- Email: [email protected]
Immigrant Children: Unmet Needs and a Myriad of Nursing Concerns
JOURNAL OF PEDIATRIC NURSING: NURSING CARE OF CHILDREN & FAMILIES Official Journal of the Society of Pediatric Nurses and the Pediatric Endocrinology Nursing Society Vol 23, No 3
June 2008
EDITORIAL Immigrant Children: Unmet Needs and a Myriad of Nursing Concerns
A
CCORDING TO THE 2005 U.S. Census Bureau data, children and youth 18 years and younger constitute 25% of the U.S. population, amounting to 73.4 million children (U.S. Census Bureau, 2005). As the recent 2006 Child Health USA data indicate, there are important demographic changes among the U.S. population that have significant implications for child health practices (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2006). The U.S. population is becoming increasingly more diverse, as demonstrated by the following demographic changes. The number of children and their parents who were born outside of the United States has risen considerably during the past 30 years (Centers of Disease Control and Prevention, National Center for Health Statistics, National Survey of Children's Health, 2003). Eleven percent, amounting to 32 million people, of the U.S. population are foreign born; children amount to 4% of the foreignborn U.S. population (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2006). Over one fifth of children living in the United States were born to at least one parent who was foreign born (Centers of Disease Control and Prevention, National Center for Health Statistics, National Survey of Children's Health, 2003). Since 1990, the immigrant population of children increased 7 times more than the native-born population of children, making them the most rapidly growing segment of the child population
Journal of Pediatric Nursing, Vol 23, No 3 (June), 2008
(Hernandez, 2004). First- and second-generation immigrants are the fastest growing segment of the U.S. population (Pumariega, Rothe, & Pumariega, 2005; U.S. Census Bureau, 2007). Thirty percent of children and youth younger than 18 years are culturally diverse; it is estimated that this percentage of children will increase to 40% by 2020 (U.S. Census Bureau, 2000). Illustrative of the growth of the U.S. culturally diverse population, the percent of Hispanic children has more than doubled to 18% since 1980. Although a considerably smaller group, the Asian/ Pacific Islander population has doubled as well during this period to 4%. In contrast, the percent of non-Hispanic White children has decreased, whereas the percentage of African American children has remained stable during this same period (U.S. Census Bureau, 2000). Immigrant children are composed of highly diverse groups of children—those who are identified as documented and undocumented immigrants, temporary visitors, refugees, student-visa holders, and permanent residents (Stauffer, Maroushek, & Kamat, 2005). Most immigrant families live in the West and Northeast and in urban settings (Moharity et al., 2005). The preponderance of immigrant children live in 1 of the following 6 states in the West and Northeast: California, Florida, Illinois, New Jersey, New Work, and Texas. For example, nearly half of 0882-5963/$ - see front matter © 2008 Published by Elsevier Inc. doi:10.1016/j.pedn.2008.02.001
157
158
the California child population are of immigrant families (Hernandez, 2004). Between 1990 and 2000, the immigrant population of children more than doubled in 19 other states (Cauthen & Dinan, 2006). This highly diverse group of children require health services that are sensitive to their very unique biopsychosocial and cultural needs. As will be described in this editorial, their needs for health services may be overlooked, given the service system barriers that exist that prevent immigrant children and their families from accessing needed services and the challenges that immigrant children and families encounter in their daily lives. Immigrant children experience a number of risk factors that can adversely affect their health. These risk factors include lack of health insurance, parental lack of understanding of service systems, cultural differences, limited English proficiency of children and their families, poverty, overcrowded housing, and family's legal status. Immigrant children are at higher risk for having less access to health care and for being uninsured (Centers for Disease Control and Prevention, National Center for Health Statistics, & National Survey of Children's Health 2003; Huang, Yu, & Ledsky, 2006; Moharity et al., 2005). As a result, visits to pediatricians, dentists, and mental health professionals have been found to be considerably less than those for children who have health insurance (Guendelman, Angulo, Wier, & Oman, 2005; Huang et al., 2006). Insurance coverage for children varies considerably depending on their nativity status as 43.1% of immigrant children are uninsured compared with just 6.2% of children born in the United States (Centers for Disease Control and Prevention, National Center for Health Statistics, & National Survey of Children's Health, 2003). Analysis of data from the 1999 National Survey of America's Families found that immigrant children of foreign-born parents were 4 times more likely not to have insurance coverage compared with native-born children (Huang et al., 2006). Barriers to obtaining insurance included limited English proficiency, legal status, and poverty (Guendelman et al., 2005). Nearly half of the children of immigrant families live in poverty (200% of the poverty level) compared with 34% of children of native-born families, although 97% of the immigrant parents work, with 72% of them working full-time. The economic disparities are due to the fact that nearly half of immigrant parents are employed in low-wage jobs; more than 60% of these low-wage earners have limited English proficiency (Cauthen & Dinan, 2006; Haskins, Greenberg, & Fremstad, 2004;
