A further examination of the "epidemiologic paradox": Birth outcomes among Latinas

Medical and Health Research Association of NYC, Inc., New York, NY 10013-2988, USA.
Journal of the National Medical Association (Impact Factor: 0.96). 05/2005; 97(4):550-6.
Source: PubMed


Low rates of low birthweight (LBW) among foreign-born Latinas of low socioeconomic status have been called the "epidemiologic paradox." This study examined the extent to which the paradox can be explained by differential distribution of risk factors.
The data source was the 1996-1997 New York City Birth File with 78,364 singleton births to Latinas. Ancestries included Colombians, Dominicans, Ecuadorians, Mexicans, Puerto Ricans and other Hispanics. First, a logistic regression was used to predict a LBW birth with ancestry and birthplace as the only independent variables. Demographic, medical and behavioral risks were added in subsequent regression models.
The LBW rate for the sample was 6.8%, with significant differences between birthplace subgroups and among ancestries. Puerto Ricans had the highest LBW rates, 9.1% for the mainland-born and 9.2% for the island-born. In separate regressions for six ancestry groups, birthplace was a significant predictor of LBW only among Mexicans and other Hispanics.
In this population-based study of Latina women in New York City, the positive birth outcomes of foreign-born women are largely due to their more favorable distribution of behavioral risk factors. The "epidemiologic paradox" does not account for the LBW rates among Puerto Ricans in New York City, a high percentage of whom are mainland-born (73.4%). Compared to other Latinas, Puerto Rican women are likely to have experienced far more years of acculturation, which can result in negative health behaviors.

