Critical analyses of Latina mortality: disentangling the heterogeneity of ethnic origin, place, nativity, race, and socioeconomic status

Despite the significant body of research on social determinants of health (SDH) and mortality, limited knowledge is available on the epidemiology of aggregated Latino health overall, and by women and subgroups. In population health studies, U.S. Latinos often are considered a monolithic population and presented as an aggregate, obscuring the diversity and variations within and across Latino subgroups, contributing to missed opportunities to identify SDH of health outcomes, and limiting the understanding of health differences. Given diverse environmental, racial, class, and geographic factors, a specific focus on women facilitates a more in-depth view of health disparities. This paper provides a scoping review of current gaps in research that assesses the relationships between SDH and mortality rates for the five leading causes of chronic-disease related deaths among Latinas by ethnic origin, place, race, and SES. We analyzed 2020 national mortality statistics from the CDC WONDER Online database jointly with reviews of empirical articles on Latina health, employing the EBSCOhost MEDLINE databases. These findings challenge the phenomenon of the Hispanic paradox that identified Latinos as a relatively healthy population compared to non-Hispanic White populations despite their lower economic status. The findings confirm that prior research on Latino women had methodological limitations due to the exclusion of SDH and an overemphasis on culturalist perspectives, while overlooking the critical role of socioeconomic impacts on health. Findings indicate major knowledge gaps in Latina mortality by SDH and subgroups that may undermine surveillance efforts and treatment efficacy. We offer forward-looking recommendations to assure the inclusion of key SDH associated with Latina mortality by subgroup as essential to inform future studies, intervention programs, and health policy.

Peer Support to Enhance Type 2 Diabetes Prevention Among African American and Latino Adults

Social support occurs within complex social networks that are diffusely embedded within the social determinants of health. Social networks operate through five primary interconnected pathways: (1) provision of social support; (2) social influence; (3) social engagement; (4) social capital; and (5) social cohesion. Research has demonstrated that increased social support can have a beneficial impact on Type 2 Diabetes (T2DM) prevention and outcomes through culturally tailored Diabetes Prevention Programs in minority communities. Further research is needed to fully measure the impact of social network peer support on T2DM outcomes to better operationalize and scale up community specific interventions.

Early career Latinas in STEM: Challenges and solutions

Mexican, Puerto Rican, and Central American Ancestry (MPRCA) individuals represent 82% of US Latinos. An intergenerational group of MPRCA women and allies met to discuss persistent underrepresentation of MPRCA women in STEM, identifying multi-level challenges and solutions. Implementation of these solutions is important and will benefit MPRCA women and the entire academic community.

URiMs and Imposter Syndrome: Symptoms of Inhospitable Work Environments?

BACKGROUND AND OBJECTIVES

Workforce diversity is associated with improved health outcomes. Currently, primary care physicians who are underrepresented in medicine (URiM) disproportionately work in underserved areas. Increasingly, URiM faculty describe experiencing imposter syndrome (IS), including a sense of not belonging in their work environment and a lack of recognition. Studies of IS among family medicine faculty are not prevalent nor are the factors most associated with IS among URiMs and non-URiMs. The objectives of our study were to (1) determine prevalence of IS among URiM faculty compared to non-URiM faculty; (2) determine factors associated with IS among both URiM and non-URiM faculty.

METHODS

Four hundred thirty participants completed anonymous, electronic surveys. We measured IS using a 20-item validated scale.

RESULTS

Among all respondents, 43% reported frequent/intense IS. URiMs were not more likely than non-URiMs to report IS. Factors independently associated with IS for both URiM and non-URiM respondents include inadequate mentorship (P<.05) and poor professional belonging (P<.05). However, inadequate mentorship, low professional integration and belonging, and racial/ethnic discrimination-based exclusion from professional opportunities (all P<.05) were more prevalent among URiMs than non-URiMs.

