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Santaularia NJ, Hunt SL, Bonilla Z. Exploring the Links Between Immigration and Birth Outcomes Among Latine Birthing Persons in the USA. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01999-x. [PMID: 38713369 DOI: 10.1007/s40615-024-01999-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Birth outcomes are worse for birthing people and infants in the USA than other high-income economies and worse still for underprivileged communities. Historically, the Latine community has experienced positive birth outcomes, despite low socioeconomic status and other socio-political disadvantages, leading to what has been termed as the Hispanic birth paradox. However, this perinatal advantage and protective effect appears to have been shattered by unfavorable policies, structural conditions, societal attitudes, and traumatic events impacting Latine immigrants, leading to negative effects on the health and well-being of birthing Latines-regardless of citizenship status and increasing rates of preterm birth and low birth weight infants. METHODS AND RESULTS We conducted a comprehensive literature review and identified two pathways through which birth outcomes among Latine birthing persons may be compromised regardless of citizenship status: (1) a biological pathway as toxic levels of fear and anxiety created by racialized stressors accumulate in the bodies of Latines and (2) a social pathway as Latines disconnect from formal and informal sources of support including family, friends, health care, public health programs, and social services during the course of the pregnancy. CONCLUSION Future research needs to examine the impact of immigration climate and policies on health and racial equity in birth outcomes among Latines regardless of citizenship status. Attaining health and racial equity necessitates increased awareness among health providers, public health practitioners, and policy makers of the impact of larger socio-political pressures on the health of Latine birthing persons.
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Affiliation(s)
- N Jeanie Santaularia
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Shanda Lee Hunt
- University Libraries, University of Minnesota, Minneapolis, MN, USA
| | - Zobeida Bonilla
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Reddy KP, Ludomirsky AB, Jones AL, Shustak RJ, Faerber JA, Naim MY, Lopez KN, Mercer-Rosa LM. Racial, ethnic, and socio-economic disparities in neonatal ICU admissions among neonates born with cyanotic CHD in the United States, 2009-2018. Cardiol Young 2024:1-8. [PMID: 38653722 DOI: 10.1017/s1047951124024971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Disparities in CHD outcomes exist across the lifespan. However, less is known about disparities for patients with CHD admitted to neonatal ICU. We sought to identify sociodemographic disparities in neonatal ICU admissions among neonates born with cyanotic CHD. MATERIALS & METHODS Annual natality files from the US National Center for Health Statistics for years 2009-2018 were obtained. For each neonate, we identified sex, birthweight, pre-term birth, presence of cyanotic CHD, and neonatal ICU admission at time of birth, as well as maternal age, race, ethnicity, comorbidities/risk factors, trimester at start of prenatal care, educational attainment, and two measures of socio-economic status (Special Supplemental Nutrition Program for Women, Infants, and Children [WIC] status and insurance type). Multivariable logistic regression models were fit to determine the association of maternal socio-economic status with neonatal ICU admission. A covariate for race/ethnicity was then added to each model to determine if race/ethnicity attenuate the relationship between socio-economic status and neonatal ICU admission. RESULTS Of 22,373 neonates born with cyanotic CHD, 77.2% had a neonatal ICU admission. Receipt of WIC benefits was associated with higher odds of neonatal ICU admission (adjusted odds ratio [aOR] 1.20, 95% CI 1.1-1.29, p < 0.01). Neonates born to non-Hispanic Black mothers had increased odds of neonatal ICU admission (aOR 1.20, 95% CI 1.07-1.35, p < 0.01), whereas neonates born to Hispanic mothers were at lower odds of neonatal ICU admission (aOR 0.84, 95% CI 0.76-0.93, p < 0.01). CONCLUSION Maternal Black race and low socio-economic status are associated with increased risk of neonatal ICU admission for neonates born with cyanotic CHD. Further work is needed to identify the underlying causes of these disparities.
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Affiliation(s)
- Kriyana P Reddy
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Avital B Ludomirsky
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrea L Jones
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel J Shustak
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer A Faerber
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maryam Y Naim
- Division of Cardiac Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine and Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Keila N Lopez
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Laura M Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Meng Q, Liu J, Shen J, Del Rosario I, Lakey PS, Shiraiwa M, Su J, Weichenthal S, Zhu Y, Oroumiyeh F, Paulson SE, Jerrett M, Ritz B. Fine Particulate Matter Metal Composition, Oxidative Potential, and Adverse Birth Outcomes in Los Angeles. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:107012. [PMID: 37878796 PMCID: PMC10599636 DOI: 10.1289/ehp12196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Although many studies have linked prenatal exposure to PM 2.5 to adverse birth outcomes, little is known about the effects of exposure to specific constituents of PM 2.5 or mechanisms that contribute to these outcomes. OBJECTIVES Our objective was to investigate effects of oxidative potential and PM 2.5 metal components from non-exhaust traffic emissions, such as brake and tire wear, on the risk of preterm birth (PTB) and term low birth weight (TLBW). METHODS For a birth cohort of 285,614 singletons born in Los Angeles County, California, in the period 2017-2019, we estimated speciated PM 2.5 exposures modeled from land use regression with cokriging, including brake and tire wear related metals (barium and zinc), black carbon, and three markers of oxidative potential (OP), including modeled reactive oxygen species based on measured iron and copper (ROS), OH formation (OP OH ), and dithiothreitol (DTT) loss (OP DTT ). Using logistic regression, we estimated odds ratios (OR) and 95% confidence intervals (CI) for PTB and TLBW with speciated PM 2.5 exposures and PM 2.5 mass as continuous variables scaled by their interquartile range (IQR). RESULTS For both metals and oxidative potential metrics, we estimated increased risks for PTB (ORs ranging from 1.01 to 1.03) and TLBW (ORs ranging from 1.02 to 1.05) per IQR exposure increment that were robust to adjustment for PM 2.5 mass. Associations for PM 2.5 mass, black carbon, metal components, and oxidative potential (especially ROS and OP OH ) with adverse birth outcomes were stronger in Hispanic, Black, and mixed-race or Native American women. DISCUSSION Our results indicate that exposure to PM 2.5 metals from brake and tire wear and particle components that contribute to oxidative potential were associated with an increased risk of PTB and TLBW in Los Angeles County, particularly among Hispanic, Black, and mixed-race or Native American women. Thus, reduction of PM 2.5 mass only may not be sufficient to protect the most vulnerable pregnant women and children from adverse effects due to traffic source exposures. https://doi.org/10.1289/EHP12196.
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Affiliation(s)
- Qi Meng
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Jonathan Liu
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Jiaqi Shen
- Department of Atmospheric & Oceanic Sciences, UCLA, Los Angeles, California, USA
| | - Irish Del Rosario
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Pascale S.J. Lakey
- Department of Chemistry, University of California, Irvine, Irvine, California, USA
| | - Manabu Shiraiwa
- Department of Chemistry, University of California, Irvine, Irvine, California, USA
| | - Jason Su
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Yifang Zhu
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Farzan Oroumiyeh
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Suzanne E. Paulson
- Department of Atmospheric & Oceanic Sciences, UCLA, Los Angeles, California, USA
| | - Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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Lebron CN, Mitsdarffer M, Parra A, Chavez JV, Behar-Zusman V. Latinas and Maternal and Child Health: Research, Policy, and Representation. Matern Child Health J 2023:10.1007/s10995-023-03662-z. [PMID: 37029892 PMCID: PMC10560314 DOI: 10.1007/s10995-023-03662-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
Over the last 50 years, the Latino population in the US has grown and changed. Latinos are the nation's largest minority group and among this group, there is incredible diversity. Much of Latino health research and outcomes have been treated interchangeably with immigrant health, but as the US Latino population evolves so should the focus of Latino health research. We contend that as maternal and child health (MCH) outcomes are an utmost important indicator of a country's health, and as Latinos make up 18% of the US's population, it is imperative that we move past dated research frameworks to a more nuanced understanding of the health of Latina women and children. We summarize how acculturation has been used to describe differences in MCH outcomes, discuss how the umbrella term "Latino" masks subgroups differences, explore Afro-Latinidad in MCH, examine the effects of the sociopolitical climate on the health of families, and demonstrate the limited representation of Latinos in MCH research. We conclude that a deeper understanding of Latino health is necessary to achieve health equity for Latina women and their children.
