Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: In 2000, roughly one in five children and adolescents in the U.S. reported that they spoke a language other than English at home. Although the influx of new and diverse immigrants has dramatically changed patterns of language use, and health care providers are increasingly likely to encounter these children and adolescents in their practice, little is known about the association between language use and health outcomes. The purpose of the current study is to better understand the unique role that language use at home plays in ethnic minority adolescents' health status, medical insurance status, and access to health care.

Methods: Using the 2001 California Health Interview Survey (CHIS), this study compared health status, medical insurance, and having a usual source of care for 2,230 ethnic minority adolescents (Asian Americans, Latino Americans, American Indians, and multi-ethnic) in three language subgroups: (1) English only at home (n=698), (2) English and other language (n=1,312), and (3) Exclusively other language (n=220). Chi-square and logistic regression analyses examined the association between language use and the various health factors.

Results: Evidence of health disparities was demonstrated by the striking association found between language use at home and health status, having health insurance, and having a usual source of care. Among adolescents who spoke other language-only at home, 26% reported fair or poor health and 34% did not have medical insurance, compared to 10% and 5% respectively among those who spoke English-only at home (p < .001). In multivariate analyses, compared to those speaking English-only at home, adolescents who exclusively used another language at home had 2.36 greater odds (p < .05) of reporting fair or poor health and 4.60 greater odds (p<.001) of not having medical insurance after adjusting for age, gender, ethnicity, parental marital status, poverty, and citizenship status. For the adolescents 15 years and older, there is no evidence that the odds of not having usual source of care varies with their language use at home. However, for the younger adolescents, the odds of not having a usual source of care were 4.07 times higher for those who do not use English at home than for those who speak only English at home (p < .05).

Implications for practice and policy: This study illustrates substantial disparities in health status and insurance among California minority adolescents based on their language use at home. The interaction of age and language use demonstrated that for adolescents who are old enough, language use at home may not be a critical factor for having a usual source of care because they are more independent, and therefore less likely to rely on their parents to access health care than younger adolescents. Interventions to improve these health disparities will need to consider the importance of language use at home in the context of the developmental stage of adolescents.