CECILY L. BETZ
Hernandez, 2004; Shields & Behrman, 2004). They work in low-paying employment sectors that do not require English proficiency such as agriculture, food service, clothing apparel manufacturing, and environmental services (De Cos, 1999). Another factor contributing to low-wage status is the legal status of parents as most working immigrants are noncitizens, whereas 70% of their children are U.S. citizens (Cauthen & Dinan, 2006). Children who live in poverty are at greater health risk as their families have less access to health care services and are less able to afford health care services that their children may need (Shields & Behrman, 2004). In addition, given the limited resources of families, parents may not budget funds for preventive health services when their children appear to be healthy including ensuring their children's immunizations are up to date as other family necessities take precedence (Guendelman et al., 2005; Stauffer et al., 2005). Immigrant families, especially those who are undocumented, are fearful that contact with the health care system will result in deportation (Huang et al., 2006; Moharity et al., 2005). Due to the economic hardships low-income families face, nearly half of immigrant children live in overcrowded conditions, having to share living space with other relatives, nonrelatives, or both (Hernandez, 2004; Shields & Behrman, 2004). Immigrant children are nearly twice as likely to be living with other relatives or nonrelatives as compared with children who are native born. Living with other individuals is more likely for families whose children are younger; 21% of families with children aged from birth to 2 years have living arrangements that include other individuals (Hernandez, 2004). Living in crowded living arrangements creates stress for children and their families as family's routines and children's needs are subsumed to the needs of the collective group. In addition, living in overcrowded spaces puts children at risk through close exposure to ill individuals and compromised hygienic conditions. By economic necessity, many immigrant families live in neighborhoods that are not safe and with high rates of criminal activity, creating an atmosphere of stress, fear, and anxiety about personal safety (Pumariega et al. 2005). Parents who have limited English proficiency are less able to communicate their children's health needs to health care providers or advocate on behalf of their children (Hernandez, 2004; Huang et al., 2006). Twenty-six percent of immigrant children live in linguistically isolated families, meaning that
IMMIGRANT CHILDREN: UNMET NEEDS AND A MYRIAD OF NURSING CONCERNS
no one in the home speaks English, thereby creating even more hurdles for families to confront (Hernandez, 2004). Immigrant families, due to their limited English proficiency, have understandable difficulty comprehending how to access the health care system and navigate it (Huang et al., 2006; Jaycox et al., 2002). In addition, they have problems understanding not only the terminology used by health care professionals and practitioners, but also its meaning, and it may not be translatable to their native language (Stauffer, 2005). Parental difficulties with limited English proficiency extend to the other services their children receive in the community and at school, making them less able to provide the type of advocacy and academic and programmatic support their children need (Haskins et al., 2004). Closely related with parental limited English proficiency is the educational attainment of immigrant parents that can adversely affect their children's health status. The educational attainment of immigrant parents differs considerably from native-born parents. Parents with less than a high school education with immigrant and native-born status are 40% fathers and 23% mothers and 12% fathers and 12% mothers, respectively. Limitations with educational attainment and English proficiency limit the ability of immigrant parents to assist their children in learning important sociocultural norms needed for academic achievement and occupational and career development and navigating health care and community services (Shields & Behrman, 2004). Ensuring that immigrant families receive understandable health information is essential to promoting health outcomes. Promoting the health literacy of immigrant children and families is a paramount nursing challenge. Although it is beyond the scope of this editorial to discuss interventions to promote the health literacy of children and families with limited English proficiency, the reader is encouraged to access health literacy Internet sites listed at the conclusion of this editorial. The contrasts associated with their cultural differences and values that immigrant children and their families experience in the United States create challenges for them in adapting to the American lifestyle (Stauffer et al., 2005). Immigrant children are at risk for experiencing discrimination in their schools, health care settings, and communities due to cultural differences, immigrant status, and limited language proficiency (Pumariega et al. 2005). Yet, the acculturation process of immigrant children may evolve differently from
