Social determinants of physician care utilization vary by generational status for Mexican-identified Californians

Background: Previous research shows Hispanics are less likely to report a usual health care provider, which combined with high prevalence of overweight/obese, heightens risk for chronic diseases. A health in all policies approach requires understanding generational  differences in Latino health care utilization. In California, fewer foreign born Latinos have health insurance coverage(23% vs 36%)  or have visited a physician (73% vs 78%) compared to US born Latinos. We examined behavioral and social factors including access to care that predict these generational differences in medical care utilization..

Methods:  We explored risk factors among first, second, and third generational status Mexican-identified respondents from the 2011-12 California Health Interview Survey (N=7,466) using a logistic regression analysis. Predictor variables included smoking status, binge drinking, insurance status, self-rated health, social capital, obesity and other demographic variables. We then stratified the sample by nativity (US born: N=3,142; foreign-born: N=4,324), re-running the analysis for each subsample.

Results: Second generation individuals had higher odds of visiting a physician than first generation individuals (OR=1.36, p=0.009). Smoking, civic engagement, and being in good health were associated with decreased odds of visiting a physician. After stratifying our sample by nativity, several variables remained a salient predictor for US born Latinos, but not foreign-born Latinos: smoking, civic engagement, and being 60 or older. 

Conclusion:  Policy interventions to increase health care utilization among Latinos should consider generational differences in behavioral and social factors. Our findings supports the assertion that smoking plays a role in health differences between US and foreign born Latinos.