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Affiliation(s)
- Cynthia N Lebron
- University of Miami School of Nursing and Health Studies, 5030 Brunson Avenue, Coral Gables, FL, 33146, USA.
| | - Mary Mitsdarffer
- Biden School of Public Policy & Administration, University of Delaware, Newark, USA
| | - Alexa Parra
- University of Miami School of Nursing and Health Studies, 5030 Brunson Avenue, Coral Gables, FL, 33146, USA
| | | | - Victoria Behar-Zusman
- University of Miami School of Nursing and Health Studies, 5030 Brunson Avenue, Coral Gables, FL, 33146, USA
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Patel I, Dev A. What is prenatal stress? A scoping review of how prenatal stress is defined and measured within the context of food insecurity, housing instability, and immigration in the United States. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231191091. [PMID: 37596926 PMCID: PMC10440065 DOI: 10.1177/17455057231191091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Stress during pregnancy can lead to significant adverse outcomes for maternal mental health. Early evaluation of prenatal stress can help identify treatment needs and appropriate interventions. Disparities in the social determinants of health can contribute to stress, but what constitutes stress during pregnancy within the social determinants of health framework is poorly understood. OBJECTIVE To scope how prenatal stress is defined and measured among pregnant people exposed to three prominent social stressors in the United States: insecurity pertaining to food, housing, and immigration. ELIGIBILITY CRITERIA We included all studies that focused on stress during pregnancy in the context of food insecurity, housing instability, and immigration, given their recent policy focus due to the COVID-19 pandemic and ongoing political discourse, in addition to their importance in American College of Obstetricians and Gynecologists (ACOG's) social determinants of health screening tool. SOURCES OF EVIDENCE We searched PubMed, Scopus, and Web of Science for articles published between January 2012 and January 2022. CHARTING METHODS Using a piloted charting tool, we extracted relevant study information from the selected articles and analyzed the content pertaining to stress. RESULTS An initial search identified 1,023 articles, of which 24 met our inclusion criteria. None of the studies defined prenatal stress, and only one used the Prenatal Distress Questionnaire, a prenatal stress-specific tool to measure it. The Perceived Stress Scale was the most common instrument used in seven studies. Fifteen studies measured over 25 alternative exposures that researchers theorized were associated with stress, and 4 of the 15 studies did not explain the association between the measure and stress. CONCLUSIONS Our findings demonstrate a fundamental inconsistency in how prenatal stress is defined and measured in the context of social determinants of health, limiting the comparison of results across studies and the potential development of effective interventions to promote better maternal mental health.
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Affiliation(s)
- Ishani Patel
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA
| | - Alka Dev
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, IL, USA
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Nelson HO, Spencer KL. Sociological contributions to race and health: Diversifying the ontological and methodological agenda. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1801-1817. [PMID: 34435689 PMCID: PMC8900670 DOI: 10.1111/1467-9566.13362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
Abstract
Sociologists have made fundamental contributions to the study of race and health in the United States. They have disrupted biological assumptions of race, uncovered individual and structural factors that drive racial health disparities and explored the effects of racism on health. In recent years, however, with broader shifts towards big data, the work to understand the dynamics between race and health has been increasingly pursued from a quantitative perspective. Often, such analyses isolate intermediary mechanisms to further explain race as a cause of disease. While important, these approaches potentially limit our investigations of underlying assumptions about race and the complexity of this critical social construct. We argue that the resulting dearth of qualitative research on race and health substantially limits the knowledge being produced. After providing an overview of the overwhelming shift towards quantitative methods in the study of race and health, we present three areas of study that would benefit from greater qualitative inquiry as follows: (1) Healthy Immigrant Effect, (2) Maternal Health and (3) End-of-Life Care. We conclude with a call to the discipline to embrace the critical role of qualitative research in exploring the dynamics of race and health in the United States.
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Affiliation(s)
- Hyeyoung Oh Nelson
- Department of Health and Behavioral Sciences, University of Colorado-Denver, Denver, Colorado, USA
| | - Karen Lutfey Spencer
- Department of Health and Behavioral Sciences, University of Colorado-Denver, Denver, Colorado, USA
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Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, Horbar JD. Quality of Care in US NICUs by Race and Ethnicity. Pediatrics 2021; 148:e2020037622. [PMID: 34301773 PMCID: PMC8344358 DOI: 10.1542/peds.2020-037622] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Summary measures are used to quantify a hospital's quality of care by combining multiple metrics into a single score. We used Baby-MONITOR, a summary quality measure for NICUs, to evaluate quality by race and ethnicity across and within NICUs in the United States. METHODS Vermont Oxford Network members contributed data from 2015 to 2019 on infants from 25 to 29 weeks' gestation or of 401 to 1500 g birth weight who were inborn or transferred to the reporting hospital within 28 days of birth. Nine Baby-MONITOR measures were individually risk adjusted, standardized, equally weighted, and averaged to derive scores for African American, Hispanic, Asian American, and American Indian infants, compared with white infants. RESULTS This prospective cohort included 169 400 infants at 737 hospitals. Across NICUs, Hispanic and Asian American infants had higher Baby-MONITOR summary scores, compared with those of white infants. African American and American Indian infants scored lower on process measures, and all 4 minority groups scored higher on outcome measures. Within NICUs, the mean summary scores for African American, Hispanic, and Asian American NICU subsets were higher, compared with those of white infants in the same NICU. American Indian summary NICU scores were not different, on average. CONCLUSIONS With Baby-MONITOR, we identified differences in NICU quality by race and ethnicity. However, the summary score masked within-measure quality gaps that raise unanswered questions about the relationships between race and ethnicity and processes and outcomes of care.
