Limited English Proficiency, Primary Language at Home, and Disparities in Children's Health Care: How Language Barriers are Measured Matters

Abstract

Background. Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. Objectives. Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. Methods. We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. Results. Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. “Dose-response” relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar “dose-response” relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. Conclusions. Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP categories are associated with different risks of adverse outcomes in children's health and health care. Consistent data collection on parental English proficiency and referral of LEP parents to English classes by pediatric providers have the potential to contribute toward reduction and elimination of health care disparities for children of LEP parents.

Changes in Language Services Use by US Pediatricians

“…Whereas children in LEP families are most often covered by Medicaid or CHIP, state policies do not apply to privately insured children. 27,31 Reimbursement for language services by private insurance companies is not currently mandated, except in California, and few private insurance companies provide reimbursement. 27,32 Whether additional states would enact similar mandates, or if there are mechanisms other than mandates, to encourage insurance companies to provide language services reimbursement is not known.…”

Navigating Language Barriers: A Systematic Review of Patient Navigators’ Impact on Cancer Screening for Limited English Proficient Patients

“…The average Downs and Black score for quantitative articles was 17 (range 11-25, fair to very good), which has been categorized in previous literature as Bgood.^2 5,26 The range in scores was due to studies not controlling for confounders, study populations not being generalizable, not reporting adverse events, or small sample sizes. The spoken non-English language skills of the patient navigators were minimally reported in seven, as navigators were described as Bbilingual,^either noted to be originally from a country where the target language was spoken, or the navigator's ethnicity was used as an additional descriptor (i.e., Bbilingual Hispanic woman^).…”

“…1 LEP persons have difficulty reading, writing and understanding English, 3 which creates obstacles to participation in the English-language dominant healthcare system. Language barriers play a significant role in poor health processes and outcomes, [4][5][6][7] including reduced accessing of preventive services 8,9 and cancer screening rates among LEP patients. [10][11][12][13] These obstacles to cancer screenings for LEP patients can be reduced with language assistance.…”

Attitudes towards mixed martial arts sports medicine coverage

“…(1) male gender; (2) self-reported athleticism; (3) being Hispanic, Asian, and/or white; and (4) having a main language at home other than English, which, to our minds, may indicate residual influence from cultures perhaps less averse to extreme and bloody violence in life, and in sports (Flores, Abreu, & Tomany-Korman, 2005;Stewart & Simons, 2010). …”