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PEDIATRICS Vol. 111 No. 5 May 2003, pp. 956-963

Health Services Use by Children of Migratory Agricultural Workers: Exploring the Role of Need for Care

Andrea Weathers, MD, DrPH*, Cynthia Minkovitz, MD, MPP{ddagger}, Patricia O’Campo, PhD{ddagger} and Marie Diener-West, PhD§

* Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
{ddagger} Departments of Population and Family Health Sciences
§ Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

--> 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.

Key Words: child • Hispanic Americans • transients and migrants • health services accessibility • health services needs and demand • health status • residential mobility • emigration and immigration

Abbreviations: MFW, migrant farm worker • WIC, Special Supplemental Nutrition Program for Women, Infants, and Children • CI, confidence interval • OR, odds ratio

Received for publication Apr 23, 2002; Accepted Oct 3, 2002.




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