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Affiliation(s)
- Erika M Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner, MD College of Medicine
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, The University of Vermont, Burlington, Vermont
| | | | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California
- California Perinatal Quality Care Collaborative, Palo Alto, California
| | - David Draper
- Department of Statistics, Jack Baskin School of Engineering, University of California, Santa Cruz, Santa Cruz, California
| | - Daniel Helkey
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner, MD College of Medicine
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Merkt PT, Kramer MR, Goodman DA, Brantley MD, Barrera CM, Eckhaus L, Petersen EE. Urban-rural differences in pregnancy-related deaths, United States, 2011-2016. Am J Obstet Gynecol 2021; 225:183.e1-183.e16. [PMID: 33640361 DOI: 10.1016/j.ajog.2021.02.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The US pregnancy-related mortality ratio has not improved over the past decade and includes striking disparities by race and ethnicity and by state. Understanding differences in pregnancy-related mortality across and within urban and rural areas can guide the development of interventions for preventing future pregnancy-related deaths. OBJECTIVE We sought to compare pregnancy-related mortality across and within urban and rural counties by race and ethnicity and age. STUDY DESIGN We conducted a descriptive analysis of 3747 pregnancy-related deaths during 2011-2016 (the most recent available data) with available zone improvement plan code or county data in the Pregnancy Mortality Surveillance System, among Hispanic and non-Hispanic White, Black, American Indian or Alaska Native, and Asian or Pacific Islander women aged 15 to 44 years. We aggregated data by US county and grouped counties per the National Center for Health Statistics Urban-Rural Classification Scheme for Counties. We used R statistical software, epitools, to calculate the pregnancy-related mortality ratio (number of pregnancy-related deaths per 100,000 live births) for each urban-rural grouping, obtain 95% confidence intervals, and perform exact tests of ratio comparisons using the Poisson distribution. RESULTS Of the total 3747 pregnancy-related deaths analyzed, 52% occurred in large metro counties, and 7% occurred in noncore (rural) counties. Large metro counties had the lowest pregnancy-related mortality ratio (14.8; 95% confidence interval, 14.2-15.5), whereas noncore counties had the highest (24.1; 95% confidence interval, 21.4-27.1), including race and ethnicity and age groups. Pregnancy-related mortality ratio age disparities increased with rurality. Women aged 25 to 34 years and 35 to 44 years living in noncore counties had pregnancy-related mortality ratios 1.5 and 3 times higher, respectively, than women of the same age groups in large metro counties. Within each urban-rural category, pregnancy-related mortality ratios were higher among non-Hispanic Black women than non-Hispanic White women. Non-Hispanic American Indian or Alaska Native pregnancy-related mortality ratios in small metro, micropolitan, and noncore counties were 2 to 3 times that of non-Hispanic White women in the same areas. CONCLUSION Although more than half of pregnancy-related deaths occurred in large metro counties, the pregnancy-related mortality ratio rose with increasing rurality. Disparities existed in urban-rural categories, including by age group and race and ethnicity. Geographic location is an important context for initiatives to prevent future deaths and eliminate disparities. Further research is needed to better understand reasons for the observed urban-rural differences and to guide a multifactorial response to reduce pregnancy-related deaths.
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Affiliation(s)
- Peter T Merkt
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - David A Goodman
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mary D Brantley
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chloe M Barrera
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lindsay Eckhaus
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Emily E Petersen
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Wing SE, Larson TV, Hudda N, Boonyarattaphan S, Fruin S, Ritz B. Preterm Birth among Infants Exposed to in Utero Ultrafine Particles from Aircraft Emissions. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:47002. [PMID: 32238012 PMCID: PMC7228090 DOI: 10.1289/ehp5732] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 02/24/2020] [Accepted: 03/04/2020] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Ambient air pollution is a known risk factor for adverse birth outcomes, but the role of ultrafine particles (UFPs) is not well understood. Aircraft-origin UFPs adversely affect air quality over large residential areas downwind of airports, but their reproductive health burden remains uninvestigated. OBJECTIVES This analysis evaluated whether UFPs from jet aircraft emissions are associated with increased rates of preterm birth (PTB) among pregnant mothers living downwind of Los Angeles International Airport (LAX). METHODS This population-based study used birth records, provided by the California Department of Public Health, to ascertain birth outcomes and a novel, validated geospatial UFP dispersion model approach to estimate in utero exposures. All mothers who gave birth from 2008 to 2016 while living within 15km of LAX were included in this analysis (N=174,186; including 15,134 PTBs). RESULTS In utero exposure to aircraft-origin UFPs was positively associated with PTB. The odds ratio (OR) per interquartile range (IQR) increase [9,200 particles per cubic centimeter (cc)] relative UFP exposure was 1.04 [95% confidence interval (CI): 1.02, 1.06]. When comparing the fourth quartile of UFP exposure to the first quartile, the OR for PTB was 1.14 (95% CI: 1.08, 1.20), adjusting for maternal demographic characteristics, exposure to traffic-related air pollution, and airport-related noise. CONCLUSION Our results suggest that emissions from aircraft play an etiologic role in PTBs, independent of noise and traffic-related air pollution exposures. These findings are of public health concern because UFP exposures downwind of airfields are common and may affect large, densely populated residential areas. https://doi.org/10.1289/EHP5732.
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Affiliation(s)
- Sam E. Wing
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Timothy V. Larson
- Departments of Civil & Environmental Engineering and Occupational & Environmental Health Sciences, University of Washington, Seattle, Washington, USA
| | - Neelakshi Hudda
- Department of Civil & Environmental Engineering, Tufts University, Medford, Massachusetts, USA
| | - Sarunporn Boonyarattaphan
- Departments of Civil & Environmental Engineering and Occupational & Environmental Health Sciences, University of Washington, Seattle, Washington, USA
| | - Scott Fruin
- Division of Environmental Health, University of Southern California, Los Angeles, California, USA
| | - Beate Ritz
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, California, USA
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Premkumar A, Debbink MP, Silver RM, Haas DM, Simhan HN, Wing DA, Parry S, Mercer BM, Iams J, Reddy UM, Saade G, Grobman WA. Association of Acculturation With Adverse Pregnancy Outcomes. Obstet Gynecol 2020; 135:301-309. [PMID: 31923068 PMCID: PMC7054005 DOI: 10.1097/aog.0000000000003659] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the relationship between acculturation and adverse pregnancy outcomes, and whether these relationships differ across racial or ethnic groups. METHODS This is a planned secondary analysis of the nuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study of 10,038 pregnant women at eight academic health care centers in the United States. Nulliparous pregnant women with singleton gestations were recruited between 6 0/7 and 13 6/7 weeks of gestation from October 2010-September 2013. Acculturation was defined by birthplace (United States vs non-United States), language used during study visits (English or Spanish), and self-rated English proficiency. The adverse pregnancy outcomes of interest were preterm birth (less than 37 weeks of gestation, both iatrogenic and spontaneous), preeclampsia or eclampsia, gestational hypertension, gestational diabetes, stillbirth, small for gestational age, and large for gestational age. Multivariable regression modeling was performed, as was an interaction analysis focusing on the relationship between acculturation and adverse pregnancy outcomes by maternal race or ethnicity. RESULTS Of the 10,006 women eligible for this analysis, 8,100 (80.9%) were classified as more acculturated (eg, born in the United States with high English proficiency), and 1,906 (19.1%) were classified as having less acculturation (eg, born or not born in the United States with low proficiency in English or use of Spanish as the preferred language during study visits). In multivariable logistic regression modeling, more acculturation was significantly associated with higher frequency of preterm birth (odds ratio [OR] 1.46, adjusted odds ratio [aOR] 1.50, 95% CI 1.16-1.95); spontaneous preterm birth (OR 1.54, aOR 1.62, 95% CI 1.14-2.24); preeclampsia or eclampsia (OR 1.39, aOR 1.31, 95% CI 1.03-1.67); preeclampsia without severe features (OR 1.44, aOR 1.43, 95% CI 1.03-2.01); and gestational hypertension (OR 1.68, aOR 1.48, 95% CI 1.22-1.79). These associations did not differ by self-described race or ethnicity. CONCLUSION In a large cohort of nulliparous women, more acculturation, regardless of self-described race or ethnicity, was associated with increased odds of several adverse pregnancy outcomes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01322529.