CONCLUSIONS

While URiMs are not more likely than non-URiMS to experience frequent/intense IS, they are more likely to report racial/ethnic discrimination, inadequate mentorship, and low professional integration and belonging. These factors are associated with IS and may be reflective of how institutionalized racism impedes mentorship and optimal professional integration, which may be internalized and perceived as IS among URiM faculty. Yet, URiM career success in academic medicine is crucial for achieving health equity.

Institutional penalty: mentoring, service, perceived discrimination and its impacts on the health and academic careers of Latino faculty

Institutional ethnoracial taxation increases work stress and reduces research productivity among Mexican American and Puerto Rican faculty. Latinos are a heterogenous group, yet little is known about differences in taxation, discrimination experiences and health by race, ethnicity, and nativity. This study explores three questions: Are there differences between URM (historically underrepresented) and non-URM Latinos in: 1) demographic factors, 2) taxation experiences and 3) physical and depressive symptoms and role overload? Survey respondents included 134 Mexican American, 76 Puerto Rican, and 108 non-URM Latino faculty. URM respondents are significantly less likely to report white race, more likely to report racial/ethnic discrimination, and more likely to report joint appointments compared to non-URM faculty. Almost 25% of respondents report clinical depressive symptoms. Disproportionate combinations of taxation from service, administrative demands and discrimination without institutional supports constitute an "Institutional Penalty." Reducing taxation demands requires institutional equity agendas to support research productivity, promotion, and retention.

The Intellectual Roots Of Current Knowledge On Racism And Health: Relevance To Policy And The National Equity Discourse

Research related to racism and health has evolved in recent decades, with a growing appreciation of the centrality of the social determinants of health, life-course approaches and structural racism, and other upstream factors as drivers of health inequities. Examining how race, class, and structural racism relate to each other and combine over the life course to affect health can facilitate a clearer understanding of the determinants of health. Yet there is ongoing discomfort in many public health and medical circles about research on racism, including opposition to the use of racial terminology. Similarly, most major national reports on racial and ethnic inequities in health have given limited attention to the role of racism. We conclude that there is a need to acknowledge the central role of racism in the national discourse on racial inequities in health, and paradigmatic shifts are needed to inform equity-driven policy and practice innovations that would tackle the roots of the problem of racism and dismantle health inequities.

Analysis of Latina/o Sociodemographic and Health Data Sets in the United States From 1960 to 2019: Findings Suggest Improvements to Future Data Collection Efforts

Introduction. Prior to 1980, U.S. national demographic and health data collection did not identify individuals of Hispanic/Latina/o heritage as a population group. Post-1990, robust immigration from Latin America (e.g., South America, Central America, Mexico) and subsequent growth in U.S. births, dynamically reconstructed the ethnoracial lines among Latinos from about 20 countries, increasing racial admixture and modifying patterns of health disparities. The increasing racial and class heterogeneity of U.S. Latina/os demands a critical analysis of sociodemographic factors associated with population health disparities. Purposes. To determine the state of available Latina/o population demographic and health data in the United States, assess demographic and health variables and trends from 1960 to the present, and identify current strengths, gaps, and areas of improvement. Method. Analysis of 101 existing data sets that included demographic, socioeconomic, and health characteristics of the U.S. Latina/o population, grouped by three, 20-year intervals: 1960-1979, 1980-1999, and 2000-2019. Results. Increased Latina/o immigration and U.S. births between 1960 and 2019 was associated with increases of Latino population samples in data collection. Findings indicate major gaps in the following four areas: children and youth younger than 18 years, gender and sexual identity, race and mixed-race measures, and immigration factors including nativity and generational status. Conclusions. The analysis of existing ethnoracial Latina/o population data collection efforts provides an opportunity for critical analysis of past trends, future directions in data collection efforts, and an equity lens to guide appropriate community health interventions and policies that will contribute to decreasing health disparities in Latina/o populations.

