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Findings From the National Agricultural Workers Survey

Roberto L. Rodríguez, MD, MPH; Marc N. Elliott, PhD; Katherine D. Vestal, MPH; Marika J. Suttorp, MS; Mark A. Schuster, MD, PhD

Arch Pediatr Adolesc Med. 2008;162(12):1175-1180.

Objective  To characterize the health insurance status of farm workers' children, an understudied topic.

Design  A population-based multistage survey.

Setting  Employer-based study conducted in the continental United States from 2000 to 2002.

Participants  A total of 3136 parents with children younger than 18 years and no children residing outside of the United States who participated in the US Department of Labor's National Agricultural Workers Survey, which is administered to a national probability sample of US farm workers.

Outcome Measures  Children’s parent-reported health insurance status.

Results  Of the farm workers who were parents, 87% were Latino, 81% were foreign born, 15% were migrant workers, 55% had less than a sixth-grade education, and 68% reported little to no English language proficiency. Thirty-two percent of all farm-worker parents, including 45% of migrant-worker parents, reported that their children were uninsured. In multivariate analyses, older parental age (odds ratio [OR] for parents aged 30-39 years, 1.71; 95% confidence interval [CI], 1.16-2.50; OR for parents aged 40 years, 3.07; 95% CI, 1.99-4.74), less parental education (OR, 1.52; 95% CI, 1.09-2.10), less time in the United States (OR, 0.68; 95% CI, 0.56-0.91 per 10 years in the United States), being a migrant worker (OR, 1.96; 95% CI, 1.31-2.93), and living in the Southeast (OR, 3.17; 95% CI, 2.00-5.02) or Southwest (OR, 3.91; 95% CI, 2.32-6.57) were significantly associated with having uninsured children.

Conclusions  Farm workers' children were uninsured at roughly 3 times the rate of all other children and almost twice the rate of those at or near the federal poverty level. Programs aimed at extending insurance coverage for children should consider the unique social barriers that characterize this vulnerable population of US children. Moreover, there is significant regional variation that may reflect varying levels of insurance resources and eligibility from state to state.

Author Affiliations: Department of Pediatrics, University of Texas Medical Branch–Austin and Dell Children's Medical Center of Central Texas, Austin (Dr Rodríguez); RAND Corporation, Santa Monica, California (Drs Elliott and Schuster and Ms Suttorp); Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (Ms Vestal); and Department of Medicine, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts (Dr Schuster).