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OBJECTIVES: We examined trends in racial/ethnic, socioeconomic, and geographic disparities in age- and cause-specific infant mortality in the United States during 1915-2017. METHODS: Log-linear regression and inequality indices were used to analyze temporal infant mortality data from the National Vital Statistics System and the National Linked Birth/Infant Death files according to maternal and infant characteristics. RESULTS: During 1915-2017, the infant mortality rate (IMR) declined dramatically overall and for black and white infants; however, black/white disparities in mortality generally increased through 2000. Racial disparities were greater in post-neonatal mortality than neonatal mortality. Detailed racial/ethnic comparisons show an approximately five-fold difference in IMR, ranging from a low of 2.3 infant deaths per 1,000 live births for Chinese infants to a high of 8.5 for American Indian/Alaska Natives and 11.2 for black infants. Infant mortality from major causes of death showed a downward trend during the past 5 decades although there was a recent upturn in mortality from prematurity/low birthweight and unintentional injury. In 2016, black infants had 2.5-2.8 times higher risk of mortality from perinatal conditions, sudden infant death syndrome, influenza/pneumonia, and unintentional injuries, and 1.3 times higher risk of mortality from birth defects compared to white infants. Educational disparities in infant mortality widened between 1986 and 2016; mothers with less than a high school education in 2016 experienced 2.4, 1.9, and 3.7 times higher risk of infant, neonatal, and post-neonatal mortality than those with a college degree. Geographic disparities were marked and widened across regions, with states in the Southeast region having higher IMRs. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Social inequalities in infant mortality have persisted and remained marked, with the disadvantaged ethnic and socioeconomic groups and geographic areas experiencing substantially increased risks of mortality despite the declining trend in mortality over time. Widening social inequalities in infant mortality are a major factor contributing to the worsening international standing of the United States.
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Preterm birth (PTB, <37 weeks of gestation) is influenced by a wide range of environmental, genetic and psychosocial factors, and their interactions. However, the individual and joint effects of genetic factors and psychosocial stress on PTB have remained largely unexplored among U.S. born versus immigrant mothers.We studied 1121 African American women from the Boston Birth Cohort enrolled from 1998 to 2008. Regression-based analyses were performed to examine the individual and joint effects of genetic ancestry and stress (including lifetime stress [LS] and stress during pregnancy [PS]) on PTB and related traits among U.S. born and immigrant mothers.Significant associations between LS and PTB and related traits were found in the total study population and in immigrant mothers, including gestational age, birthweight, PTB, and spontaneous PTB; but no association was found in U.S. born mothers. Furthermore, significant joint associations of LS (or PS) and African ancestral proportion (AAP) on PTB were found in immigrant mothers, but not in U.S. born mothers.Although, overall, immigrant women had lower rates of PTB compared to U.S. born women, our study is one of the first to identify a subset of immigrant women could be at significantly increased risk of PTB and related outcomes if they have high AAP and are under high LS or PS. In light of the growing number of immigrant mothers in the U.S., our findings may have important clinical and public health implications.
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Negro o Afroamericano/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Madres/estadística & datos numéricos , Nacimiento Prematuro/etnología , Estrés Psicológico/etnología , Adulto , Consumo de Bebidas Alcohólicas/etnología , Peso al Nacer , Parto Obstétrico , Femenino , Genotipo , Edad Gestacional , Humanos , Embarazo , Complicaciones del Embarazo/etnología , Fumar/etnología , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/etnología , Adulto JovenRESUMEN
OBJECTIVES: This study sought to determine whether women's report of gestational weight gain (GWG) advice from a health care provider is consistent with the Institute of Medicine (IOM) guidelines and the association between provider advice and women's weight gain during pregnancy. METHODS: Data came from the 2007 Los Angeles Mommy and Baby study (n = 3,402). The 1990 IOM GWG guidelines were used to define whether the provider's advice on weight gain and women's weight gain were below, within, or above the guidelines. RESULTS: Approximately 4 months after delivery, 18.8% of the women reported having not discussed weight gain with any health care providers during pregnancy. Among those who reported such discussions, 42% reported receiving weight gain advice from a health care provider within IOM guidelines, 16.5% below guidelines, and 10% above. An additional 13.5% reported the discussion but did not report the recommended weight gain amount. Compared with women who reported provider advice on weight gain within guidelines, women who reported advice below guidelines were 1.7 times (95% confidence interval [CI], 1.3-2.2) more likely to gain less than the IOM recommended amount. Women who reported provider advice above IOM guidelines were 2.0 times (95% CI, 1.4-2.9) more likely to exceed guidelines. CONCLUSIONS: There is a need for more women to receive advice consistent with the IOM GWG guidelines from their prenatal care providers. Intervention strategies are needed to educate providers about IOM guidelines and how to counsel on GWG.