Expert Perspectives on Effective Community-Based Pediatric Healthcare for Low-Income Latino Families: Persistent Issues over Time

US Latinos continue to experience significant health inequity, despite fluctuating healthcare policies over the past 20 years. Recent studies highlight the importance of comprehensive care and collaboration of stakeholders in reducing inequity. Few studies examine the perspectives of community-based organization leaders, health researchers, and policy experts regarding the most effective practices in the delivery of healthcare to Latino children and families. This unique study employed a mixed-methods cross-sectional design to compare perceptions of effective practices and action strategies among two groups. Analysis of qualitative data gathered from 17 organizational leaders and 28 research/policy experts resulted in four broad themes: (1) engagement of families as participants in their healthcare; (2) provision of comprehensive, family-focused healthcare services across the lifespan; (3) engagement of ethnically competent staff to provide outreach; and (4) development of community collaborations for resource building. Respondents identified three major barriers to the provision of high-quality care: (1) inequities in social determinants; (2) ongoing changes in insurance coverage; and (3) funding challenges for the support of community-based health centers (CHCs). Although the data were collected in 2001, these thematic findings remain relevant given the persistence of inequities and the lack of progress in mitigating inequity among Latino children and families, despite evolving healthcare system changes. The study conclusions reaffirm the importance of community-driven preventive healthcare services across the life course. These community services are the frontline of healthcare for many Latino children and their families; therefore, their sustainability is crucial. The voices of organizational leaders, health research, and policy experts are important and relevant.

Workplace stress and discrimination effects on the physical and depressive symptoms of underrepresented minority faculty

Evidence-based research and interventions to address systemic institutional racism have never been more urgent. Yet, underrepresented minority (URM) professionals in research institutions who primarily produce that evidence have remained abysmally low for decades. This unique study of URM university professors assesses factors-vocational strain, role overload, discrimination, coping strategies-that contribute to health and well-being, research productivity, and ultimately their retention in high impact research positions. We administered a web-based survey assessing demographics, workplace stressors, perceived discrimination, life events, coping strategies, and physical and depressive symptoms. Study participants include 404 faculty of whom 254 are African Americans, 99 are Mexican Americans, and 51 are Puerto Ricans. Hierarchical regression analyses were employed to assess the associations between workplace stress, coping strategies, and symptoms. Results show that perceived discrimination, vocational strain, role overload, and life events directly affected physical symptoms, with self-care (p < 0.001) moderating these effects. Vocational strain and life events had direct effects on depressive symptoms with self-care (p < 0.05) and social support (p < 0.001) moderating these effects. Findings inform health care providers and university leaders about work stress and health conditions that may explain early morbidity and premature departures of URM faculty, and proffer institutional interventions to retain these faculty.

Challenging Stereotypes: A Counter-Narrative of the Contraceptive Experiences of Low-Income Latinas

Purpose: Reproductive autonomy is associated with educational attainment, advanced employment, and well-being. While U.S. Latinas use contraception to control their own childbearing and have reported a desire to do so, they often use it inconsistently and have the lowest rates of contraceptive use of any group. Reasons previously cited for why Latinas do not use contraception compared with non-Latino white women include lack of access, lack of knowledge, language barriers, emphasis on large families, machismo, and religiosity. These reasons are often overly simplistic and can lead to widespread generalizations about Latinas. Methods: Using focus groups and semistructured interviews from November 2014 through June 2015, this study describes the family planning perspectives and experiences of 16 Latinas living in Baltimore and recruited from two federally qualified health centers. A social determinant of health framework was used to guide identification of important concepts and explain findings. Results: Results demonstrated that respondents reported contraceptive agency and claimed autonomy over their bodies; described a sense of responsibility and often expressed caution about having families too large to care for; expressed educational and career aspirations; and perceived contraception as critical for the postponement of childbearing to achieve their goals. Conclusion: The patient/provider encounter should include communication that recognizes all patient preferences and lived experiences to support vulnerable and/or marginalized Latinas in their desires to control their own childbearing and life choices.