159
their family members as the children may adjust more readily to the American culture than other family members who relate more strongly to the native culture they left behind. This difference in the acculturation process can create uncomfortable levels of tension among family members (Hwang, 2006a, 2006b). It is understandable that ethnically and culturally diverse families find social and cultural support living in community ethnic enclaves wherein they can comfortably maintain their native culture and language while learning to acculturate to the new societal community (De Cos, 1999). In addition, as children learn to live within a new cultural community, they may encounter the discrimination from others due to their cultural differences (Pumariega et al., 2005). Differences in cultural practices extend to the understanding of the treatment and causes of diseases. For example, Asian American groups view disability as a stigma and as a punishment for their or their ancestors' moral transgressions (Shah, 1997). Guilt and shame may prevent Asian Americans from seeking professional or agency services, and in addition, Asian Americans may have privacy concerns and be reluctant to share sensitive personal information, even pertaining to treatment (Choi & Wynne, 2000). Other challenges include the use of complementary and alternative treatments based on native cultural practices that may harm or put the child at risk. These practices include female genital mutilation, coining, cupping, and burning (Stauffer et al., 2005). It is important that pediatric and child health nurses seek out cultural resources and experts to educate them in providing culturally competent care. Health care services for children should include certified translators who can accurately communicate both the children's and their family's needs and their requests for information to pediatric and child health nurses and the nurses' interdisciplinary health care colleagues. It is imperative that health care resources be available that reflect current and evidence-based practices in the languages and reading levels of the populations served (Guendelman et al., 2005). Ensuring that the health needs of immigrant children and families are met is a step in promoting the health needs of all. HEALTH LITERACY WEB SITES California Health Literacy Initiative: provides resources to foster health literacy. http://literacyworks.org/healthliteracy/index.html
160
CECILY L. BETZ
Ask Me Three: provides a communication model for communicating effectively with patients using health literacy approach. http:// www.npsf.org/askme3/ Quick Guide to Health Literacy: provides a summary of information on the topic of health literacy and resources. http://www.health.gov/
communication/literacy/quickguide/factsliteracy.htm Cecily L. Betz, PhD, RN, FAAN Editor-in-Chief Journal of Pediatric Nursing Los Angeles, CA 90027 E-mail address: [email protected]
REFERENCES Cauthen, N. K., & Dinan, K. A. (2006). Immigrant children: America's future. Retrieved on January 16, 2008 from www. futureofchildren.org. Centers for Disease Control and Prevention, National Center for Health Statistics, & National Survey of Children's Health. (2003). Analysis conducted by the Maternal and Child Health Information Resource Center. Child Health USA, 2006. Retrieved on January 14 from ftp://ftp.hrsa.gov/mchb/ chusa_06/c06rc.pdf. Choi, K. H., & Wynne, M. E. (2000). Providing services to Asian Americans with developmental disabilities and their families: Mainstream service providers' perspective. Community Mental Health Journal, 26, 589−595. De Cos, P. (1999). Educating California's immigrant children: An overview of bilingual education. Sacramento: California Research Bureau. Retrieved on January 15, 2008 from http:// www.library.ca.gov/crb/99/09/99009.pdf. Guendelman, S., Angulo, V., Wier, M., & Oman, D. (2005). Overcoming the odds: Access to care for immigrant children in working poor families in California. Maternal and Child Health Journal, 9, 351−362. Haskins, R., Greenberg, M., & Fremstad, S. (2004). Federal policy for immigrant children: Room for common ground?The Future of Children, 14, 1−6. Retrieved on January 20, 2008 from www.futureofchildren.org. Hernandez, D. J. (2004). Demographic change and the life circumstances of immigrant families. The Future of Children, 14, 17−47. Retrieved on January 20, 2008 from www. futureofchildren.org. Huang, A. J., Yu, S. M., & Ledsky, R. (2006). Health status and health service access and use among children in U.S. immigrant families. American Journal of Public Health, 96, 634−640. Hwang, W. C. (2006). Acculturative family distancing: theory, research, and clinical practice. Psychotherapy: Theory/Research/ Practice/Training, 43, 397−409.
