The “Latina Epidemiologic Paradox” Revisited: The Role of Birthplace and Acculturation in Predicting Infant Low Birth Weight for Latinas in Los Angeles, CA

Abstract

The “Latina epidemiologic paradox” refers to the observation that despite socioeconomic disadvantages, Latina mothers in the United States (US) have a similar or lower risk for delivering an infant with low birth weight (LBW) compared to non-Latina White mothers. An analogous paradox may exist between foreign-born (FB) and US-born (USB) Latinas. Our goal was to assess differences in LBW in USB Latinas, FB Latinas, and non-Latina Whites in Los Angeles County in 2003 using birth records and survey data. Using logistic regression, we estimated associations between LBW and birthplace/ethnicity in a birth cohort and nested survey responder group and between LBW and acculturation in responders to a follow-up survey. USB Latinas and FB Latinas had a higher prevalence of LBW infants compared to Whites (odds ratio [OR] = 1.34, 95% confidence interval [CI] = (1.17, 1.53) and OR = 1.32, 95% CI = (1.18, 1.49), respectively); when we adjusted for additional maternal risk factors these point estimates were attenuated, and interval estimates were consistent with a modest positive or inverse association. Among Latinas only, LBW was more common for high-acculturated FB and USB Latinas compared to low-acculturated FB Latinas, and there was limited evidence that environmental or behavior risk factors had less impact in low-acculturated Latinas. In summary, adjusting only for demographics, Latinas in our study were more likely to have LBW infants compared to Whites, in contrast to the Latina paradox hypothesis. Furthermore, adjusting for environmental or behavioral factors attenuated the positive association, but there was little evidence that Latinas had a lower prevalence of LBW regardless of the variables included in the models. Finally, among Latinas, there was limited evidence that associations between known risk factors and LBW were modified by acculturation.

The “Latina Epidemiologic Paradox”: Contrasting Patterns of Adverse Birth Outcomes in U.S.-Born and Foreign-Born Latinas

“…A recent study done in California was based on birth certificate data augmented with survey data (Hoggatt, Flores, Solorio, Wilhelm, & Ritz, 2011). The authors performed some analyses similar to the comparisons we did.…”

Maternal and pediatric health and disease: integrating biopsychosocial models and epigenetics

“…More generally, Mexican-American women seem to have different health profiles stratified by generation in the United States, which serves as a surrogate measure for acculturation. In particular, LBW increases from first-to third-generation residence (66,(76)(77)(78)(79).…”

Maternal Acculturation and the Prenatal Care Experience

“…This consistency between the four measures of acculturation is reassuring, both from the internal consistency standpoint (all trends were in the same direction) and for external comparison purposes (as compared with other studies that may have only analyzed one or two acculturation measures). 31,45,46 Among the 1024 women who delivered term and normal birth weight infants in our study, we found the largest variation in adjusted mean scores for the patient-centered decision making domain (scores ranged from 3.62 among more acculturated women to 4.10 among less acculturated women) and also varied substantially by type of health insurance (scores ranged from 3.07 among privately insured women to 4.36 among uninsured women). This variation in scores may reflect underlying differences in expectation or preferences, with higher expectations for patient-centered decision making among US-born and privately insured women than among less acculturated and publicly insured women.…”

“…30 Measures of acculturation are based on theoretical models that consider acculturation as a multi-dimensional process that involves integration of members of the minority group into the social structure of the majority group. 30,31 Thus, measures of acculturation may be correlated with behavioral and environmental factors that could influence women's perception of health care experiences. These perceptions are important to consider in studies that assess the quality of care.…”

“…[32][33][34] In studies that measured the relationship between acculturation and health outcomes, US-born individuals (the majority society) usually serve as the comparison group. 23,25,29,31,33 This study sought to evaluate the relationship between four measures of maternal acculturation and specific measures of interpersonal processes of care among childbearing women who received prenatal care and delivered infants in two distinct health care settings. Based on previous studies which reported that women with low income, low educational attainment and public health insurance reported higher satisfaction with care than their counterparts, 10,35,36 we hypothesized that less acculturated childbearing women would report higher (better) process scores than more acculturated women or USborn women.…”