A Critical Examination of Acculturation: The Impact of Health Behaviors, Social Support and Economic Resources on Birth Weight among Women of Mexican Descent

HPV vaccine uptake among daughters of Latinx immigrant mothers: Findings from a cluster randomized controlled trial of a community-based, culturally relevant intervention

OBJECTIVE

We examined the efficacy of a culturally relevant, community-based HPV vaccination intervention among Latinx immigrant mothers with daughters aged 9-12 in Alabama.

METHODS

We conducted a cluster-randomized controlled trial with "place of residence" (e.g., apartment complexes, trailer parks) as the unit of randomization that evaluated two interventions: 1) promotion of HPV vaccination and 2) promotion of healthy eating and appropriate nutrition label interpretation. Identical baseline/post/7-month follow up questionnaires were completed by all participants and both interventions consisted of four group sessions and one individual session. A total of 40 locations were randomized with 317 mother-daughter dyads enrolled in the study between May 2013 and October 2017.

RESULTS

A total of 278 mother-daughter dyads met full eligibility and initiated the intervention/control participation. Retention rate overall was 93.2% (92.6% for the intervention arm and 93.7% for the control arm). Daughters in the intervention arm were significantly more likely to receive one, two, and three doses of HPV vaccine than daughters in the control arm p < 0.001). In multivariate analyses, mothers in the intervention arm had a six times greater odds of vaccinating daughters with the first dose (OR = 5.96, 95% CI: 3.38, 10.49), eight times greater odds of vaccinating daughters with the second dose (OR = 8.09, 95% CI: 4.0, 16.35), and more than 16 times greater odds of completing the three-dose HPV vaccine series than mothers in the control arm after adjusting for mother's age, time in the U.S., income, and daughter's health insurance status (OR = 16.5, 95% CI: 5.73, 47.48). Only perceived risk of their daughters' future HPV infection remained significant as a predictor of three-dose HPV vaccination completion (OR = 0.69, 95% CI: 0.23, 2.1).

CONCLUSIONS

A theory-driven, culturally-relevant intervention developed through extensive formative assessments in collaboration with community members can effectively promote HPV vaccination among 9-12 years of age daughters of Latina immigrants.

Acculturation and Acculturation Stress: A Social-Epidemiological Approach to Mexican Migrant Farmworkers’ Health

Utilizing a cluster sampling design to maximize representativeness, we look at the health effects of acculturation and acculturation stressors among 1,001 adult migrant farmworkers in Fresno, California. Using self-ratings of mental and physical health as well as the CES-D depression scale, we find that the amount of time one spends in the United States, the level of English-language usage, as well as the intensity of acculturation stresses that one reports, are all related to declines in health. In addition, acculturation stress has more deleterious effects on self-rated health (both physical and mental) among the more highly acculturated.

Racial/Ethnic and nativity differences in birth outcomes among mothers in New York City: the role of social ties and social support

Immigrants have lower rates of low birth weight (LBW) and to some extent preterm birth (PTB), than their US-born counterparts. This pattern has been termed the 'immigrant health paradox'. Social ties and support are one proposed explanation for this phenomenon. We examined the contribution of social ties and social support to LBW and PTB by race/ethnicity and nativity among women in New York City (NYC). The NYC Pregnancy Risk Assessment Monitoring System survey (2004-2007) data, linked with the selected items from birth certificates, were used to examine LBW and PTB by race/ethnicity and nativity status and the role of social ties and social support to adverse birth outcomes using bivariate and multivariable analyses. SUDAAN software was used to adjust for complex survey design and sampling weights. US- and foreign-born Blacks had significantly increased odds of PTB [adjusted odds ratio (AOR) = 2.43, 95 % CI 1.56, 3.77 and AOR = 2.6, 95 % CI 1.66, 4.24, respectively] compared to US-born Whites. Odds of PTB among foreign-born Other Latinas, Island-born Puerto Ricans' and foreign-born Asians' were not significantly different from US-born Whites, while odds of PTB for foreign-born Whites were significantly lower (AOR = 0.47, 95 % CI 0.26, 0.84). US and foreign-born Blacks' odds of LBW were 2.5 fold that of US-born Whites. Fewer social ties were associated with 32-39 % lower odds of PTB. Lower social support was associated with decreased odds of LBW (AOR 0.69, 95 % CI 0.50, 0.96). We found stronger evidence of the immigrant health paradox across racial/ethnic groups for PTB than for LBW. Results also point to the importance of accurately assessing social ties and social support during pregnancy and to considering the potential downside of social ties.