Hwang, W. C. (2006). The psychotherapy adaptation and modification framework: Application to Asian Americans. American Psychologist, 61, 702−715. Jaycox, L., Stein, B. D., Kataoka, S. H., Wond, M., Fink, A., Escudero, P., et al. (2002). Violence exposure, post traumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1104−1110. Moharity, S. A., Woolhandler, S., Himmelstein, D. U., Pati, S., Carrasquillo, O., & Bor, D. H. (2005). Health care expenditures of immigrants in the United States: A nationally representative analysis. American Journal of Public Health, 95, 1431−1438. Pumariega, A. J., Rothe, E., & Pumariega, J. B. (2005). Mental health of immigrants and refugees. Community Mental Health Journal, 41, 581−597. Shah, R. (1997). Improving services to Asian American families and their children with disabilities. Child: Care, Health and Development, 23, 41−46. Shields, M. K., & Behrman, R. E. (2004). Children of immigrant families: Analysis and recommendations. The Future of Children, 14, 4−16. Retrieved on January 20, 2008 from www.futureofchildren.org. Stauffer, W. M., Maroushek, S., & Kamat, D. (2005). Medical screening of immigrant children.Clinical Pediatrics, 42, 763−773. Retrieved on January 29, 2008 from http://cpj.sagepub.com. U.S. Census Bureau. (2007). Minority population tops 100 million. U.S. Census Press Release, May 15, 2007. Retrieved on March 5, 2008 from http://www.census.gov/ Press-Release/www/releases/archives/population/010048.html. U.S. Census Bureau, Population Division. (2005). Annual population estimates. Washington, DC: Author. U.S. Department of Health and Human Services, Health Resources and Services Administration, & Maternal and Child Health Bureau. (2006). Child Health USA 2006. Retrieved on January 15, 2008 from Rockville, MD: U.S. Department of Health and Human Serviceshttp://mchb.hrsa.gov/chusa_06/.
June 2008
EDITORIAL Immigrant Children: Unmet Needs and a Myriad of Nursing Concerns
A
CCORDING TO THE 2005 U.S. Census Bureau data, children and youth 18 years and younger constitute 25% of the U.S. population, amounting to 73.4 million children (U.S. Census Bureau, 2005). As the recent 2006 Child Health USA data indicate, there are important demographic changes among the U.S. population that have significant implications for child health practices (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2006). The U.S. population is becoming increasingly more diverse, as demonstrated by the following demographic changes. The number of children and their parents who were born outside of the United States has risen considerably during the past 30 years (Centers of Disease Control and Prevention, National Center for Health Statistics, National Survey of Children's Health, 2003). Eleven percent, amounting to 32 million people, of the U.S. population are foreign born; children amount to 4% of the foreignborn U.S. population (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2006). Over one fifth of children living in the United States were born to at least one parent who was foreign born (Centers of Disease Control and Prevention, National Center for Health Statistics, National Survey of Children's Health, 2003). Since 1990, the immigrant population of children increased 7 times more than the native-born population of children, making them the most rapidly growing segment of the child population
Journal of Pediatric Nursing, Vol 23, No 3 (June), 2008
(Hernandez, 2004). First- and second-generation immigrants are the fastest growing segment of the U.S. population (Pumariega, Rothe, & Pumariega, 2005; U.S. Census Bureau, 2007). Thirty percent of children and youth younger than 18 years are culturally diverse; it is estimated that this percentage of children will increase to 40% by 2020 (U.S. Census Bureau, 2000). Illustrative of the growth of the U.S. culturally diverse population, the percent of Hispanic children has more than doubled to 18% since 1980. Although a considerably smaller group, the Asian/ Pacific Islander population has doubled as well during this period to 4%. In contrast, the percent of non-Hispanic White children has decreased, whereas the percentage of African American children has remained stable during this same period (U.S. Census Bureau, 2000). Immigrant children are composed of highly diverse groups of children—those who are identified as documented and undocumented immigrants, temporary visitors, refugees, student-visa holders, and permanent residents (Stauffer, Maroushek, & Kamat, 2005). Most immigrant families live in the West and Northeast and in urban settings (Moharity et al., 2005). The preponderance of immigrant children live in 1 of the following 6 states in the West and Northeast: California, Florida, Illinois, New Jersey, New Work, and Texas. For example, nearly half of 0882-5963/$ - see front matter © 2008 Published by Elsevier Inc. doi:10.1016/j.pedn.2008.02.001
