title: Impact of individual-, environmental-, and policy-level factors on health care utilization among US farmworkers.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: San Diego State University/University of California, San Diego, CA, USA. Katherine.Hoerster@va.gov
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Hoerster
authors.forename: Joni A
authors.initials: JA
authors.lastname: Mayer
authors.forename: Susan
authors.initials: S
authors.lastname: Gabbard
authors.forename: Richard G
authors.initials: RG
authors.lastname: Kronick
authors.forename: Scott C
authors.initials: SC
authors.lastname: Roesch
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Malcarne
authors.forename: Maria L
authors.initials: ML
authors.lastname: Zuniga
mesh_terms: D000328:Adult; D000383:Agriculture; D005260:Female; D040362:Geographic Information Systems; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D057766:Policy; D012306:Risk; D012923:Social Class; D014481:United States