Foreign-born Hispanic Mothers Research Articles

Timely Prenatal and Infant Pertussis Vaccine Uptake in an Integrated Health System.

Hispanic infants bear the burden of pertussis infection. We examined pertussis protection from vaccination in infants with US-born and foreign-born Hispanic mothers. Retrospective cohort study of infants up to 1 year of age. Secondary data of mothers with continuous membership since the 27th week of pregnancy with infants born 1/1/2012-12/31/2017 in an integrated health care delivery organization, which broadly represent the Southern California population. Foreign-born Hispanic mothers had higher prenatal tetanus, diphtheria, acellular pertussis (Tdap) uptake compared to US-born white mothers [adjusted risk ratio (aRR): 1.04, 95% confidence interval (CI): 1.03, 1.05]. Infants with mothers on Medicaid insurance disproportionately did not enroll in the health plan by the time they were eligible for their first dose of the DTaP vaccine (68.4%). Once initiating the infant vaccine series, foreign-born Hispanic mothers more likely adhered than US-born white mothers (aRR: 1.05, CI: 1.02, 1.08). In an integrated health system, disparities in vaccine uptake can be minimized. Infants who are born to mothers with Medicaid insurance and are not enrolled in the health plan after birth may be under-protected from pertussis.

Hispanic Ethnicity, Nativity and the Risk of Stillbirth

The objective of this study was to examine stillbirth risk by nativity and Hispanic ethnicity. We analyzed births and fetal deaths among women of Hispanic origin within gestational ages of 20-42weeks from the 2014-2019 Birth and Fetal Death. Foreign-born Hispanic mothers were 8% less likely (HR 0.92, 95% CI 0.90-0.95) to experience stillbirth than their counterparts. Stratified by ethnicity, foreign-born Mexican and Central/South American women had a lower risk of stillbirth (HR 0.85, 95% CI 0.81-0.88 and HR 0.68, 95% CI 0.63-0.75, respectively) while foreign-born Puerto Rican women were more likely to experience stillbirth (HR 1.37, 95% CI 1.24-1.51) than their native-born counterparts. While overall foreign-born Hispanic mothers were less likely to experience stillbirth than native-born Hispanic mothers, this differed depending on ethnicity. Counseling regarding risk of stillbirth among Hispanic women should take into consideration nativity and country of origin as influential factors.

Effects of Stress and Nativity on Maternal Antenatal Substance Use and Postnatal Mental Disorders.

Background: Maternal substance use and common mental disorders (CMDs) during or after pregnancy can lead to negative health outcomes among mothers and infants. We examined whether nativity (US-born versus foreign-born) and stress levels during pregnancy were associated with antenatal substance use and postnatal CMDs. Methods: We analyzed the Boston Birth Cohort, a racially diverse cohort recruited at birth with rolling enrollment since 1998. Information on antenatal substance use (tobacco and/or alcohol use) was obtained using an in-person postpartum questionnaire (n = 6,514). Information on postnatal CMDs (depression and/or anxiety) was obtained from medical records (n = 2,052). Nativity and stress during pregnancy were self-reported. We performed multivariate logistic regression to examine how nativity and stress levels were jointly associated with antenatal substance use and postnatal CMDs. We further investigated if blacks, Hispanics, and whites were differentially at risk. Results: We found that US-born mothers were at higher risk of substance use and CMDs than their foreign-born counterparts. In analyses combining nativity and stress, being US-born with high stress was associated with increased odds of antenatal substance use (adjusted odds ratio [aOR] = 14.91, 95% confidence interval [CI]: 12.09-18.39) and postnatal CMDs (aOR = 4.09, 95% CI: 2.72-6.15) compared with foreign-born mothers with low stress. The results of the subanalyses limited to black and Hispanic women separately were similar; high stress alone was associated with fourfold increased odds of CMDs among foreign-born Hispanic mothers (aOR = 4.27, 95% CI: 1.96-9.33). Conclusions: Findings suggest that identifying and alleviating high stress among pregnant women may reduce their risk of antenatal substance use and postnatal CMDs.

Means-Tested Safety Net Programs and Hispanic Families: Evidence from Medicaid, SNAP, and WIC.

Hispanic families have historically used means-tested assistance less than high-poverty peers, and one explanation for this may be that anti-immigrant politics and policies are a barrier to program participation. We document the participation of Hispanic children in three antipoverty programs by age and parental citizenship and the correlation of participation with state immigrant-based restrictions. Hispanic citizen children with citizen parents participate in Supplemental Nutrition Assistance Program (SNAP) and Medicaid more than Hispanic citizen children with noncitizen parents. Foreign-born Hispanic mothers use Medicaid less than their socioeconomic status would suggest. However, little evidence exists that child participation in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) varies by mother's nativity: foreign-born mothers of Hispanic infants participate in WIC at higher rates than U.S.-born Hispanic mothers. State policies that restrict immigrant program use correlate to lower SNAP and Medicaid uptake among citizen children of foreign-born Hispanic mothers. WIC participation may be greater because it is delivered through nonprofit clinics, and WIC eligibility for immigrants is largely unrestricted.