157
158
the California child population are of immigrant families (Hernandez, 2004). Between 1990 and 2000, the immigrant population of children more than doubled in 19 other states (Cauthen & Dinan, 2006). This highly diverse group of children require health services that are sensitive to their very unique biopsychosocial and cultural needs. As will be described in this editorial, their needs for health services may be overlooked, given the service system barriers that exist that prevent immigrant children and their families from accessing needed services and the challenges that immigrant children and families encounter in their daily lives. Immigrant children experience a number of risk factors that can adversely affect their health. These risk factors include lack of health insurance, parental lack of understanding of service systems, cultural differences, limited English proficiency of children and their families, poverty, overcrowded housing, and family's legal status. Immigrant children are at higher risk for having less access to health care and for being uninsured (Centers for Disease Control and Prevention, National Center for Health Statistics, & National Survey of Children's Health 2003; Huang, Yu, & Ledsky, 2006; Moharity et al., 2005). As a result, visits to pediatricians, dentists, and mental health professionals have been found to be considerably less than those for children who have health insurance (Guendelman, Angulo, Wier, & Oman, 2005; Huang et al., 2006). Insurance coverage for children varies considerably depending on their nativity status as 43.1% of immigrant children are uninsured compared with just 6.2% of children born in the United States (Centers for Disease Control and Prevention, National Center for Health Statistics, & National Survey of Children's Health, 2003). Analysis of data from the 1999 National Survey of America's Families found that immigrant children of foreign-born parents were 4 times more likely not to have insurance coverage compared with native-born children (Huang et al., 2006). Barriers to obtaining insurance included limited English proficiency, legal status, and poverty (Guendelman et al., 2005). Nearly half of the children of immigrant families live in poverty (200% of the poverty level) compared with 34% of children of native-born families, although 97% of the immigrant parents work, with 72% of them working full-time. The economic disparities are due to the fact that nearly half of immigrant parents are employed in low-wage jobs; more than 60% of these low-wage earners have limited English proficiency (Cauthen & Dinan, 2006; Haskins, Greenberg, & Fremstad, 2004;
CECILY L. BETZ
Hernandez, 2004; Shields & Behrman, 2004). They work in low-paying employment sectors that do not require English proficiency such as agriculture, food service, clothing apparel manufacturing, and environmental services (De Cos, 1999). Another factor contributing to low-wage status is the legal status of parents as most working immigrants are noncitizens, whereas 70% of their children are U.S. citizens (Cauthen & Dinan, 2006). Children who live in poverty are at greater health risk as their families have less access to health care services and are less able to afford health care services that their children may need (Shields & Behrman, 2004). In addition, given the limited resources of families, parents may not budget funds for preventive health services when their children appear to be healthy including ensuring their children's immunizations are up to date as other family necessities take precedence (Guendelman et al., 2005; Stauffer et al., 2005). Immigrant families, especially those who are undocumented, are fearful that contact with the health care system will result in deportation (Huang et al., 2006; Moharity et al., 2005). Due to the economic hardships low-income families face, nearly half of immigrant children live in overcrowded conditions, having to share living space with other relatives, nonrelatives, or both (Hernandez, 2004; Shields & Behrman, 2004). Immigrant children are nearly twice as likely to be living with other relatives or nonrelatives as compared with children who are native born. Living with other individuals is more likely for families whose children are younger; 21% of families with children aged from birth to 2 years have living arrangements that include other individuals (Hernandez, 2004). Living in crowded living arrangements creates stress for children and their families as family's routines and children's needs are subsumed to the needs of the collective group. In addition, living in overcrowded spaces puts children at risk through close exposure to ill individuals and compromised hygienic conditions. By economic necessity, many immigrant families live in neighborhoods that are not safe and with high rates of criminal activity, creating an atmosphere of stress, fear, and anxiety about personal safety (Pumariega et al. 2005). Parents who have limited English proficiency are less able to communicate their children's health needs to health care providers or advocate on behalf of their children (Hernandez, 2004; Huang et al., 2006). Twenty-six percent of immigrant children live in linguistically isolated families, meaning that