Metropolitan residential segregation and very preterm birth among African American and Mexican-origin women

Residential segregation is associated with poor health-including poor birth outcomes-among African Americans in US cities and metropolitan areas. However, the few existing studies of this relationship among Mexican-origin women have produced mixed results. In this study, the relationship between segregation and very preterm birth was examined with National Center for Health Statistics (NCHS) data on singleton births to African American women (n = 400,718) in 238 metropolitan areas and to Mexican-origin women (n = 552,382) in 170 metropolitan areas. The study evaluated 1) whether residential segregation is positively associated with very preterm birth among both African American and Mexican-origin women and 2) if so, whether exposure to neighborhood poverty accounts for these associations. Results from multi-level analysis indicate that residential segregation is positively associated with very preterm birth among both groups of women. However, this association is robust across different measures of segregation only for African Americans. Conversely, differences across metropolitan areas in average levels of exposure to neighborhood poverty account for the positive association between segregation and very preterm birth among Mexican-origin women, but not among African American women.

Contextualizing nativity status, Latino social ties, and ethnic enclaves: an examination of the 'immigrant social ties hypothesis'

OBJECTIVES

Researchers have posited that one potential explanation for the better-than-expected health outcomes observed among some Latino immigrants, vis-à-vis their US-born counterparts, may be the strength of social ties and social support among immigrants.

METHODS

We examined the association between nativity status and social ties using data from the Chicago Community Adult Health Study's Latino subsample, which includes Mexicans, Puerto Ricans, and other Latinos. First, we used ordinary least squares (OLS) regression methods to model the effect of nativity status on five outcomes: informal social integration; social network diversity; network size; instrumental support; and informational support. Using multilevel mixed-effects regression models, we estimated the association between Latino/immigrant neighborhood composition and our outcomes, and whether these relationships varied by nativity status. Lastly, we examined the relationship between social ties and immigrants' length of time in the USA.

RESULTS

After controlling for individual-level characteristics, immigrant Latinos had significantly lower levels of social ties than their US-born counterparts for all the outcomes, except informational support. Latino/immigrant neighborhood composition was positively associated with being socially integrated and having larger and more diverse social networks. The associations between two of our outcomes (informal social integration and network size) and living in a neighborhood with greater concentrations of Latinos and immigrants were stronger for US-born Latinos than for immigrant Latinos. US-born Latinos maintained a significant social ties advantage over immigrants - regardless of length of time in the USA - for informal social integration, network diversity, and network size.

CONCLUSION

At the individual level, our findings challenge the assumption that Latino immigrants would have larger networks and/or higher levels of support and social integration than their US-born counterparts. Our study underscores the importance of understanding the contexts that promote the development of social ties. We discuss the implications of these findings for understanding Latino and immigrant social ties and health outcomes.

The Mexican Health Paradox

The Mexican health paradox refers to initially favorable health and mental health outcomes among recent Mexican immigrants to the United States. The subsequent rapid decline in Mexican health outcomes has been attributed to the process of acculturation to U.S. culture. However, the construct of acculturation has come under significant criticism for oversimplifying complex relations between health, behavior, race and ethnic relations, and the environment. Moreover, measurement issues for the construct abound. This article reviews the current state of the acculturation debate, and argues for an integration of current theoretical perspectives and critiques of the construct in order to strengthen the explanatory power of acculturation with regard to the Mexican health paradox.

Acculturation and health care utilization among Mexican heritage women in the United States

With the increasing Latino population in the United States, it is critical to examine the influence of the process of acculturation on health care practices and utilization. The purpose of this study was to evaluate the relationship between acculturation level and post-partum visit (PPV) compliance among Latinas participating in a larger psycho-educational intervention aimed at encouraging women to engage in positive healthcare practices. Acculturation was measured with the Bicultural Involvement Questionnaire which assigned participants to five categories: Assimilated, Separated, Moderate, Bicultural and Alienation. Logistic Regression analyses were conducted to predict post-partum visit attendance. Odds ratios and relative risk of not attending the post-partum visit are presented. Results suggest women in the Separation and Assimilation groups were less likely than bicultural group members to attend the PPV. The only other variable that was significant in this analysis is the group condition, indicating that the intervention group was more likely to attend the PPV than the control group. Women identifying as bicultural seem to participate more actively in their own healthcare as they draw on the cultural assets that have a positive influence on informal health practices, such as healthy eating and refraining from drug use. Bicultural group members can also use formal skills related to language and knowledge of the dominant culture to help effectively navigate the healthcare system. Implications for research, intervention and practice are discussed to improve healthcare practices and increase utilization among Latinas.

