- Minority and Immigrant Child Health
- Health Disparities
- Health Workforce
Board Member, Stanford Medical Alumni Association (2004 - 2010)
Executive Board, Hispanic Serving Health Professions School, Inc (2000 - 2012)
Executive Board, Pan American Health Education Foundation (2006 - 2012)
Associate Dean of Minority Advising and Programs, Office of Student Affairs (1983 - Present)
Chief, Division of General Pediatrics, Department of Pediatrics (1996 - 2014)
Honors & Awards
Henry J. Kaiser Award for Outstanding and Innovation Contribution in Medical Education,, Stanford University School of Medicine (June 1990)
Hispanic Profile of Excellence, KGO Channel 7, (ABC Affiliate in San Francisco (October 2002)
Top Doctors in Silicon Valley, San Jose Magazine (1999 to 2007)
100 Most Influencial Hispanics in the United States, Hispanic Business Magazine (2002)
Leadership Award, National Hispanic Medical Association (March 20, 2004)
Juan Villagomez Humanitarian Award, California Latino Medical Association (September 2004)
Dr. Fernando S. Mendoza Award, awarded by LSMA, SNMA, SAIMS (May 2005)
The Gardner Community Spirit Award, Gardner Family Health Services (September 2008)
GSA-MAS Service Award, Association of American Medical Colleges (November 2005)
100 Most Influencial Latinos in Silicon Valley, Mexican American Community Service Agency (June 2007)
Visiting Diversity Professor, Harvard Medical School (October 2009)
Who's Who Worldwide, Who's Who (2012-2013)
JE Wallace Sterling "Muleshoe" Lifetime Alumni Achievement Award, Stanford University Medical Center Alumni Association (May 2012)
President's Award for Excellence through Diversity, Stanford University (June 2012)
CDC’s Health Equity Champion, CDC (2012)
Leonard P. Rome CATCH Visiting Professor, Children’s National Medical Center (April 2014)
Medical Staff Distinguish Service Award, Stanford Children's Health Lucile Packard Children's Hospital Stanford (April 2015)
The Augustus A. White III and Family Faculty Professionalism Award, Stanford University, School of Medicine (June 2015)
Dr. Phil DeChavez LMSA National Mentor of the Year Award, The National Latino Medical Student Association (2016)
Board Certification: Pediatrics, American Board of Pediatrics (1980)
Fellowship:Stanford University School of Medicine (1981) CA
Residency:Stanford University School of Medicine (1978) CA
Internship:Stanford University School of Medicine (1976) CA
Residency:Harvard School of Public Health (1979) MA
Medical Education:Stanford University School of Medicine (1975) CA
M.P.H., Harvard University, Maternal and Child Health (1979)
B.A., San Jose State College, Biochemistry (1971)
Community and International Work
Gardner Packard Children's Health Center, Palo Alto
Gardner Family Health Center
Opportunities for Student Involvement
Co-Chair Children's Agenda, Santa Clara County
Kids In Common
Santa Clara County
Opportunities for Student Involvement
Ravenswood Family Health Center, East Palo Alto
general pediatric services and edcuation
Ravenswood Family Health Center
Opportunities for Student Involvement
Current Research and Scholarly Interests
I have two research interests: childhood health disparities and workforce diversity. My research on childhood health disparities centers on Latino and immigrant children with a focus on early childhood health and development. My work in workforce diversity examines the pipeline for diversity in academic pediatrics, with special attention on the pipeline for underrepresent minorities.
Children in immigrant families (CIF) represented that fastest growing child population, representing 75% of the growth of the US child population over the past two decades. CIF will become 1 out of every 3 children in the US, thus making the health and development issues of this population of children important for the future of the US. We have an interested in exploring the early health and development of this group of children, and the patterns of parenting that may affect their outcomes. Using the California Heath Interview Survey, we have examined the frequency of early book-sharing parental behaviors among immigrant parents, and the prevalence of chronic disease and health care utilization among their children.
Workforce diversity has been a goal of a number of organizations, and is an important aspect of preparing academic pediatrics to address the health needs of children resulting from the shifting demographics of US children. Working with national organizations, assessments of academic pediatrics diversity shows improved diversity in gender and ethnic/racial, but still low number of underrepresented minorities in academic pediatrics, particularly in leadership positions. Further exploring the process by which diversity can be improved is currently under way.
- Clinical Excellence and Best Practice in Delivering Health Care to Diverse Populations
PEDS 260 (Aut)
- Independent Studies (5)
Prior Year Courses
- Well-Being in Immigrant Children & Youth: A Service Learning Course
CHILATST 177B, CSRE 177F, EDUC 177B (Win)
- Well-Being in Immigrant Children & Youth: A Service Learning Course
- Caring for Children in Immigrant Families: Vulnerabilities, Resilience, and Opportunities PEDIATRIC CLINICS OF NORTH AMERICA 2016; 63 (1): 115-?
- Children in Immigrant Families: The Foundation for America's Future. Advances in pediatrics 2015; 62 (1): 105-136
Blueprint for Action: Visioning Summit on the Future of the Workforce in Pediatrics
2015; 136 (1): 161-169
The Federation of Pediatric Organizations engaged members of the pediatric community in an 18-month process to envision the future of the workforce in pediatrics, culminating in a Visioning Summit on the Future of the Workforce in Pediatrics. This article documents the planning process and methods used. Four working groups were based on the 4 domains that are likely to affect the future workforce: Child Health Research and Training, Diversity and Inclusion, Gender and Generations, and Pediatric Training Along the Continuum. These groups identified the issues and trends and prioritized their recommendations. Before the summit, 5 key megatrends cutting across all domains were identified:1. Aligning Education to the Emerging Health Needs of Children and Families2. Promoting Future Support for Research Training and for Child Health Research3. Striving Toward Mastery Within the Profession4. Aligning and Optimizing Pediatric Practice in a Changing Health Care Delivery System5. Taking Advantage of the Changing Demographics and Expertise of the Pediatric WorkforceAt the Visioning Summit, we assembled members of each of the working groups, the Federation of Pediatric Organizations Board of Directors, and several invited guests to discuss the 5 megatrends and develop the vision, solutions, and actions for each megatrend. Based on this discussion, we offer 10 recommendations for the field of pediatrics and its leading organizations to consider taking action.