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    • "Another interesting finding to emerge from our study is that among foreign-born youth, perpetration of peer violence seems to increase with successive generations and more time spent in the United States. This pattern is consistent with existing literature that has documented that health behaviors and outcomes (e.g., substance use, body mass index, birth outcomes, psychiatric disorders, intimate partner violence perpetration) worsen with increased time spent in the United States (Abraido-Lanza, Chao, & Florez, 2005; Alegria, Sribney, et al., 2007; Bates, Acevedo-Garcia, Alegria, & Krieger, 2008; Escobar, Nervi, & Gara, 2000; Fuentes-Afflick, Hessol, & Perez-Stable, 1999; Gupta et al., 2010; Landale, Oropesa, Llanes, & Gorman, 1999; Rosenberg, Raggio, & Chiasson, 2005). Given that the potential discrepancy in years of exposure to U.S. norms was small (≤4 years/>4 years), it is especially interesting that we observed a significant difference in risk of violence perpetration between the recent and nonrecent immigrant groups. "
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    ABSTRACT: Researchers have found an inverse relationship between immigrant status and violence perpetration. Most studies have examined Mexican immigrants, and few have assessed immigration factors other than nativity. Additionally, the majority have focused on the most serious forms of violence despite the fact that moderate violence is more common. Using data from the 2008 Boston Youth Survey, we generated prevalence estimates of peer violence perpetration across immigration related factors, examined whether risk factors for peer violence differed by these variables, and explored the contribution of risk factors to peer violence perpetration. Recent immigrants had a significantly lower prevalence of peer violence compared to each other generations/time in U.S. group. Known risk factors for violence perpetration varied by generation/time in U.S.: compared to other groups, recent immigrants were less likely to have used substances, and were more likely earn A's and B's in school. Recent immigrants had a significantly lower risk of violence perpetration relative to U.S.-born (RR = 0.35, 95% CI: 0.19, 0.62). Adjusting for known risk factors did not attenuate differences in risk. While immigrant youth had a lower risk of peer violence, the protective effect was diminished among immigrants who had resided in the U.S. for >4 years. This pattern demonstrates that negative assimilation occurs within the first generation, not just across generations. Results suggest that perpetration of violence worsens with increased time in the U.S. Research is needed to identify factors that contribute to the acquisition of behaviors such as violence among recently arrived immigrant youth.
    Journal of Interpersonal Violence 09/2011; 26(13):2658-80. DOI:10.1177/0886260510388288 · 1.64 Impact Factor
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    • "prednisone or other corticosteroid); multiple gestation pregnancy; under age 16 or over 40 years of age; >20 weeks gestation. The population was limited to Caribbean Islanders (e.g., Puerto Ricans and Dominican Republicans) as they constituted the majority of the Latina population at the study site and have cultural practices and disease risks which differ substantively from other Latina groups (e.g., Mexican-Americans)[14]. The study protocol and written informed consent statements were approved by the Institutional Review Boards of the University of Massachusetts-Amherst and Baystate Medical Center. "
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    ABSTRACT: The purpose of this article was to describe effective strategies for recruitment of Hispanic women into a prospective cohort study of modifiable risk factors for gestational diabetes mellitus (GDM). Although Hispanic women have two to four times the risk of developing GDM compared with non-Hispanic white women, few GDM prevention studies have included Hispanic women. The study was conducted in the ambulatory obstetrical practices of Baystate Medical Center located in a socioeconomically and ethnically diverse city in Massachusetts. The study employed a range of strategies to recruit Hispanic women based on a review of the literature as well as prior experience with the study population. Over a period of 32 months, a total of 851 Hispanic prenatal care patients were recruited. Among eligible women, 52.4% agreed to participate. Participants were young (70% <25 years), with low levels of education, and on public health insurance (81.5%); 88% were unmarried. Study design features such as use of bilingual recruiters, a flexible recruitment process, training recruiters to be culturally sensitive, use of culturally tailored materials, prescreening participants, participant compensation, seeking the cooperation of clinic staff, and continuous monitoring of recruitment goals emerged as important issues influencing recruitment. Findings suggest that investigators can successfully recruit pregnant women from ethnic minority groups of low socioeconomic status into observational studies. The study provides culturally appropriate recruitment strategies useful for practice-based settings recruiting Hispanic research participation.
    BMC Pregnancy and Childbirth 12/2009; 9(1):57. DOI:10.1186/1471-2393-9-57 · 2.19 Impact Factor
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    • "Foreign-born women tend to have more favorable behavioral risk factors than U.S.-born women. Compared with those born in the U.S., foreign-born women reportedly smoke less tobacco and drink less alcohol during their pregnancy (Rosenberg et al., 2005; Leslie et al., 2006; McDonald et al., 2008), use less marijuana and cocaine (Singh and Yu, 1996), and engage in healthier nutritional practices. Foreign-born women also have higher intakes of protein and vitamins, including folic acid (Abrams and Guendelman, 1995), and greater consumption of fruits and vegetables; consumption levels decline with longer residence in the U.S. (Gordon-Larsen et al., 2003; Lin et al., 2003; Dubowitz et al., 2008). "
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    ABSTRACT: The prevalence of gastroschisis is increasing in many parts of the world, although the etiology is largely unexplained. Young maternal age has been the only consistently identified, strong risk factor. The objective of this study was to examine the role of maternal nativity in relation to other suspected risk factors for gastroschisis in Florida. We conducted a retrospective cohort study of singleton infants born in Florida from 1998-2003. Gastroschisis cases were identified from the Florida Birth Defects Registry. Demographic and perinatal data were obtained from birth records. Multivariable Poisson regression was used to estimate adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for each factor of interest. The 6-year birth prevalence of gastroschisis was 3.26 per 10,000 live births, and the annual rate increased 41% during the study period. In addition to maternal age and marital status, maternal race/ethnicity and nativity were significantly associated with the risk of delivering an infant with gastroschisis. Compared with non-Hispanic white women, non-Hispanic black women had the lowest risk of delivering an infant with gastroschisis (PR, 0.19; 95% CI, 0.13-0.26), followed by Hispanic women (PR, 0.60; 95% CI, 0.43-0.83). Women born outside the United States were significantly less likely than U.S.-born women to deliver an infant with gastroschisis (PR, 0.59; 95% CI, 0.41-0.86). Although young maternal age remains a strong significant risk factor for gastroschisis in Florida, other factors such as maternal race/ethnicity and nativity could be important in explaining the increasing prevalence of gastroschisis.
    Birth Defects Research Part A Clinical and Molecular Teratology 11/2009; 85(11):890-6. DOI:10.1002/bdra.20612 · 2.09 Impact Factor
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