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Affiliation(s)
| | - Michelle P. Debbink
- University of Utah Health, Salt Lake City, UT, United States of America
- Intermountain Healthcare, Salt Lake City, UT, United States of America
| | - Robert M. Silver
- University of Utah Health, Salt Lake City, UT, United States of America
| | - David M. Haas
- Indiana University, Indianapolis, IN, United States of America
| | | | - Deborah A. Wing
- University of California, Irvine, Irvine, CA, United States of America
| | - Samuel Parry
- University of Pennsylvania, Philadelphia, PA, United States of America
| | - Brian M. Mercer
- Case Western Reserve University, Cleveland, OH, United States of America
| | - Jay Iams
- The Ohio State University, Columbus, OH, United States of America
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - George Saade
- University of Texas Medical Branch, Galveston, Galveston, TX, United States of America
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Sumbul T, Spellen S, McLemore MR. A Transdisciplinary Conceptual Framework of Contextualized Resilience for Reducing Adverse Birth Outcomes. QUALITATIVE HEALTH RESEARCH 2020; 30:105-118. [PMID: 31752598 DOI: 10.1177/1049732319885369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Research in preterm birth has focused on the disparate outcomes for Black, Hispanic, and Latina women as compared with White women. However, research studies have not focused on centering these women in frameworks that discuss how resilience is embodied. This article is a presentation of our transdisciplinary contextual framework of resilience, building on work that centers Black, Hispanic, and Latina women, as well as historical oppression and trauma resilience frameworks developed by transcultural psychiatry, psychology, public health, anthropology, medicine, nursing, sociology, and social work. To develop the model, we reviewed 115 articles and books (1977-2019), which were then evaluated and synthesized to develop a transdisciplinary framework of contextualized resilience to enable a better understanding of the complex interplay of medical and social conditions influencing preterm birth. The framework includes multiple ecological layers that cross the individual, familial and intimate, community, structural, policy and law, and hegemonic domains.
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Affiliation(s)
- Tijen Sumbul
- University of California, San Francisco, San Francisco, California, USA
| | - Solaire Spellen
- University of California, Berkeley, Berkeley, California, USA
| | - Monica R McLemore
- University of California, San Francisco, San Francisco, California, USA
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12
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Yan Q, Liew Z, Uppal K, Cui X, Ling C, Heck JE, von Ehrenstein OS, Wu J, Walker DI, Jones DP, Ritz B. Maternal serum metabolome and traffic-related air pollution exposure in pregnancy. ENVIRONMENT INTERNATIONAL 2019; 130:104872. [PMID: 31228787 PMCID: PMC7017857 DOI: 10.1016/j.envint.2019.05.066] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Maternal exposure to traffic-related air pollution during pregnancy has been shown to increase the risk of adverse birth outcomes and neurodevelopmental disorders. By utilizing high-resolution metabolomics (HRM), we investigated perturbations of the maternal serum metabolome in response to traffic-related air pollution to identify biological mechanisms. METHODS We retrieved stored mid-pregnancy serum samples from 160 mothers who lived in the Central Valley of California known for high air particulate levels. We estimated prenatal traffic-related air pollution exposure (carbon monoxide, nitric oxides, and particulate matter <2.5 μm) during first-trimester using the California Line Source Dispersion Model, version 4 (CALINE4) based on residential addresses recorded at birth. We used liquid chromatography-high resolution mass spectrometry to obtain untargeted metabolic profiles and partial least squares discriminant analysis (PLS-DA) to select metabolic features associated with air pollution exposure. Pathway analyses were employed to identify biologic pathways related to air pollution exposure. As potential confounders we included maternal age, maternal race/ethnicity, and maternal education. RESULTS In total we extracted 4038 and 4957 metabolic features from maternal serum samples in hydrophilic interaction (HILIC) chromatography (positive ion mode) and C18 (negative ion mode) columns, respectively. After controlling for confounding factors, PLS-DA (Variable Importance in Projection (VIP) ≥2) yielded 181 and 251 metabolic features (HILIC and C18, respectively) that discriminated between the high (n = 98) and low exposed (n = 62). Pathway enrichment analysis for discriminatory features associated with air pollution indicated that in maternal serum oxidative stress and inflammation related pathways were altered, including linoleate, leukotriene, and prostaglandin pathways. CONCLUSION The metabolomic features and pathways we found to be associated with air pollution exposure suggest that maternal exposure during pregnancy induces oxidative stress and inflammation pathways previously implicated in pregnancy complications and adverse outcomes.
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Affiliation(s)
- Qi Yan
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA; Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Karan Uppal
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Xin Cui
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA; California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Chenxiao Ling
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Julia E Heck
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Jun Wu
- Program in Public Health, UCI Susan and Henry Samueli College of Health Sciences, Irvine, CA, USA
| | - Douglas I Walker
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dean P Jones
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Department of Medicine, Emory University, Atlanta, GA, USA
| | - Beate Ritz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Neurology, UCLA School of Medicine, CA, USA.
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Krishnaswami J, del C. Colon-Gonzalez M. Reforming Women's Health Care: A Call to Action for Lifestyle Medicine Practitioners to Save Lives of Mothers and Infants. Am J Lifestyle Med 2019; 13:495-504. [PMID: 31523215 PMCID: PMC6732876 DOI: 10.1177/1559827619838461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 12/16/2022] Open
Abstract
Maternal and infant mortality are fundamental indicators of a society's health and wellness. These measures depict a health crisis in the United States. Compared with other rich countries, women in the United States more frequently die from pregnancy or childbirth, and infants are less likely to survive to their first birthday. Most of these deaths are preventable; disproportionately affect diverse, low-income groups; and are perpetuated by social and health care inequities and subpar preventive care. Lifestyle medicine (LM) is uniquely positioned to ameliorate this growing crisis. The article presents key prescriptions for LM practitioners to build health and health equity for women. These prescriptions, summarized by the acronym PURER, include action in the areas of (1) practice, (2) understanding/empathy, (3) reform, (4) empowerment, and (5) relationship health. The PURER approach focuses on partnering with diverse female patients to promote resilience, promoting social connection and engagement, facilitating optimal family planning and advocating for culturally responsive, equitable health care systems. Through PURER, LM practitioners can help women and partners resiliently overcome the harmful challenges of discrimination and stress characterizing present-day American life. Over time, the equitable and collective practice of LM can help ameliorate the health care barriers undermining the health of women, families, and society.
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Affiliation(s)
- Janani Krishnaswami
- Internal Medicine / Preventive Medicine, University
of Texas Rio Grande Valley. Texas (MDCCG)
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14
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Abshire C, Mcdowell M, Crockett AH, Fleischer NL. The Impact of CenteringPregnancy Group Prenatal Care on Birth Outcomes in Medicaid Eligible Women. J Womens Health (Larchmt) 2019; 28:919-928. [PMID: 31259671 DOI: 10.1089/jwh.2018.7469] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: CenteringPregnancy group prenatal care (GPNC) has been shown to reduce rates of preterm birth (PTB). We evaluated the impact of GPNC on spontaneous PTB (sPTB) as a first step in exploring the possible mechanism by which GPNC may decrease rates of PTB. We also evaluated whether attending more than five GPNC sessions affected PTB risk and examined all differences by race/ethnicity. Materials and Methods: We conducted a retrospective cohort study among women delivering at a single institution between April 2009 and March 2014. Birth outcome data from vital statistics records were appended to patient records, and detailed chart abstraction was used to determine spontaneous versus indicated PTB. The association between GPNC and attending more than five GPNC sessions and birth outcomes (i.e., PTB, sPTB, low birth weight [LBW], and neonatal intensive care unit [NICU] admissions) was analyzed using generalized estimating equation log binomial regression models. We examined effect modification of the associations by race/ethnicity. Results: The analysis included 1,292 women in GPNC and 8,703 in traditional individual prenatal care (IPNC). After controlling for potential confounders, the risk of PTB (risk ratio [RR] 0.38; 95% confidence interval [CI] 0.31-0.47), sPTB (RR 0.49; 95% CI 0.38-0.63), LBW (RR 0.46; 95% CI 0.37-0.56), and NICU admissions (RR 0.46; 95% CI 0.37-0.57) was lower in GPNC compared to IPNC women. Results differed by maternal race/ethnicity, with the strongest associations among non-Hispanic white mothers and the weakest associations among Hispanic mothers, especially for sPTB. Similarly, the risk of PTB, LBW, and NICU admissions was lower among GPNC women who attended more than five sessions. Conclusion: Participation in GPNC demonstrated a decreased risk for sPTB, as well as other adverse birth outcomes. In addition, participation in more than five GPNC sessions demonstrated a decreased risk for adverse birth outcomes. Prospective longitudinal studies are needed to further explore mechanisms associated with these findings.