View details for DOI 10.1542/peds.2014-3493
View details for Web of Science ID 000357296000058
Diversity and inclusion training in pediatric departments.
2015; 135 (4): 707-713
The diversifying US population of children necessitates assessing the diversity of the pediatric academic workforce and its level of cultural competency training. Such data are essential for workforce and educational policies.An 8-question survey was sent to 131 US pediatric chairs to assess plans for diversity, targeted groups, departmental diversity, diversity measures, perceived success in diversity, and presence and type of cultural competency training.In all, 49.6% of chairs responded, and three-quarters of them reported having a plan for diversity, which targeted racial; ethnic; gender; lesbian, gay, bisexual, and transgender; disabled; and social class groups. Of the residents, 75% were women, as compared with 54% of faculty and 26% of chairs. Racial and ethnic diversity was limited among trainees, faculty, and leaders; <10% of each group was African American, Hispanic, or Native American. Asian Americans were more common among trainees (15%-33%) but were less common in faculty and leadership positions (0%-14%). Lesbian, gay, bisexual, and transgender physicians were represented in some groups. Measures of diversity included the number of trainees and faculty, promotion success, climate assessments, and exit interviews. Overall, 69% of chairs reported being successful in diversity efforts. A total of 90% reported cultural competency training for trainees, and 74% reported training for faculty and staff. Training in cultural competency included linguistic training, primarily in Spanish.Pipeline issues for minorities are ongoing challenges. Pediatric leadership needs more representation of racial and ethnic minorities, women, and LGBT. Suggestions for workforce and educational policies are made.
View details for DOI 10.1542/peds.2014-1653
View details for PubMedID 25755235
- Disparities in Early Exposure to Book Sharing Within Immigrant Families PEDIATRICS 2014; 134 (1): E162-E168
- Reframing the disparities agenda: a time to rethink, a time to focus. Academic pediatrics 2014; 14 (2): 115-116
- New American children: supporting the health and well-being of immigrant populations. JAMA pediatrics 2013; 167 (1): 12-13
Health disparities and children in immigrant families: a research agenda.
2009; 124: S187-95
Children in immigrant families now comprise 1 in 5 children in the United States. Eighty percent of them are US citizens, and 53% live in mixed-citizenship families. Their families are among the poorest, least educated, least insured, and least able to access health care. Nonetheless, these children demonstrate better-than-expected health status, a finding termed "the immigrant paradox" and one suggesting that cultural health behaviors among immigrant families might be protective in some areas of health. In this article the strength of the immigrant paradox, the effect of acculturation on health, and the relationships of acculturation, enculturation, language, and literacy skills to health disparities are reviewed. The current public policy issues that affect the health disparities of children of immigrant families are presented, and a research agenda for improving our knowledge about children in immigrant families to develop effective interventions and public policies that will reduce their health disparities is set forth.
View details for DOI 10.1542/peds.2009-1100F
View details for PubMedID 19861469
Training Health Care Professionals for 21st-Century Practice: A Systematic Review of Educational Interventions on Chronic Care
2015; 90 (11): 1561-1572
To systematically review the evidence for high-quality and effective educational strategies to train health care professionals across the education continuum on chronic disease care.A search of English-language publications and conference proceedings was performed in November 2013 and updated in April 2014. Studies that evaluated a newly developed curriculum targeting chronic disease care with learner outcomes were included. Two primary reviewers and one adjudicating reviewer evaluated the studies and assessed their quality using the validated Medical Education Research Study Quality Instrument (MERSQI). Studies were also mapped onto elements of Wagner's chronic care model (CCM) to evaluate their use of established evidence-based models for chronic care delivery. Miller's classification of clinical competence was used to assess the quality of learner achievements for each educational intervention.A total of 672 articles were found for this review. Twenty-two met criteria for data extraction. The majority of studies were of moderate quality according to MERSQI scoring. Only three studies reported both learner and patient outcomes. The highest-quality studies incorporated more elements of Wagner's CCM and showed high-level learner competence according to Miller's classification. Successful interventions redesigned health care delivery systems to include team-based care, emphasized training of health care professionals on patient self-management, and included learner-based quality improvement initiatives.The growing number of children and adults with chronic disease necessitates improved educational interventions for health care professionals that involve evidence-based models for restructuring chronic care delivery, aim for high-level learner behavioral outcomes, and evolve through quality improvement initiatives.
