Number 82 n September 10, 2015

Reported Child Health Status, Hispanic Ethnicity, and
 

Language of Interview: United States, 2011–2012
 by Patricia N. Pastor, Ph.D.; Cynthia A. Reuben, M.A.; and Catherine R. Duran, B.S.

Abstract

Objectives—This report has three objectives: a) to describe the reported

health status of four subgroups of school-age children: Hispanic children with a

Spanish interview (Hispanic–Spanish interview), Hispanic children with an

English interview (Hispanic–English interview), non-Hispanic black children, and

non-Hispanic white children; b) to describe selected characteristics of children in

the four subgroups; and c) to consider whether the characteristics of children

account for subgroup variations in reported health status.

Data source and methods—Data from the 2011–2012 National Survey of

Children’s Health were used to describe the health status of children aged 5–17

years using three categories: a) poor or fair, b) good, and c) very good or

excellent health. The reported health status of children in the four subgroups was

examined using multinomial logistic regression, controlling for the effects of

demographic and socioeconomic characteristics and a measure of acculturation.

Results—Compared with children in the other subgroups, Hispanic–Spanish

interview children were more likely to have reports of poor or fair health (10.6%

compared with 1.8%–4.4%) and good health (39.7% compared with 7.7%–

14.4%). Controlling for demographic and socioeconomic characteristics and a

measure of acculturation eliminated the subgroup differences in poor or fair

health, but not good health. Even after adjustment for confounders, Hispanic–

Spanish interview children more often were reported to have good health rather

than very good or excellent health compared with children in the other

subgroups.

Conclusions—Worse reported health status of Hispanic–Spanish interview

children, compared with children in other subgroups, could not be explained

completely by the confounders in the analysis. Additional research is needed to

determine whether the worse reported health status of Hispanic children with

Spanish interviews reflects the actual health conditions of these children or

difficulties in translating the health status question.

Keywords: poor or fair child health • household interviews • parent-reported

health status • National Survey of Children’s Health

Introduction

Epidemiological studies have

documented that Hispanic adults in the

United States report worse health status

than non-Hispanic adults, even though

Hispanic adults have lower death rates

than non-Hispanic adults at most

ages (1,2). Additionally, several studies

of Hispanics have noted that Spanishspeaking Hispanic adults more often

report worse health status than Englishspeaking Hispanic adults, despite

evidence of lower death rates among

Spanish-speaking Hispanic adults (3–7).

While a number of factors have been

cited as possible explanations for the

worse self-reported health among

Hispanic adults, especially Spanishspeaking Hispanic adults, recent national

and community-based studies have

focused on the possibility that Spanish

language translations of the health status

question may be an important

factor (4,5). Bzostek et al., using results

from the first wave of the Los Angeles

Family and Neighborhood Survey, found

that the language of interview was a

better predictor of the self-reported

health status of Hispanic adults than any

of the other measures of acculturation (1).

The study also found that adjustment for

socioeconomic status narrowed, but did

not eliminate, the difference between the

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2 National Health Statistics Reports n Number 82 n September 10, 2015

health status of non-Hispanic white and

Hispanic adults. A similar study by

Kandula et al., using data from the 2001

California Health Interview Survey, also

noted worse self-reported health status for

Hispanic adults with limited English

proficiency compared with Hispanic adults

who were proficient in English (3).

Studies of adult health status have

suggested that difficulties in the

translation of specific response

categories may contribute to worse

health reports by particular ethnic

groups. After analyzing responses from

the Chicago Community Adult Health

Study (2001–2003) and the 2003

Behavioral Risk Factor Surveillance

System, Viruell-Fuentes et al. suggested

that the Spanish translation of the

English word fair to regular induced

Spanish-speaking respondents to report

worse health status than they might have

reported in English (5). An investigation

by Seo et al., based on two consecutive

waves of the California Health Interview

Survey, also showed that responses to

the five-category health status question

may have been influenced by a

respondent’s language of interview (4).

Hispanic respondents interviewed in

Spanish, compared with respondents

interviewed in English, tended to choose

a lower level of health status and more

often selected fair health and less often

selected very good or excellent health.

