness-related care within the past year. The only significant predictor of recent dental care was having private insurance.

CONCLUSION

For adolescents enabling variables, such as having a regular source of care and health insurance, are stronger predictors of routine use of medical and dental care, whereas medical need and sociodemographic factors, such as age and gender, are more important in predicting use of illness-related care. These results support, in part, models that have been previously developed to explain use of ambulatory health services.

Correlates of emergency room utilization in the first year of life

We conducted a case-control study to examine the correlates of emergency room use in the first year of life, particularly the role of parental health beliefs, among the families of inner-city children enrolled in a hospital-based primary care program. Data was collected by structured interviews and by medical record review. Emergency room users were more likely to have single mothers and to have acute, recurrent medical conditions than were non-users. Health beliefs differed between groups by maternal report of worry about the kinds of illnesses that her child acquires. Emergency room use was predicted by: maternal marital status, maternal worry and concern that illness interferes with her child's activity, acute recurrent illnesses, hospitalization. This model may be applicable to other populations in designing intervention strategies to modify emergency room utilization.

Morbidity and use of ambulatory care services among poor and nonpoor children

Using data from the Child Health Supplement to the 1981 National Health Interview Survey, illness and use of physician services are compared for children under 18 years old in three family income groups. The results indicate that although annual prevalence of many health problems does not differ greatly by income level, disability as measured by bed days is greater among low income children. A substantial minority of children from all socioeconomic levels are afflicted by multiple health problems. The impact of multiple conditions, as measured by days spent ill in bed, appears much greater for children from low income families. Use of physician services was found to be similar for children of all socioeconomic levels when no significant health problems were present, but low income children with health problems used fewer physician visits on an adjusted basis than their higher income counterparts.