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.     

HIV/AIDS Surveillance Data for New York City West Indian–Born Blacks: Comparisons With Other Immigrant and US-Born Groups

Objectives. Although the risk of HIV among New York City West Indian–born Black immigrants often is assumed to be high, population-based data are lacking, a gap we aimed to address.Methods. Using 2006–2007 HIV/AIDS surveillance data from the New York City Department of Health and Mental Hygiene and population data from the US Census American Community Survey 2007, we compared the rate of newly reported HIV diagnoses, prevalence of people living with HIV/AIDS, and distribution of transmission risk categories in West Indian–born Blacks, 2 other immigrant groups, and US-born Blacks and Whites.Results. The age-adjusted rate of newly reported HIV diagnoses for West Indian–born Blacks was 43.19 per 100 000 (95% confidence interval [CI] = 38.92, 49.10). This was higher than the rate among US-born Whites (19.96; 95% CI = 18.63, 21.37) and Dominican immigrants and lower than that among US-born Blacks (109.48; 95% CI = 105.02, 114.10) and Haitian immigrants. Heterosexual transmission was the largest risk category in West Indian–born Blacks, accounting for 41% of new diagnoses.Conclusions. Although much lower than in US-born Blacks, the rate of newly reported HIV diagnoses in West Indian–born Blacks exceeds that among US-born Whites. Additional work is needed to understand the migration-related sources of risk.Immigrants from English-speaking Caribbean basin countries, often referred to as the West Indians, have been migrating to the United States for many decades, and they and their descendants constitute a large and culturally significant population in major Eastern seaboard cities, including New York City (NYC). The majority (81%) identify as Black, with a significant minority identifying as East Indian.1 Considering only those who are first-generation immigrants, the latest estimates (2007–2008) show that West Indians represent 21% of foreign-born persons in NYC and almost 25% of the NYC Black population.2 Despite the size of this immigrant group, in HIV/AIDS surveillance reports they have not been disaggregated from all Blacks nor from the Caribbean-born population overall, although some data suggest their HIV risk may be high.3     

Nativity and Neighborhood Characteristics and Cervical Cancer Stage at Diagnosis and Survival Outcomes Among Hispanic Women in California