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Affiliation(s)
- Chelsea Abshire
- 1Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI 48109
| | - Misty Mcdowell
- 2Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of South Carolina School of Medicine-Greenville, Greenville, South Carolina
| | - Amy H Crockett
- 2Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of South Carolina School of Medicine-Greenville, Greenville, South Carolina
| | - Nancy L Fleischer
- 1Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI 48109
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Kim S, Choi S, Chung-Do JJ, Fan VY. Comparing Birth Outcomes in Hawai'i between US- and Foreign-Born Women. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2018; 77:188-198. [PMID: 30083431 PMCID: PMC6077953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objective of this study is to examine the relationship between maternal nativity status and preterm birth (PTB) or low birth weight (LBW) for Hawai'i resident mothers, to compare these relationships across different maternal race/ethnicity groups, and to identify other potential risk and protective factors related to PTB and LBW. Using the 2004 Natality Birth Data from the National Vital Statistic System of the National Center for Health Statistics, crude and adjusted odds ratios were calculated using logistic regression to determine maternal racial/ethnic-specific nativity effects on PTB and LBW. Other Asian or Pacific Islander foreign-born mothers had higher unadjusted rates of PTB, and Samoan foreign-born mothers had lower rates of LBW after adjusting for the socio-demographic covariates compared to their native-born counterparts. Given the limitation of this study particularly relating to data quality, further research is needed to identify socio-contextual factors that are involved in the relationship between nativity status and PTB/LBW.
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Affiliation(s)
- Sunja Kim
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (SK, JJC, VYF)
- Eugene Bell Foundation, Washington, D.C. (SC)
| | - Seemoon Choi
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (SK, JJC, VYF)
- Eugene Bell Foundation, Washington, D.C. (SC)
| | - Jane J Chung-Do
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (SK, JJC, VYF)
- Eugene Bell Foundation, Washington, D.C. (SC)
| | - Victoria Y Fan
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (SK, JJC, VYF)
- Eugene Bell Foundation, Washington, D.C. (SC)
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Villalonga-Olives E, Kawachi I, von Steinbüchel N. Pregnancy and Birth Outcomes Among Immigrant Women in the US and Europe: A Systematic Review. J Immigr Minor Health 2018; 19:1469-1487. [PMID: 27553259 DOI: 10.1007/s10903-016-0483-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human migration is not a new phenomenon, but it has changed significantly with the advance of globalization. We focus on differences in the published literature concerning migration and health (EU vs the US), centering specifically on reproductive health outcomes. We conducted a literature search in the Pubmed and Embase databases. We reviewed papers that contrast migrants to native-born populations and analyzed differences between countries as well as challenges for future research. The prevalence of low birthweight among migrants varies by the host country characteristics as well as the composition of migrants to different regions. The primary driver of migrant health is the migrant "regime" in different countries at specific periods of time. Future health outcomes of immigrants will depend on the societal characteristics (legal protections, institutions and health systems) of host countries.
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Affiliation(s)
- E Villalonga-Olives
- Institute of Medical Psychology and Medical Sociology, Georg-Augst-University Göttingen, Göttingen, Germany. .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Landmark Center West, 401 Park Drive, 4th Floor, Boston, MA, 02215, USA.
| | - I Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Landmark Center West, 401 Park Drive, 4th Floor, Boston, MA, 02215, USA
| | - N von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, Georg-Augst-University Göttingen, Göttingen, Germany
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17
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Bandoli G, von Ehrenstein O, Ghosh JKC, Flores MES, Dunkel Schetter C, Ritz B. Prenatal Maternal Stress and the Risk of Lifetime Wheeze in Young Offspring: An Examination by Stressor and Maternal Ethnicity. J Immigr Minor Health 2018; 18:987-995. [PMID: 26343048 DOI: 10.1007/s10903-015-0269-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Prenatal psychosocial stressors may increase the risk of wheeze in young offspring, yet little attention has been given to the effects that maternal ethnicity may have on this relationship. From a population-based cohort of 1193 children, we assessed the effect of maternal prenatal stressors on the risk of lifetime wheeze in young offspring. We further studied whether maternal Latina ethnicity modified these associations. The risk of wheeze in the offspring was increased from high levels of pregnancy anxiety (aRR 1.40, 95 % CI 1.07, 1.83), negative life events (aRR 1.36, 95 % CI 1.06, 1.75), or low paternal support (aRR 1.41, 95 % CI 1.02, 1.96). The risk of lifetime wheeze was stronger in the offspring of Latina mothers than of White mothers for these same stressors. Multiple maternal prenatal stressors are associated with increased risk of lifetime wheeze in young offspring, with slight effect modification by Latina ethnicity.
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Affiliation(s)
- Gretchen Bandoli
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Box 951772, Los Angeles, CA, 90095, USA.
| | - Ondine von Ehrenstein
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Marie E S Flores
- Department of Family and Social Medicine, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Box 951772, Los Angeles, CA, 90095, USA
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18
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Abstract
Objectives To investigate Latina-White differences in birth outcomes in California from 2003 to 2010, looking for evidence of the often-cited "Latina paradox" and assessing the possible role of socioeconomic factors in observed differences. MethodsUsing statewide-representative data from the California Maternal and Infant Health Assessment, an annual population-based postpartum survey, we compared rates of preterm birth (PTB) and low birth weight (LBW) in five groups: U.S.-born non-Latina Whites ("Whites"), U.S.-born Mexican-Americans, U.S.-born non-Mexican Latinas, Mexican immigrants, and non-Mexican Latina immigrants. Logistic regression models examined the relative likelihood of PTB and LBW for women in each Latina subgroup compared with Whites, before and after adjustment for socioeconomic and other covariates. Results In unadjusted analyses, women in each Latina subgroup appeared more likely than White women to have PTB and LBW, although the increased likelihood of LBW among Mexican immigrants was statistically non-significant. After adjustment for less favorable socioeconomic characteristics among Latinas compared with Whites, observed differences in the estimated likelihoods of PTB or LBW for Latina subgroups relative to Whites were attenuated and (with the exception of PTB among U.S.-born Mexican Americans) no longer statistically significant. Conclusions We found no evidence of a "Latina paradox" in birth outcomes, which some have cited as evidence that social disadvantage is not always health-damaging. As observed in several previous studies, our findings were non-paradoxical: consistent with their socioeconomic disadvantage, Latinas had worse birth outcomes than non-Latina White women. Policy-makers should not rely on a "Latina paradox" to ensure good birth outcomes among socioeconomically disadvantaged Latina women.
