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Caregivers’ Health Literacy and Gaps in Children’s Medicaid Enrollment: Findings from the Carolina Oral Health Literacy Study

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Listed:
  • Jessica Y Lee
  • Kimon Divaris
  • Darren A DeWalt
  • A Diane Baker
  • Ziya Gizlice
  • R Gary Rozier
  • William F Vann Jr

Abstract

Background and Objectives: Recent evidence supports a link between caregivers’ health literacy and their children’s health and use of health services. Disruptions in children’s health insurance coverage have been linked to poor health care and outcomes. We examined young children’s Medicaid enrollment patterns in a well-characterized cohort of child/caregivers dyads and investigated the association of caregivers’ low health literacy with the incidence of enrollment gaps. Methods: We relied upon Medicaid enrollment data for 1208 children (mean age = 19 months) enrolled in the Carolina Oral Health Literacy project during 2008–09. The median follow-up was 25 months. Health literacy was measured using the Newest Vital Sign (NVS). Analyses relied on descriptive, bivariate, and multivariate methods based on Poisson modeling. Findings: One-third of children experienced one or more enrollment gaps; most were short in duration (median = 5 months). The risk of gaps was inversely associated with caregivers’ age, with a 2% relative risk decrease for each added year. Low health literacy was associated with a modestly elevated risk increase [Incidence Rate Ratio (IRR) = 1.17 (95% confidence interval (CI) 0.88–1.57)] for enrollment disruptions; however, this estimate was substantially elevated among caregivers with less than a high school education [IRR = 1.52 (95% CI 0.99–2.35); homogeneity p

Suggested Citation

  • Jessica Y Lee & Kimon Divaris & Darren A DeWalt & A Diane Baker & Ziya Gizlice & R Gary Rozier & William F Vann Jr, 2014. "Caregivers’ Health Literacy and Gaps in Children’s Medicaid Enrollment: Findings from the Carolina Oral Health Literacy Study," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-11, October.
    • Handle: RePEc:plo:pone00:0110178
    DOI: 10.1371/journal.pone.0110178
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    References listed on IDEAS

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    1. Lee, J.Y. & Rozier, R.G. & Norton, E.C. & Kotch, J.B. & Vann Jr., W.F., 2004. "Effects of WIC Participation on Children's Use of Oral Health Services," American Journal of Public Health, American Public Health Association, vol. 94(5), pages 772-777.
    2. Congressional Budget Office, 2014. "Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014," Reports 45231, Congressional Budget Office.
    3. Chatterji, P. & Brooks-Gunn, J., 2004. "WIC participation, breastfeeding practices, and well-child care among unmarried, low-income mothers," American Journal of Public Health, American Public Health Association, vol. 94(8), pages 1324-1327.
    4. Peninah Thomson & Jacey Graham & Tom Lloyd, 2008. "Mind the gap," Palgrave Macmillan Books, in: A Woman’s Place is in the Boardroom, chapter 0, pages 94-102, Palgrave Macmillan.
    5. Lee, J.Y. & Divaris, K. & Baker, A.D. & Rozier, R.G. & Vann Jr., W.F., 2012. "The relationship of oral health literacy and self-efficacy with oral health status and dental neglect," American Journal of Public Health, American Public Health Association, vol. 102(5), pages 923-929.
    6. Congressional Budget Office, 2012. "Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act," Reports 43076, Congressional Budget Office.
    7. Congressional Budget Office, 2014. "Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014," Reports 45231, Congressional Budget Office.
    8. Wise, P.H. & Wampler, N.S. & Chavkin, W. & Romero, D., 2002. "Chronic illness among poor children enrolled in the temporary assistance for needy families program," American Journal of Public Health, American Public Health Association, vol. 92(9), pages 1458-1461.
    9. Congressional Budget Office, 2012. "Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act," Reports 43076, Congressional Budget Office.
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