As Seo et al. noted in their study,

treating responses in different languages

as equivalent, particularly the responses

of adults in Hispanic and Asian

subgroups, had the effect of

exaggerating the racial and ethnic

differences in health status between

adults in these subgroups and nonHispanic white adults (4).

Few studies have examined the

factors associated with differences in

proxy-reported health status of Hispanic

and non-Hispanic children. A small

study of children in Arizona in 1989

found worse reported health status

among Hispanic children whose parents

were interviewed in Spanish, compared

with Hispanic children whose parents

were interviewed in English (8). While

the results of recent national surveys

have shown a higher percentage of

Hispanic children with reports of poor

or fair or good health compared with

non-Hispanic children, no recent studies

have examined the effect of language of

interview on the reporting of child

health status by parents (9–12). Recent

studies of the health status of Hispanic

children using parent-reported data in

national surveys have primarily focused

on household language and, in some

cases, the immigrant status of parents

and children (13–15). Avila and

Bramlett, however, suggest in the

discussion of the results of their analysis

of the 2007 National Survey of

Children’s Health (NSCH) that

additional research might explore why

Hispanic parents compared with

non-Hispanic white parents report

poorer overall child health status despite

reporting lower rates of illness and

special health care needs for their

children (14).

This study considers the association

between Spanish-language interviews

and the reporting of child health status

by comparing the health status of

Hispanic children with a Spanishlanguage interview with the health status

of children in three other subgroups:

Hispanic children with English language

interviews, non-Hispanic black children,

and non-Hispanic white children.

Differences between Hispanic children

with a Spanish interview and children in

the other subgroups were examined

before and after adjusting for two sets

of confounding factors: (a) demographic

and socioeconomic characteristics and

(b) a measure of acculturation. The two

socioeconomic characteristics included

in the analysis were the child’s health

insurance coverage and household

income as a percentage of the poverty

threshold. Because both of these factors

have been shown to be significantly

associated with both the child’s health

status and the child’s Hispanic ethnicity

and race, it seemed likely that these

characteristics might account for the

ethnic and racial differences in the

reported health status of children (16).

An acculturation measure, primary

household language, was added to the

analysis in an effort to take into account

the household’s cultural and social

connections with the larger community.

Findings from studies of adult

self-reported health status have

suggested that language of interview has

a stronger effect on responses to the

health status question than other

variables measuring acculturation (1). In

an analysis of data from the 2007

NSCH, Singh et al. found that Hispanic

immigrant parents compared with

non-Hispanic white parents more often

reported children’s overall health to be

poor or fair (15). To date, though, no

studies have examined both the effects

of other measures of acculturation and

language of interview on the reporting

of the health status of Hispanic children.

This study uses data from the

2011–2012 NSCH to: a) describe the

reported health status of Hispanic

children with a Spanish interview

(Hispanic–Spanish interview), Hispanic

children with an English interview

(Hispanic–English interview), nonHispanic black children, and nonHispanic white children; b) describe the

characteristics of children in four

Hispanic ethnicity, language of

interview, and race subgroups; and c)

examine whether differences in selected

demographic and socioeconomic

characteristics, and a measure of

acculturation account for the variations

in the reported health status of schoolage children in the four subgroups.

Methods

The data for this report are from the

2011–2012 NSCH. NSCH is a

nationally representative survey

conducted by CDC’s National Center for

Health Statistics (NCHS) as a module of

the State and Local Area Integrated

Telephone Survey, with direction and

principal funding from the Health

Resources and Services Administration’s

Maternal and Child Health Bureau.

The 2011–2012 NSCH was fielded

as a random-digit-dial telephone survey

of households with children aged 0–17

years; the survey included both landlines

and cell phones. Contacted households

were screened for the presence of

children, and one child was randomly

selected from identified households with

children to be the subject of the survey.

The respondent was a parent or guardian

in the household, usually a mother, who
National Health Statistics Reports n Number 82 n September 10, 2015 Page 3

was knowledgeable about the child’s

health. These respondents are referred to

as parents throughout this report. A total

of 95,677 interviews were completed

from February 2011 through June 2012

for the 2011–2012 NSCH. The overall

response rate in the 2011–2012 was

23.0%; see Technical Notes for more

information. Nonresponse bias analyses

suggest that, although the potential for

bias cannot be ruled out, differences

between respondents and

nonrespondents should not have a major

impact on the conclusions in this

report (17).