Casting a Wider Net: Engaging Community Health Worker Clients and Their Families in Cancer Prevention

Engaging family members in an intervention to prevent breast and cervical cancer can be a way to reach underserved women; however, little is known about whether family member recruitment reaches at-risk women. This study reports the kin relationship and risk characteristics of family members who chose to participate in the Kin Keeper^SM cancer prevention intervention, delivered by community health workers (CHWs) via existing community programs. African American, Latina, and Arab family members reported risk factors for inadequate screening, including comorbid health conditions and inadequate breast or cervical cancer literacy. CHW programs can be leveraged to reach underserved families with cancer preventive interventions.

Disparities in hypertension-related mortality among selected Hispanic subgroups and non-Hispanic White women ages 45 years and older--United States, 1995-1996 and 2001-2002

OBJECTIVES

To compare hypertension-related mortality (HRM) age-standardized and age-specific rates for Hispanic subgroup and non-Hispanic White (NHW) women; to identify underlying causes of HRM by Hispanic subgroup and age; and to examine relative percent change in HRM among Hispanic subgroups and NHW women.

DESIGN

Secondary data analyses of 1995-1996 and 2001-2002 national vital statistics multiple cause mortality files.

SETTING

United States-50 states and District of Columbia.

SUBJECTS

Mexican American (MA), Puerto Rican (PR), Cuban (CA) and NHW female decedents ages > or =45 years with hypertension listed as one of up to 20 conditions resulting in death.

MAIN OUTCOME MEASURES

Age-standardized death rates (ASDR per 100,000) for HRM and relative percent change to examine trends (2-year intervals).

RESULTS

During 1995-1996, the ASDR (per 100,000) for HRM was highest among PR (248.5) followed by NHW (188.7), MA (185.4), and CA women (139.7). During 2001-2002, PR (215.5) and MA (205.5) had higher ASDR for HRM than NHW (171.9) and CA women (104.6). The relative percent increase from 1995-1996 to 2001-2002 was 10.8% (P < .01) among MA, while CA (-25.1%, P < .01), PR (-13.3%, P < .01) and non-Hispanic Whites (-8.5%, P < .01) showed a decrease.

CONCLUSIONS

HRM was highest among PR and MA women, increased significantly for MA women between 1995-1996 to 2001-2002, and declined for CA, PR and non-Hispanic White women. Public health efforts should focus on strengthening heart health protection communication and hypertension control programs for PR and MA women and their healthcare providers.

Cultural competency as it intersects with racial/ethnic, linguistic, and class disparities in managed healthcare organizations

Culture in and of itself is not the most central variable in the patient-provider encounter. The effect of culture is most pronounced when it intersects with low education, low literacy skills, limited proficiency in English, culture-specific values regarding the authority of the physician, and poor assertiveness skills. These dimensions require attention in Medicaid managed care settings. However, the promise of better-coordinated and higher quality care for low-income and working-poor racial/ethnic populations--at a lower cost to government--has yet to be fully realized. This paper identifies strategies to reduce disparities in access to healthcare that call for partnerships across government agencies and between federal and state governments, provider institutions, and community organizations. Lessons learned from successful precedents must drive the development of new programs in Medicaid managed care organizations (MCOs) to reduce disparities. Collection of population-based data and analyses by race, ethnicity, education level, and patient's primary language are critical steps for MCOs to better understand their patients' healthcare status and improve their care. Research and experience have shown that by acknowledging the unique healthcare conditions of low-income racial and ethnic minority populations and by recruiting and hiring primary care providers who have a commitment to treat underserved populations, costs are reduced and patients are more satisfied with the quality of care.