View details for DOI 10.1097/ACM.0000000000000773
View details for Web of Science ID 000363973300032
View details for PubMedID 26039140
The effects of language concordant care on patient satisfaction and clinical understanding for Hispanic pediatric surgery patients
JOURNAL OF PEDIATRIC SURGERY
2015; 50 (9): 1586-1589
Hispanics account for over 60% of the U.S. population growth and 25% speak little-to-no English. This language barrier adversely affects both access to and quality of care. Surgical specialties trail other medical fields in assessing the effects of language barriers to surgical clinical care and patient satisfaction. This study was designed to assess the effects of patient-provider language concordance on a pediatric surgery practice.A surgery-specific, 7-point Likert scale questionnaire was designed with 14 questions modeled after validated patient satisfaction surveys from the literature. Questions concerning provider-patient language concordance, quality of understanding, and general satisfaction were included. Surveys were administered to families of patients in the General Pediatric Surgery Clinic at our institution. Families were categorized into three groups: English-speaking, regardless of race/ethnicity; Spanish-speaking using interpreter services with an English-speaking medical team; and Spanish-speaking communicating directly with a Spanish-speaking medical team (Hispanic Center for Pediatric Surgery, HCPS). One-way analysis of variance was used to test for group differences.We administered 226 surveys; 49 were removed due to lack literacy proficiency. Families in the HCPS group reported a higher level of satisfaction than the interpreter and English groups (p<0.01). The HCPS group also indicated improved understanding of the information from the visit (p<0.001). Spanish-speaking only families felt that communicating directly with their health care team in their primary language was more important than their English-speaking counterparts (p<0.001).In a pediatric surgery clinic, language concordant care improves patient satisfaction and understanding for Hispanic families in comparison to language discordant care. Other clinics in other surgery sub-specialties may consider using this model to eliminate language barriers and improve patient satisfaction and understanding of surgical care.
View details for DOI 10.1016/j.jpedsurg.2014.12.020
View details for Web of Science ID 000361499500031
View details for PubMedID 25783324
Outcomes of a Randomized Controlled Educational Intervention to Train Pediatric Residents on Caring for Children With Special Health Care Needs
2015; 54 (7): 659-666
Objective. To evaluate an innovative curriculum meeting new pediatric residency education guidelines, Special Care Optimization for Patients and Education (SCOPE). Methods. Residents were randomized to intervention (n = 23) or control (n = 25) groups. Intervention residents participated in SCOPE, pairing them with a child with special health care needs (CSHCN) and faculty mentor to make a home visit, complete care coordination toolkits, and participate in case discussions. The primary outcome was resident self-efficacy in nine skills in caring for CSHCN. Secondary outcomes included curriculum feasibility/acceptance, resident attitudes, and family satisfaction. Results. Response rates were ≥65%. Intervention residents improved in their self-efficacy for setting patient-centered goals compared with controls (mean change on 4-point Likert-type scale, 1.36 vs 0.56, P < .05). SCOPE was feasible/acceptable, residents had improved attitudes toward CSHCN, and families reported high satisfaction. Conclusion. SCOPE may serve as a model for efforts to increase residents' self-efficacy in their care of patients with chronic disease.
View details for DOI 10.1177/0009922814564050
View details for Web of Science ID 000354656600008
Parental limited English proficiency and health outcomes for children with special health care needs: a systematic review.
2014; 14 (2): 128-136
One in 10 US adults of childbearing age has limited English proficiency (LEP). Parental LEP is associated with worse health outcomes among healthy children. The relationship of parental LEP to health outcomes for children with special health care needs (CSHCN) has not been systematically reviewed.To conduct a systematic review of peer-reviewed literature examining relationships between parental LEP and health outcomes for CSHCN.PubMed, Scopus, Cochrane Library, Social Science Abstracts, bibliographies of included studies. Key search term categories: language, child, special health care needs, and health outcomes.US studies published between 1964 and 2012 were included if: 1) subjects were CSHCN; 2) studies included some measure of parental LEP; 3) at least 1 outcome measure of child health status, access, utilization, costs, or quality; and 4) primary or secondary data analysis.Three trained reviewers independently screened studies and extracted data. Two separate reviewers appraised studies for methodological rigor and quality.From 2765 titles and abstracts, 31 studies met eligibility criteria. Five studies assessed child health status, 12 assessed access, 8 assessed utilization, 2 assessed costs, and 14 assessed quality. Nearly all (29 of 31) studies used only parent- or child-reported outcome measures, rather than objective measures. LEP parents were substantially more likely than English-proficient parents to report that their CSHCN were uninsured and had no usual source of care or medical home. LEP parents were also less likely to report family-centered care and satisfaction with care. Disparities persisted for children with LEP parents after adjustment for ethnicity and socioeconomic status.Parental LEP is independently associated with worse health care access and quality for CSHCN. Health care providers should recognize LEP as an independent risk factor for poor health outcomes among CSHCN. Emerging models of chronic disease care should integrate and evaluate interventions that target access and quality disparities for LEP families.
View details for DOI 10.1016/j.acap.2013.10.003
View details for PubMedID 24602575
Resident Cross-Cultural Training, Satisfaction, and Preparedness
2013; 13 (1): 65-71
To describe the diversity of pediatric residents and examine relationships of cross-cultural training experiences with training satisfaction, perceived preparedness for providing culturally effective care, and attitudes surrounding care for underserved populations.A cross-sectional survey was conducted of a national random sample of graduating pediatric residents and an additional sample of minority residents. Using weighted analysis, we used multivariate regression to test for differences in satisfaction, preparedness, and attitudes between residents with more and less cross-cultural experiences during residency, controlling for residents' characteristics and experiences before training.The survey response rate was 57%. Eleven percent were Hispanic, 61% white, 21% Asian, 9% African American, 9% other racial/ethnic groups; 34% grew up in a bi- or multilingual family. Ninety-three percent of residents were satisfied with their residency training, 81% with the instruction they received on health and health care disparities, and 54% on global health issues. Ninety-six percent of residents felt they were prepared to care for patients from diverse backgrounds, but fewer felt prepared to care for families with beliefs at odds with Western medicine (49%) and families who receive alternative or complementary care (37%). Residents with more cross-cultural experiences during residency reported being better prepared than those with less experience to care for families with limited English proficiency (adjusted odds ratio [aOR] 2.11; 95% confidence interval [CI] 1.40-3.17), new immigrants (aOR 1.91; 95% CI 1.32-2.75), and with religious beliefs that might affect clinical care (aOR 1.62; 95% CI 1.13-2.32).Pediatric residents begin their training with diverse cross-cultural backgrounds and experiences. Residency experiences in cross-cultural care contribute to feelings of preparedness to care for diverse US children.
