DETERMINANTS OF PRENATAL-CARE USE IN HAWAII - IMPLICATIONS FOR HEALTHPROMOTION

This study examines the association between maternal sociodemographic characteristics and the receipt of different levels of prenatal care u se (no care, inadequate, intermediate, adequate) in order to determine different patterns in the relationships between maternal characterist ics and these distinct categories of prenatal care use. Using the 1979 -1992 Hawaii live birth vital record file, single live births to Hawai i resident mothers of white, Hawaiian/part-Hawaiian, Filipino, or Japa nese ethnicity, who did not indicate on the birth certificate that eit her parent was active duty military, were selected. Over one quarter o f this study population did not initiate prenatal care in the first tr imester. Given the high level of insurance coverage found in Hawaii, t his finding is disconcerting, particularly in relation to the U.S. Yea r 2000 Objective of 90% initiation in the first trimester. Overall, th e factors that predicted receipt of any prenatal care predicted more a dequate use of prenatal care as well. Noteworthy exceptions were mater nal age and ethnicity. Identifying these exceptions is important for t he development of a more detailed understanding of risk factors relate d to use of prenatal care to better target program responses aimed at improving prenatal care use. In addition, these data suggest that remo ving financial barriers to access to care does not guarantee universal use of disease prevention and health promotion services.