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19
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Tabb KM, Malinga T, Pineros-Leano M, Andrade FCD. Impact of Pre-Pregnancy Weight and Gestational Weight Gain on Birth Outcomes by Nativity in the United States: A Systematic Review. Healthcare (Basel) 2017; 5:E67. [PMID: 28961162 PMCID: PMC5746701 DOI: 10.3390/healthcare5040067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Disparities in birth outcomes remain a problem in the United States. This study examined whether pre-pregnancy weight and gestational weight gain moderate the association between nativity and birth outcomes in the United States. Methods: We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. We searched PubMED, CINAHL, PsychInfo, and Cochrane Database of Systematic Reviews for relevant articles published before May 27, 2016. Results: Four articles met the eligibility criteria by adjusting for pre-pregnancy or gestational weight gain when examining birth outcomes by nativity. Results: Results from these studies show statistically significant differences in the risk of delivering low birth weight babies between foreign-born and U.S.-born women. These differences remained after adjusting for pre-pregnancy weight or gestational weight gain. However, results stratified by nativity still vary significantly by race/ethnicity. Conclusion: Few investigations include pre-pregnancy weight and gestational weight gain when examining differences in birth outcomes by nativity. Additional studies are needed to examine possible effect modification of these weight variables on the association between nativity and birth outcomes.
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Affiliation(s)
- Karen M Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Tumani Malinga
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Maria Pineros-Leano
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Flavia C D Andrade
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA.
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20
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Breastfeeding and Asthmatic Symptoms in The Offspring of Latinas: The Role of Maternal Nativity. J Immigr Minor Health 2017; 17:1739-45. [PMID: 25576180 DOI: 10.1007/s10903-015-0158-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Previous research has generally found exclusive breastfeeding to protect against asthma in young children. However, maternal nativity in a Latina population has not been assessed as a potential confounder or effect modifier. Using cross-sectional data restricted to Latina mothers (n = 704) from a birth cohort in Los Angeles interviewed in 2003 and 2006, we estimated risk ratios (RR) for exclusive breastfeeding and asthmatic symptoms in the offspring. 56 children (8%) had asthmatic symptoms at age 3.5 years. We found a 49% reduction in risk of asthmatic symptoms with >3 months of exclusive breastfeeding (aRR 0.51, 95% CI 0.28, 0.90). Foreign-born Latinas were more likely to initiate and continue breastfeeding for at least 3 months compared with US-born Latinas. Three or more months of exclusive breastfeeding reduced the risk of asthmatic symptoms in the offspring of Latinas, and maternal nativity did not confound or modify this association.
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Armbrust R, von Rennenberg R, David M. A Retrospective Perinatal Data Analysis of Immigrant and German Women from Representative Birth Cohorts at the Virchow Hospital, Berlin. Geburtshilfe Frauenheilkd 2016; 76:1157-1162. [PMID: 27904165 DOI: 10.1055/s-0042-111011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Introduction: The aim of this study was to define and characterise differences in the level of obstetric care provided to immigrant and German women. Materials and Methods: An analysis of the Virchow Hospital's birth registers was conducted for the years 1974, 1984 and 1994. The study population of 5445 patients was grouped according to ancestry/family origin on the basis of a name analysis, and subsequently also according to parity (primiparous or multiparous). On name analysis 2741 women were defined as German, 1598 were grouped as women of Turkish origin and 810 as immigrants of other origin. χ2 tests and Fisher's exact test were used for significance testing (significance level p < 0.05), and a logistic regression analysis was performed. Results: Rates of caesarean section, episiotomy, higher grade perineal tears and severe postpartum haemorrhage did not differ between the groups. There were however significant differences in the use of uterine stimulants, analgesics in labour and both local and regional anaesthesia, with women of Turkish origin and other immigrants receiving anaesthesia less, but oxytocin more often. Rooming-in was more common among German primipara and multipara from 1984 onwards. Discussion: This retrospective analysis of three historical birth cohorts showed significant differences in perinatal care between German and immigrant women, presumably reflecting deficits in care. It seems remarkable that this trend has not changed over a time span of three decades despite a continuous increase in immigration and acculturation. A "research paradox", however, remains: Despite these increasing rates, there are no current or older, prospective or systematic studies of obstetric care in immigrants.
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Affiliation(s)
- R Armbrust
- Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Gynäkologie, Berlin, Germany
| | - R von Rennenberg
- Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Gynäkologie, Berlin, Germany
| | - M David
- Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Gynäkologie, Berlin, Germany
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22
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Rubin LP. Maternal and pediatric health and disease: integrating biopsychosocial models and epigenetics. Pediatr Res 2016; 79:127-35. [PMID: 26484619 DOI: 10.1038/pr.2015.203] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/13/2015] [Indexed: 11/09/2022]
Abstract
The concepts of allostasis (stability through adaptation) and accumulated life stress (McEwen's allostatic load) aim to understand childhood and adult outcomes. Chronic malnutrition, changes in social condition, and adverse early-life experiences may program phenotypes and contribute to long-lasting disease risk. However, integration of life course approaches, social and economic contexts, and comparison among different biopsychosocial models has not generally been explored. This review critically examines the literature and evaluates recent insights into how environmental stress can alter lifelong hypothalamic-pituitary-adrenal axis and immune system responsiveness and induce metabolic and neurodevelopmental maladaptation. Models of biopsychosocial stress overlap but may consider different conditions. Concepts include allostasis, which incorporates hormonal responses to predictable environmental changes, and Geronimus's "weathering," which aims to explain how socially structured, repeated stress can accumulate and increase disease vulnerability. Weathering emphasizes roles of internalized/interpersonal racism in outcomes disparities. For Mexican immigrants and Mexican Americans, the "acculturation" framework has proven especially useful to explore disparities, including preterm birth and neuropsychiatric risks in childhood. Complexities of stress assessments and recent research into epigenetic mechanisms mediating effects of physical, nutritional, psychological, and social stress are reviewed.
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Affiliation(s)
- Lewis P Rubin
- Department of Pediatrics, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, Texas
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Sentell T, Chang A, Ahn HJ, Miyamura J. Maternal language and adverse birth outcomes in a statewide analysis. Women Health 2015; 56:257-80. [PMID: 26361937 DOI: 10.1080/03630242.2015.1088114] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Limited English proficiency is associated with disparities across diverse health outcomes. However, evidence regarding adverse birth outcomes across languages is limited, particularly among U.S. Asian and Pacific Islander populations. The study goal was to consider the relationship of maternal language to birth outcomes using statewide hospitalization data. Detailed discharge data from Hawaii childbirth hospitalizations from 2012 (n = 11,419) were compared by maternal language (English language or not) for adverse outcomes using descriptive and multivariable log-binomial regression models, controlling for race/ethnicity, age group, and payer. Ten percent of mothers spoke a language other than English; 93% of these spoke an Asian or Pacific Islander language. In multivariable models, compared to English speakers, non-English speakers had significantly higher risk (adjusted relative risk [ARR]: 2.02; 95% confidence interval [CI]: 1.34-3.04) of obstetric trauma in vaginal deliveries without instrumentation. Some significant variation was seen by language for other birth outcomes, including an increased rate of primary Caesarean sections and vaginal births after Caesarean, among non-English speakers. Non-English speakers had approximately two times higher risk of having an obstetric trauma during a vaginal birth when other factors, including race/ethnicity, were controlled. Non-English speakers also had higher rates of potentially high-risk deliveries.