View details for Web of Science ID 000313932900011
View details for PubMedID 23312858
Children with Special Health Care Needs: How Immigrant Status is Related to Health Care Access, Health Care Utilization, and Health Status
MATERNAL AND CHILD HEALTH JOURNAL
2010; 14 (4): 567-579
To compare health care access, utilization, and perceived health status for children with SHCN in immigrant and nonimmigrant families. This cross-sectional study used data from the 2003 California Health Interview Survey to identify 1404 children (ages 0-11) with a special health care need. Chi-square and logistic regression analyses were used to examine relations between immigrant status and health access, utilization, and health status variables. Compared to children with special health care needs (CSHCN) in nonimmigrant families, CSHCN in immigrant families are more likely to be uninsured (10.4 vs. 4.8%), lack a usual source of care (5.9 vs. 1.9%), report a delay in medical care (13.0 vs. 8.1%), and report no visit to the doctor in the past year (6.8 vs. 2.6%). They are less likely to report an emergency room visit in the past year (30.0 vs. 44.0%), yet more likely to report fair or poor perceived health status (33.0 vs. 16.0%). Multivariate analyses suggested that the bivariate findings for children with SHCN in immigrant families largely reflected differences in family socioeconomic status, parent's language, parental education, ethnicity, and children's insurance status. Limited resources, non-English language, and limited health-care use are some of the barriers to staying healthy for CSHCN in immigrant families. Public policies that improve access to existing insurance programs and provide culturally and linguistically appropriate care will likely decrease health and health care disparities for this population.
View details for DOI 10.1007/s10995-009-0487-9
View details for Web of Science ID 000279477400010
View details for PubMedID 19554437
Lessons learned from a community-academic partnership addressing adolescent pregnancy prevention in Filipino American families.
Progress in community health partnerships : research, education, and action
2010; 4 (4): 305-313
Filipino Americans have more adolescent pregnancies than other Asian-Pacific Islanders (APIs). Few community-academic collaborations have addressed adolescent pregnancy prevention in this community.We sought to describe the lessons learned from and impact of a community-based teen pregnancy prevention program for Filipino Americans implemented by a Filipina pediatrics resident.We formed a community-academic partnership between the Filipino Youth Coalition, a community-based organization (CBO) in San Jose, California, and the Stanford School of Medicine's Pediatric Advocacy Program. We developed a culturally tailored parent-teen conference addressing adolescent pregnancy prevention in Filipino Americans. We qualitatively and quantitatively evaluated this intervention by collecting both pre- and post-conference data using a convenience sample design.Engaging particular aspects of Filipino culture (i.e., religion and intergenerational differences) helped to make this community-academic partnership successful. For physicians-in-training who are conducting community-based participatory research (CBPR), project challenges may include difficulties in building and maintaining academic- community relationships, struggles to promote sustainability, and conflicting goals of "community insiders" and "academic outsiders." Authors offer insights and implications for residents interested in practicing CBPR.CBPR is a key tool for exploring health issues in understudied populations. CBPR experiences can provide meaningful educational opportunities for physicians-in-training and can build sustained capacity in CBOs. They can also help residents to develop analytic skills, directly affect the health of the communities they serve, and, for minority physicians, give back to the communities they call home.
View details for DOI 10.1353/cpr.2010.0023
View details for PubMedID 21169708
The relationship of immigrant status with access, utilization, and health status for children with asthma
2007; 7 (6): 421-430
Despite their high levels of poverty and less access to health care, children in immigrant families have better than expected health outcomes compared with children in nonimmigrant families. However, this observation has not been confirmed in children with chronic illness. The objective of this study was to determine whether children with asthma in immigrant families have better than expected health status than children with asthma in nonimmigrant families.Data from the 2001 and 2003 California Health Interview Survey (CHIS) were used to identify 2600 children, aged 1 to 11, with physician-diagnosed asthma. Bivariate analyses and logistic regression were performed to examine health care access, utilization, and health status measures by our primary independent variable, immigrant family status.Compared with children with asthma in nonimmigrant families, children with asthma in immigrant families are more likely to lack a usual source of care (2.6% vs 1.0%; P < .05), report a delay in medical care (8.9% vs 5.2%; P < .01), and report no visit to the doctor in the past year (7.0% vs 3.8%; P < .05). They are less likely to report asthma symptoms (60.8% vs 74.4%; P < .01) and an emergency room visit in the past year (14.1% vs 21.1%; P < .01), yet more likely to report fair or poor perceived health status (25.0% vs 10.5%; P < .01). Multivariate models revealed that the relationship of immigrant status with health measures was complex. These models suggested that lack of insurance and poverty was associated with reduced access and utilization. Children in immigrant families were less likely to visit the emergency room for asthma in the past year (odds ratio 0.58, confidence interval, 0.36-0.93). Poverty was associated with having a limitation in function and fair or poor perceived health, whereas non-English interview language was associated with less limitation in function but greater levels of fair or poor perceived health.Clinicians should be aware of important barriers to care that may exist for immigrant families who are poor, uninsured, and non-English speakers. Reduced health care access and utilization by children with asthma in immigrant families requires policy attention. Further research should examine barriers to care as well as parental perceptions of health for children with asthma in immigrant families.