The health status of children was

determined by responses to the question,

‘‘Would you say [your child’s] health in

general is excellent, very good, good,

fair, or poor?’’ For households

interviewed in Spanish, the health status

of children was determined by responses

to the question, ‘‘En general, ¿cómo

describiría la salud de [S.C.]? ¿Diría

que su salud es excelente, muy buena,

buena, regular, o mala?’’ In this

analysis, responses to the health status

question were grouped into three

categories: 1) poor or fair (mala o

regular) health, 2) good (buena) health,

and 3) very good or excellent (muy

buena o excelente) health. The

combined category of poor or fair health

was necessary due to the small

percentage (less than 1.0%) of children

reported to have poor health. The

categories of very good health and

excellent health were combined because

of the similar use of health care for

children in these categories (18).

Children were classified into four

Hispanic ethnicity, language of

interview, and race subgroups:

Hispanic–Spanish interview, Hispanic–

English interview, non-Hispanic white,

and non-Hispanic black. Several

variables were included as potential

factors confounding the relationship

between health status and the child’s

subgroup. The confounding variables

were the following demographic

variables: child’s age and child’s sex,

and socioeconomic

variables—household income as a

percentage of the poverty threshold

[which is based on the U.S. Department

of Health and Human Services (HHS)

poverty guidelines] and the child’s

health insurance coverage at the time of

interview. A widely used measure of

acculturation was also included in the

analysis: primary household language

(classified as English or not English).

Because the nonresponse rates for

questions about household income were

relatively high in 2011–2012, the

analysis included multiply imputed

household income data (17,19).

Percentages and standard errors

were calculated using SUDAAN

software, which takes into account the

sampling weights and the complex

sample design of NSCH. The Taylor

series linearization method was used for

variance estimation in SUDAAN (20).

Two-tailed tests of significance were

performed on all comparisons discussed

in the Results section. No adjustments

were made for multiple comparisons.

Multinomial logistic regression (PROC

MULTI-LOG in SUDAAN) was used to

generate model-adjusted estimates

(percentages) adjusting for selected

confounding variables (20). Adjusted

estimates were calculated to determine

whether the relationship between the

child’s subgroup and reported health

status could be explained by the effects

of selected confounding variables.

The 2011–2012 NSCH collected

information about the reported health

status of 61,863 Hispanic, non-Hispanic

white, and non-Hispanic black children

aged 5–17 years. Children in other racial

subgroups were not included in the

analysis because the numbers of

children of races other than white and

black were too small to provide

meaningful results. Seventeen children

with unknown reported health status and

478 with unknown language of

interview were excluded from the

analysis. The final analytic sample

included 61,368 children.

More information about NSCH,

including its sample design, data

collection procedures, and questionnaire

content, is available from: http://

www.cdc.gov/nchs/slaits/nsch.htm.

Results

Health status of children, by

Hispanic ethnicity, language

of interview, and race

Hispanic–Spanish interview children

(10.6%) were more likely to have a

parent report of poor or fair health

compared with children in the other

three subgroups. Similar percentages of

Hispanic–English interview (3.8%) and

non-Hispanic black (4.4%) children

were reported to be in poor or fair

health. Non-Hispanic white children

(1.8%) were least likely to have a

parental report of poor or fair health

compared with children in the other

three subgroups (Figure 1).

Hispanic–Spanish interview children

(39.7%) were also more likely to have a

report of good health compared with

children in the other three subgroups.

Again, similar percentages of Hispanic–

English interview (13.1%) and nonHispanic black (14.4%) children were

reported to be in good health. NonHispanic white children (7.7%) were

least likely to have a parental report of

good health compared with children in

the other three subgroups. Non-Hispanic

white children (90.5%) were more likely

to have a report of very good or

excellent health than children in any of

the other three subgroups (49.7%–

83.1%).