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Consejo/métodos , Conocimientos, Actitudes y Práctica en Salud , Obesidad/prevención & control , Relaciones Médico-Paciente , Mujeres Embarazadas/etnología , Atención Prenatal/métodos , Aumento de Peso , Adulto , California , Comunicación , Estudios Transversales , Femenino , Adhesión a Directriz , Encuestas de Atención de la Salud , Personal de Salud , Hispánicos o Latinos , Humanos , Entrevistas como Asunto , Obesidad/complicaciones , Obesidad/etnología , Educación del Paciente como Asunto , Embarazo , Complicaciones del Embarazo/psicología , Mujeres Embarazadas/psicología , Investigación Cualitativa , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenAsunto(s)
Trastorno del Espectro Autista , Investigación Biomédica/organización & administración , Discapacidades del Desarrollo , United States Health Resources and Services Administration/organización & administración , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/terapia , Investigación Biomédica/legislación & jurisprudencia , Niño , Discapacidades del Desarrollo/diagnóstico , Discapacidades del Desarrollo/terapia , Humanos , Estados Unidos , United States Health Resources and Services Administration/legislación & jurisprudenciaRESUMEN
BACKGROUND: Structured out-of-school time (OST) activities are associated with positive academic and psychosocial outcomes. METHODS: Data came from the 2007 National Survey of Children's Health, restricted to 36,132 youth aged 12-17 years. Logistic regression models were used to examine the joint effects of race/ethnicity and immigrant family type on the participation in OST activities. RESULTS: Compared with US-born (USB) non-Hispanic White youth with USB parents, USB Hispanic youth with USB parents were less likely to participate in sports, whereas non-Hispanic Black youth with immigrant parents were more likely to participate in sports. White youth with at least 1 immigrant parent had higher odds of participating in after-school clubs. All Hispanic youth were less likely to participate in after-school clubs. USB Hispanic youth, USB Black youth, and White youth and "other" youth with at least 1 immigrant parent had higher odds of engaging in community services. Youth from immigrant families had lower odds of doing paid work. CONCLUSIONS: Hispanic youth were less likely to participate in OST activities. Non-Hispanic youth with immigrant parents did not engage in fewer OST activities compared with USB White youth with USB parents. Intervention and recruitment strategies for OST activities may need to be customized for immigrant groups.
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Conducta del Adolescente/etnología , Conducta Infantil/etnología , Emigrantes e Inmigrantes/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Actividades Recreativas , Conducta Social , Deportes Juveniles/estadística & datos numéricos , Adolescente , Negro o Afroamericano/estadística & datos numéricos , Distribución por Edad , Niño , Empleo/economía , Empleo/estadística & datos numéricos , Etnicidad/etnología , Femenino , Encuestas Epidemiológicas , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Modelos Logísticos , Masculino , Distribución por Sexo , Clase Social , Factores de Tiempo , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: The prevalence of autism spectrum disorder (ASD) in United State (US) has surged from 1 in 150 children in 2007 to 1 in 88 children in 2012 with substantial increase in immigrant minority groups including Hispanic and Somali children. Our study objective is to examine the associations between household language among children with ASD and national health quality indicators attainment. METHODS: We conducted bivariate and multivariate logistic regression analyses using cross-sectional data from the publicly-available 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) to investigate the association between household language use and quality indicators of medical home, adequate insurance, and early and continuous screening. RESULTS: Approximately, 28% of parents of children with ASD from non-English primary language (NEPL) households reported their child having severe ASD as compared with 13% of parents from English primary language (EPL) households. Older children were more likely to have care that met the early and continuous screening quality indicator, while lower income children and uninsured children were less likely to have met this indicator. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Despite the lack of differences in the attainment of quality indicators by household language, the higher severity found in children in NEPL households suggests that they are exceptionally vulnerable. Enhanced early screening and identification for these children and supporting their parents in navigating the complex US health care delivery system would increase their participation in early intervention services. Immigration of children with special health care needs from around the world to the US has been increasing from countries with diverse healthcare systems. Our findings will help to inform policies and interventions to reduce health disparities for children with ASD from immigrant populations. As the prevalence of ASD has increased worldwide, understanding of the condition and care-seeking behavior in migrant populations is especially valuable.