Health data issues for Hispanics: implications for public health research

The limited availability of Hispanic health data has hampered the development of targeted public health policies. Hispanics represent 11.5 percent of the population and are projected to become the largest minority group in the United States by the year 2010. This paper explores current issues in Hispanic health data collection, examines methodological concerns, and presents recommendations for future Hispanic public health data collection. Data are derived from statistical reports of the U.S. Bureau of the Census, National Center for Health Statistics, Bureau of Labor Statistics, and other empirical studies. Recommendations include: collecting both race and ethnic-specific data by Hispanic subgroup, designing appropriate data collection instruments and approaches, and selecting referent groups for comparison purposes. The authors conclude that the renewed national focus on health disparities among underserved populations requires an increased commitment to adequately identify Hispanic subgroups.

Latino child health: need for inclusion in the US national discourse

The "rediscovery" of poverty, as echoed in concepts of social inequality, has contributed to the goal of eliminating racial/ethnic and social class disparities in the United States. This commentary focuses on what we know about the pressing health care needs and issues relevant to Latino children and families and how extant knowledge can be linked to priority policy recommendations to ensure the inclusion of Latino health issues in the national discourse. A systematic review of the literature on Latino children and of expert opinion revealed 4 evidence-based themes focused on poverty: economic factors, family and community resources, health system factors, and pitfalls in Latino subgroup data collection. Consensus was found on 4 priority policy recommendations: (1) reduce poverty and increase access to health care coverage, (2) increase funding in targeted primary and preventive health care services, (3) provide funds needed to fully implement relevant health legislation, and (4) improve measurement and quality of data collection. If these recommendations are not instituted, the goals of Healthy People 2010 will not be achieved for the Latino population.

Criollo, mestizo, mulato, LatiNegro, indígena, white, or black? The US Hispanic/Latino population and multiple responses in the 2000 census

Current dialogues on changes in collecting race and ethnicity data have not considered the complexity of tabulating multiple race responses among Hispanics. Racial and ethnic identification--and its public reporting--among Hispanics/Latinos in the United States is embedded in dynamic social factors. Ignoring these factors leads to significant problems in interpreting data and understanding the relationship of race, ethnicity, and health among Hispanics/Latinos. In the flurry of activity to resolve challenges posed by multiple race responses, we must remember the larger issue that looms in the foreground--the lack of adequate estimates of mortality and health conditions affecting Hispanics/Latinos. The implications are deemed important because Hispanics/Latinos will become the largest minority group in the United States within the next decade.

Use of cancer screening practices by Hispanic women: analyses by subgroup

OBJECTIVES

This study compares the use of three cancer screening practices (Pap smear, mammogram, and clinical breast examination) 3 years prior to interview among five subgroups of Hispanic women, and examines whether sociodemographic; access; health behavior, perception, and knowledge; and acculturation factors predict screening practices for any subgroup.

METHODS

Descriptive and multiple logistic regression analyses were conducted with data pooled from the 1990 and 1992 National Health Interview Surveys on women who reported that they were Hispanic. The study sample includes 2,391 respondents: 668 Mexican-American, 537 Mexican, 332 Puerto Rican, 143 Cuban, and 711 other Hispanic women.

RESULTS

Subgroup profiles reveal differences in education, health insurance, use of English language, and screening use. Mexican women were the least likely to be screened with any procedure. Logistic regression results for each screening practice show that having a usual source of care was a positive predictor for obtaining each of the three screening practices within the last 3 years. Being married, being more than 50 years of age, and having knowledge of breast self-examination were all predictors of having a Pap smear. Having health insurance and ever having had a clinical breast examination and Pap smear were predictors of having a mammography, while age, knowledge of breast self-examination, ever having had a Pap smear and mammogram, and being a nonsmoker all predicted having a clinical breast examination.

CONCLUSIONS

We conclude that access factors and prior screening are more strongly associated with current screening than are language and ethnic factors. Our data confirm that a disproportionate percentage of Hispanic women are low income and at risk of being underscreened. Our findings from a nationally representative sample of Hispanics have implications for provider practices, ethnic-specific community interventions, and future development of measures and data collection approaches.

Mediators of ethnic-associated differences in infant birth weight

PURPOSE

To examine whether ethnic differences in low birth weight babies of low-income women may be explained in part by group differences in prenatal health behaviors and psychosocial factors.

