Impact of Individual-, Environmental-, and Policy-Level Factors on Health Care Utilization Among US Farmworkers

We examined individual-, environmental-, and policy-level correlates of US farmworker health care utilization, guided by the behavioral model for vulnerable populations and the ecological model. The 2006 and 2007 administrations of the National Agricultural Workers Survey (n = 2884) provided the pri...

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Bibliographic Details
Published in:American journal of public health (1971) 2011-04, Vol.101 (4), p.685-692
Main Authors: HOERSTER, Katherine D, MAYER, Joni A, GABBARD, Susan, KRONICK, Richard G, ROESCH, Scott C, MALCARNE, Vanessa L, ZUNIGA, Maria L
Format: Article
Language:English
Subjects:
Adult
Agriculture
Ambulatory care
Biological and medical sciences
Chronic illnesses
Disease
Educational attainment
Employers
Environment. Living conditions
Ethnicity
Family income
Farmworkers
Female
General aspects
Geographic Information Systems
Health care
Health care policy
Health Care Surveys
Health Services - utilization
Health Services Accessibility
Hispanic Americans
Hospitals
Humans
Immigration policy
Logistic Models
Male
Medical sciences
Miscellaneous
Missing data
Mortality
Policy
Public health
Public health. Hygiene
Public health. Hygiene-occupational medicine
Regression analysis
Research and Practice
Risk
Social Class
Studies
United States
Variables
Wages & salaries
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Summary:We examined individual-, environmental-, and policy-level correlates of US farmworker health care utilization, guided by the behavioral model for vulnerable populations and the ecological model. The 2006 and 2007 administrations of the National Agricultural Workers Survey (n = 2884) provided the primary data. Geographic information systems, the 2005 Uniform Data System, and rurality and border proximity indices provided environmental variables. To identify factors associated with health care use, we performed logistic regression using weighted hierarchical linear modeling. Approximately half (55.3%) of farmworkers utilized US health care in the previous 2 years. Several factors were independently associated with use at the individual level (gender, immigration and migrant status, English proficiency, transportation access, health status, and non-US health care utilization), the environmental level (proximity to US-Mexico border), and the policy level (insurance status and workplace payment structure). County Federally Qualified Health Center resources were not independently associated. We identified farmworkers at greatest risk for poor access. We made recommendations for change to farmworker health care access at all 3 levels of influence, emphasizing Federally Qualified Health Center service delivery.
ISSN:0090-0036
1541-0048
DOI:10.2105/ajph.2009.190892