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OBJECTIVE: Children with developmental disabilities (DDs) have higher rates of emergency department use (EDU) than their typically developing peers do. This study sought to elucidate the relationship between EDU frequency and access to a comprehensive medical home for children with DD. METHODS: This study conducted multivariate logistic regression analysis on data from the 2005-2006 National Survey of Children with Special Health Care Needs to explore the association between EDU frequency among children with DD and medical home. RESULTS: Compared with children with DD reporting zero EDU, children with 3 or more EDU were less likely to report access to usual health care source (adjusted odds ratio [AOR], 0.63; 95% confidence interval [CI], 0.45-0.88). Moreover, children with DD who had 3 or more EDU were less likely to have clinicians who listen to parental concerns (AOR, 0.58; 95% CI, 0.45-0.76), demonstrate sensitivity toward family values and customs (AOR = 0.60, 95% CI = 0.46, 0.78), and build meaningful family partnerships (AOR, 0.69; 95% CI, 0.53-0.89). CONCLUSIONS: The study suggests that children with DD reporting 3 or more EDU per year would likely reduce their EDU by having access to usual source of primary care services and to clinicians with skills in building meaningful partnership with the parents. The inclusion of these medical home attributes in the adoption of patient-centered medical homes with the implementation of the Affordable Care Act presents a mechanism to improve care at lower cost as well as facilitate chronic disease management and coordination between emergency medicine and primary care physicians that may lead to reductions in EDU and unnecessary hospitalization.
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Discapacidades del Desarrollo/terapia , Servicio de Urgencia en Hospital/organización & administración , Atención Dirigida al Paciente , Trastorno por Déficit de Atención con Hiperactividad/terapia , Trastorno Autístico/terapia , Parálisis Cerebral/terapia , Comunicación , Estudios Transversales , Síndrome de Down/terapia , Humanos , Discapacidad Intelectual/terapia , Modelos Logísticos , Análisis Multivariante , Distrofias Musculares/terapia , Relaciones Profesional-Familia , Estados UnidosRESUMEN
This study aimed to identify actual and perceived barriers to postpartum care among a probability sample of women who gave birth in Los Angeles County, California in 2007. Survey data from the 2007 Los Angeles Mommy and Baby (LAMB) study (N = 4,075) were used to identify predictors and barriers to postpartum care use. The LAMB study was a cross-sectional, population-based study that examined maternal and child health outcomes during the preconception, prenatal, and postpartum periods. Multivariable analyses identified low income, being separated/divorced and never married, trying hard to get pregnant or trying to prevent pregnancy, Medi-Cal insurance holders, and lack of prenatal care to be risk factors of postpartum care nonuse, while Hispanic ethnicity was protective. The most commonly reported barriers to postpartum care use were feeling fine, being too busy with the baby, having other things going on, and a lack of need. Findings from this study can inform the development of interventions targeting subgroups at risk for not obtaining postpartum care. Community education and improved access to care can further increase the acceptability of postpartum visits and contribute to improvements in women's health. Postpartum care can serve as a gateway to engage underserved populations in the continuum of women's health care.