Restrictive sub-federal immigration policy climates and very preterm birth risk among US-born and foreign-born Hispanic mothers in the United States, 2005-2016.

Immigration policy climate may have pervasive effects on the health of immigrants and their families. We examine how living in a state at the time of delivery with a more restrictive immigration policy climate impacts risk of very preterm birth (VPTB) among Hispanic mothers in the United States. We used data from the United States live birth files, 2005-2016. We fit generalized linear mixed models predicting VPTB including information on individual (e.g., age, parity, specific Hispanic origin group) and geographic (e.g., county level poverty, ethnic density) risk determinants. Living in a state with a more restrictive immigration policy climate is associated with a slight increase in odds of VPTB for Hispanic women (aOR: 1.07 (1.04-1.10)).

Can the “Hispanic Paradox” Shed Light on Childhood Cancer Risk?

Abstract The “Hispanic epidemiologic paradox” is the commonly observed phenomenon that foreign-born Hispanic mothers who emigrate to the United States have consistently good pregnancy outcomes, such as decreased rates of low birthweight, despite high levels of poverty. We examined whether this advantage extends to childhood cancer risk. Methods: The study included all children born in California from 1983–2007. Birthrolls were linked to California Cancer Registry records of children ages <6 who were diagnosed with cancer 1988–2007 (N = 8710 cases, 9,519,438 controls). The mother's Hispanic origin, ethnic ancestry, and country of birth were ascertained from the birth certificate. We used Cox proportional hazard models to estimate the risk for cancer based upon maternal birthplace and ethnic ancestry. Models stratified by tumor subtype and adjusted for maternal and paternal age. Summary of results: The children of foreign-born Hispanic women had lower rates of several cancers [acute lymphoblastic leukemia (ALL; odds ratio (OR) = 1.05, 95% confidence interval (CI) = 0.96–1.14); glioma (OR = 0.51, 95% CI, 0.43–0.59); neuroblastoma (OR = 0.46, 95% CI, 0.39–0.55)] in comparison to the children of US-born Hispanic women [ALL (OR = 1.23, 95% CI, 1.11–1.37); glioma (OR = 0.75, 95% CI, 0.62–0.90); neuroblastoma (OR = 0.63, 95% CI, 0.51–0.78); referent group was the children of US-born Whites]. The odds for rhabdomyosarcoma and acute myeloid leukemia were equivalent between Hispanics regardless of maternal place of birth. Hepatoblastoma was higher among the children of foreign-born mothers (OR = 1.35, 95% CI, 0.87–2.10) than those of US-born Hispanic mothers (OR = 0.93, 95% CI, 0.56–1.55) while bone tumors were higher among the children of US-born mothers (OR = 2.08, 95% CI, 1.11–3.88) compared to the children of foreign-born mothers (OR = 0.73, 95% CI, 0.38–1.41). Conclusions: With notable exceptions, the children of foreign-born Hispanic mothers tended to have cancer rates lower than those of US-born Hispanic mothers. Risk factors identified as driving the Hispanic paradox may be fruitful for study among these childhood cancer types.

Sociodemographic and hispanic acculturation factors and isolated anotia/microtia.

It has been observed in several studies that infants with anotia/microtia are more common among Hispanics compared with other racial/ethnic groups. We examined the association between selected Hispanic ethnicity and acculturation factors and anotia/microtia in the National Birth Defects Prevention Study. We examined data from mothers of 351 infants with isolated anotia/microtia and 8435 unaffected infants from the National Birth Defects Prevention Study with an expected delivery date from 1997 to 2007. Sociodemographic, maternal, and acculturation factors (e.g., age, maternal education, household income, body mass index, gestational diabetes, folic acid, smoking, alcohol intake, study center, parental birthplace, and years lived in the United States, maternal language) were assessed as overall risk factors and also as risk factors among subgroups of Hispanics (United States- and foreign-born) versus non-Hispanic whites. Compared with non-Hispanic whites, both United States- and foreign-born Hispanic mothers demonstrated substantially higher odds of delivering infants with anotia/microtia across nearly all strata of sociodemographic and other maternal factors (adjusted odds ratios range: 2.1-11.9). The odds of anotia/microtia was particularly elevated among Hispanic mothers who emigrated from Mexico after age five (adjusted odds ratios = 4.88; 95% confidence interval = 2.93-8.11) or who conducted the interview in Spanish (adjusted odds ratios = 4.97; 95% confidence interval = 3.00-8.24). We observed that certain sociodemographic and acculturation factors are associated with higher risks of anotia/microtia among offspring of Hispanic mothers.