IMMIGRANT CHILDREN: UNMET NEEDS AND A MYRIAD OF NURSING CONCERNS
no one in the home speaks English, thereby creating even more hurdles for families to confront (Hernandez, 2004). Immigrant families, due to their limited English proficiency, have understandable difficulty comprehending how to access the health care system and navigate it (Huang et al., 2006; Jaycox et al., 2002). In addition, they have problems understanding not only the terminology used by health care professionals and practitioners, but also its meaning, and it may not be translatable to their native language (Stauffer, 2005). Parental difficulties with limited English proficiency extend to the other services their children receive in the community and at school, making them less able to provide the type of advocacy and academic and programmatic support their children need (Haskins et al., 2004). Closely related with parental limited English proficiency is the educational attainment of immigrant parents that can adversely affect their children's health status. The educational attainment of immigrant parents differs considerably from native-born parents. Parents with less than a high school education with immigrant and native-born status are 40% fathers and 23% mothers and 12% fathers and 12% mothers, respectively. Limitations with educational attainment and English proficiency limit the ability of immigrant parents to assist their children in learning important sociocultural norms needed for academic achievement and occupational and career development and navigating health care and community services (Shields & Behrman, 2004). Ensuring that immigrant families receive understandable health information is essential to promoting health outcomes. Promoting the health literacy of immigrant children and families is a paramount nursing challenge. Although it is beyond the scope of this editorial to discuss interventions to promote the health literacy of children and families with limited English proficiency, the reader is encouraged to access health literacy Internet sites listed at the conclusion of this editorial. The contrasts associated with their cultural differences and values that immigrant children and their families experience in the United States create challenges for them in adapting to the American lifestyle (Stauffer et al., 2005). Immigrant children are at risk for experiencing discrimination in their schools, health care settings, and communities due to cultural differences, immigrant status, and limited language proficiency (Pumariega et al. 2005). Yet, the acculturation process of immigrant children may evolve differently from
159
their family members as the children may adjust more readily to the American culture than other family members who relate more strongly to the native culture they left behind. This difference in the acculturation process can create uncomfortable levels of tension among family members (Hwang, 2006a, 2006b). It is understandable that ethnically and culturally diverse families find social and cultural support living in community ethnic enclaves wherein they can comfortably maintain their native culture and language while learning to acculturate to the new societal community (De Cos, 1999). In addition, as children learn to live within a new cultural community, they may encounter the discrimination from others due to their cultural differences (Pumariega et al., 2005). Differences in cultural practices extend to the understanding of the treatment and causes of diseases. For example, Asian American groups view disability as a stigma and as a punishment for their or their ancestors' moral transgressions (Shah, 1997). Guilt and shame may prevent Asian Americans from seeking professional or agency services, and in addition, Asian Americans may have privacy concerns and be reluctant to share sensitive personal information, even pertaining to treatment (Choi & Wynne, 2000). Other challenges include the use of complementary and alternative treatments based on native cultural practices that may harm or put the child at risk. These practices include female genital mutilation, coining, cupping, and burning (Stauffer et al., 2005). It is important that pediatric and child health nurses seek out cultural resources and experts to educate them in providing culturally competent care. Health care services for children should include certified translators who can accurately communicate both the children's and their family's needs and their requests for information to pediatric and child health nurses and the nurses' interdisciplinary health care colleagues. It is imperative that health care resources be available that reflect current and evidence-based practices in the languages and reading levels of the populations served (Guendelman et al., 2005). Ensuring that the health needs of immigrant children and families are met is a step in promoting the health needs of all. HEALTH LITERACY WEB SITES California Health Literacy Initiative: provides resources to foster health literacy. http://literacyworks.org/healthliteracy/index.html
