Defense Date


Document Type


Degree Name

Master of Public Health


Epidemiology & Community Health

First Advisor

Derek Chapman


Objectives The objectives of our study were to: 1) summarize illness characteristics and functional ability difficulties among Children With Special Health Care Needs (CSHCN) in Virginia, 2) examine the distribution of socio-demographic, health insurance, and health-related factors among Virginia’s CSHCN, 3) quantify the influence of these socio-demographic, health insurance, and health-related factors on delayed and forgone care of CSHNC in Virginia, and 4) analyze reasons for delayed and forgone care among Virginia’s CSHCN. Methods Data from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN) were used for this study. Three categories of predictor variables were studied: socio-demographic (age, gender, race/ethnicity, household income, parental education, family structure and residence area), health insurance (type of insurance, insurance continuity, insurance adequacy, and whether a child has usual source of health care), and illness variables (severity of condition, impact on functional abilities). Outcome variable was whether respondents reported having delayed or forgone health care for their children. We explored the relationship between predictor variables and outcome variable using bivariate and multivariable logistic regression analyses. All analyses were adjusted for the complex survey design using SAS 9.1. Results Our data included 791 respondents, which represents 289,176 CSHCN from Virginia. Our results show that 6.1% of CSHCN in Virginia experienced delayed or forgone health care in the past 12 months. Bivariate analysis showed that lower income level, lower parental education, single parent household, lack of health insurance coverage, inadequate insurance, lack of continuous insurance coverage, lack of usual source of health care, severity of the condition, and impact on functional abilities were all significantly associated with delayed or forgone care. After adjusting for all potential confounders, multivariable analysis showed that family structure and insurance characteristics were significant predictors of delayed and forgone care. CSHCN who did not live in two-parent household (OR= 2.7; 1.05, 7.31), were ever uninsured during the past 12 months (OR = 17; 3.85, 75.58), had inadequate insurance (OR = 5.8; 2.06, 16.37), and who did not have a usual source of health care (OR = 22.6; 2.83, 180.55) had increased odds of delayed/forgone health care. Conclusion Lapse in health insurance coverage, lack of usual source of health care, and insurance that is inadequate, all which are modifiable, are strong predictors of delaying or forgoing health care among CSHCN. It is important to identify families that are experiencing these barriers and to place special emphasis on children who do not stem from two-parent households. Policies and programs that address health insurance coverage and continuity, that increase the number of children with medical homes and usual sources of health care, and that address the needs of families that are particularly vulnerable should be implemented to guarantee CSHCN receive timely and needed health care.


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Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

May 2009

Included in

Epidemiology Commons