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Etnicidad/estadística & datos numéricos , Conductas Relacionadas con la Salud/etnología , Estado Civil/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Atención Posnatal/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Asiático/estadística & datos numéricos , Niño , Preescolar , Estudios Transversales , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Indígenas Norteamericanos/estadística & datos numéricos , Lactante , Los Angeles , Persona de Mediana Edad , Análisis Multivariante , Atención Preconceptiva/estadística & datos numéricos , Embarazo , Embarazo no Planeado , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos , Población Blanca/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVE: We examined differentials in the prevalence of 23 parent-reported health, chronic condition, and behavioral indicators among 91,532 children of immigrant and U.S.-born parents. METHODS: We used the 2007 National Survey of Children's Health to estimate health differentials among 10 ethnic-nativity groups. Logistic regression yielded adjusted differentials. RESULTS: Immigrant children in each racial/ethnic group had a lower prevalence of depression and behavioral problems than native-born children. The prevalence of autism varied from 0.3% among immigrant Asian children to 1.3%-1.4% among native-born non-Hispanic white and Hispanic children. Immigrant children had a lower prevalence of asthma, attention deficit disorder/attention deficit hyperactivity disorder; developmental delay; learning disability; speech, hearing, and sleep problems; school absence; and ≥ 1 chronic condition than native-born children, with health risks increasing markedly in relation to mother's duration of residence in the U.S. Immigrant children had a substantially lower exposure to environmental tobacco smoke, with the odds of exposure being 60%-95% lower among immigrant non-Hispanic black, Asian, and Hispanic children compared with native non-Hispanic white children. Obesity prevalence ranged from 7.7% for native-born Asian children to 24.9%-25.1% for immigrant Hispanic and native-born non-Hispanic black children. Immigrant children had higher physical inactivity levels than native-born children; however, inactivity rates declined with each successive generation of immigrants. Immigrant Hispanic children were at increased risk of obesity and sedentary behaviors. Ethnic-nativity differentials in health and behavioral indicators remained marked after covariate adjustment. CONCLUSIONS: Immigrant patterns in child health and health-risk behaviors vary substantially by ethnicity, generational status, and length of time since immigration. Public health programs must target at-risk children of both immigrant and U.S.-born parents.
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Enfermedad Crónica/epidemiología , Emigrantes e Inmigrantes , Conductas Relacionadas con la Salud/etnología , Disparidades en el Estado de Salud , Indicadores de Salud , Adolescente , Pueblo Asiatico , Población Negra , Niño , Preescolar , Enfermedad Crónica/etnología , Ejercicio Físico/fisiología , Encuestas Epidemiológicas , Hispánicos o Latinos , Humanos , Cobertura del Seguro , Obesidad/epidemiología , Prevalencia , Factores de Riesgo , Estados Unidos/epidemiología , Población BlancaRESUMEN
Using the 2007 National Survey of Children's Health (N = 91,532), we studied the relationship between the joint effects of immigrant family type (foreign-born children, US-born children/one foreign-born parent, US-born children/both foreign-born parents, and US-born children/US-born parents) and race/ethnicity on various health measures (parent-reported physical and dental health, obesity/overweight, breast-feeding, school absence, injury, and chronic condition). We used weighted logistic regression to examine the independent effects of the 12-level joint variable on various health status measures while controlling for confounding factors. Overall, nearly one-third of families with both foreign-born parents were poor, and one-quarter of the parents in these households did not complete high school. Compared with non-Hispanic White US-born children, multivariable analyses indicate that all Hispanic children have higher odds of obesity, poor physical and dental health, with Hispanic foreign-born children 7 times as likely to report poor/fair physical health. Most children of immigrant parents were more likely to have been breast-fed and less likely to miss school more than 11 days. Child age and household poverty status were independently associated with most of the health status measures. Combined race/ethnicity and immigrant family type categories have heterogeneous associations with each health outcome measure examined. Culturally competent interventions and policies should be developed to serve these expanding communities.
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On April 9, 1912, the law establishing the Children's Bureau was signed by President William Howard Taft. The original mission of the Children's Bureau was to "investigate and report upon all matters pertaining to the welfare of children and child life among all classes of our people." This paper focuses on the transitional years from roughly 1950 to 1969, when the Children's Bureau's investigative mandate was transformed from a set of intramural activities that viewed maternal and child health research as part of a larger effort cutting across investigative, programmatic, and policy goals, and across different domains of the child's life, to an extramural research program focused specifically on maternal and child health. Discussion focuses on the mission of the Maternal and Child Health (MCH) Research Program, housed now within the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), of the U.S. Department of Health and Human Services.