METHODS

A prospective, survey of 1,071 low-income, primiparous African-American and Mexican-origin women was conducted in Los Angeles County, California. In face-to-face interviews, data were obtained on substance use, prenatal stress, social support, attitudes toward pregnancy, initiation of prenatal care, and medical risk. Medical chart data were abstracted regarding medical risk factors and labor, delivery, and neonatal data. Interview data were linked with birth outcome data retrieved from maternal medical records. Structural equation modeling was used to test a hypothesized model in which differences in birth weight were expected to be mediated by ethnic differences in substance use, psychosocial factors, and medical risk.

RESULTS

As expected, African-American women delivered babies of earlier gestational age and lower birth weight than did women of Mexican origin. Direct predictors of low birth weight were use of drugs and cigarettes, prenatal stress, and positive attitudes toward pregnancy; together, these factors accounted for the observed ethnic differences in birth weight.

CONCLUSION

These data contribute to our understanding of the factors that may account for ethnic-associated differences in low birth weight.

Economic and social vulnerability of Latino children and families by subgroup: implications for child welfare

Approximately 40% of all Latinos are under the age of 20, and close to one-third of all Latino children live in poverty. The Latino population varies considerably, however, a factor that is frequently obscured by data collection methods that either view Latinos collectively or fail to differentiate Latinos at all from within racial groups. This articles describes the social, economic, and family structure variables that place specific Latino subgroups at risk, synthesizes available data on Latino children in the child welfare system, and discusses a direction for research and practice in developing ethnic-specific child welfare policy for vulnerable Latino groups. The authors conclude that services to strengthen families have to promote economic as well as social integration within society and have to consider the unique characteristics of each Latino community.

Prenatal health behaviors and psychosocial risk factors in pregnant women of Mexican origin: the role of acculturation

OBJECTIVES

This study examined the association between acculturation of Mexican-origin women and factors in low birthweight and preterm delivery.

METHODS

Interviews were conducted with 911 Mexican-origin respondents in Los Angeles prenatal care clinics. Infant outcome data were retrieved from delivery records.

RESULTS

Mexican-American women had generally more undesirable prenatal behaviors and risk factors than Mexican-immigrant women. Although higher acculturation was significantly associated with behavioral risk factors, there were no direct effects of acculturation on infant gestational age or birthweight.

CONCLUSIONS

Future research needs to measure multiple factors to assess their effects on culture-specific protective factors.

Maternal psychosocial factors associated with substance use in Mexican-origin and African American low-income pregnant women

PURPOSE

To describe ethnic-specific patterns of substance use before and during pregnancy in low-income pregnant women, examine the associations between psychosocial factors and patterns of substance use within ethnic groups, and assess maternal sociodemographic, prenatal, and psychosocial factors of women who continue to use substances during pregnancy and those who do not.

METHOD

A prospective study of low-income, primiparous African American (n = 255), Mexican American (n = 525), and Mexican immigrant (n = 764) women was conducted in 22 prenatal care clinics in Los Angeles, CA. Data were collected in face-to-face interviews in both English and Spanish on prenatal life events, anxiety, sources of support, and substance use behaviors three months before and during pregnancy.

FINDINGS

Significant ethnic differences were found in use of alcohol, cigarettes, and illicit drugs. African American women were more likely than Mexican-origin women to report use of substances before and during pregnancy. Mexican American women were more likely than Mexican immigrant women to report use of substances before and during pregnancy. Women who continued to use substances during pregnancy were less likely to be living with the baby's father, to have planned the pregnancy, to report having been able to go for prenatal care as soon as they wanted, and more likely to be identified at medical risk.

CONCLUSIONS

Providers must increase the assessment and monitoring of substance use behaviors of low-income women in prenatal care settings. The role of health care providers must encompass advocacy and public health education.

