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FAMILIES WITH YOUNG CHILDREN IN CALIFORNIA: FINDINGS FROM THE CALIFORNIA HEALTH INTERVIEW SURVEY, 2011-2014.

Introduction

The first five years of a child's life are a critical period of development. Often, this is also a time when the child's parents are in the beginning stages of their careers and face the competing demands of working and caring for young children. In 1998, California passed the California Children and Families Act to improve development for children from the prenatal stage to five years of age. One goal of this commitment is to expand our understanding of the social and physical environments that can impact a child's well-being and school readiness. This report presents data that reflect the strengths and challenges facing families of young children in California.

Methods

Data are drawn from the 2011-2012 and 2013-2014 California Health Interview Surveys (CHIS). CHIS is an ongoing, random-digit-dial telephone survey of California's non-institutionalized population living in households, and is the largest statewide health survey in the nation (approximately 20,000 households per year). CHIS is conducted in seven languages: English, Spanish, Mandarin, Cantonese, Vietnamese, Korean, and Tagalog (beginning in 2014). Additional information on CHIS methodology is available at www.chis.ucla.edu.

For this report, we analyzed data from CHIS adult respondents aged 18 and over who were the parent or legal guardian of at least one child age 0-5 years. Data are presented for the total sample of 6,600 parents of young children, and by urban (n=4,500), suburban (n=967) and rural (n=1,133) residence. We also describe parents of dual language learner families (n=3,493), defined as those where the parent-respondent reported speaking a language other than, or in addition to, English in the home.

Demographic characteristics include family structure (marital status, family size), parental education, household income (% of US Federal Poverty Level (FPL)), race/ethnicity immigration status, and language(s) spoken in the home. Immigration status is defined as US-born, naturalized citizen, green card holder or no green card. The no green card category includes respondents with valid visas and those not lawfully present in the U.S.

We report estimates of young families enrolled in public programs: food stamps (CalFresh), Medi-Cal (California's version of Medicaid), and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) among female respondents with incomes below 200% FPL. The study sample does not map precisely to the WIC population because we exclude women who were pregnant and did not have a child under age five. The study sample included women with a five-year-old and no other child under age five, as well as those with household incomes below 200% FPL (WIC income eligibility is 185% FPL).

Neighborhood characteristics include the breakdown of urban, suburban and rural residents. Urban, suburban and rural designation is based on the Claritas definition, which uses census block population sizes. We used the four level Claritas and combined "urban" and "second city" categories into urban. Additional neighborhood characteristics are perceived neighborhood safety, cohesion and civic engagement. Respondents were asked how often they felt safe in their neighborhood and whether they agreed that their neighbors helped one another, could be trusted, and watched out to make sure neighborhood children did not get into trouble. Civic engagement during the past 12 months was measured by asking respondents whether they had performed any volunteer or unpaid community service, had volunteered for an organization that addressed community problems, or had met informally with others to address community problems.

The final sample is weighted to California's non-institutionalized population by adjusting for sampling design and error. Determination of reliability of reportable estimates was based on analysis of the coefficient of variation (CV), using a criterion of 30%. Descriptive statistics include weighted percents and the 95% confidence interval (95% CI). We did not formally test for statistical differences, but highlight some differences in results where the confidence intervals did not overlap.

CHIS is a collaboration between the University of California Los Angeles' Center for Health Policy Research (UCLA CHPR), the California Department of Public Health and the California Department of Healthcare Services. UCLA CHPR is responsible for CHIS data and maintains standards to protect respondent confidentiality. CHIS protocols have been reviewed and approved by UCLA's Institutional Review Board and the California Committee for Protection of Human Subjects.

Results

Parents and legal guardians surveyed (hereafter referred to as "parents") spanned a wide range of ages, with a mean of 34.5 years. Approximately 92% of respondents were under age 45. Over half (55.8%) of the respondents were women (data not shown in tables). Other characteristics of young families in California are presented in Table 1.

Most parents of young children were married or living in a marriage-like relationship. Family size ranged from 2 to 12, with 4 being the average family size across all demographic groups. 60% of parents had more than a high school education. More than one-third had a bachelor's degree or higher, and an additional 22.2% had completed some college. Almost 20% had less than 12 years of education.