Objectives. We examined stage of diagnosis and survival after cervical cancer among Hispanic women, and their associations with Hispanic nativity, and explored whether neighborhood socioeconomic status (SES) and residence in a Hispanic enclave modify the association of nativity with stage and survival.Methods. We used California Cancer Registry data (1994–2009) to identify 7958 Hispanic women aged 21 years and older with invasive cervical cancer. We used logistic and Cox proportional hazards models to estimate the associations between stage and mortality with nativity, neighborhood factors, and other covariates.Results. Foreign-born women had similar adjusted relative odds of being diagnosed with stages II through IV (vs stage I) cervical cancer compared with US-born Hispanic women. However, among foreign-born women, those in low-SES–low-enclave neighborhoods were more likely to have late-stage disease than those in high-SES–low-enclave neighborhoods (adjusted odds ratio = 1.91; 95% confidence interval = 1.18, 3.07). Foreign-born women had lower cervical cancer mortality (adjusted hazard ratio = 0.67; 95% confidence interval = 0.58, 0.76) than US-born women, but only in high enclaves.Conclusions. Among Hispanic women, nativity, neighborhood enclaves, and SES interact in their influence on stage and survival of cervical cancer.Despite advances in early detection, cervical cancer remains the second most-common cancer worldwide and the third most-common gynecologic malignancy in the United States,1,2 with an age-adjusted incidence rate of 7.8 per 100 000 and mortality rate of 2.3 per 100 000 from 2007 to 2011.3 Notably, although the incidence of cervical cancer is higher among Hispanic women (10.2 per 100 000) than among Asian/Pacific Islander (6.4), African American (9.4), and non-Hispanic White (7.8) women, mortality rates among Hispanic women are comparable with those of other groups (2.8 per 100 000).3–5Compared with women of other racial/ethnic groups, studies consistently show a survival advantage for Hispanic women after control for stage at diagnosis and other clinical and sociodemographic characteristics2,6–13; this observation of lower mortality among Hispanics compared with non-Hispanic Whites is consistent with the “Hispanic paradox.”14,15 Previous studies further suggest that the paradox applies in particular to Hispanic immigrants, particularly immigrants born in Mexico.15 A recent analysis of national data from the Surveillance, Epidemiology, and End Results (SEER) program found that foreign-born Hispanic women had lower survival than US-born Hispanic women for early-stage disease, but better survival for late-stage disease.16,17 However, this analysis was based on imputed data for women missing place of birth, which is problematic when one considers that SEER birthplace data are not missing at random.18–20 The observed survival advantage may also reflect higher rates of losses to follow-up among foreign-born Hispanics, causing underreporting of cervical cancer mortality in this group if significant numbers of women return to their native country once diagnosed with later-stage disease. Thus, to date, reasons for the apparent immigrant survival advantage among women with cervical cancer are poorly understood.The “healthy immigrant effect” suggests that the Hispanic mortality advantage is greater among the foreign-born than US-born because immigrants are selected for better health21 and have strong family and community ties that support health behaviors22,23 and buffer against discrimination24; this hypothesis may explain the patterns seen for cervical cancer survival. Therefore, neighborhood characteristics including socioeconomic status (SES) and ethnic enclave (geographical areas that are culturally and ethnically concentrated and distinct from the surrounding area) may be important contributors to survival after cervical cancer diagnosis. Low-income residential ethnic enclaves may protect health by increasing residents’ ability to maintain positive health behaviors such as a healthy native diet or abstention from smoking, and provide increased social support. Residents of ethnic enclave communities may also receive targeted public health services or perceive fewer barriers to care. However, ethnic enclaves tend to be of low SES and frequently have higher crime rates and may have lower availability of healthy foods, all of which are risk factors for poor health outcomes.The disproportionate burden of cervical cancer among Hispanic women but paradoxical incidence–mortality patterns, coupled with the rapid rate at which this population is growing, underscores the need to examine diagnostic and survival differences within this population. The purpose of this study was to examine stage of diagnosis and survival after cervical cancer, and their associations with Hispanic nativity, and to explore whether neighborhood SES and residence in a Hispanic enclave modify the association of nativity with stage and survival. Understanding how individual- and neighborhood-level factors jointly and independently contribute to survival outcomes after cervical cancer among Hispanic women may help target interventions that can improve survival after cancer diagnosis, despite socioeconomic disadvantage.     

Use of maternal health services: comparing refugee,immigrant and US-born populations

Objectives To determine use of recommended maternal healthcare services among refugee and immigrant women in a setting of near-universal insurance coverage. Methods Refugee women age ≥18 years, who arrived in the US from 2001 to 2013 and received care at the same Massachusetts community health center, were matched by age, gender, and date of care initiation to Spanish-speaking immigrants and US-born controls. The primary outcome was initiation of obstetrical care within the first trimester (12 weeks gestation). Secondary outcomes were number of obstetrical visits and attending a postpartum visit. Results We included 375 women with 763 pregnancies (women/pregnancies: 53/116 refugee, 186/368 immigrant, 136/279 control). More refugees (20.6 %) and immigrants (15.0 %) had their first obstetric visit after 12 weeks gestation than controls (6.0 %, p < 0.001). In logistic regression models adjusted for age, education, insurance, BMI, and median census tract household income, both refugee (odds ratio [OR] 4.58, 95 % confidence interval [CI] 1.73–12.13) and immigrant (OR 2.21, 95 % CI 1.00–4.84) women had delayed prenatal care initiation. Refugees had fewer prenatal visits than controls (median 12 vs. 14, p < 0.001). Refugees (73.3 %) and immigrant (78.3 %) women were more likely to have postpartum care (controls 54.8 %, p < 0.001) with differences persisting after adjustment (refugee [OR 2.00, 95 % CI 1.04–3.83] and immigrant [OR 2.79, 95 % CI 1.72–4.53]). Conclusions for Practice Refugee and immigrant women had increased risk for delayed initiation of prenatal care, but greater use of postpartum visits. Targeted outreach may be needed to improve use of beneficial care.     

