Purpose-The purpose of this study is to investigate parent reports of the diabetes care support their children receive in school, their concerns about diabetes management in school, and their knowledge of federal laws that protect children with diabetes. In addition, the study explores ethnic and socioeconomic status differences in diabetes management in school.Methods-An ethnically heterogeneous sample of 309 parents of children with diabetes was recruited from a community-based and a university-based diabetes outpatient clinic. Parents completed a survey assessing supports their child's school provides for diabetes care, worries about diabetes care in school, and awareness of federal laws that pertain to children with diabetes.Results-Many children did not have a written care plan or a nurse at school, but significantly more white children had these supports than Hispanic or black children. Most children were not allowed to check blood glucose levels or administer insulin in class. Most parents were worried about hyperglycemia and hypoglycemia in school, and most were not at all or only a little confident in the school's ability to care for diabetes. Most parents were not aware of federal laws, but high-income and white parents were more likely to be aware.Conclusions-According to parents in the current study, children receive inadequate diabetes management support in schools. Minority children are less likely to receive supports than white children. Parents are worried about diabetes management in school, but most do not have the knowledge of federal laws necessary to protect their children.Diabetes mellitus is one of the most common chronic conditions of childhood. 1 Type 1 diabetes is the most common diagnosis, with 1 in every 400 to 600 individuals younger than 20 years affected. 2 Recent studies suggest that the incidence of type 1 diabetes may be increasing in the United States and worldwide. 3,4 Although type 2 diabetes is less common among school-age children than type 1 diabetes, the incidence of type 2 diabetes has increased in the past several years in concordance with the unprecedented rates of obesity among youth. 5 The increasing prevalence of type 2 diabetes among overweight children and adolescents is especially dramatic among minorities. 4,6 In total, an estimated 18 700 children younger than 20 years are newly diagnosed with diabetes mellitus each year in the United States. 4 Diabetes self-care is complex and requires significant lifestyle adaptations that can be difficult for all people with diabetes; however, these changes are especially complicated for children and adolescents. Frequent monitoring of blood glucose levels is required, and constant access to glucose meters is a necessity. Food intake, particularly carbohydrates, must be carefully Balancing the array of diabetes self-care behaviors can be frustrating. 7 For children and adolescents, who spend approximately half of their waking hours at school, these frustrations can be compounded by difficulties getting the support...

Unlike regions with larger Latino populations, the health care infrastructure in Cincinnati does not include linguistically and culturally appropriate services to meet the need of the growing Latino immigrant community. In order to guide development of appropriate health care services, a team of academic and community researchers collaborated on a community-based participatory research project to understand health care use, barriers to health care, perceptions of health care, and health care needs of Latino immigrants. Co-researchers administered 518 surveys and conducted focus groups with 34 Latino immigrants. Participants relied on community clinics for care more often than is seen in nationwide Hispanic samples. Results revealed significant health care barriers, which Latino immigrants attribute to language, lack of quality interpreters, documentation status, and discrimination. Results suggest that the dearth of established social support networks and health care infrastructure in new Latino growth areas exacerbate the health care obstacles experienced by Latino immigrants throughout the country.

This paper identifies differences in adult Latino immigrant barriers to healthcare in the Cincinnati area in Hamilton County, OH on three levels: by region, by neighborhood, and by community health center. Secondary data analysis was performed on 439 surveys. Respondents were aggregated by the geographic regions and neighborhoods where they live and by two community health centers where they receive care. Outcome measures included pragmatic and skill barrier indices adapted from the Barriers to Care Questionnaire (BCQ); the pragmatics index consists logistical barriers, including transportation and cost; the skills index is made up of items related to navigating the healthcare system, including communicating with physicians and completing paperwork. The results indicate that immigrant Latinos living in western Cincinnati and northern Hamilton County face significantly higher pragmatic barriers to care, while Latino immigrants going to a community health center in western Cincinnati have significantly fewer pragmatic and skill barriers than immigrants utilizing a nearby community health center. Because healthcare options for undocumented immigrants do not improve with the Affordable Care Act, community health centers will continue to serve as their primary source of care. This is particularly true in non-traditional migration areas, where immigrants tend to be isolated and lack resources. Efforts to improve access to healthcare for immigrant Latinos require place-based approaches that allow for targeted resources to improve care in these locations. This study helps to fill that need by identifying variation in barriers to care on multiple levels and offering strategies to alleviate these barriers.

The tremendous Latino growth combined with the challenges of living in a nontraditional migration area make Latinos, particularly those who are undocumented, a "difficult-to-reach" and understudied population in research. We describe the development and practice of an immigrant community research team created to investigate and improve research quality regarding health-related needs, beliefs, and behaviors of recent Latino immigrants living in Cincinnati, Ohio. Our community research team, Latinos Unidos por la Salud (LU-Salud), is composed of Latino immigrant community members and academic researchers working in a health research partnership. The community team members are considered "co-researchers" since LU-Salud was designed within a community-based participatory research framework where we engaged in shared decision making at each phase of the research process from design, data collection, and interpretation of findings to dissemination. The co-researcher approach promoted shared decision-making and community empowerment throughout the research process with our community members providing expertise about the "what" (Latino immigrant health-related beliefs and behaviors, questionnaire content, interpretation of data) and the "why" (to obtain perspectives from Latino immigrants who typically don't engage with academics) and our academic members bringing expertise about the "how" (research design and methods, grant funding).

Similar to many other secondary migration hubs across the United States, our city has experienced dramatic growth in its Latino population in the last several years. Although health care providers anecdotally report increased service to Spanish-speaking populations, very little is known about the health care experience of Latino families in our area. To provide both equal and expert care to Latino children in the PED setting, it is essential that providers have this information specific to the context in which they work.