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Affiliation(s)
- Tetine Sentell
- a Office of Public Health Studies , University of Hawaii at Manoa , Honolulu , Hawaii , USA
| | - Ann Chang
- b Department of Obstetrics, Gynecology, and Women's Health , John A. Burns School of Medicine, University of Hawaii , Honolulu , Hawaii , USA
| | - Hyeong Jun Ahn
- c Biostatistics Core, John A. Burns School of Medicine , University of Hawaii , Honolulu , Hawaii , USA
| | - Jill Miyamura
- d Hawaii Health Information Corporation , Honolulu , Hawaii , USA
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Sentell T, Chang A, Cheng Y, Miyamura J. Maternal quality and safety outcomes for Asians and Pacific Islanders in Hawai'i: an observational study from five years of statewide data. BMC Pregnancy Childbirth 2014; 14:298. [PMID: 25174436 PMCID: PMC4158120 DOI: 10.1186/1471-2393-14-298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/27/2014] [Indexed: 11/14/2022] Open
Abstract
Background Empirical evidence regarding maternal quality and safety outcomes across heterogeneous Asian and Pacific Islanders subgroups in the United States is limited, despite the importance of this topic to health disparities research and quality improvement efforts. Methods Detailed discharge data from all Hawai‘i childbirth hospitalizations (n = 75,725) from 2008 to 2012 were considered. Validated measures of maternal quality and safety were compared in descriptive and multivariable models across seven racial/ethnic groups: Filipino, Native Hawaiian, other Pacific Islander (e.g., Samoan, Tongan, Micronesian), Japanese, Chinese, white, and other race/ethnicity. Multivariable models adjusted for age group, payer, rural vs. urban hospital location, multiple gestation, and high-risk pregnancy. Results Compared to whites, Japanese, Filipinos, and Other Pacific Islanders had significantly higher overall delivery complication rates while Native Hawaiians had significantly lower rates. Native Hawaiians also had significantly lower rates of obstetric trauma in vaginal delivery with and without instruments compared to whites (Rate Ratio (RR):0.66; 95% CI:0.50-0.87 and RR:0.62; 95% CI:0.52-0.74, respectively). Japanese and Chinese had significantly higher rates of obstetric trauma for vaginal deliveries without instruments (RR:1.52; 95% CI:1.27-1.81 and RR:1.95;95% CI:1.53-2.48, respectively) compared to whites, and Chinese also had significantly higher rates of birth trauma in vaginal delivery with instrument (RR 1.42; 95% CI:1.06-1.91). Filipinos and Other Pacific Islanders had significantly higher rates of Cesarean deliveries compared to whites (RR:1.15; 95% CI:1.11-1.20 and RR:1.16; 95% CI:1.10-1.22, respectively). Other Pacific Islanders also had significantly higher rates of vaginal births after Cesarean (VBAC) deliveries compared to whites (RR: 1.28; 95% CI:1.08-1.51) and Japanese had significantly lower rates of uncomplicated VBACs (RR:0.77; 95% CI:0.63-0.94). Conclusions Significant variation was seen for Asian and Pacific Islander subgroups across maternal quality and safety outcomes. Notably, high rates of obstetric trauma were seen among Chinese and Japanese vaginal deliveries. Filipinos and other Pacific Islanders had high rates of Cesarean deliveries. Native Hawaiians had better quality and safety outcomes than whites on several quality and safety measures, including obstetric trauma during vaginal delivery. Other Pacific Islanders had high rates of VBACs, while Japanese had lower rates. This information can help guide clinical practice, research, and quality improvement efforts.
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Affiliation(s)
- Tetine Sentell
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Biomed T102, Honolulu, HI 96822, USA.
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Newborn Birth Weights and Related Factors of Native and Immigrant Residents of Spain. J Immigr Minor Health 2014; 17:339-48. [DOI: 10.1007/s10903-014-0089-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McCurdy SA, Stoecklin-Marois MT, Tancredi DJ, Hennessy-Burt TE, Schenker MB. Region of birth, sex, and reproductive health in rural immigrant latino farmworkers: the MICASA study. J Rural Health 2014; 31:165-75. [PMID: 25066185 DOI: 10.1111/jrh.12083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Characterize sexual and reproductive health among immigrant Latino farmworkers. METHODS We surveyed 806 immigrant Latino farmworkers from Mexico and Central America in a rural agricultural community in California's Central Valley. FINDINGS A total of 556 respondents were born in Mexico (272 men, 284 women) and 250 in Central America (135 men, 115 women). The majority entered the United States as young adults, with median age at immigration ranging from 20 (Mexican-born men) to 24 (Central American-born women). Nearly 95% of respondents were married or cohabiting. Median age for sexual debut was 18 for women and was younger for men (adjusted mean difference: -2.1 years, 95% CI: -2.6 to -1.7). Median number of lifetime sexual partners was 1 for women and greater for men (adjusted mean difference: 2.0 partners, 95% CI: 1.3-2.7). Contraception use was less likely among men and among Central American women compared to Mexico-born women. Among sexually active persons not using contraception, the most common reasons for nonuse were "Don't want to"/"Don't like any" followed by desire to become or being pregnant. Women reported a median of 3 pregnancies; there were no significant differences based on respondents' region of birth. CONCLUSIONS This group of Latino immigrants demonstrated behaviors conducive to reproductive health: late sexual debut, few lifetime sexual partners, and high prevalence of marriage. Preventive education campaigns should focus on maintaining healthy behaviors, especially in men. Identifying groups with common provenance and cultural heritage may aid in maximizing acceptability and effectiveness of prevention programs.
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Affiliation(s)
- Stephen A McCurdy
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, California
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Fuentes-Afflick E, Odouli R, Escobar GJ, Stewart AL, Hessol NA. Maternal acculturation and the prenatal care experience. J Womens Health (Larchmt) 2014; 23:688-706. [PMID: 24979178 DOI: 10.1089/jwh.2013.4585] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acculturation may influence women's perceptions of health care experiences and may explain the epidemiologic paradox, whereby foreign-born women have lower rates of adverse birth outcomes than United States (US)-born women. We evaluated the relationship between maternal acculturation and specific dimensions of prenatal interpersonal processes of care (IPC) in ethnically diverse women. METHODS Cross-sectional analysis of 1243 multiethnic, postpartum women who delivered at Kaiser Permanente Medical Center in Walnut Creek or San Francisco General Hospital. Women retrospectively reported on their experiences in seven domains of IPC during their pregnancy pertaining to communication, decision making, and interpersonal style. The primary independent variables were four measures of maternal acculturation: birthplace, English language proficiency, the number of years residing in the US, and age at immigration to the US. Generalized linear models, stratified by infant outcome, measured the association between each maternal acculturation measure and specific IPC domains while adjusting for type of health insurance, demographic, and reproductive factors. RESULTS Approximately 60% of the sample was foreign-born, 36% reported low English proficiency, 43% had resided in the US <10 years, and 35% were age 20 years or older when they immigrated to the US. Over 64% of the women reported having public insurance during pregnancy. In adjusted analyses among women who delivered term and normal birth weight infants, less acculturated women and women with non-private health insurance were more likely to have higher mean IPC scores when compared to more acculturated or US-born women and women with private health insurance, respectively. CONCLUSION In a large and ethnically diverse sample of childbearing women in Northern California, less acculturated pregnant women reported better prenatal care experiences than more acculturated and US-born women, another dimension of the "epidemiologic paradox." However, the relationship between acculturation and IPC, as reported during the postpartum period, differed according to infant outcomes.