View details for Web of Science ID 000251638400005
View details for PubMedID 17996835
Filipino child health in the United States: do health and health care disparities exist?
Preventing chronic disease
2007; 4 (2): A36-?
Filipinos are the second largest Asian subgroup in the United States, but few studies have examined health and health care disparities in Filipino children. The objectives of this review are 1) to appraise current knowledge of Filipino children's health and health care and 2) to present the implications of these findings for research, clinical care, and policy.We identified articles for review primarily via a Medline search emphasizing the terms Filipino and United States crossed with specific topics in child and adolescent health that fall under one of Healthy People 2010's 28 focus areas.Filipino children are underrepresented in medical research. Studies that compare Filipino children and adolescents with white children or children of other Asian Pacific Islander subgroups suggest disparities with regard to gestational diabetes, rates of neonatal mortality and low birth weight, malnutrition in young children, overweight, physical inactivity and fitness, tuberculosis, dental caries, and substance abuse. Studies that compare Filipino adults with white adults describe adult Filipino health problems similar to those of Filipino children, including higher rates of diabetes, hypertension, and metabolic syndrome. Health care disparities remain to be determined.Health and health care disparities appear to exist for Filipino children, but more research is needed to confirm these findings. Practitioners serving this population need to consider social and cultural factors that can increase or diminish risk for health problems. There are priorities in research and policy that, if pursued, may improve the health care and health outcomes of Filipino children.
View details for PubMedID 17362627
- Preventing Obesity in Mexican-American Children and Adolescents. In Joint U.S.-Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin Institute of Medicine of the National Academies. The National Academies Press, Washington, D.C., 2007: 128-186
- Health of Children in Immigrant Families In Lansford, JE, Deater-Deckard, K, and Bornsten, MH, (eds) Immigrant Families in Contemporary Society. Guilford Press 2007
Filipino American families and intergenerational communication about sex.
2006; 6 (2): 120-?
View details for PubMedID 16530151
Importance of generational status in examining access to and utilization of health care services by Mexican American children
2005; 115 (3): E322-E330
To describe the sociodemographic differences among Mexican American children (first, second, and third generation), non-Hispanic black children, and non-Hispanic white children; to compare the health status and health care needs of Mexican American children (first, second, and third generation) with those of non-Hispanic black children and non-Hispanic white children; and to determine whether first-generation Mexican American children have poorer health care access and utilization than do non-Hispanic white children, after controlling for health insurance status and socioeconomic status.The Third National Health and Nutrition Examination Survey was used to create a sample of 4372 Mexican American children (divided into 3 generational groups), 4138 non-Hispanic black children, and 4594 non-Hispanic white children, 2 months to 16 years of age. We compared parent/caregiver reports of health status and needs (perceived health of the child and reported illnesses), health care access (usual source of health care and specific provider), and health care utilization (contact with a physician within the past year, use of prescription medications, physician visit because of earache/infection, and hearing and vision screenings) for different subgroups within the sample.More than two thirds of first-generation Mexican American children were poor and uninsured and had parents with low educational attainment. More than one fourth of first-generation children were perceived as having poor or fair health, despite experiencing similar or better rates of illnesses, compared with other children. Almost one half of first-generation Mexican American children had not seen a doctor in the past year, compared with one fourth or less for other groups. Health care needs among first-generation Mexican American children were lower, on the basis of reported illnesses, but perceived health status was worse than for all other groups. After controlling for health insurance coverage and socioeconomic status, first-generation Mexican American children and non-Hispanic black children were less likely than non-Hispanic white children to have a usual source of care, to have a specific provider, or to have seen or talked with a physician in the past year.Of the 3 groups of children, Mexican American children had the least health care access and utilization, even after controlling for socioeconomic status and health insurance status. Our findings showed that Mexican American children had much lower levels of access and utilization than previously reported for Hispanic children on the whole. As a subgroup, first-generation Mexican American children fared substantially worse than second- or third-generation children. The discrepancy between poor perceived health status and lower rates of reported illnesses in the first-generation group leads to questions regarding generalized application of the "epidemiologic paradox." Given the overall growth of the Hispanic population in the United States and the relative growth of individual immigrant subgroups, the identification of subgroups in need is essential for the development of effective research and policy. Furthermore, taking generational status into account is likely to be revealing with respect to disparities in access to and utilization of pediatric services.
View details for DOI 10.1542/peds.2004-1353
View details for Web of Science ID 000227596900012
View details for PubMedID 15713905
Associations among familism, language preference, and education in Mexican-American mothers and their children
JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
2004; 25 (1): 34-40
Latino families who express a higher degree of familism are characterized by positive interpersonal familial relationships, high family unity, social support, interdependence in the completion of daily activities, and close proximity with extended family members. Retention of cultural values, such as familism, may be linked to positive health outcomes; however, little is known about how families retain culture of origin values in the face of acculturation pressures. The current study explores acculturation influences as indexed by language preference and household education on maternal and child familism. Mothers and children of Mexican descent (fourth grade students) (n = 219) completed measures of demographics, household education, language preference, and familism. Three hypotheses were examined. First, we predicted that lower household education would be correlated with higher familism scores. However, contrary to our prediction, a higher familism score was significantly associated with a higher level of household education (p <.05). Second, we predicted that higher child familism would be associated with the preference for speaking Spanish. Children who preferred to use both English and Spanish (p <.01) or English alone (p <.05) had higher familism scores than those who preferred Spanish. Third, we predicted that lower child familism scores would be associated with greater differences in mother and child language preferences. There were no significant differences in child familism based on differences between parent and child language. Protective influences of cultural maintenance deserve further attention in longitudinal studies and in relation to the physical and mental health of youth.
