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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    • "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.
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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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