The role of health insurance on Pap smear and mammography utilization by immigrants living in the United States

BACKGROUND: Nearly half of recent immigrants to the United States lack health insurance. Access to cancer screening services for this group is problematic. We examine the role of health insurance and having a usual source of care (USC) on Pap smear and mammography utilization by immigrant women using a nationally representative sample. METHODS: We used a telephone survey that oversampled racial and ethnic minorities. We analyzed data on 3,622 women age 18-70. We classified the 822 foreign-born women as recent immigrants if they had resided in the United States for under 10 years; LT immigrants were those with a longer tenure. RESULTS: Among recent immigrants, 73% and 78% (SE 4%) reported a Pap smear or mammogram, respectively, in the previous 2 years versus 89% and 89% of U.S.-born women (P < 0.05 for both comparisons). Among those with insurance or a USC, differences in screening between recent immigrants and U.S.-born women were four percentage points or less and not statistically significant. However, uninsured recent immigrants were less likely than uninsured U.S.-born women to have Pap smears [60% (SE 7%) versus 71%, P < 0.05]. Adjusting for differences in sociodemographics, health attitudes or beliefs, patient or provider communication, and the medical care environment, insurance remained the strongest predictor of screening. CONCLUSION: Disparities in screening were greatly attenuated among the insured population. Increasing awareness of available safety net sources of care may also improve cancer screening among uninsured recent immigrants.     

Preconception Wellness: Differences in Health by Immigrant Status

Disparities in health between immigrant and non-immigrant pregnant women in the United States is well documented, but few have documented disparities before pregnancy. Using the National Health and Nutrition Examination Survey (1999–2006), we examined the health of reproductive-aged women (8,095), sorted by immigrant and pregnancy pregnant US-born (P-US), pregnant foreign-born (P-FB), non-pregnant US-born (NP-US), and non-pregnant foreignborn (NP-FB). P-US women were 5.2 times more likely to report illicit drug use than P-FB women. NP-US women were 3.7 times more likely to report illicit drugs use, 45% less likely to have a normal BMI, 2.0 times more likely to binge drink, 7.6 times more likely to smoke, 1.6 times more likely to engage in moderate physical activity, and 1.7 times more likely to use birth control than NP-FB women. The lower prevalence of numerous destructive health behaviors among preconceptional immigrant women is an important finding.     

Disparities in Pregnancy Healthcare Utilization Between Hispanic and Non-Hispanic White Women in Rhode Island

Low healthcare utilization is a prime contributor to adverse health outcomes in both the general population and the Hispanic community. This study compares background characteristics and rates of prenatal and postpartum health care utilization between Hispanic and non-Hispanic white women. Using the Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS), 2002?C2008, we assess rates of prenatal and postpartum healthcare utilization relevant to maternal and neonatal care. Associations between maternal ethnicity and adequacy of health care utilization were quantified using survey weighted multivariable logistic regression. Compared with non-Hispanic white women, Hispanic women were younger (less than 24?years, 43.8% vs. 25.2%), had less education (less than 12?years of education, 38.2% vs. 10.6%), lower annual income levels (incomes less than $19,999, 72.2% vs. 21.7%), and lower insurance rates before pregnancy (47.8% uninsured vs. 12.8%). Hispanic women had higher odds of having delayed prenatal care (AOR 1.84, 95% CI 1.27?C2.65) or inadequate prenatal care (AOR 2.01, 95% CI 1.61?C2.50), and their children had higher odds of not having a 1-week check-up (AOR 1.73, 95% CI 1.21?C2.47) or any well-baby care (AOR 3.44, 95% CI 1.65?C7.10). Disparities in inadequate prenatal care and not having any well-baby care remained significant after adjusting collectively for age, marital status, education, income, and insurance status of mother and newborn. Although many previously uninsured women became insured during pregnancy, disparities in healthcare utilization remained. Interventions focusing on reducing barriers to access prior to and during pregnancy should consider potential structural, informational, and educational barriers.     