View details for Web of Science ID 000189076300005
View details for PubMedID 14767354
Use of the pediatric symptom checklist in a low-income, Mexican American population
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE
2003; 157 (12): 1169-1176
To evaluate the usefulness of the Pediatric Symptom Checklist (PSC) in identifying behavioral problems in low-income, Mexican American children.A cross-sectional study design was used to examine the PSC as a screening test, with the Child Behavior Checklist (CBCL) as the criterion standard.The study was conducted at a health center in a diverse low-income community. Patients Eligible patients were children and adolescents, 4 to 16 years of age, who were seen for nonemergent, well-child care. Of 253 eligible children during a 9-month study period, 210 agreed to participate in the study. There was a 100% completion rate of the questionnaires. The average age of the children was 7.5 years, and 45% were female. Ninety-five percent of patients were of Hispanic descent (Mexican American); 86% of families spoke only Spanish. Socioeconomic status was low (more than three fourths of families earned <$20 000 annually).The CBCL Total scale determined that 27 (13%) of the children had clinical levels of behavioral problems. With a cutoff score of 24, the PSC screened 2 (1%) of the 210 children as positive for behavioral problems. Using the CBCL as the criterion standard, the PSC sensitivity was 7.4%, and the specificity was 100%. Receiver operator characteristic analysis determined that a PSC cutoff score of 12 most correctly classified children with and without behavioral problems (sensitivity, 0.74; specificity, 0.94).When using the PSC, a new cutoff score of 12 for clinical significance should be considered if screening low-income, Mexican American children for behavioral problems. Additional study is indicated to determine the causes of the PSC's apparently lower sensitivity in Mexican American populations.
View details for Web of Science ID 000186959800007
View details for PubMedID 14662568
- Effects of a videotape to increase use of poison control centers by low-income and Spanish-speaking families: a randomized controlled trial. Pediatrics 2003; 111 (1): 21-26
- Socioeconomic and Cultural Issues in Pediatrics In Daniel Bernstein and Steven Shelov (eds), Pediatrics for Medical Students, 2nd Edition. Baltimore, MD: Williams and Wilkins 2003: 112-120
The health of Latino children - Urgent priorities, unanswered questions, and a research agenda
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
2002; 288 (1): 82-90
Latinos recently became the largest racial/ethnic minority group of US children. The Latino Consortium of the American Academy of Pediatrics Center for Child Health Research, consisting of 13 expert panelists, identified the most important urgent priorities and unanswered questions in Latino child health. Conclusions were drawn when consensus was reached among members, with refinement through multiple iterations. A consensus statement with supporting references was drafted and revised. This article summarizes the key issues, including lack of validated research instruments, frequent unjustified exclusion from studies, and failure to analyze data by pertinent subgroups. Latino children are at high risk for behavioral and developmental disorders, and there are many unanswered questions about their mental health needs and use of services. The prevalence of dental caries is disproportionately higher for Latino children, but the reasons for this disparity are unclear. Culture and language can profoundly affect Latino children's health, but not enough cultural competency training of health care professionals and provision of linguistically appropriate care occur. Latinos are underrepresented at every level of the health care professions. Latino children are at high risk for school dropout, environmental hazards, obesity, diabetes mellitus, asthma, lack of health insurance, nonfinancial barriers to health care access, and impaired quality of care, but many key questions in these areas remain unanswered. This article suggests areas in which more research is needed and ways to improve research and care of Latino children.
View details for Web of Science ID 000176573400023
View details for PubMedID 12090866
- ?Dolor Aqui? ?Fiebre? A little knowledge requires caution ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2002; 156 (7): 638-640
- Why ethnicity and race are so important in child health services research today ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2001; 155 (10): 1178-1179
- A book a day keeps the doctor away: A look at the implementation and effects of reach out and read, a pediatric clinic-based early literacy promotion program Resources in Education 2001
- Are perceived neighborhood hazards a barrier to physical activity in children? Archives of Pediatrics and Adolescent Medicine 2001; 155: 1143-1148
Prescribing books for immigrant children - A pilot study to promote emergent literacy among the children of Hispanic immigrants
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE
2000; 154 (8): 771-777
To assess book-sharing activities within first-generation Hispanic immigrant families, and to assess the effect of pediatricians giving books to their patients.Survey.Convenience sample of 122 predominantly Hispanic immigrant parents of children aged 2 months to 5 years. Of these parents, 56 had received children's books from the pediatrician, and 66 had not.House staff continuity clinic at a university children's hospital.Frequent Book Sharing (FBS) was defined as a parent's reporting more than 3 days per week of sharing books with the child. Main independent variables included the following: (1) exposure to the Reach Out and Read program, defined as having received a children's book from the pediatrician; (2) socioeconomics, as measured by parents' years of education and Medicaid enrollment; (3) acculturation, as defined by 4 questions relating to parents' proficiency with the English language; (4) parent's country of origin; (5) parent literacy, as measured by a parent's reporting more than 3 days per week of reading alone; (6) parent's age; (7) marital status; (8) household size; (9) child's