Selected demographic and

socioeconomic

characteristics and an

acculturation measure, by

Hispanic ethnicity, language

of interview, and race

Demographic and socioeconomic

characteristics

The ages of children in the four

subgroups varied (Table 1). The

percentage of children aged 5–11 years

was similar among Hispanic–Spanish

interview and Hispanic–English

interview children. However, a higher

percentage of Hispanic children (both

with Spanish and English interviews)

(57.9%–58.0%) compared with nonHispanic white (50.7%) and non­
Page 4 National Health Statistics Reports n Number 82 n September 10, 2015

Figure 1. Percentages of children aged 5–17 years in poor or fair, good, and very good or excellent health, by Hispanic ethnicity, language

of interview, and race: United States, 2011–2012

0 20 40 60 80 100 

Non-Hispanic white 

Non-Hispanic black 

Hispanic 

(English interview) 

Hispanic 

(Spanish interview) 

Poor or fair Good Very good or excellent 

NOTE: All figures may not add to 100 due to rounding. 

SOURCE: CDC/NCHS, State and Local Area Integrated Telephone Survey, National Survey of Children's Health, 2011–2012. 

Percent

10.6 39.7 

14.4 

3.8 13.1

4.4 

7.7 

1.8 

49.7 

83.1 

81.3 

90.5 

Hispanic black (52.6%) children were

younger (5–11 years).

In terms of household poverty status

and health insurance coverage,

Hispanic–Spanish interview children

differed substantially from children in

the other three subgroups (Table 1).

Hispanic–Spanish interview children

were more than five times as likely to

live in a poor household (less than

100% of the poverty threshold) (57.8%)

as non-Hispanic white children (10.0%),

and were also more likely to live in

poverty than either non-Hispanic black

(33.6%) or Hispanic–English interview

(18.7%) children. Hispanic–Spanish

interview children (69.0%) were also

more likely than their counterparts in

the other three subgroups to be covered

by public health insurance. The

percentages of children in the three

other subgroups covered by public

insurance ranged from 21.8% for

non-Hispanic white children to 40.1%

for Hispanic–English interview children

to 54.0% for non-Hispanic black

children. Compared with children in the

other subgroups, Hispanic–Spanish

interview children were more likely to

be uninsured. Hispanic–Spanish

interview children were more than four

times as likely to be uninsured (17.1%)

as non-Hispanic white children (3.9%).

Hispanic–Spanish interview children

were about three times as likely to be

uninsured as non-Hispanic black (5.5%)

and Hispanic–English interview (5.7%)

children.

In contrast to Hispanic–Spanish

interview children, non-Hispanic white

children were more likely to live in a

nonpoor household (200% or more of

the poverty threshold) (71.8%) and were

more likely than children in the three

other subgroups to have private health

insurance (74.2%). The poverty status

and insurance status of Hispanic–

English interview children and nonHispanic black children were between

the values for the Hispanic–Spanish

interview children and non-Hispanic

white children. Hispanic–English

interview children (18.7%) were more

likely than non-Hispanic white children

(10.0%) to live in a poor household, but

were less likely when compared with

Hispanic–Spanish interview (57.8%)

children. Similarly, Hispanic–English

interview children (40.1%) were more

likely to be covered by public health

insurance than non-Hispanic white

children (21.8%), but less likely than

Hispanic–Spanish interview children

(69.0%) to be covered by public health

insurance. Non-Hispanic black children

(33.6%) were less likely to live in a

poor household than Hispanic–Spanish

interview children (57.8%), but were

more likely to live in a poor household

than either Hispanic–English interview

(18.7%) or non-Hispanic white (10.0%)

children. Non-Hispanic black children

(54.0%) were also less likely to be

covered by public insurance than

Hispanic–Spanish interview children

(69.0%), but were more likely to be

covered by public insurance than either

Hispanic–English interview (40.1%) or

non-Hispanic white (21.8%) children.

Acculturation measure

Among Hispanic children, 6.0% of

those with a Spanish interview lived in

a household in which the primary

language was English compared with

86.3% of Hispanic children with an

English interview (Table 1). Among

non-Hispanic children, nearly all

children lived in a household in which
National Health Statistics Reports n Number 82 n September 10, 2015 Page 5

the primary language was English

(98.1% of non-Hispanic black children

and 99.0% of non-Hispanic white

children).