Close to half of the families with young children had incomes below 200% of the federal poverty level (FPL), which is the income eligibility cutoff for many public programs in California. Among these parents, 46.6% reported that they were enrolled in Medi-Cal and 37.8% received food stamp benefits. Among female respondents whose incomes were below 200% FPL, 67.1% participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Nearly half of parents surveyed for this report were Hispanic. More than half of the interviewed parents had been born in the United States, and an additional 15.9% were naturalized citizens. 13% were legal permanent residents with a green card, and 14.4% were neither citizens nor permanent residents. 40% of households spoke English and another language, and 20.3% did not speak English in the home.

Three-quarters of the families in the survey were urban residents, 14.5% lived in the suburbs, and about 10% lived in rural areas. 80% of parent respondents felt safe in their neighborhood all or most of the time, and the same percentage agreed or strongly agreed that their neighbors helped one another. More than three-quarters agreed or strongly agreed that their neighbors could be trusted, and there were similar responses to the statement that neighbors "watch out that children are safe and don't get into trouble."

Perceived neighborhood safety and cohesion differed by income category (data not shown in tables). 30% (95% CI: 26.3, 33.6) of parents with house-hold incomes below 100% FPL felt safe only some or none of the time. By contrast, only 6.9% (95% CI: 5.3, 8.49) of those with incomes at or above 300% FPL said they felt safe some or none of the time. Similarly, only 60% (95% CI: 55.9, 64.0) of those in the lowest income category said their neighbors could be trusted, compared with 89.5% (95% CI: 87.9, 91.2) of those in the highest income category.

Characteristics of Urban, Suburban, and Rural Families

California's population is diverse in its geographic distribution, and geographic variation is seen across several characteristics (Table 2). Suburban and rural areas have higher proportions of Whites compared with urban areas, and suburban areas also have a higher percentage of Asian families than do rural or urban areas. Half of the urban parent respondents were Hispanic, compared with 31.9% of suburban parents and 40.9% of rural parents. In terms of income, 70% of suburban parents with young children had house-hold incomes at or above 200% FPL, compared to 51.1% of urban households with young children and 46.4% of young rural families. A smaller proportion of suburban families were enrolled in Medi-Cal or WIC compared to urban families.

California is diverse, especially in cities. Sixty-two percent of urban families with children ages 0-5 spoke a language other than or in addition to English in the home, compared with 48% of young suburban families and 44.9% of young rural families. Fifty-four% of urban respondents were born in the U.S., compared with 61.8% of suburban parents and 66.3% of rural parents. The proportion of rural parents who were naturalized U.S. citizens (8.4%) was about half that found among urban (16.5%) and suburban parents (17.9%). The noncitizen proportion was highest among urban parent respondents, at 29.5%.

A greater proportion of urban than suburban parents had fewer than 12 years of education, and suburban parents were more likely to report having more than 12 years of education (72.1% vs. 57.8% and 57.7%, respectively). While more than half of families living in all areas reported feeling safe in their neighborhoods all or most of the time, the percentage of urban parents who reported feeling safe only some or none of the time was almost double that of parents living in suburban or rural areas (18.9% vs. 9.4% and 10.7%, respectively). Perceptions of neighborhood safety were highest in rural areas. Similarly, while neighborhood cohesion was high across all three areas, it was slightly higher in suburban and rural areas. Indicators of neighborhood cohesion (trusting, getting along with neighbors, and believing that neighbors watch out for the welfare of neighborhood children) were also higher in suburban and rural areas.

Characteristics of Dual Language Learner (DLL) Families

Figure 1 shows the language distribution of dual language learner families, who comprise 60% of California families with children ages 0-5.
Figure 1. Languages Spoken in the Home, Dual Language Learner Families
with Young Children, California Health Interview Survey 2011-2014

English & Spanish                                                47.3
Spanish only                                                     24.5
English & Asian language other than Chinese                       9.2
English and Chinese                                               3.6
English & other language (non-Spanish, non-Asian, non-European)   2.7
English & European language                                       2.5
Chinese only                                                      1.6
Vietnamese only                                                   0.9
Other Asian language (1 only)                                     1.5
Other non-Asian language (1 only)                                 0.9
2 or more other languages not previously mentioned                5.5

English Proficiency
Very well/Well       63.0%
Not well/Not at all  37.0%

Note: Table made from bar graph.