Overcoming the Odds: Access to Care for Immigrant Children in Working Poor Families in California

Objectives: To explore the extent to which, among working poor families, uninsured immigrant children experience more barriers to care than uninsured nonimmigrants, and compare these differences to those of insured children. Methods: We used data from the 2001 California Health Interview Survey, a randomized, population-based telephone survey conducted from November 2000 through September 2001. Financial and nonfinancial access to health care and utilization of health services were examined for 3,978 nonimmigrant and 462 immigrant children and adolescents under the age of 18 years. We compared differences in crude rates across four subgroups (insured immigrants, uninsured immigrants, insured nonimmigrants, uninsured nonimmigrants) and in adjusted models controlling for socioeconomic and immigration characteristics, parental language, health status, and other demographic factors. Results: More immigrant than nonimmigrant children lacked health insurance at the time of the interview (44% vs. 17%, p < 0.0001). Among the uninsured, immigrants had higher odds of perceiving discrimination (11% vs. 5%, p < 0.05) and postponing emergency room (ER) (16% vs. 7%, p < 0.05) and dental care (40% vs. 30%, p < 0.05) after controlling for covariates. Among the insured, immigrants fared worse on almost every access and utilization outcome. Among insured immigrants, child and parent undocumented status and having a non-English-speaking parent contributed to missed physician and ER visits. Conclusions: Disparities in access and use remain for immigrant poor children despite public insurance eligibility expansions. Insurance does not guarantee equitable health care access and use for undocumented children. Financial and nonfinancial barriers to health care for immigrant children must be removed if we are to address disparities among minority children.     

Disparities in Cesarean Delivery by Ethnicity and Nativity in New York City

Our objective was to examine differences in risk of cesarean delivery among diverse ethnic groups in New York City. Using cross-sectional New York City birth and hospitalization data from 1995 to 2003 (n = 961,381) we estimated risk ratios for ethnic groups relative to non-Hispanic whites and immigrant women relative to US-born women. Adjusting for insurance, pre-pregnancy weight, maternal age, education, parity, birthweight, gestational age, year, medical complications, and pregnancy complications, all ethnic groups except East Asian women were at an increased risk of cesarean delivery, with the highest risk among Hispanic Caribbean women [adjusted risk ratio (aRR) = 1.27, 95 % CI (confidence interval) = 1.24, 1.30] and African American women (aRR = 1.20, 95 % CI = 1.17, 1.23). Among Hispanic groups, immigrant status further increased adjusted risk of cesarean delivery; adjusted risk ratios for foreign-born women compared to US-born women of the same ethnic group were 1.27 for Mexican women (95 % CI = 1.05, 1.53), 1.23 for Hispanic Caribbean women (95 % CI = 1.20, 1.27), and 1.12 for Central/South American women (95 % CI = 1.04, 1.21). Similar patterns were found in subgroup analyses of low-risk women (term delivery and no pregnancy or medical complications) and primiparous women. We found evidence of disparities by ethnicity and nativity in cesarean delivery rates after adjusting for multiple risk factors. Efforts to reduce rates of cesarean delivery should address these disparities. Future research should explore potential explanations including hospital environment, provider bias, and patient preference.     

