Article

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: 0.91). 05/2005; 97(4):550-6.
Source: PubMed

ABSTRACT 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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    • "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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    • "Among Hispanics (Landale et al, 1999; Markides and Coreil, 1986), blacks (Cabral et al, 1990; David and Collins, 1997; Fang et al, 1999; Singh and Yu, 1996), and Asians (Alexander et al, 1996; Singh and Yu, 1996), immigrants have more favorable birth outcomes than their U.S.-born racial or ethnic counterparts. Studies have also documented an absence of the immigrant advantage, however, among Whites and Asians (Acevedo-Garcia et al, 2005), Asian Indians (Gould et al, 2003), and island-born Puerto Ricans (Rosenberg et al, 2005). "
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