Adjusted differences in

health status, by Hispanic

ethnicity, language of

interview, and race

Adjusted differences in poor or

fair health

Adjusting for only demographic and

socioeconomic characteristics did not

eliminate the differences between the

percentages of children with poor or fair

health in Hispanic–Spanish interview

children compared with children in the

other three subgroups (Table 2). A

higher percentage of Hispanic–Spanish

interview children continued to have

reports of poor or fair health compared

with Hispanic–English interview,

non-Hispanic black, and non-Hispanic

white children. However, adjusting for

only the acculturation measure

eliminated significant differences

between Hispanic–Spanish interview

children and children in two subgroups

(Hispanic–English interview and

non-Hispanic black). Further, adjusting

for both sets of confounders

(demographic and socioeconomic

characteristics and an acculturation

measure) eliminated significant

subgroup differences in the percentages

of children in poor or fair health.

Adjusting for differences in

demographic and socioeconomic

characteristics narrowed the gap

between Hispanic–Spanish interview and

non-Hispanic white children more than

adjusting for differences in the

acculturation measure (Table 2). Before

adjustment for any confounders, the

percentage of Hispanic–Spanish

interview children reported to have poor

or fair health was almost six times the

percentage of non-Hispanic white

children. After adjustment including

both sets of confounders, the percentage

of Hispanic–Spanish interview children

reported to have poor or fair health did

not differ significantly from the

percentages in the other subgroups. The

percentages of children in poor or fair

health were: 5.0% for Hispanic–Spanish

interview, 3.6% for Hispanic–English

interview, 3.6% for non-Hispanic black,

and 2.7% for non-Hispanic white

children (Figure 2).

Adjusted differences in good

health

Adjusting for demographic and

socioeconomic characteristics decreased

the percentage of Hispanic–Spanish

interview children in good health by

approximately one-quarter, from 39.7%

to 28.9%, but adjusting for these

characteristics had no significant effect

on the percentages of children reported

to be in good health in the three other

subgroups. Adjusting for the

acculturation measure did not lessen the

differences among the subgroups. Even

after adjustments for both demographic

and socioeconomic characteristics and

the acculturation measure, significant

differences were noted between

Hispanic–Spanish interview children and

children in the other subgroups in the

percentages reported to have good

health.

Figure 2. Adjusted percentages of children aged 5–17 years in poor or fair, good, and very good or excellent health, by Hispanic ethnicity,

language of interview, and race: United States, 2011–2012

0 20 40 60 80 100 

Non-Hispanic white 

Non-Hispanic black 

Hispanic 

(English interview) 

Hispanic 

(Spanish interview) 

Poor or fair Good Very good or excellent 

NOTE: Percentages are adjusted for child’s age, sex, poverty status, health insurance, and primary household language. 

SOURCE: CDC/NCHS, State and Local Area Integrated Telephone Survey, National Survey of Children's Health, 2011–2012. 

Percent

5.0 27.9 

12.5 

3.6 13.2

3.6 

9.0 

2.7 

67.1 

83.2 

83.9 

88.3 
Page 6 National Health Statistics Reports n Number 82 n September 10, 2015

The adjusted percentage of

Hispanic–Spanish interview children

reported to have good health (27.9%)

was three times the percentage of

non-Hispanic white children (9.0%), and

more than twice the percentage of

non-Hispanic black (12.5%) and

Hispanic–English interview (13.2%)

children (Table 2).

Summary and

Conclusions

Hispanic–Spanish interview children

more often had reports of poor or fair

health than children in the other

subgroups (10.6% compared with

1.8%–4.4%). Hispanic–Spanish

interview children also more often had

reports of good health compared with

children in the other subgroups (39.7%

compared with 7.7%–14.4%). Adjusting

for demographic and socioeconomic

characteristics and an acculturation

measure accounted for the subgroup

differences in the reporting of poor or

fair health, but not for differences in the

reporting of good health. Compared

with children in the other subgroups,

Hispanic–Spanish interview children

more often had parental reports of good

health than very good or excellent

health.

Studies of child health status over

several decades have described racial

and ethnic differences in parental reports

of child health status (11,12,16). Most

of the early studies of child health status

focused on the strong association

between poor or fair health and lower

socioeconomic status. Findings from this

study indicate that the subgroup

differences in parental reports of poor or

fair health were accounted for by

controlling for the demographic and

socioeconomic characteristics and a

measure of acculturation. More detailed

measure, including measures of

acculturation and information about the

child’s past and present socioeconomic

status, would help to define the

importance of each of these sets of

factors.

