Award Date

5-2010

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Epidemiology and Biostatistics

First Committee Member

Michelle Chino, Chair

Second Committee Member

Linda Stetzenbach

Third Committee Member

Denise Tanata Ashby

Graduate Faculty Representative

Katherine Howard

Number of Pages

67

Abstract

Access to health care is an important factor for the well-being of America's children. The principal goal of this study was examine the 2008-2009 Kindergarten Health Survey data to advance understanding and appreciation of the health status of children in addition to their discrepancies in accessing health care in the state of Nevada (n = 11,073). This dataset serves as a secondary data source to determine whether socio-demographic and medical factors are associated with disparity in accessing health care for children entering kindergarten. This study looked at both independent and combined effects of annual household income, race/ethnicity, primary language spoken in the family, rural/urban residence, and existing medical condition for preventive health care. A Chi-Square test of association was calculated to test for the statistical significance of the differences between select predictor and outcome variables. A binary logistic regression with forward likelihood ratio (LR) of covariates method selection was performed to obtain a validated estimate of the predictive quality. Odds ratio estimates with corresponding 95% confidence intervals (CIs) are presented for significant variables. Results from analyses indicate that annual household income for the sample was a significant predictor of access to health care, with low income category having less opportunity for consistent access to care than those in the middle or high income category. The significance of independent effects indicates that Caucasian sample participants were more likely than all other minority categories to have access to routine preventive care. Results also showed that families with limited English skills had greater barriers to health care. Indeed, those who are Hispanic but speak English were over 2.5 times more likely to have regular access to care than Hispanics who primarily speak Spanish. Findings indicate that rural residents had decreased odds of access to preventive care and having a primary care provider. However, unexpectedly, rural residents have increased odds of having access to dental care compared to Clark County residents. When looking at the independent effects of medical conditions on health care outcomes, parents of children with no medical conditions were more likely to have access to care than those with medical condition. Evaluating health care access outcomes and their potential predictors gives public health officials an idea of where the emphasis should be placed for possibly reducing barriers to care. The consequences for not addressing health care access issues include deteriorating health and well being for vulnerable sociodemographic groups in the state. Altogether these findings suggest that programs and policies within the state must be sensitive to the specific needs of at risk groups, including minorities, those with low income, regionally- and linguistically- isolated residents.

Keywords

Child health services; Children; Children of minorities; Children – Social conditions; Health care access; Nevada; Pre-school / kindergarten; Poor children; Public schools; Socio-demographic

Disciplines

Pediatrics | Public Health

Language

English


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