Acculturation among Mexican-heritage preadolescents: A latent class analysis

This study applies advanced conceptualization and measurement to an analysis of acculturation among 1,632 Mexican-heritage preadolescents. We assessed whether - and how - multiple measures combine to form a latent acculturation construct that groups individuals into classes; and determine how many and what classes (or types) of acculturation are experienced by this sample of 5(th) graders. Measures included attitudinal, behavioral, and linguistic acculturation, generation status, time in the U.S., ethnic identification, and contact with the culture of origin. The analysis identified five classes of acculturation, differing in size and characterized by specific measures of acculturation: less acculturated, moderately bicultural, strongly bicultural, highly acculturated, and marginalized. Although most youths fell into the first four classes, consonant with their exposure to American society, a small minority of youths fell into the last class. Despite substantial exposure to U.S. culture and recent exposure to Mexican culture, these youth showed little affinity for either culture.

Migrants' competing commitments: sexual partners in urban Africa and remittances to the rural origin

Migrants form nonfamilial ties in urban destinations, which could compete with origin families for a share of remittances. A framework of competing commitment predicts that new relationships affect remittances depending on the extent to which they substitute for the benefits provided by origin families. Analyses of data from urban migrants in Kenya show that serious nonmarital sexual partners substitute for psychosocial support from the rural family and that material transfers migrants give to these partners significantly reduce remittances. The findings have implications for the ways scholars conceive of competition, the nature of exchange, and substitution of support across intimate relationships.

Toward a dynamic conceptualization of social ties and context: implications for understanding immigrant and Latino health

Researchers have posited that social ties and social support may contribute to better-than-expected health outcomes among Mexican immigrants vis-à-vis their US-born counterparts. However, in our review of studies examining social ties and health by immigration-related variables among this group, we found little support for this hypothesis. To better understand the social factors that contribute to the health of Mexicans in the United States, we conducted a qualitative analysis of social relationships and social context among first- and second-generation Mexican women. Our results highlight the interplay between immigration processes and social ties, draw attention to the importance of identity support and transnational social relationships, and suggest ways to reconceptualize the relationship between social contexts, social ties, and immigrant and Latino health.

One size does not fit all: an examination of low birthweight disparities among a diverse set of racial/ethnic groups

To examine disparities in low birthweight using a diverse set of racial/ethnic categories and a nationally representative sample. This research explored the degree to which sociodemographic characteristics, health care access, maternal health status, and health behaviors influence birthweight disparities among seven racial/ethnic groups. Binary logistic regression models were estimated using a nationally representative sample of singleton, normal for gestational age births from 2001 using the ECLS-B, which has an approximate sample size of 7,800 infants. The multiple variable models examine disparities in low birthweight (LBW) for seven racial/ethnic groups, including non-Hispanic white, non-Hispanic black, U.S.-born Mexican-origin Hispanic, foreign-born Mexican-origin Hispanic, other Hispanic, Native American, and Asian mothers. Race-stratified logistic regression models were also examined. In the full sample models, only non-Hispanic black mothers have a LBW disadvantage compared to non-Hispanic white mothers. Maternal WIC usage was protective against LBW in the full models. No prenatal care and adequate plus prenatal care increase the odds of LBW. In the race-stratified models, prenatal care adequacy and high maternal health risks are the only variables that influence LBW for all racial/ethnic groups. The race-stratified models highlight the different mechanism important across the racial/ethnic groups in determining LBW. Differences in the distribution of maternal sociodemographic, health care access, health status, and behavior characteristics by race/ethnicity demonstrate that a single empirical framework may distort associations with LBW for certain racial and ethnic groups. More attention must be given to the specific mechanisms linking maternal risk factors to poor birth outcomes for specific racial/ethnic groups.