For reports of good health, several

explanations have been suggested for

the finding that Hispanic–Spanish

interview children were more likely to

have a report of good health compared

with Hispanic–English interview,

non-Hispanic black, and non-Hispanic

white children—even after adjustment

for demographic and socioeconomic

characteristics and a measure of

acculturation. One plausible, and

commonly assumed, explanation for this

finding is that true health conditions are

more prevalent among Hispanic–Spanish

interview children compared with

children in other subgroups. If children’s

health conditions could be measured by

direct examination rather than by

parental reports of diagnosed conditions,

it might be possible to determine if

those with reports of good health status

actually have more health conditions

than those with reports of very good or

excellent health status. Several

researchers have noted that the children

of immigrants from Latin America, even

when insured, face more barriers to

receiving medical and dental health care

compared with other children in the

United States (21). The difficulties that

Hispanic–Spanish interview children

experience in the health care system

compared with other children may lead

to delayed health diagnoses and

treatment (22,23). These problems in

accessing health care may result in more

serious health conditions among

Hispanic–Spanish interview children

compared with other children.

Another possible explanation that

may account for the findings in this

report may be that the Spanish

translation of the health status question

is not equivalent to the English version.

As a result, the responses to the Spanish

language version of the question may

not have the same meaning as the

responses to the English language

version. This hypothesis has been

examined in several studies using the

self-reported health status question for

adults interviewed in English and

Spanish. More studies will be needed to

further clarify the importance of

Spanish-language interviews for proxy

reports of child health status. Before

deciding how parents’ answers are

influenced by the specific wording and

response categories of the health status

question, though, it may be necessary to

know more about what parents include

in their definition of child health (24).

Does a parent think about both physical

and mental health? Does a parent

consider both chronic and acute

problems? Does a parent compare the

child with a specific group of children?

What does a parent believe the term

good or buena means? Additional

questions may be needed to obtain a

valid and reliable measure of children’s

health status in multicultural and

multilingual populations.

The analysis has several limitations.

As a sample survey, NSCH is subject to

nonrandom error, including coverage

bias and nonresponse bias. The inclusion

of more detailed measures of the child’s

socioeconomic status and better

indicators of acculturation could have

narrowed the gap between Hispanic–

Spanish interview children and children

in the other subgroups. Another

acculturation variable might have

provided a better measure of the degree

to which a child and his or her

household was integrated into the larger

society. Additionally, NSCH includes

parental reports of diagnosed child

health conditions. These measures of

child health depend on access to health

care. Data from the 2011–2012 NSCH

have shown that parental reports of

diagnosed health conditions and missed

school days are less frequent among

Hispanic–Spanish interview children

than among other subgroups of children

(data not shown). Similar results based

on the 2007 NSCH have also been

reported for Hispanic immigrant

children and Hispanic children from

Spanish-speaking households (14).

The growing number and diversity

of Hispanic households in the United

States underscore the need to monitor

the health of Hispanic children (25).

This report examines the worse health

status reported for Hispanic children

with Spanish interviews compared with

Hispanic children with English

interviews and non-Hispanic white and

non-Hispanic black children. While

demographic and socioeconomic

characteristics, and to a lesser extent

levels of acculturation, accounted for the

subgroup differences in the reporting of

poor or fair health, the significantly

greater percentage of Hispanic children
National Health Statistics Reports n Number 82 n September 10, 2015	 Page 7

with Spanish interviews reported to have

good rather than very good or excellent

health remained unexplained. The

problems of language translation of

responses to the health status question

may be another explanation for the

differences in health status reported for

Hispanic children with Spanish

interviews compared with children in

other subgroups. The findings from the

present study suggest the need for more

research to improve the measurement of

reported child health status in culturally

and linguistically diverse subgroups in

the U.S. population.

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Page 8 National Health Statistics Reports n Number 82 n September 10, 2015

Table 1. Selected

2011–2012

characteristics of children aged 5–17 years, by Hispanic ethnicity, language of interview, and race: United States,

Hispanic Non-Hispanic

All children Spanish interview English interview Black White

Characteristic n = 61,368 n = 3,081 n = 5,656 n = 6,597 n = 46,034

Sex

Male ............................