Comparing Pregnancy Outcomes of Immigrants from Ethiopia and the Former Soviet Union to Israel,to those of Native-Born Israelis

To compare pregnancy outcomes of immigrants from Former-Soviet-Union (FSUI) and Ethiopia (EI) to those of Jewish-native-born Israelis (JNB), in context of universal health insurance. Birth outcomes of all singletons born in Soroka-University Medical-Center (1998–2011) of EI (n = 1,667) and FSUI (n = 12,920) were compared with those of JNB (n = 63,405). Low birthweight rate was significantly higher among EI (11.0 %) and slightly lower (7.0 %) among FSUI, compared to JNB (7.5 %). Preterm-delivery rates were similar to those of JNB. Both immigrant groups had significantly (p < 0.001) higher rates of perinatal mortality (PM) than JNB (21/1000 in EI, and 11/1000 in FSUI, compared to 9/1000). Using multivariable GEE models both immigrant groups had significantly increased risk for PM; however, EI had twice as much FSUI origin (OR 2.3, 95 % CI 1.6–3.4, and OR 1.3, 95 % CI 1.1–1.6, respectively). Universal health care insurance does not eliminate excess PM in immigrants, nor the gaps between immigrant groups.     

Perceived neighborhood social cohesion and cervical and breast cancer screening utilization among U.S.-born and immigrant women

Research suggests that factors beyond the individual level, such as neighborhood-level factors, warrant further investigation in explaining preventive screening utilization disparities. In addition, research shows that immigrant women, especially recent immigrants, are less likely than U.S.-born women to utilize preventive screenings. Our study examined the relationship between perceived neighborhood social cohesion and breast and cervical cancer screening utilization among U.S.-born and immigrant women. Data came from the 2018 National Health Interview Survey (NHIS). The sample for this study included 7801 women ages 21−64 without a hysterectomy. Of them, 1477 (19%) reported being born outside the United States. Logistic regression was used to examine associations of perceived neighborhood social cohesion and sociodemographic factors with the odds of screening by nativity status. Though we found no link between neighborhood social cohesion and Papanicolaou (Pap) test or mammogram utilization, our findings contribute to understanding sociodemographic barriers to and facilitators of preventive screening utilization among immigrant and U.S.-born women. Most importantly, racial/ethnic and socioeconomic disparities in Pap tests and mammogram utilization were evident among immigrant women. The disparities we identified indicate the need to target prevention messages and tailor interventions to address each group''s sociodemographic characteristics and needs. Our findings also support the need to expand health insurance so that all women are covered.     

Health, life expectancy, and mortality patterns among immigrant populations in the United States

BACKGROUND: The US immigrant population has grown considerably in the last three decades, from 9.6 million in 1970 to 32.5 million in 2002. However, this unprecedented population rise has not been accompanied by increased immigrant health monitoring. In this study, we examined the extent to which US- and foreign-born blacks, whites, Asians, and Hispanics differ in their health, life expectancy, and mortality patterns across the life course. METHODS: We used National Vital Statistics System (1986-2000) and National Health Interview Survey (1992-1995) data to examine nativity differentials in health outcomes. Logistic regression and age-adjusted death rates were used to examine differentials. RESULTS: Male and female immigrants had, respectively, 3.4 and 2.5 years longer life expectancy than the US-born. Compared to their US-born counterparts, black immigrant men and women had, respectively, 9.4 and 7.8 years longer life expectancy, but Chinese, Japanese, and Filipino immigrants had lower life expectancy. Most immigrant groups had lower risks of infant mortality and low birthweight than the US-born. Consistent with the acculturation hypothesis, immigrants' risks of disability and chronic disease morbidity increased with increasing length of residence. Cancer and other chronic disease mortality patterns for immigrants and natives varied considerably, with Asian Immigrants experiencing substantially higher stomach, liver and cervical cancer mortality than the US-born. Immigrants, however, had significantly lower mortality from lung, colorectal, breast, prostate and esophageal cancer, cardiovascular disease, cirrhosis, diabetes, respiratory diseases, HIV/AIDS, and suicide. INTERPRETATION: Migration selectivity, social support, socio-economic, and behavioural characteristics may account for health differentials between immigrants and the US-born.     