age; (10) child's sex.Ninety percent of the parents were born outside of the United States (71% in Mexico), 85% spoke Spanish in the home, and 63% had completed less than a high-school education. Seventy-five percent of children's medical insurance was provided by Medi-Cal (Medicaid), and 9% of children were uninsured. Sixty-seven percent spoke exclusively Spanish at home, and 84% of parents want their children to learn to read in both English and Spanish. High FBS was reported among parents whose children had received books from the physician when compared with parents whose children had received no books. The odds ratio (OR) was 3.62 (95% confidence interval [CI], 1.40-9.37; P<.05). Also associated with FBS were parents reading frequently to themselves (OR = 9.52; 95% CI, 2.09-43.27; P<.05) and national origin outside Mexico (OR = 5.54; 95% CI, 1.59-19.27; P<.05). These findings were independent of parent's educational level, parent's employment, parent's age, acculturation, and family size.Pediatricians can promote literacy development among Hispanic immigrant children through the provision of free books at well-child visits. Our findings also suggest the independent effects of adult literacy and child age. Further research is needed to understand the effect of pediatric literacy programs on Hispanic immigrant children, their bilingual environments, and their readiness for school entry. Arch Pediatr Adolesc Med. 2000;154:771-777
View details for Web of Science ID 000088655000003
View details for PubMedID 10922272
- Health Risk Profiles and Race, Culture, and Socioeconomic Status 31st Ross Roundtable, Child Health in the Multicultural Environment 2000: 5-26
- Nutritional Status of Immigrant Children In Children in Immigrant Families: Issues for California?s Future. California Policy Research Center, California Program on Access to Care and the UCLA Center for Health Policy Research 2000: 11-12
- The Health and Nutritional Status of Immigrant Hispanic Children: Analyses of the Hispanic Health and Nutrition Examination Survey In D Hernandez (ed) Children of Immigrants. Washington, D.C.: National Academy Press 1999
- Latino Children's Health and the Family-Community Health Profmotion Model. Western Journal of Medicine 1999; 170 (2): 85-92
- From Generation to Generation: The Health and Well-Being of Children in Immigrant Families Board on Children, Youth, and Families, National Research Council, Institute of Medicine, National Academy Press 1998
- Health Issues of Immigrant Children of Color In H. Fitzgerald, B. Lester, and B. Zuckerman (ed), Children of Color, Research, Health, and Policy Issues. Garland Publishing, Inc. New York and London 1997: 141-158
- My Obligation to Others: A Tradition Carried Forward In Ellen Bassuk (ed.), The Doctor Activist: Physician Fighting For Social Change. New York, New York: Plenum Publication Corporation 1996
- Socioeconomic, Cultural, and Ethical Issues in Pediatrics. In Daniel Bernstein and Steven Shelov (eds), Pediatrics for Medical Students. Baltimore, MD: Williams and Wilkins 1996: 99-105
- Our Nation?s Challenge, Vaccinating Latino Children; Can We Do It? Medico InterAmericano 1996; 15 (1): 7-8
- Stanford Medical School?s Minority Faculty Development and the Center of Excellence In L. Bergeisen (ed) Minority Faculty in the Health Professions For the 21st Century. Selected Proceedings, Leesburg, Virginia, September 6-8, 1995
- The health of Latino children in the United States. Current Problems in Pediatrics 1995; Nov-Dec: 314-335
- Physical Growth, Sexual Maturation, and Obesity in Puerto Rican Children In Cynthia Garcia Cole and Gontran Lamberty (eds.), Health and Development of Puerto Rican Mothers and Children in the Mainland, New York, New York: Plenum Publication Corporation 1994
- Measures of Health Status and Health Care Access for Mainland Puerto Rican Children: Results from the Hispanic Health and Nutrition Examination Survey. In C.G. Cole and G. Lamberty (eds.), Health and Development of Puerto Rican Mothers and Children in the Mainland 1994
HEALTH-STATUS AND HEALTH-CARE ACCESS FOR MAINLAND PUERTO-RICAN CHILDREN - RESULTS FROM THE HISPANIC HEALTH AND NUTRITION EXAMINATION SURVEY
PLENUM PRESS DIV PLENUM PUBLISHING CORP. 1994: 211-227
View details for Web of Science ID A1994BA60F00013
PHYSICAL GROWTH, SEXUAL-MATURATION, AND OBESITY IN PUERTO-RICAN CHILDREN
PLENUM PRESS DIV PLENUM PUBLISHING CORP. 1994: 119-135
View details for Web of Science ID A1994BA60F00009
- Latino child health policy issues The Future of Children. Center for the Future of Children, The David and Lucile Packard Foundation 1994; 4 (3): 43-72
- Health Status of U.S. Hispanic Children In Antonio Furino (ed.), Health Policy and the Hispanic, Boulder, Colorado: Westview Press 1992
THE ESTIMATED COST OF TREATING UNMET DENTAL RESTORATIVE NEEDS OF MEXICAN-AMERICAN CHILDREN FROM SOUTHWESTERN UNITED-STATES-HHANES, 1982-83
JOURNAL OF PUBLIC HEALTH DENTISTRY
1991; 51 (4): 195-204
The dental restorative treatment needs of Mexican-American children, aged 1-17 years, were assessed from the 1982-83 Southwestern US Hispanic Health and Nutrition Examination Survey (HHANES). This report analyzed those needs and applied a dollar cost to them, using 1982 median fees of US general practitioners. The total estimated cost required to meet those needs for the population estimate of 3,396,770 children was $236,856,772 (95% CI: $198,575,174 to $275,138,370). The mean cost per child was $69.73 (SE: 5.75). Although a majority of the children had no unmet need, 15-, 16-, and 17-year-olds had extensive needs for crowns, endodontics, and prosthetic replacement of teeth, with accompanying high costs: mean total cost per examinee was $177 (SE: 28.97), $161 (SE: 32.20), and $237 (SE: 33.26), respectively. The treatment needs were compared with the previously published regional data from the 1979-80 NIDR survey, which used the same dental restorative treatment needs (DRTN) index. The findings indicated a great need for dental treatment among Mexican-American children that appeared to exceed that of the general school-aged population. Our analysis, in providing estimates of the cost of needed treatment, might be useful in planning dental treatment programs and in comparing surveys.