Most of the children in the respondent families who were dual language learners (DLLs) were in Spanish-speaking families, followed by families speaking an Asian language. 10% of respondents spoke only another language in the home, excluding Spanish. More than 60% of the parent respondents said they spoke English well or very well, and 37% said they spoke English "not well" or "not at all."

Of the parents in DLL families, 69.7% were Hispanic, 17.9% were Asian, 10.2% were White non-Hispanic, and 2.2% were other races (including African-American). About two-thirds of the parent respondents in these families were born outside the U.S., and 23.4% had been naturalized (data not shown in tables).

Discussion

Although the overall picture of families with young children in California is one of two-parent families with high educational achievement and strong perceived neighborhood cohesion, there is a significant percentage who are struggling. 46% of the families with children ages 0-5 years in the survey had household incomes below 200% FPL, and 20% of the parent respondents had not finished high school. Addressing these economic and educational inequalities must be a high priority for California as we prepare the next generation to enter the labor force. To that end, a bill recently passed by both the state assembly and senate declares California's commitment to reduce child poverty by 50% over the next 20 years (Lifting Children and Families Out of Poverty Task Force (CA), 2017).

More than half of the children under age six in the survey were dual language learners (DLLs), many them from homes in which Spanish or an Asian language were spoken. These findings indicate a tremendous potential for foreign language capability among children who will be entering school in California in the next five years. Learning more than one language can increase analytical ability, concept formation, and cognitive flexibility in young children(Castro and Espinosa, 2014; Espinosa, 2015).

The number of dual language learners presents California with opportunities and challenges, since dual language acquisition is not uniform across all families with young children. Children from low-income families and those whose parents have not graduated from high school are more likely to enter kindergarten with less developed primary language skills than children from middle- and upper-income families and from families in which the parents have more education. This difference becomes more pronounced as children grow older and advance through school (Olsen, 2010; Reardon and Galindo, 2006).

Children who enter school without strong skills in their primary language have more difficulty becoming proficient in English, and they often end up as long-term English-language learners. This puts them at a significant disadvantage when they reach high school, diminishing their higher education and career opportunities (Olsen, 2010; Castro et al., 2011).

Research has identified some successful strategies for strengthening language competence in young children before they enter school (Olsen, 2010; Castro et al., 2011). Such strategies include encouraging parents to read often to their child in their primary language; promoting storytelling in group settings to develop vocabulary; and using visual aids, gestures, and repetition of key words to reinforce learning (Castro et al., 2011). The Talk. Read. Sing.[R] campaign conducted by this study's funder, First 5 California, encourages parents and caregivers to engage with young children in order to promote healthy brain development. More resource-intensive recommendations include providing dual language instruction in preschools and schools, training teachers in best practices for DLL children, and using curricula specifically developed for these students (Olsen, 2010).

This profile expands our understanding of the strengths and challenges of families with young children in California. The strengths lie in high levels of trust and compatibility with neighbors, and with a generation of young children who speak both English and another language. The challenges are in reducing poverty among the 46% of young families living below 200% of the federal poverty level, improving these families' perceived neighborhood safety in California's cities, and enhancing school readiness among dual language learners so that the benefits of being multilingual can be optimized.

Acknowledgments

The authors would like to thank Kelly Wu, who conducted the data analyses at the UCLA Center for Health Policy Research. We are also grateful to David Dodds, Stacy Rilea, and Robert Dean of First 5 California for their guidance in preparation of this policy brief. Valuable reviews were provided by Josie Ramos, MA, principal investigator and senior program manager at the Public Health Institute, and Christy McCain, MPH, research scientist and project director at the Public Health Institute.

Funder Information: This paper was made possible by funds received from First 5 California, which is working to ensure that California's children receive the best possible start in life and thrive.

The authors declare no competing interests.

REFERENCES

Castro, Dina C., Mariela M. Paez, David K. Dickinson, and Ellen Frede (2011). "Promoting Language and Literacy in Young Dual Language Learners: Research, Practice, and Policy," Child Development Perspectives 5(1): 15-21.

Castro, Dina C., and Linda M. Espinosa (2014). "Developmental Characteristics of Young Dual Language Learners: Implications for Policy and Practice in Infant and Toddler Care," Zero to Three 34(3): 34-38.