Another Mexican birthweight paradox? The role of residential enclaves and neighborhood poverty in the birthweight of Mexican-origin infants

Examining whether contextual factors influence the birth outcomes of Mexican-origin infants in the US may contribute to assessing rival explanations for the so-called Mexican health paradox. We examined whether birthweight among infants born to Mexican-origin women in the US was associated with Mexican residential enclaves and exposure to neighborhood poverty, and whether these associations were modified by nativity (i.e. mother's place of birth). We calculated metropolitan indices of neighborhood exposure to Mexican-origin population and poverty for the Mexican-origin population, and merged with individual-level, year 2000 natality data (n = 490,332). We distinguished between neighborhood exposure to US-born Mexican-origin population (i.e. ethnic enclaves) and neighborhood exposure to foreign-born (i.e. Mexico-born) Mexican-origin population (i.e. immigrant enclaves). We used 2-level hierarchical linear regression models adjusting for individual, metropolitan, and regional covariates and stratified by nativity. We found that living in metropolitan areas with high residential segregation of US-born Mexican-origin residents (i.e. high prevalence of ethnic enclaves) was associated with lower birthweight for infants of US-born Mexican-origin mothers before and after covariate adjustment. When simultaneously adjusting for exposure to ethnic and immigrant enclaves, the latter became positively associated with birthweight and the negative effect of the former increased, among US-born mothers. We found no contextual birthweight associations for mothers born in Mexico in adjusted models. Our findings highlight a differential effect of context by nativity, and the potential health effects of ethnic enclaves, which are possibly a marker of downward assimilation, among US-born Mexican-origin women.     

Disentangling Race and Social Context in Understanding Disparities in Chronic Conditions among Men

Disparities in men’s health research may inaccurately attribute differences in chronic conditions to race rather than the different health risk exposures in which men live. This study sought to determine whether living in the same social environment attenuates race disparities in chronic conditions among men. This study compared survey data collected in 2003 from black and white men with similar incomes living in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. Multivariable logistic regression models estimated to determine whether race disparities in chronic conditions were attenuated among men living in the same social environment. In the national sample, black men exhibited greater odds of having hypertension (odds ratio [OR] = 1.58, 95 % confidence interval [CI] 1.34, 1.86) and diabetes (OR = 1.62, 95 % CI 1.27–2.08) than white men. In the sample of men living in the same social context, black and white respondents had similar odds of having hypertension (OR = 1.05, 95 % CI 0.70, 1.59) and diabetes (OR = 1.12, 95 % CI 0.57–2.22). There are no race disparities in chronic conditions among low-income, urban men living in the same social environment. Policies and interventions aiming to reduce disparities in chronic conditions should focus on modifying social aspects of the environment.     

Trends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979-2003

BACKGROUND: Immigrants are a growing segment of the US population. In 2003, there were 33.5 million immigrants, accounting for 12% of the total US population. Despite a rapid increase in their numbers, little information exists as to how immigrants' health and mortality profile has changed over time. In this study, we analysed trends in social and behavioural characteristics, life expectancy, and mortality patterns of immigrants and the US-born from 1979 to 2003. METHODS: We used national mortality and census data (1979-2003) and 1993 and 2003 National Health Interview Surveys to examine nativity differentials over time in health and social characteristics. Life tables, age-adjusted death rates, and logistic regression were used to examine nativity differentials. RESULTS: During 1979-81, immigrants had 2.3 years longer life expectancy than the US-born (76.2 vs 73.9 years). The difference increased to 3.4 years in 1999-2001 (80.0 vs 76.6 years). Nativity differentials in mortality increased over time for major cancers, cardiovascular diseases, diabetes, respiratory diseases, unintentional injuries, and suicide, with immigrants experiencing generally lower mortality than the US-born in each period. Specifically, in 1999-2001, immigrants had at least 30% lower mortality from lung and oesophageal cancer, COPD, suicide, and HIV/AIDS, but at least 50% higher mortality from stomach and liver cancer than the US-born. Nativity differentials in mortality, health, and behavioural characteristics varied substantially by ethnicity. CONCLUSIONS: Growing ethnic heterogeneity of the immigrant population, and its migration selectivity and continuing advantages in behavioural characteristics may partly explain the overall widening health gaps between immigrants and the US-born.     