Early childhood economic disadvantage and the health of Hispanic children

This research provides a longitudinal view of early childhood economic deprivation and its associations with health among young Hispanic children born in the United States. Of additional interest is whether economic deprivation is associated with child health similarly across all Hispanic children or whether associations differ by maternal nativity or country of origin. Fragile Families and Child Wellbeing data and multinomial logistic regression are used to estimate the effects of total years in poverty, material hardship, and lack of health insurance on Hispanic children's health status at age 5 and change in health status between ages 1 and 5. Results show that multiple measures of early childhood economic deprivation have additive negative associations with Hispanic child health, and that living more years in poverty is associated with declining health status among young Hispanic children. Interaction effects indicate that early childhood poverty has stronger associations with lower age 5 health status and declining health between ages 1 and 5 for children with foreign-born Hispanic mothers than for those with native-born Hispanic mothers. No differences were found in the associations between economic deprivation and child health by maternal country of origin. These results suggest an important role of economic resources for protecting Hispanic child health, and that poor Hispanic children with immigrant mothers may be at particularly high risk of developing health problems as they move out of infancy and into early childhood.

Direct and Mediated Effects of Nativity and Other Indicators of Acculturation on Hispanic Mothers’ Use of Physical Aggression

This study used data from 845 foreign-born (n = 328) and native-U.S. born (n = 517) Hispanic mothers who participated in the Fragile Families and Child Wellbeing Study (FFCWS) to examine four indicators of acculturation--nativity, years lived in the United States, religious attendance, and endorsement of traditional gender norms--as predictors of maternal physical aggression directed toward young children. The authors also examined whether psychosocial risk factors associated with child maltreatment and acculturation--maternal alcohol use, depression, parenting stress, and intimate partner aggression and violence--mediate relationships between acculturation and maternal aggression. Foreign-born Hispanic mothers had significantly lower rates of physical aggression than native-born Hispanic mothers. In path modeling results, U.S. nativity, along with maternal alcohol use, parenting stress, and child aggressive behavior, emerged as the strongest risk factors for maternal physical aggression. Among the four acculturation indicators, only foreign birth was directly associated with lower maternal aggression. Study findings suggest immigrant status is a unique protective factor that contributes to lower levels of physical aggression among Hispanic mothers.

Do foreign‐ and U.S.‐born mothers across racial/ethnic groups have a similar risk profile for selected sociodemographic and periconceptional factors?

We examined differences in selected pregnancy-related risk factors, including maternal sociodemographic characteristics, health-related conditions, and periconceptional behavioral factors, among foreign-born versus U.S.-born control mothers across race/ethnic groups. We used data from the National Birth Defects Prevention Study, and calculated odds ratios (ORs) and 95% confidence intervals (CIs) of the risk factors, for foreign-born Hispanic, non-Hispanic white, non-Hispanic black, and Asian/Pacific Islander (API) mothers, compared to their U.S.-born counterparts. Across all race/ethnic groups, foreign-born mothers were older and had lower odds of obesity compared to their U.S.-born counterparts. With the exception of foreign-born black mothers, foreign-born mothers from other race/ethnic groups had significantly lower odds of binge drinking during the periconceptional period. Compared to U.S.-born, foreign-born Hispanic mothers had twice the odds of gestational diabetes (OR = 2.23; 95% CI = 1.36-3.66). Certain health behaviors were less prevalent in foreign-born black mothers (e.g., folic acid use; OR = 0.54; 95% CI = 0.31-0.96) and foreign-born API mothers (e.g., cigarette smoking; OR = 0.10; 95% CI = 0.02-0.48). Significant differences in pregnancy related risk factors during the periconceptional period and throughout pregnancy were observed between maternal nativity groups and across race/ethnicity. Prevention efforts for both prepregnancy and after conception should be designed and delivered according to maternal nativity for each racial/ethnic group.

Are birth defects among Hispanics related to maternal nativity or number of years lived in the United States?

Literature on the risk of birth defects among foreign- versus U.S.-born Hispanics is limited or inconsistent. We examined the association between country of birth, immigration patterns, and birth defects among Hispanic mothers. We used data from the National Birth Defects Prevention Study and calculated odds ratios (ORs) and 95% confidence intervals and assessed the relationship between mothers' country of birth, years lived in the United States, and birth defects among 575 foreign-born compared to 539 U.S.-born Hispanic mothers. Hispanic mothers born in Mexico/Central America were more likely to deliver babies with spina bifida (OR = 1.53) than their U.S.-born counterparts. Also, mothers born in Mexico/Central America or who were recent United States immigrants (< or =5 years) were less likely to deliver babies with all atrial septal defects combined, all septal defects combined, or atrial septal defect, secundum type. However, Hispanic foreign-born mothers who lived in the United States for >5 years were more likely to deliver babies with all neural tube defects combined (OR = 1.42), spina bifida (OR = 1.89), and longitudinal limb defects (OR = 2.34). Foreign-born mothers, regardless of their number of years lived in the United States, were more likely to deliver babies with anotia or microtia. Depending on the type of birth defect, foreign-born Hispanic mothers might be at higher or lower risk of delivering babies with the defects. The differences might reflect variations in predisposition, cultural norms, behavioral characteristics, and/or ascertainment of the birth defects.