160
CECILY L. BETZ
Ask Me Three: provides a communication model for communicating effectively with patients using health literacy approach. http:// www.npsf.org/askme3/ Quick Guide to Health Literacy: provides a summary of information on the topic of health literacy and resources. http://www.health.gov/
communication/literacy/quickguide/factsliteracy.htm Cecily L. Betz, PhD, RN, FAAN Editor-in-Chief Journal of Pediatric Nursing Los Angeles, CA 90027 E-mail address: [email protected]
REFERENCES Cauthen, N. K., & Dinan, K. A. (2006). Immigrant children: America's future. Retrieved on January 16, 2008 from www. futureofchildren.org. Centers for Disease Control and Prevention, National Center for Health Statistics, & National Survey of Children's Health. (2003). Analysis conducted by the Maternal and Child Health Information Resource Center. Child Health USA, 2006. Retrieved on January 14 from ftp://ftp.hrsa.gov/mchb/ chusa_06/c06rc.pdf. Choi, K. H., & Wynne, M. E. (2000). Providing services to Asian Americans with developmental disabilities and their families: Mainstream service providers' perspective. Community Mental Health Journal, 26, 589−595. De Cos, P. (1999). Educating California's immigrant children: An overview of bilingual education. Sacramento: California Research Bureau. Retrieved on January 15, 2008 from http:// www.library.ca.gov/crb/99/09/99009.pdf. Guendelman, S., Angulo, V., Wier, M., & Oman, D. (2005). Overcoming the odds: Access to care for immigrant children in working poor families in California. Maternal and Child Health Journal, 9, 351−362. Haskins, R., Greenberg, M., & Fremstad, S. (2004). Federal policy for immigrant children: Room for common ground?The Future of Children, 14, 1−6. Retrieved on January 20, 2008 from www.futureofchildren.org. Hernandez, D. J. (2004). Demographic change and the life circumstances of immigrant families. The Future of Children, 14, 17−47. Retrieved on January 20, 2008 from www. futureofchildren.org. Huang, A. J., Yu, S. M., & Ledsky, R. (2006). Health status and health service access and use among children in U.S. immigrant families. American Journal of Public Health, 96, 634−640. Hwang, W. C. (2006). Acculturative family distancing: theory, research, and clinical practice. Psychotherapy: Theory/Research/ Practice/Training, 43, 397−409.
Hwang, W. C. (2006). The psychotherapy adaptation and modification framework: Application to Asian Americans. American Psychologist, 61, 702−715. Jaycox, L., Stein, B. D., Kataoka, S. H., Wond, M., Fink, A., Escudero, P., et al. (2002). Violence exposure, post traumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1104−1110. Moharity, S. A., Woolhandler, S., Himmelstein, D. U., Pati, S., Carrasquillo, O., & Bor, D. H. (2005). Health care expenditures of immigrants in the United States: A nationally representative analysis. American Journal of Public Health, 95, 1431−1438. Pumariega, A. J., Rothe, E., & Pumariega, J. B. (2005). Mental health of immigrants and refugees. Community Mental Health Journal, 41, 581−597. Shah, R. (1997). Improving services to Asian American families and their children with disabilities. Child: Care, Health and Development, 23, 41−46. Shields, M. K., & Behrman, R. E. (2004). Children of immigrant families: Analysis and recommendations. The Future of Children, 14, 4−16. Retrieved on January 20, 2008 from www.futureofchildren.org. Stauffer, W. M., Maroushek, S., & Kamat, D. (2005). Medical screening of immigrant children.Clinical Pediatrics, 42, 763−773. Retrieved on January 29, 2008 from http://cpj.sagepub.com. U.S. Census Bureau. (2007). Minority population tops 100 million. U.S. Census Press Release, May 15, 2007. Retrieved on March 5, 2008 from http://www.census.gov/ Press-Release/www/releases/archives/population/010048.html. U.S. Census Bureau, Population Division. (2005). Annual population estimates. Washington, DC: Author. U.S. Department of Health and Human Services, Health Resources and Services Administration, & Maternal and Child Health Bureau. (2006). Child Health USA 2006. Retrieved on January 15, 2008 from Rockville, MD: U.S. Department of Health and Human Serviceshttp://mchb.hrsa.gov/chusa_06/.