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Servicios de Salud del Niño/historia , Servicios de Salud Materna/historia , Centros de Salud Materno-Infantil , Investigación , Niño , Servicios de Salud del Niño/tendencias , Historia del Siglo XX , Humanos , Legislación como Asunto , Servicios de Salud Materna/tendencias , Estados UnidosRESUMEN
OBJECTIVES: Recent census data show that nearly one-quarter of US children have at least 1 immigrant parent; moreover, there has been a dramatic increase in children diagnosed with autism spectrum disorders (ASDs) and select developmental disabilities (DDs). However, little is known about access to medical home and adequacy of insurance coverage for children with ASDs and select DDs from immigrant families. METHODS: By using the 2007 National Survey of Children's Health, we compared children with ASDs and select DDs from immigrant (n = 413, foreign born or reside with at least 1 immigrant parent) and nonimmigrant (n = 5411) families on various measures of medical home and insurance coverage. We used weighted logistic regression to examine the association between immigrant family and selected outcome measures while controlling for confounding factors. RESULTS: Compared with nonimmigrant families, children with ASD and select DD from immigrant families were more than twice as likely to lack usual source of care and report physicians not spending enough time with family. Furthermore, multivariable analyses indicate that insurance coverage is an important factor in mitigating health care barriers for immigrant families. CONCLUSIONS: The study demonstrates important areas of deficits in the health care experiences of children with ASD and select DD from immigrant households. Public policy implications include increasing access to existing insurance programs, augmenting public awareness resources for ASD and select DD, and offering assistance to immigrant families that are struggling with the medical needs of their children.
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Trastornos Generalizados del Desarrollo Infantil/epidemiología , Discapacidades del Desarrollo/epidemiología , Emigrantes e Inmigrantes/estadística & datos numéricos , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: We examined the association between the joint effects of children's immigrant family type and race/ethnicity on parenting aggravation. METHODS: We analyzed data on a nationally representative sample of 101 032 children aged birth through 17 years from the 2003 National Survey of Children's Health. RESULTS: Analysis of the Aggravation in Parenting Scale showed that 26% of foreign-born parents with foreign-born children were highly aggravated, followed by 22% of foreign-born parents with US-born children and 11% of US-born parents. Multivariable analyses indicated that all minority parents experienced high parenting aggravation compared with non-Hispanic White US-born parents; the odds of reporting parenting aggravation were 5 times higher for Hispanic foreign-born parents. All foreign-born parents, regardless of race/ethnicity, reported significantly elevated parenting aggravation. Parents of adolescents, children with special health care needs, and nontraditional and lower-income households were also more likely to report high parenting aggravation. CONCLUSIONS: Our findings clearly document significantly elevated levels of parenting aggravation among immigrant and minority families. Public health programs and clinicians should target referrals and interventions for these families to avoid potential health problems for both children and their families.
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Emigrantes e Inmigrantes/psicología , Familia/psicología , Responsabilidad Parental/psicología , Estrés Psicológico/epidemiología , Adolescente , Factores de Edad , Distribución de Chi-Cuadrado , Niño , Preescolar , Emigrantes e Inmigrantes/estadística & datos numéricos , Etnicidad/psicología , Etnicidad/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Recién Nacido , Masculino , Análisis Multivariante , Pobreza/psicología , Pobreza/estadística & datos numéricos , Grupos Raciales/psicología , Grupos Raciales/estadística & datos numéricos , Factores Socioeconómicos , Estrés Psicológico/etiologíaRESUMEN
We examined the prevalence and correlates of parent-reported behavioral problems among immigrants and US-born children aged 6-17 years. The 2007 National Survey of Children's Health was used to develop an 11-item factor-based behavioral problems index (BPI) and a dichotomous serious behavioral problems (SBP) measure. Logistic and least-squares regression and disparity indices were used to analyze differentials. BPI scores varied from 92.3 for immigrant Asian children to ≥102.4 for native Hispanic and Black children. The prevalence of SBP ranged from 2.9% for immigrant Asian children to 17.0% for native Black children. Children in most ethnic-immigrant groups had higher adjusted levels of behavioral problems than immigrant Asian children. Native Hispanic children, native and immigrant White children, immigrant Black children, and native Asian children had ≥3.0 times higher adjusted odds of SBP than immigrant Asian children. Lower socioeconomic status, obesity, physical inactivity, lack of sports participation, increased television viewing, and sleep disruption were associated with greater behavioral problems. Sociodemographic and behavioral factors accounted for 37.0% and 48.5% of ethnic-immigrant disparities in BPI and SBP, respectively. Immigrant children had fewer behavioral problems than native-born children. Policies aimed at modifying obesity-related behaviors and social environment may lead to improved behavioral/emotional health in both immigrant and native children.