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Affiliation(s)
- Elena Fuentes-Afflick
- 1 Department of Pediatrics and Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California
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Maternal occupation and term low birth weight in a predominantly latina population in los angeles, california. J Occup Environ Med 2014; 55:1046-51. [PMID: 23969503 DOI: 10.1097/jom.0b013e31829888fe] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Focusing on Latinas, we investigated whether maternal occupations during pregnancy increase term low birth weight (TLBW) (less than 2500 g; 37 weeks or more). METHODS In a case-control study (n = 1498) nested within a 2003 birth cohort (n = 58,316) in Los Angeles County, California (65% Latina), we assessed the influence of maternal occupation on TLBW, using Occupational Codes based on the 2000 US Census Occupational Classification System. RESULTS Odds ratios (ORs) for TLBW were increased among women working during pregnancy in "transportation and material moving operations" (adjusted OR = 3.28; 95% confidence interval = 1.00 to 10.73), "food preparation and serving occupations" (adjusted OR = 3.03, 95% confidence interval = 1.21 to 7.62), or "production occupations" (adjusted OR = 2.63, 95% confidence interval = 1.01 to 6.82) compared with "office occupations;" 73% to 93% of women working in these higher-risk jobs were immigrant Latinas. CONCLUSIONS Working conditions in various jobs held mainly by first-generation immigrant Latinas increase risks for TLBW and need to be addressed to develop strategies to reduce TLBW.
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von Ehrenstein OS, Wilhelm M, Wang A, Ritz B. Preterm birth and prenatal maternal occupation: the role of Hispanic ethnicity and nativity in a population-based sample in Los Angeles, California. Am J Public Health 2013; 104 Suppl 1:S65-72. [PMID: 24354840 DOI: 10.2105/ajph.2013.301457] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated preterm birth (PTB) in relation to maternal occupational exposure and whether effect measures were modified by Hispanic ethnicity and nativity in a population-based sample with high proportion of Hispanics. METHODS We used a case-control study (n = 2543) nested within a cohort of 58,316 births in Los Angeles County, California, in 2003. We categorized prenatal occupations using the US Census Occupation Codes and Classification System and developed a job exposure matrix. Odds ratios for PTB were estimated using logistic regression. RESULTS Odds ratios for PTB were increased for all women in health care practitioner and technical occupations, but the 95% confidence intervals included the null value; effects were more pronounced among Hispanics. We estimated elevated odds ratios for foreign-born Hispanic women in building and grounds cleaning and maintenance occupations. Shift work and physically demanding work affected births among US-born but not foreign-born Hispanics. CONCLUSIONS Hispanic women are at particular risk for PTB related to adverse prenatal occupational exposure. Nativity may moderate these effects on PTB. Maternal occupational exposures likely contribute to ethnic disparities in PTB.
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Affiliation(s)
- Ondine S von Ehrenstein
- Ondine S. von Ehrenstein is with the Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA). Michelle Wilhem, Anthony Wang, and Beate Ritz are with the Department of Epidemiology, Fielding School of Public Health, UCLA
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de Leon Siantz ML, Castaneda X, Benavente V, Peart T, Felt E. The health status of latino immigrant women in the United States and future health policy implications of the affordable care act. Glob Adv Health Med 2013; 2:70-4. [PMID: 24416697 PMCID: PMC3833563 DOI: 10.7453/gahmj.2013.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Immigrant women of Mexican birth face unique health challenges in the United States. They are at increased risk for developing many preventable health conditions due in part to limited access to healthcare and benefits, legal status, and inadequate income. Increased vulnerability of women has established a growing need to focus on their healthcare needs because of their role, position, and influence in the family. The purpose of this article is to review factors that impact the health status of Mexican-born women living in the United States and review policy implications of the Affordable Care Act for this population. Mexican-born women are the largest female immigrant group in the United States. Therefore, they comprise the group that will need health coverage in the greatest proportion. As a result, there will be a need for culturally and linguistically appropriate healthcare services and culturally sensitive providers.
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Affiliation(s)
- Mary Lou de Leon Siantz
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, United States
| | - Xochitl Castaneda
- School of Public Health, Health Initiative of the Americas, University of California, Berkeley, United States
| | - Viola Benavente
- William F. Connell School of Nursing, Boston College, Massachusetts, United States
| | - Tasha Peart
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, United States
| | - Emily Felt
- School of Public Health, Health Initiative of the Americas, University of California, Berkeley, United States
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Becerra TA, Wilhelm M, Olsen J, Cockburn M, Ritz B. Ambient air pollution and autism in Los Angeles county, California. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:380-6. [PMID: 23249813 PMCID: PMC3621187 DOI: 10.1289/ehp.1205827] [Citation(s) in RCA: 218] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 12/17/2012] [Indexed: 04/14/2023]
Abstract
BACKGROUND The prevalence of autistic disorder (AD), a serious developmental condition, has risen dramatically over the past two decades, but high-quality population-based research addressing etiology is limited. OBJECTIVES We studied the influence of exposures to traffic-related air pollution during pregnancy on the development of autism using data from air monitoring stations and a land use regression (LUR) model to estimate exposures. METHODS Children of mothers who gave birth in Los Angeles, California, who were diagnosed with a primary AD diagnosis at 3-5 years of age during 1998-2009 were identified through the California Department of Developmental Services and linked to 1995-2006 California birth certificates. For 7,603 children with autism and 10 controls per case matched by sex, birth year, and minimum gestational age, birth addresses were mapped and linked to the nearest air monitoring station and a LUR model. We used conditional logistic regression, adjusting for maternal and perinatal characteristics including indicators of SES. RESULTS Per interquartile range (IQR) increase, we estimated a 12-15% relative increase in odds of autism for ozone [odds ratio (OR) = 1.12, 95% CI: 1.06, 1.19; per 11.54-ppb increase] and particulate matter ≤ 2.5 µm (OR = 1.15; 95% CI: 1.06, 1.24; per 4.68-μg/m3 increase) when mutually adjusting for both pollutants. Furthermore, we estimated 3-9% relative increases in odds per IQR increase for LUR-based nitric oxide and nitrogen dioxide exposure estimates. LUR-based associations were strongest for children of mothers with less than a high school education. CONCLUSION Measured and estimated exposures from ambient pollutant monitors and LUR model suggest associations between autism and prenatal air pollution exposure, mostly related to traffic sources.
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Affiliation(s)
- Tracy Ann Becerra
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California 90095-1772, USA
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Heck JE, Lombardi CA, Meyers TJ, Cockburn M, Wilhelm M, Ritz B. Perinatal characteristics and retinoblastoma. Cancer Causes Control 2012; 23:1567-75. [PMID: 22843021 PMCID: PMC3429932 DOI: 10.1007/s10552-012-0034-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The etiology of retinoblastoma remains poorly understood. In the present study, we examined associations between perinatal factors and retinoblastoma risk in California children. METHODS We identified 609 retinoblastoma cases (420 unilateral, 187 bilateral, and 2 with laterality unknown) from California Cancer Registry records of diagnoses 1988-2007 among children < 6 years of age. We randomly selected 209,051 controls from California birth rolls. The source of most study data was birth certificates. Multivariable logistic regression was used to examine associations between retinoblastoma and perinatal characteristics. RESULTS Bilateral retinoblastoma was associated with greater paternal age [for fathers over 35, crude odds ratio (OR) = 1.73, 95 % confidence interval (CI) 1.20, 2.47] and with twin births (OR = 1.93, 95 % CI 0.99, 3.79). Among unilateral cases, we observed an increased risk among children of US-born Hispanic mothers (OR = 1.34, 95 % CI 1.01, 1.77) while a decreased risk was observed for infants born to mothers with less than 9 years of education (OR = 0.70, 95 % CI 0.49, 1.00), a group that consisted primarily of mothers born in Mexico. We observed that maternal infection in pregnancy with any STD (OR = 3.59, 95 % CI 1.58, 8.15) was associated with bilateral retinoblastoma. CONCLUSIONS This study supports the findings of previous investigations reporting associations between parental age, HPV infection, and retinoblastoma.
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Affiliation(s)
- Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, Box 951772, 650 Charles E. Young Drive, Los Angeles, CA 90095-1772, USA.
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