Measuring the adequacy of antenatal health care: a national cross-sectional study in Mexico

ObjectiveTo propose an antenatal care classification for measuring the continuum of health care based on the concept of adequacy: timeliness of entry into antenatal care, number of antenatal care visits and key processes of care.MethodsIn a cross-sectional, retrospective study we used data from the Mexican National Health and Nutrition Survey (ENSANUT) in 2012. This contained self-reported information about antenatal care use by 6494 women during their last pregnancy ending in live birth. Antenatal care was considered to be adequate if a woman attended her first visit during the first trimester of pregnancy, made a minimum of four antenatal care visits and underwent at least seven of the eight recommended procedures during visits. We used multivariate ordinal logistic regression to identify correlates of adequate antenatal care and predicted coverage.FindingsBased on a population-weighted sample of 9 052 044, 98.4% of women received antenatal care during their last pregnancy, but only 71.5% (95% confidence interval, CI: 69.7 to 73.2) received maternal health care classified as adequate. Significant geographic differences in coverage of care were identified among states. The probability of receiving adequate antenatal care was higher among women of higher socioeconomic status, with more years of schooling and with health insurance.ConclusionWhile basic antenatal care coverage is high in Mexico, adequate care remains low. Efforts by health systems, governments and researchers to measure and improve antenatal care should adopt a more rigorous definition of care to include important elements of quality such as continuity and processes of care.     

Health care utilization patterns of Russian-speaking immigrant women across age groups

The collapse of the Soviet Union in 1989 substantially increased the numbers of refugees and immigrants to the United States from the former Soviet Union. Little research has been conducted with this population although studies found that immigrant's access to health care services are based on patterns of utilization in their countries of origin. The purpose of this study was to learn about the experiences of immigrant women from three former Soviet Republics (Belarus, Russia, and Ukraine) with women's health care services. Three focus groups of women were formed; ages 20–30, 37–46, and 60 and above. A focus-group guide was used to learn about their health care experiences. These immigrant women did access health care services based on patterns of utilization in their countries of origin. Greater understanding of immigrant populations' cultural patterns of health care utilization is needed to improve access and delivery of health care services to these populations.     

Health Status and Health Insurance Coverage of Women with Live-Born Infants: An Opportunity for Preventive Services After Pregnancy

Most women in the US have access to health care and insurance during pregnancy; however women with Medicaid-paid deliveries lose Medicaid eligibility in the early postpartum period. This study examined the association between health insurance coverage at the time of delivery and health conditions that may require preventive or treatment services extending beyond pregnancy into the postpartum period. We used 2008 Pregnancy Risk Assessment Monitoring System data from 27 states (n = 35,980). We calculated the prevalence of maternal health conditions, including emotional and behavioral risks, by health insurance status at the time of delivery. We used multivariable logistic regression to assess the association between health insurance coverage, whether Medicaid or private, and maternal health status. As compared to women with private health insurance, women with Medicaid-paid deliveries had higher odds of reporting smoking during pregnancy (adjusted odds ratio [AOR]: 1.85, 95 % confidence interval [CI]: 1.56–2.18), physical abuse during pregnancy (AOR: 1.73, 95 % CI: 1.24–2.40), having six or more stressors during pregnancy (AOR: 2.48, 95 % CI: 1.93–3.18), and experiencing postpartum depressive symptoms (AOR: 1.24, 95 % CI: 1.04–1.48). There were no significant differences by insurance status at delivery in pre-pregnancy overweight/obesity, pre-pregnancy physical activity, weight gain during pregnancy, alcohol consumption during pregnancy, or postpartum contraceptive use. Compared to women with private insurance, women with Medicaid-paid deliveries were more likely to experience risk factors during pregnancy such as physical abuse, stress, and smoking, and postpartum depressive symptoms for which continued screening, counseling, or treatment in the postpartum period could be beneficial.