Female...........................

Age (years)

5–11 ............................

12–17 ...........................

Poverty status1

Less than 100% .....................

100%–199% .......................

200% or more ......................

Health insurance2

Private ...........................

Public3 ............. .............

Uninsured .........................

Primary household language

English ...........................

Not English ........................

51.4

48.6

52.8

47.2

20.2

22.0

57.7

59.4

34.7

5.9

86.3

13.7

(0.5)

(0.5)

(0.5)

(0.5)

(0.4)

(0.4)

(0.5)

(0.5)

(0.5)

(0.3)

(0.4)

(0.4)

52.6

47.4

58.0

42.0

57.8

35.1

7.1

13.9

69.0

17.1

6.0

94.0

(1.8)

(1.8)

(1.8)

(1.8)

(1.9)

(1.9)

(0.9)

(1.3)

(1.7)

(1.3)

(0.8)

(0.8)

Percent (standard error)

52.5 (1.6)

47.5 (1.6)

57.9 (1.7)

42.1 (1.7)

**18.7 (1.2)

**23.7 (1.4)

**57.7 (1.6)

**54.2 (1.6)

**40.1 (1.6)

**5.7 (0.8)

**86.3 (1.2)

**13.7 (1.2)

*48.3

*51.7

*52.6

*47.4

**33.6

**25.8

**40.6

**40.5

**54.0

**5.5

**98.1

**1.9

(1.2)

(1.2)

(1.2)

(1.2)

(1.2)

(1.1)

(1.2)

(1.1)

(1.2)

(0.6)

(0.3)

(0.3)

51.7

48.3

*50.7

*49.3

**10.0

**18.2

**71.8

**74.2

**21.8

**3.9

**99.0

**1.0

(0.5)

(0.5)

(0.5)

(0.5)

(0.3)

(0.4)

(0.5)

(0.5)

(0.4)

(0.2)

(0.1)

(0.1)

* Difference from Hispanic–Spanish interview children significant at p < 0.05.
 

** Difference from Hispanic–Spanish interview children significant at p < 0.001.
 1Household income as a percentage of the federal poverty threshold.
 2Health insurance coverage at the time of interview.
 3Public insurance may include other types of insurance.
 

SOURCE: CDC/NCHS, State and Local Area Integrated Telephone Survey, National Survey of Children’s Health, 2011–2012.
 
National Health Statistics Reports n Number 82 n September 10, 2015 Page 9

Table 2. Unadjusted and adjusted percentages

language of interview, and race: United States,

of children

2011–2012

aged 5–17 years in poor or fair health and good health, by Hispanic ethnicity,

Hispanic Non-Hispanic

Spanish interview English interview Black White

Characteristic n = 3,081 n = 5,656 n = 6,597 n = 46,034

Poor or fair health

Unadjusted ..............................

Adjusted for:

Demographic and socioeconomic characteristics1 . . . . 2 Acculturation measure .......... ..........

Both demographic and socioeconomic characteristics

and acculturation measure ..................

Good health

Unadjusted ..............................

Adjusted for:

Demographic and socioeconomic characteristics1 . . . . 2 Acculturation measure .......... ..........

Both demographic and socioeconomic characteristics

and acculturation measure ..................

10.6

6.6

7.5

5.0

39.7

28.9

37.2

27.9

(1.1)

(0.9)

(1.8)

(1.3)

(1.8)

(1.8)

(3.3)

(3.0)

Percent (standard

**3.8 (0.7)

*3.5 (0.7)

3.8 (0.7)

3.6 (0.7)

**13.1 (1.1)

**13.1 (1.1)

**13.1 (1.1)

**13.2 (1.1)

error)

**4.4

**3.3

4.7

3.6

**14.4

**12.4

**14.7

**12.5

(0.5)

(0.4)

(0.5)

(0.5)

(0.8)

(0.8)

(0.9)

(0.8)

**1.8

**2.5

*2.0

2.7

**7.7

**8.9

**7.7

**9.0

(0.1)

(0.2)

(0.2)

(0.3)

(0.3)

(0.4)

(0.3)

(0.4)

* Difference from Hispanic–Spanish interview children significant at p < 0.05.
 