View details for Web of Science ID A1991GK59600001
View details for PubMedID 1941770
PREVALENCE OF OVERWEIGHT AND OBESITY IN UNITED-STATES HISPANIC POPULATIONS
AMER SOC CLIN NUTRITION INC. 1991: S1522-S1528
View details for Web of Science ID A1991FP05900005
- STATISTICAL CONSIDERATIONS IN THE ANALYSIS OF GROWTH DATA FROM HHANES AMERICAN JOURNAL OF CLINICAL NUTRITION 1991; 53 (4): 978-980
SELECTED MEASURES OF HEALTH-STATUS FOR MEXICAN-AMERICAN, MAINLAND PUERTO-RICAN, AND CUBAN-AMERICAN CHILDREN
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
1991; 265 (2): 227-232
The 1987 National Vital Statistics System and the Hispanic Health and Nutrition Examination Survey (1982 through 1984) were used to assess the health status of Mexican-American, mainland Puerto Rican, and Cuban-American children by examining the prevalences of pregnancy outcomes and chronic medical conditions. The low-birth-weight rate among Hispanics (7.0%) compared favorably with that of non-Hispanic whites (7.1%) despite the greater poverty and lower levels of education among Hispanics. When examined by Hispanic subgroup, however, significant differences were present, with mainland Puerto Ricans having the highest prevalences of low-birth-weight infants. Premature births were more common among all three Hispanic subgroups than among non-Hispanic whites. Mexican-American and Cuban-American children had a similar prevalence of (3.9% and 2.5%, respectively) chronic medical conditions compared with non-Hispanic white children; Puerto Rican children had a higher prevalence of chronic medical conditions (6.2%). When assessed by these health status indicators, Hispanic children seem to have a health status similar to non-Hispanic white children. However, mainland Puerto Rican children seem at greater risk for poor health, reflecting the US Hispanic population's heterogeneity. Health programs targeted at US Hispanics should appropriately consider these group differences.
View details for Web of Science ID A1991EQ60200030
View details for PubMedID 1984152
- Prevalence of overweight and obesity in US Hispanic Populations American Journal of Clinic Nutrition 1991; 53: 1522S-1528S
- An evaluation of four food group intakes by Mexican-American children The Journal of the American Dietetic Association 1990; 90 (3): 388-393
GENETIC AND ENVIRONMENTAL DETERMINANTS OF GROWTH IN MEXICAN-AMERICANS
1989; 84 (5): 864-871
Height and weight data from the Mexican-American portion of the Hispanic Health and Nutrition Examination Survey (HHANES) are shown for children of ages 2 to 17 years and compared with data for non-Hispanic white children from the second National Health and Nutrition Examination Survey and with the National Center for Health Statistics (NCHS) reference curves. Differences in stature between the Hispanic Health and Nutrition Examination Survey and the reference populations were minor prior to adolescence and could be entirely attributed to the greater poverty of Mexican-Americans. However, differences increased during adolescence (ie, median stature was less than the 25th percentile of the NCHS reference population at 17 years of age) and, in contrast with earlier ages, were independent of poverty. Similar growth patterns were observed in samples of upper-class subjects from Mexico and Guatemala. Nonetheless, the extent to which the short stature of Mexican-American adolescents is genetic is unclear because there is an apparent time trend toward greater stature in the Mexican-American population. In conclusion, the NCHS reference curves are appropriate growth standards for preadolescent Mexican-American children. Whether they are valid for Mexican-American adolescents remains unclear.
View details for Web of Science ID A1989AX61000020
View details for PubMedID 2797981
- Sexual maturation in Mexican-American adolescents American Journal of Human Biology 1989; 1: 87-95
- Fatness and fat distribution in Mexican American children and youths from the Hispanic Health and Nutrition Examination Survey American Journal of Human Biology 1989; 1: 631-648
- Which Side to Measure: Right or Left? In TG Lohman, AF Roche, and R. Martorell (eds.), Anthropometry Standardization Reference ManualChampaign, Illinois: Human Kinetics Publishers, Inc. 1988: 87-91
- Poverty and Stature in Children In John C. Waterlow (ed.), Linear Growth Retardation in Less Developed Countries, Nestle Nutrition Workshop Series. New York: Vavey/Raven Press. 1988; 14
- Elevated serum iron concentration in adolescent alcohol users American Journal of Diseases of Children 1988; 142 (2): 156-159
- Vitamin A intoxication presenting with ascites and a normal vitamin A level The Western Journal of Medicine 1988; 148 (1): 88-90
- MINORITY ADMISSIONS - QUO-VADIS JOURNAL OF MEDICAL EDUCATION 1987; 62 (8): 698-700
- Short and plump physique of Mexican-American Children American Journal of Physical Anthropology 1987; 73: 475-487
- Rhabdomyolysis complicating doxylamine overdose. Clinical Pediatrics 1987; 26 (11): 595-597
GROWTH ABNORMALITIES IN MEXICAN-AMERICAN CHILDREN IN THE UNITED-STATES - THE NATIONAL-HEALTH AND NUTRITION EXAMINATION SURVEY I-STUDY
1986; 6 (11): 1247-1257
View details for Web of Science ID A1986F386100002
- INCREASING MINORITIES IN ACADEMIA - THE FACULTY ROLE-MODEL JOURNAL OF MEDICAL EDUCATION 1986; 61 (10): 850-851
GROWTH STATUS OF MEXICAN-AMERICAN CHILDREN AND YOUTHS - HISTORICAL TRENDS AND CONTEMPORARY-ISSUES
YEARBOOK OF PHYSICAL ANTHROPOLOGY
1986; 29: 45-79
View details for Web of Science ID A1986F847300002