title: Access to care for children of migratory agricultural workers: factors associated with unmet need for medical care.
abstract: OBJECTIVE
  To assess the correlates of unmet need for medical care among migrant children.
  
  
  METHODS
  A cross-sectional household survey used multistage sampling to identify migrant families in eastern North Carolina.
  
  
  METHODS
  Three hundred adult caretakers of 1 (per household) randomly selected child <13 years old.
  
  
  RESULTS
  Fifty-three percent of the children had an unmet medical need. The most common reasons for unmet medical need were lack of transportation (80%) and lack of knowledge of where to go for care (20%). Unmet medical need was associated inversely with less than very good health (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.16-0.61) and less than high school caretaker education (OR: 0.62; 95% CI: 0.39-0.98) and was associated directly with 1) having bed-days due to illness (OR: 2.46; 95% CI: 1.42-4.26), 2) lacking an annual well examination (OR:1.89; 95% CI: 1.12-3.20), 3) transportation dependence (OR:1.97; 95% CI: 1.24-3.13), 4) female gender (OR: 1.69; 95% CI: 1.07-2.67), 5) preschool age (OR: 2.24; 95% CI: 1.28-3.92), and 6) very high caretaker work pressure (OR: 5.01; 95% CI: 2.98-8.42). Adjustment using multiple logistic regression reveals unmet medical need to be independently associated with preschool age (OR: 2.08; 95% CI: 1.05-4.13) and very high caretaker pressure to work (OR: 5.93; 95% CI: 3.24-10.85). Of sampled children, 27% were preschool aged, and 40% had caretakers categorized with high work pressure.
  
  
  CONCLUSIONS
  Medical-access barriers among migrant children are largely nonfinancial. Preschool-aged migrant children disproportionately experience unmet medical need. Decreasing forgone care among migrant children will likely require a combination of individual, health-system, and labor-policy modifications.
authors.affiliation: Department of Maternal and Child Health, University of North Carolina, Chapel Hill, North Carolina 27599-7445, USA. andrea_weathers@unc.ecu
authors.forename: Andrea
authors.initials: A
authors.lastname: Weathers
authors.forename: Cynthia
authors.initials: C
authors.lastname: Minkovitz
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
authors.forename: Marie
authors.initials: M
authors.lastname: Diener-West
mesh_terms: D000328:Adult; D000383:Agriculture; D017028:Caregivers; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology / Q000706:statistics & numerical data; D009657:North Carolina; D012494:Sampling Studies; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000706:statistics & numerical data*