Espinosa, Linda M. (2015). "Challenges and Benefits of Early Bilingualism in the United States' Context," Global Education Review 2(1): 40-53.

Lifting Children and Families Out of Poverty Task Force (CA) (2017). AB-1520. Available at: https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1520

Olsen, Laurie (2010). "Reparable Harm: Fulfilling the Unkept Promise of Educational Opportunity for California's Long Term English Learners," Californians Together. Available at: https://www.californianstogether.org/reparable-harm-fulfilling-the-unkept-promise-of-educational-opportunity-for-californias-long-term-english-learners/Accessed November 28, 2016.

Reardon, Sean F., and Claudia Galindo (2006). Patterns of Hispanic Students' Math and English Literacy Test Scores in the Early Elementary Grades: Report from the National Task Force on Early Childhood Education for Hispanics. Available at: https://lesacreduprintemps19.files.wordpress.com/2012/05/patterns-of-hispanic-students-math-and-english-literacy-test-scores-in-the-early-elementary-grades.pdf. Accessed November 28, 2016.

SUE HOLTBY

Public Health Institute, Capitola, CA

NICOLE LORDI

nlordi@phi.org Public Health Institute, Capitola, CA (corresponding author)

ROYCE PARK

Department of Health Policy and Management, Center for Health Policy Research & Center for Global and Immigrant Health, Fielding School of Public Health, The University of California, Los Angeles

NINEZ A. PONCE

Department of Health Policy and Management, Center for Health Policy Research & Center for Global and Immigrant Health, Fielding School of Public Health, The University of California, Los Angeles

How to cite: Holtby, Sue, Nicole Lordi, Royce Park, and Ninez A. Ponce (2017). "Families with Young Children in California: Findings from the California Health Interview Survey, 2011-2014," American Journal of Medical Research 4(2): 168-178.

Received 15 June 2017 * Received in revised form 28 September 2017

Accepted 29 September 2017 * Available online 18 October 2017
Table 1 Parents with Young Children, California Health Interview
Survey 2011-2014 (n=6,600) (a)

Characteristics                                      % (95% CI)
Marital status
Married                                              71.8 (70.0-73.2)
Living with partner                                  13.4 (12.0-14.7)
Widowed                                               0.4 (0.1-0.6)
Divorced                                              2.2 (1.7-2.7)
Separated                                             3.4 (2.7-4.0)
Never married                                         9.0 (7.9-10.1)
Family size
Mean                                                  3.9 (3.9-4.0)
Range                                                 2.0-12.0
Education
<12 years                                            19.5 (18.0-21.0)
12 years/GED                                         20.6 (19.0-22.2)
Some college                                         22.2 (20.6-23.8)
BA/BS or higher                                      37.7 (35.8-39.6)
Income (percent US Federal Level (FPL))
0-99% FPL                                            24.7 (23.0-26.4)
100-199% FPL                                         22.0 (20.3-23.7)
200-299% FPL                                         13.3 (12.1-14.6)
300% FPL and above                                   40.0 (38.1-41.8)
Public program participation (income is < 200% FPL)
Medi-Cal                                             46.6 (43.4-49.8)
Food Stamps                                          37.8 (34.8-40.8)
Women, Infants, and Children (WIC) (b)               67.1 (63.4-70.7)
Race/Ethnicity
Hispanic                                             47.1 (45.3-48.9)
White, non-Hispanic                                  32.9 (31.3-34.5)
Asian                                                13.3 (12.1-15.6)
African-American                                      4.3 (3.6-4.9)
Two or more races                                     1.5 (1.1-1.9)
Native Hawaiian, other Pacific Islander               0.5 (0.2-0.8)
American Indian/Alaska Native                         0.3 (0.2-0.5)
Immigration status
U.S.-born                                            56.3 (54.4-58.2)
Naturalized Citizen                                  15.9 (14.4-17.4)
Green Card                                           13.4 (12.0-14.8)
No Green Card                                        14.4 (13.0-15.8)
Languages spoken in the home
English only                                         41.7 (39.8-43.6)
English and another language                         38.0 (36.2-39.9)
Other language only                                  20.3 (18.7-22.0)
Area of residence
Urban                                                75.6 (74.0-77.2)
Suburban                                             14.5 (13.0-15.9)
Rural                                                 9.9 (9.0-10.9)
Neighborhood cohesion
How often feel safe in neighborhood
 All of the time                                     43.8 (42.0-45.7)
 Most of the time                                    39.5 (37.5-41.4)
 Some of the time                                    14.9 (13.4-16.4)
 None of the time                                     1.80 (1.3-2.3)
Neighbors help each other
Strongly Agree                                       19.5 (18.0-21.1)
 Agree                                               59.3 (57.2-61.3)
 Disagree                                            17.6 (15.9-19.4)
 Strongly Disagree                                    3.6 (2.8-4.3)
Neighbors can be trusted
 Strongly Agree                                      15.0 (13.8-16.3)
 Agree                                               62.3 (60.4-64.2)
 Disagree                                            18.9 (17.3-20.5)
 Strongly Disagree                                    3.8 (3.0-4.6)
Neighbors watch out that children
are safe and don't get into
trouble
 Strongly Agree                                      17.9 (16.5-19.3)
 Agree                                               60.3 (58.3-62.2)
 Disagree                                            17.8 (16.3-19.3)
 Strongly Disagree                                    3.2 (2.3-4.1)
Civic engagement, past 12 months
Volunteer/community service                          36.7 (34.8-38.6)
Volunteer in organization addressing
community problems                                   10.2 (9.1-11.2)
Meet informally to address community problems        14.1 (12.7-15.4)