Hispanic drug abuse in an evolving cultural context: an agenda for research

Drug abuse in the U.S. Hispanic population appears to be in a dynamic state of acceleration, although there are differences in drug use patterns between U.S.-born and foreign-born Hispanics, and across Hispanic subgroups (i.e., Mexican, Cuban, Puerto Rican, and Central or South American). An understanding of the consequences of cultural adjustments for drug use is needed to effectively anticipate the scope and dimensions of illicit drug use in the largest, rapidly growing, minority group in the U.S. This paper provides an epidemiologic overview of current Hispanic drug use, summarizes research on the relationship between culture change and drug use, organized according to individual, social (i.e., family and peer group), and community level influences on drug use, and offers a systematic agenda for future research.

The differential effect of foreign-born status on low birth weight by race/ethnicity and education

OBJECTIVES

This article investigates whether foreign-born status confers a protective effect against low birth weight (LBW) and whether this protective effect varies across racial/ethnic groups and by socioeconomic status (ie, education) within various racial/ethnic groups.

METHODS

Logistic regression analyses of the Detail Natality Data, 1998 (n = 2,436,890), were used to examine differentials in LBW by nativity across racial/ethnic groups and by education level.

RESULTS

Although foreign-born status does not protect against LBW among white women (95% confidence interval [CI]: 0.96, 1.03) and it increases the risk among Asian women by 24% (95% CI: 1.13, 1.36), it reduces the risk by approximately 25% among black women (95% CI: 0.72, 0.78) and by approximately 19% among Hispanic women (95% CI: 0.78, 0.84). By educational attainment, for whites, blacks, and Hispanics the protective effect of foreign-born status is stronger among women with low education (ie, 0-11 years) than among women with more education. The educational gradient in LBW is less pronounced among foreign-born white, black, and Hispanic women than among their US-born counterparts.

CONCLUSIONS

Foreign-born status is associated with LBW. The direction and strength of this association varies across racial/ethnic groups, and within those groups it varies by educational level. Future research may test hypotheses regarding the mechanisms underlying these variations in LBW, including health selection of immigrants, cultural factors, social support, and social environment.

Acculturation Status and Substance Use Prevention with Mexican and Mexican-American Youth

This study examined whether language preference, as an indicator of acculturation, moderated the effects of a culturally grounded substance use prevention intervention for Mexican and Mexican American middle school students (N = 2,146) in Phoenix, Arizona. The main hypothesis was that levels of program effectiveness would vary based on the language preference of the students and the specific culturally grounded version of the intervention they were assigned. Findings show that matching language preference to particular versions of the intervention did not influence substance use related program outcomes, but that overall program effects (intervention versus control) did vary by language preference. English-language dominant participants, the most at risk sub-group, responded more positively to the intervention, while Spanish dominant, who had low substance use rates at baseline, and bilingual participants did not demonstrate significant differences between the intervention and control groups. Implications for school social work prevention interventions and prevention science in general, are discussed.

The Latina paradox: an opportunity for restructuring prenatal care delivery

Latina mothers in the United States enjoy surprisingly favorable birth outcomes despite their social disadvantages. This "Latina paradox" is particularly evident among Mexican-born women. The social and cultural factors that contribute to this paradox are maintained by community networks--informal systems of prenatal care that are composed of family, friends, community members, and lay health workers. This informal system confers protective factors that provide a behavioral context for healthy births. US-born Latinas are losing this protection, although it could be maintained with the support of community-based informal care systems. We recommend steps to harness the benefits of informal systems of prenatal care in Latino communities to meet the increasing needs of pregnant Latina women.

Should "acculturation" be a variable in health research? A critical review of research on US Hispanics

Acculturation has become a popular variable in research on health disparities among certain ethnic minorities, in the absence of serious reflection about its central concepts and assumptions. Key constructs such as what constitutes a culture, which traits pertain to the ethnic versus "mainstream" culture, and what cultural adaptation entails have not been carefully defined. Using examples from a systematic review of recent articles, this paper critically reviews the development and application of the concept of acculturation in US health research on Hispanics. Multiple misconceptions and errors in the central assumptions underlying the concept of acculturation are examined, and it is concluded that acculturation as a variable in health research may be based more on ethnic stereotyping than on objective representations of cultural difference.