The role of Latino/Hispanic communities in health services research: strategies for a meaningful partnership

This paper critically assesses the important elements of the Latino/Hispanic community's participation in health services research and the known barriers to effective collaboration, and provides suggestions that may contribute toward a meaningful partnership among health care providers, researchers and the community. The discussion focuses on central strategies for community participation to help improve existing health care services' effectiveness, specifically for low-income Latino/Hispanic groups. It reviews current approaches for including communities in health care delivery and health services research and draws examples from the author's experiences of working with Latino/Hispanic communities for almost 20 years. The data implies that mutual benefits can be derived from forging alliances and meaningful partnerships between the health services research community and the Latino/Hispanic community.

The underrepresentation of Hispanic women in the health professions

Hispanics are severely underrepresented in medicine and the health professions, particularly Hispanic women compared to other women. Hispanics represent only 4.9% of medical and health professionals, with a disproportionate representation in allied health professions, and Hispanic women represent less than 2% of those in health professions that require advanced degrees. The purposes of this paper are to review the available data on Hispanic women in medicine and the health professions, to examine the factors that contribute to their underrepresentation, and to present and discuss recommendations to decrease the barriers to Hispanic women in the health professions. Factors associated with this underrepresentation include high levels of family poverty linked to high secondary school dropout rates, inadequate educational background and work experiences, and lack of information on resources and opportunities. Central recommendations to increase representation of Hispanic women call for institutional changes and commitments in data collection, early math and science preparation, access to financial resources, and improvements in community linkages and the academic environment.

Ethnic minorities, health care systems, and behavior

This article presents an overview of research on health care use and provider behavior, on doctor-patient relationships, adherence to medical regimens, self-care, practices and avoidance health care behaviors, and attitudes of 4 ethnoracial groups: African Americans, American Indians, Asian Americans, and Latinos. Although issues within the groups varied, common themes between the groups emerged. It became apparent, after discussion, that whatever the issues and health problems, these can be resolved most effectively when addressed within the social contexts of each ethnoracial group.

Ethnic minorities, health care systems, and behavior

This article presents an overview of research on health care use and provider behavior, on doctor-patient relationships, adherence to medical regimens, self-care, practices and avoidance health care behaviors, and attitudes of 4 ethnoracial groups: African Americans, American Indians, Asian Americans, and Latinos. Although issues within the groups varied, common themes between the groups emerged. It became apparent, after discussion, that whatever the issues and health problems, these can be resolved most effectively when addressed within the social contexts of each ethnoracial group.

The relationship between psychosocial status of immigrant Latino mothers and use of emergency pediatric services

Consistent empirical evidence has shown that low-income Latino populations tend to underutilize health care services and do not have a usual source of care. This article identifies and describes the sociodemographic and psychosocial characteristics of Latino immigrant mothers who use emergency pediatric services, assesses the association of maternal characteristics with perceived barriers to care, and examines key predictors of total number of pediatric visits in a year. A survey was carried out to obtain data on reason for emergency room visit, usual sources of care, child's health, and mother's physical and psychosocial health. The results revealed a clear pattern of delayed care for acute problems in the children, a high number of reported barriers to pediatric care, and high mental distress reported by mothers.

Factors which influence use of prenatal care in low-income racial-ethnic women in Los Angeles County

There is very limited information on ethnic differences in use of prenatal care services. The purpose of this study was to examine the effect of sociodemographic, health behaviors, medical risk, and psychosocial risk factors on the timing of prenatal care among Black-American, Mexican-American, and recent Mexican immigrant women in Los Angeles. A sample of 107 primiparous women were interviewed using a structured questionnaire. Information obtained included socioeconomic indicators, relationship with baby's father, timing of prenatal care, psychosocial factors, and substance use before pregnancy. Ethnic patterns of timing of prenatal care revealed no significant differences. The relationship with the baby's father was associated with early timing of prenatal care and more prenatal care visits. Substance use before pregnancy was significantly related to total number of visits for this pregnancy.

