A Further Examination of the "Epidemiologic
Paradox": Birth Outcomes among Latinas
Terry J. Rosenberg, PhD; Tanya Pagan Raggio, MD, MPH, FAAP; and Mary Ann Chiasson, DrPH
New York, New York and Rockville, Maryland
Purpose: Low rates of low birthweight (LBW) among foreign-
bor Ldtins Of low socioeconomic status have been called
the "epidemiologic padox" This stdy 0exmined the
extent tbowich the pard
can be explied by differen-
tialdisulon of rsk factor.
Procedures: The data source was the 1996-1997 New York
City Birh File with 782364sigleton births to Latinas. Ances-
tres included Colmbn
omincn, Ecuados Me-
cans, Puerto Ricans and other Hispani.st, a logitic
r nwas usedt Predicta LBW birthwhncestry and
birthlace as the only indepdent variables. Demograph-
ic, medical and behaviofl were added insUbsequent
FindIn T NW rtatorthesample wos46.8%
cont- diffeences betwe
among ancestres. Pu0rtoRics had the highest LBW rates,
9.1% forthe mainland-borh and 9.2% forfthe ind-born. In
separat regressions forix aestry groups, bithlace was
LBW only among Mexicans and
in New York City, the postive birth outcomesof foreign-born
women are largelydue to theirmore favorable distibution of
behavioral rsk factors.Theepiemdiologic paradox" does
not cout for the LB
atemong Puertons in New
York Ciy, a high percentageohf whom are ma
(73.4%). Compared to otherLatinas, Puefto Ricanwomen are
likely to have experienced for more years of acculturation,
Whichcan sult innegatN hath behavio
lk S;t. taDat
birthplace ;subgroups and
In this population-based stud of Latia women
birthweght l New York CtyUPuerto Ricans
©2005. From Medical and Health Research Association of NYC, Inc., New
York, NY (Rosenberg, Chiasson) and HRSA, Bureau of Professionals, Division of
Medicine and Dentistry, Rockville, MD (Raggio). Send correspondence and
reprint requests for J NatI Med Assoc. 2005;97:550-556 to: Terry J. Rosenberg,
PhD, Medical and Health Research Association of NYC, Inc., 40 Worth St.,
Suite 720, New York, NY 10013-2988; phone: (212) 285-0220; fax: (212) 385-
0565; e-mail: firstname.lastname@example.org
Rates oflow birthweight (LBW) among Latinas in
the United States are low, despite low educational
attainment, low socioeconomic status, high rates of
uninsurance and late entry into prenatal care.' This
phenomena has been called an "epidemiologic para-
dox" or the "immigrant advantage." The proposed
explanations for the paradox include: 1) self-selection
ofthe healthiest migrants; 2) protective factors in the
immigrant culture; and 3) strong social supports in
the immigrant community.2'3 It is also well-recognized
that as foreign-born Latinas spend more time on the
U.S. mainland, their birth outcomes become less
favorable.4 A small study ofLatinas in NewYork City
added immigration status to this equation and found
that there was a significant trend for rates ofLBW to
increase from the lowest rates among documented
immigrant women, through intermediate rates among
undocumented immigrants, through the highest rates
among U.S.-born women.5
Prior studies reporting these trends have exam-
ined either differences among Latina subgroups6 or
differences between native-born and immigrant
women ofone subgroup.7'8 Our study examined both
simultaneously using a large population-based data
set with a very diverse Latina population in which
Puerto Ricans and Dominicans predominated.
It is important to understand the "epidemiologic
paradox" because Latinos are the fastest-growing pop-
ulation in the United States. Close to a third ofall births
in NewYork City are to Latinas (32.3% in 1999) and
the number ofbirths to some Latina subgroups inNew
York City (e.g., Mexicans) doubled during the 1990s.
Finally, as immigrant populations are here longer and
the first generation gives way to the second generation,
understanding-the reasons that birth outcomes worsen
could lead to interventions impacting ever larger num-
bers of women and their children. We attempted to
assess whether the "epidemiologic paradox" is due to a
differential distribution ofdemographic, medical and
behavioral risk factors among Latina subgroups in the
urban context ofNewYork City.
550 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
VOL. 97, NO. 4, APRIL 2005
"EPIDEMIOLOGIC PARADOX": BIRTH OUTCOMES
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