Preconception Insurance Status and Preconception Care Utilization Among

Latinas in Los Angeles

Findings from the 2007 Los Angeles Mommy and Baby (LAMB) Survey

Angie Denisse Otiniano, MPH

CityMatCH Promising Practice Presentation

September 22, 2008

Overview

• Significance• Research Questions• Methods• Results• Public Health Implications

Significance

• 2006 Census estimated 9,744,896 people residing in Los Angeles County– 56.3% speak a language other than English at

home

Significance

• In 2005, 63% of the live births were to Latina mothers

• Growing interest in preconception health and health care among Latinas

Research Questions

• Does preconception care use vary by race/ethnicity?

• Does preconception care use vary by acculturation factors among Latinas in Los Angeles?

• Does preconception care use vary by socioeconomic factors among Latinas in Los Angeles?

Methods:Study Design

• Data collection– Mailed questionnaire with multiple follow-up

attempts and by telephone

• Multistage clustered design– cross-sectional, population-based survey of a

stratified random sample of mothers who recently delivered a liveborn infant in Los Angeles County

• Data collected for the 2007 birth cohort

Methods:Population

LAMB Respondents by Race/Ethnicity

48.4

18.215.4

17.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Latina Black Asian White

Pe

rce

nta

ge

NTotal= 1135

NLatina= 543

NBlack= 204

NAsian= 173

NWhite= 201

Methods:Variables

Acculturation factorsLanguage preference

Language in which the mother preferred to answer the survey Nativity

“Were you born in the United States?”

Socioeconomic factorsIncome

“What was your family income in 2006 before taxes?”Insurance

“Just before your last pregnancy, did you have health insurance?”

Preconception care use“During the six months before you got pregnant with your new baby, did

you talk to a doctor, nurse or other health care worker about how to prepare for a healthy pregnancy and baby?”

Methods:Data Analysis

• Pearson’s chi square tests used to determine if:– Preconception care use varied by

race/ethnicity among all LAMB respondents– Preconception care use varied by

acculturation factors among Latinas in Los Angeles

– Preconception care use varied by socioeconomic factors among Latinas in Los Angeles

Results:Race/Ethnicity

Preconception Care Utilization by Race/Ethnicity

23.2

29.9

35.8

40.8

0

5

10

15

20

25

30

35

40

45

Latina Black Asian White

Per

cen

tag

e

*p<0.001

Results:Language Barrier

*p<0.001

Language Barrier to Preconception Care by Language Preference Among Latinas

1.6

26.7

0

5

10

15

20

25

30

English preference Spanish preference

Pe

rce

nta

ge

Results:Acculturation Factors

*p = 0.87

Preconception Care Utilization by Language Preference Among Latinas

23.5 22.9

0

5

10

15

20

25

English preference Spanish preference

Per

cen

tag

e

Results:Acculturation Factors

*p=0.5685

Preconception Care Utilization by Nativity Among Latinas

24

22

0

5

10

15

20

25

US Born Foreign Born

Per

cen

tag

e

Results:Socioeconomic Factors

*p=0.0001

Preconception Care Utilization by Income Among Latinas

19.916.94

37.72

0

5

10

15

20

25

30

35

40

<$20,000 $20,000-$40,000 >$40,000

Per

cen

tag

e

Results:Socioeconomic Factors

Preconception Care Utilization by Insurance Status Among Latinas

27.8

17.8

0

5

10

15

20

25

30

Insured Uninsured

Per

cen

tag

e

*p=0.0063

Results:Race/Ethnicity

*p<0.001

Uninsured Status by Race/Ethnicity of LAMB Respondents

44.8

25.6

12.1 11.5

05

10

1520253035

404550

Latina Black Asian White

Pe

rce

nta

ge

Results:Acculturation Factors

*p<0.001

Insurance Status Among Latinas by Language Preference

31.9

72.1

0

10

20

30

40

50

60

70

80

English preference Spanish preference

Pe

rce

nta

ge

Results:Acculturation Factors

Insurance Status by Nativity Among Latinas

66.1

39.5

0

10

20

30

40

50

60

70

US Born Foreign Born

Per

cen

tag

e

*p<0.0001

Results:Summary

• Preconception care use did vary by race/ethnicity.

• Preconception care use did not vary by acculturation factors among Latinas in Los Angeles.

• Preconception care use did vary by socioeconomic factors among Latinas in Los Angeles.

• Insurance status varied by acculturation factors.

Public Health Implications

• Additional research among Latinas– Improvement of measures of acculturation

• Address language barrier– Assure quality care through linguistically competent

health care providers and promotoras (community health workers)

• Address lack of health insurance– Policies ensuring access to care throughout the life

course

• Address overall low rates of preconception care use among Latinas

Acknowledgements

Los Angeles County Public Health Department Margaret Chao, Cindy Harding, Gina Donnatoni,

Yvonne Lau, Chandra Higgins, Marian Eldahaby, Karen Coller

University of California, Los Angeles

Michael Lu, Eunice Muthengi, Fathima Wakeel,

Erin Rains, Luu Cortes Doan