Prenatal and postnatal anxiety in Mexican women giving birth in Los Angeles

Examined psychosocial factors related to prenatal and postnatal anxiety in 291 primiparous Mexican women giving birth in Los Angeles. Characteristics of health care providers preferred by more anxious and less anxious women were also assessed. Higher prenatal anxiety was associated with less desire for an active role during labor, lower assertiveness, higher pain expectation at delivery, lack of support from family members other than the husband, and preferences for health care providers who are female and Latino. All groups of women preferred health care providers who provided good medical explanations and who were knowledgeable, friendly, and sympathetic. Postnatal anxiety was significantly lower than prenatal anxiety. Negative attitudes toward the baby and number of complications during labor and delivery, however, were related to postnatal anxiety adjusted for prenatal anxiety.

A research agenda on issues affecting poor and minority women: a model for understanding their health needs

Acquiring data on quality of life indicators such as health, mental health and family roles of poor and minority women remains a low research priority. This paper provides an assessment of current knowledge in this area and an overview of the context in which poor and racial/ethnic women utilize health care services. A model that encompasses the interactive effects of race, gender and class variables is proposed. Such a model is a necessity for understanding the health needs of poor and racial/ethnic women. Suggestions for future research and policy formulation are given.

Gender and level of training differences in obstetricians' attitudes towards patients in childbirth

This paper explores male and female obstetricians' attitudes towards their patients in childbirth. Individual interviews were conducted with 50 obstetricians using a semistructured questionnaire. Across gender and level-of-training there were few differences in descriptions of easy patients. The few differences that did emerge reveal that attending physicians see patients as less difficult to handle than do residents and that female residents place more emphasis on compliance and control than do male residents. The results of the study are discussed in terms of sex-role stereotypes, the medical school socialization process and the medical model of health care.

The interactive effect of health status on work patterns among urban Puerto Rican women

This paper aims to integrate two existing bodies of literature on the sociology of work and health. Using data from a study conducted in New York City in 1980 of 40 Puerto Rican women, a conceptual model is proposed for additional research in the area. The findings are discussed within the context of the larger structural and socioeconomic status of this particular racial/ethnic group. The findings clearly indicate that health status is related to work patterns and economic as well as social resources. Of the respondents who reported a major health event in their lives, 80 percent had a discontinuous work history. Children's health was also a major determinant of work status. The results of this study clearly reveal the need for research that will take into account the interplay between economic conditions, structural work factors, and the process by which women evaluate their roles and fulfill their function as economic and health caretakers of the family.

The working mother in contemporary perspective: a review of the literature

The purpose of this article is to provide a perspective on the dilemmas working mothers face due to the contradictory messages that emanate from both popular child-rearing books and clinical studies. A review of the working mothers' sections of popular child-rearing books, and an interdisciplinary review of research in the area of maternal employment over the last decade was conducted in order to assess current knowledge in the field. Both popular child-rearing books and books for the working mother tend to reflect the cultural norms of appropriate maternal behavior, but rarely include evidence from empirical research. Findings from a review of literature in medicine, psychology, sociology, and education are discussed in relation to effects of maternal employment on children and families. An understanding of recent research regarding maternal employment will enable the pediatrician to better respond to the needs of the working mothers and their families.

Prenatal and postnatal anxiety in Mexican women giving birth in Los Angeles

Examined psychosocial factors related to prenatal and postnatal anxiety in 291 primiparous Mexican women giving birth in Los Angeles. Characteristics of health care providers preferred by more anxious and less anxious women were also assessed. Higher prenatal anxiety was associated with less desire for an active role during labor, lower assertiveness, higher pain expectation at delivery, lack of support from family members other than the husband, and preferences for health care providers who are female and Latino. All groups of women preferred health care providers who provided good medical explanations and who were knowledgeable, friendly, and sympathetic. Postnatal anxiety was significantly lower than prenatal anxiety. Negative attitudes toward the baby and number of complications during labor and delivery, however, were related to postnatal anxiety adjusted for prenatal anxiety.