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OBJECTIVE: To compare office-based care (OBC) with a care model using a home nursing visit (HNV) as the initial postdischarge encounter for "well" breastfeeding newborns and mothers. DESIGN: Randomized controlled trial. SETTING: A single academic hospital. PARTICIPANTS: A total of 1154 postpartum mothers intending to breastfeed and their 1169 newborns of at least 34 weeks' gestation. INTERVENTIONS: Home nursing visits were scheduled no later than 2 days after discharge; OBC timing was physician determined. OUTCOME MEASURES: Mothers completed telephone surveys at 2 weeks, 2 months, and 6 months. The primary outcome was unplanned health care utilization for mothers and newborns within 2 weeks of delivery. Other newborn outcomes were proportion seen within 2 days after discharge and breastfeeding duration. Maternal mental health, parenting competence, and satisfaction with care outcomes were assessed. Analyses followed an intent-to-treat paradigm. RESULTS: At 2 weeks, hospital readmissions and emergency department visits were uncommon, and there were no study group differences in these outcomes or with unplanned outpatient visit frequency. Newborns in the HNV group were seen no more than 2 days after discharge more commonly than those in the OBC group (85.9% vs 78.8%) (P = .002) and were more likely to be breastfeeding at 2 weeks (92.3% vs 88.6%) (P = .04) and 2 months (72.1% vs 66.4%) (P = .05) but not 6 months. No group differences were detected for maternal mental health or satisfaction with care, but HNV group mothers had a greater parenting sense of competence (P < .01 at 2 weeks and 2 months). CONCLUSIONS: Home nursing visits are a safe and effective alternative to OBC for the initial outpatient encounter after maternity/nursery discharge with similar patterns of unplanned health care utilization and modest breastfeeding and parenting benefits.
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Servicios de Atención de Salud a Domicilio/organización & administración , Alta del Paciente , Atención Posnatal/organización & administración , Adulto , Lactancia Materna/estadística & datos numéricos , Femenino , Servicios de Salud/estadística & datos numéricos , Humanos , Recién Nacido , Tiempo de Internación , Rol de la Enfermera , Visita a Consultorio MédicoRESUMEN
OBJECTIVES: We examined health status and health services access and utilization of Chinese, Filipino, Japanese, Korean, South Asian, Vietnamese, and non-Hispanic White children in California. METHODS: We analyzed aggregated data from the 2003 and 2005 California Health Interview Survey (648 Chinese, 523 Filipino, 235 Japanese, 308 Korean, 314 South Asian, 264 Vietnamese, and 8468 non-Hispanic White children aged younger than 12 years), examining the relationship between Asian ethnicities and outcomes. RESULTS: Compared with non-Hispanic White children, Korean children were 4 times more likely to lack health insurance; Filipino children were twice as likely to not have had recent contact with a doctor; Chinese, Korean, and Vietnamese children were less likely to have visited an emergency room in the past year; and Chinese, Korean, and Vietnamese children were more likely to be in fair or poor health. Age, gender, poverty, citizenship-nativity status, health insurance, and parental marital and child health statuses were related to most outcomes. CONCLUSIONS: Asian ethnicities have heterogeneous health care access and utilization patterns, suggesting the need for targeted outreach to different Asian ethnic groups.