(a) Estimates are weighted to represent the California Population and
adjusted for survey design effects.
(b) Female respondents with income below 200 percent FPL and children
age 0-5 years CI = confidence interval

Table 2 Parents of Young Children, Urban, Suburban and Rural
Households, California Health Interview Survey 2011-2014 (a)

                                 Urban            Suburban
Characteristics                (n=4,500)          (n=967)
                               % (95% CI)        % (95% CI)

Marital status
Married/living with partner  84.0 (82.3-85.7)  90.2 (87.1-93.3)
Never married                 9.7 (8.3-11.0)    5.2 (2.5-8.0)
Widowed/divorced/separated    6.4 (5.3-7.5)     4.6 (2.8-6.3)
Family size (mean)            3.9 (3.9-4.0)     4.0 (3.9-4.1)
Education
<12 years                    20.7 (18.7-22.6)  13.6 (9.3-17.9)
12 years/GED                 21.6 (19.5-23.6)  14.3 (11.1-17.5)
>12 years                    57.8 (55.6-60.0)  72.1 (67.3-76.9)
Income (% Federal
Poverty Level (FPL))
Less than 200% FPL           48.9 (46.6-51.1)  30.5 (25.4-35.7)
200% FPL or greater          51.1 (48.9-53.4)  69.5 (64.3-74.6)
Public program
participation
(income <200% FPL)
Medi-Cal                     48.1 (44.3-51.9   35.0 (26.8-43.2)
Food Stamps                  39.2 (35.7-42.7)  30.2 (21.4-38.9)
Women, Infants, and
Children (WIC) (b)
Race/Ethnicity
Hispanic                     50.9 (48.7-53.0)  31.9 (27.2-36.5)
White, non-Hispanic          28.9 (27.0-30.7)  44.8 (39.7-49.9)
Asian                        13.4 (11.9-14.8)  18.7 (14.9-22.4)
African-American              5.0 (4.1-5.8)     1.8 (0.8-2.7)
Other                         2.0 (1.4-2.5)     2.9 (1.3-4.6)
Citizenship status
U.S.-born citizen            54.0 (51.8-56.2)  61.8 (56.5-67.0)
Naturalized citizen          16.5 (14.8-18.3)  17.9 (14.3-21.5)
Non-citizen (green card and  29.5 (27.5-31.5)  20.4 (15.8-24.9)
no green card)
Language(s) spoken in the
home
English only                 38.0 (35.9-40.1)  52.0 (46.6-57.3)
Spanish only                 14.9 (13.3-16.4)   7.7 (4.3-11.0)
Other language only           6.6 (5.3-7.8)     6.0 (3.6-8.5)
English & Spanish            30.3 (28.2-32.4)  19.1 (15.2-23.1
English & other language     10.3 (8.9-11.7)   15.2 (11.7-18.7)
Neighborhood cohesion
How often feel safe in
neighborhood
All of the time              41.7 (39.5-44.0)  47.4 (42.7-52.1)
Most of the time             39.4 (37.1-41.6)  43.2 (38.2-48.2)
Some/None of the time        18.9 (17.1-20.7)   9.4 (5.6-13.1)