** Difference from Hispanic–Spanish interview children significant at p < 0.001.
 1Demographic and socioeconomic characteristics include the child’s age, sex, and household income as a percentage of the

time of interview.
 2Based on primary household language.
 

SOURCE: CDC/NCHS, State and Local Area Integrated Telephone Survey, National Survey of Children’s Health, 2011–2012.

federal poverty threshold, and the child’s health insurance coverage at
 
 

 

 

 

 

 

 

 

Page 10 National Health Statistics Reports n Number 82 n September 10, 2015

Technical Notes

Response rate and analysis

of nonresponse

The 2011–2012 National Survey of

Children’s Health (NSCH) overall

response rate was 23.0%. The low

response rate was largely due to the

inclusion of cell phone interviews,

which was necessary to provide good

coverage of the population of children,

but which resulted in lower response

rates compared with previous iterations

of the survey that included only landline

numbers in the sample. The lower

response rates for cell phone interviews

largely resulted from the higher

proportion of telephone numbers that

were not answered and, therefore,

provided no indication of whether the

number belonged to an eligible

household. When only noncooperation

among eligible households was

examined, more than one-half of eligible

parents and guardians who were

contacted to participate in the survey

did so.

To reduce the potential for bias, the

sampling weights were adjusted for

nonresponse and further adjusted to

match external demographic control

totals. As summarized in the online

documentation (17), nonresponse bias

analyses were conducted using several

recommended approaches to examine

estimates before and after the

nonresponse weighting adjustment. Bias

was found to greatly decrease after the

weighting adjustment, and estimated

biases using the final weights were

small—in each case, the maximum

estimated bias was within the 95%

confidence interval for the survey

estimate, indicating that nonresponse

bias was consistently smaller than

potential sampling error. Bias estimates

were so small that, for most of the key

survey variables examined, changing the

method used to estimate bias changed

the estimated direction of the bias.

Definition of terms

Health insurance coverage—Type

of health insurance coverage at the time

of interview is determined by two

questions in NSCH. The first question

asks whether a child has any kind of

health care coverage, including health

insurance, prepaid plans such as health

maintenance organizations, or

government plans such as Medicaid. The

second question asks whether the child

is insured by Medicaid or the State

Children’s Health Insurance Program.

Children who are insured but do not

have public insurance are coded as

having private insurance.

Health status—Responses to the

following question determined a child’s

health status, ‘‘Would you say [your

child’s] health in general is excellent,

very good, good, fair, or poor?’’ For

households interviewed in Spanish, the

health status of children was determined

by responses to the question, ‘‘En

general, ¿cómo describiría la salud de

[S.C.]? ¿Diría que su salud es

excelente, muy buena, buena, regular o

mala?’’

Language of interview—Recorded

by the interviewer in response to the

question, ‘‘Was this interview completed

using English only?’’ In the sample, the

interview language was assumed to be

Spanish for Hispanic respondents for

whom the interviewer recorded that the

interview had not been completed using

English only.

Poverty status—Based on total

household income, number of people

residing in the household, and state. The

U.S. Department of Health and Human

Services poverty guidelines are derived

from U.S. Census Bureau poverty

thresholds and are issued annually. More

information is available from:

http://aspe.hhs.gov/poverty/index.cfm.

Primary household

language—Based on the question,

‘‘What is the primary language spoken

in the household?’’ Responses were

recoded to ‘‘English’’ or ‘‘language

other than English.’’ The primary

household language of Hispanic

respondents was assumed to be Spanish.

Race and Hispanic ethnicity—The

revised 1997 Office of Management and

Budget standards for race were used for

the classification of race and Hispanic

ethnicity. A person’s race is described by

one or more of five racial groups: white,

black or African American, American

Indian or Alaska Native, Asian, and

Native Hawaiian or Other Pacific

Islander. Data on race and Hispanic

ethnicity are collected separately but

combined for reporting. Persons of

Hispanic origin may be of any race.
National Health Statistics Reports n Number 82 n September 10, 2015

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Suggested citation

Pastor PN, Reuben CA, Duran CR. Reported

child health status, Hispanic ethnicity, and

language of interview: United States, 2011–

2012. National health statistics reports; no 82.

Hyattsville, MD: National Center for Health

Statistics. 2015.

Copyright information

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