Neighbors help each other
Strongly Agree/Agree         77.0 (74.8-79.2)  84.6 (80.6-88.6)
Disagree/Strongly Disagree   23.0 (20.6-25.2)  15.4 (11.4-19.4)
Neighbors can be trusted
Strongly Agree/Agree         75.2 (73.1-77.3)  83.9 (79.8-87.9)
Disagree/Strongly Disagree   24.8 (22.7-26.9)  16.1 (12.1-20.2)
Neighbors watch out that
children are safe and don't
get into trouble
Strongly Agree/Agree         76.5 (74.5-78.6)  86.3 (82.5-90.1)
Disagree/Strongly Disagree   23.5 (21.4-25.6)  13.7 (9.9-17.5)
Civic engagement, past 12
months
Volunteer/community service  34.8 (32.6-36.9)  45.3 (39.8-50.7)
Meet informally to address   13.8 (12.2-15.4)  14.7 (11.7-17.7)
community problems
Volunteer in organization     9.8 (8.5-11.0)   10.9 (8.5-13.3)
addressing community
problems

                                Rural
Characteristics                (n=1,133)
                               % (95% CI)

Marital status
Married/living with partner  86.6 (83.6-89.5)
Never married                 9.34 (6.7-12.1)
Widowed/divorced/separated    4.0 (2.7-5.4)
Family size (mean)            4.0 (3.9-4.1)
Education
<12 years                    19.5 (15.3-23.8)
12 years/GED                 22.8 (18.8-26.8)
>12 years                    57.7 (52.6-62.9)
Income (% Federal
Poverty Level (FPL))
Less than 200% FPL           53.6 (48.6-58.7)
200% FPL or greater          46.4 (41.3-51.4)
Public program
participation
(income <200% FPL)
Medi-Cal                     44.2 (37.5-50.8)
Food Stamps                  25.4 (20.1-30.6)
Women, Infants, and
Children (WIC) (b)
Race/Ethnicity
Hispanic                     40.9 (35.8-46.0)
White, non-Hispanic          46.4 (41.4-51.5)
Asian                         5.3 (2.7-7.9)
African-American              2.5 (1.1-4.0)
Other                         4.8 (2.7-7.0)
Citizenship status
U.S.-born citizen            66.3 (61.3-71.2)
Naturalized citizen           8.4 (5.8-10.9)
Non-citizen (green card and  25.4 (20.7-30.0)
no green card)
Language(s) spoken in the
home
English only                 55.1 (50.0-60.3)
Spanish only                 19.5 (14.9-24.1)
Other language only           1.9 (0.6-3.1)
English & Spanish            18.3 (14.2-22.4)
English & other language     5.2 (2.8-7.6)
Neighborhood cohesion
How often feel safe in
neighborhood
All of the time              54.8 (49.7-59.9)
Most of the time             34.6 (29.7-39.5)
Some/None of the time        10.7 (7.3-14.0)

Neighbors help each other
Strongly Agree/Agree         84.3 (80.7-87.5)
Disagree/Strongly Disagree   15.7 (12.1-19.3)
Neighbors can be trusted
Strongly Agree/Agree         83.8 (80.2-87.3)
Disagree/Strongly Disagree   16.3 (12.7-19.8)
Neighbors watch out that
children are safe and don't
get into trouble
Strongly Agree/Agree         86.4 (82.9-89.8)
Disagree/Strongly Disagree   13.6 (10.2-17.1)
Civic engagement, past 12
months
Volunteer/community service  38.9 (34.0-43.8)
Meet informally to address   15.0 (11.5-18.6)
community problems
Volunteer in organization    12.0 (9.0-15.0)
addressing community
problems

(a) Estimates are weighted to represent the California Population and
adjusted for survey design effects.
(b) Female respondents with income below 200 percent FPL and children
age 0-5 years CI = confidence interval


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Author:Holtby, Sue; Lordi, Nicole; Park, Royce; Ponce, Ninez A.
Publication:American Journal of Medical Research
Geographic Code:1U9CA
Date:Oct 1, 2017
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