The “Latina Epidemiologic Paradox”: Contrasting Patterns of Adverse Birth Outcomes in U.S.-Born and Foreign-Born Latinas

BackgroundThe “Latina epidemiologic paradox” postulates that despite socioeconomic disadvantages, Latina mothers have a lower risk for delivering low birth weight (LBW) babies than non-Latina Whites. However, these patterns may be changing over time and may differ depending on the mother's birthplace and legal status in the United States. This study investigates differences in risk for three birth outcomes among Whites, U.S.-born Latinas, and foreign-born Latinas.MethodsWe undertook a cross-sectional study of rates of LBW, preterm, and small-for-gestational-age (SGA) births among 196,617 women delivering live, singleton births in Utah from 2004 to 2007. Each group was compared using logistic regression.ResultsU.S.-born Latinas had a similar or greater risk for all three outcomes when compared with Whites. Foreign-born Latinas had lower risk for preterm birth (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.80–0.90) compared with Whites, but not for LBW and SGA; foreign-born Latinas had a lower risk for LBW (OR, 0.82; 95% CI, 0.74–0.92), preterm birth (OR, 0.81; 95% CI, 0.74–0.89), and SGA (OR, 0.91; 95% CI, 0.83–0.99) compared with U.S.-born Latinas. Among foreign-born Latinas only, there was no difference in risk between documented (i.e., those who had a legal social security number) and undocumented women for LBW, preterm birth, or SGA.ConclusionsThese data support the existence of a variation of the “Latina paradox” among Latinas according to birthplace, where U.S.-born Latinas do not experience better birth outcomes than Whites, but foreign-born Latinas experience better birth outcomes for several endpoints compared with U.S.-born Latinas. Prevention efforts may prove more effective by considering the different composition of risk factors among foreign- and U.S.-born Latina populations.     

Role of a Psychiatric Pharmacist in a Los Angeles “Skid-Row” safety-net clinic

Limited access to a psychiatrist prompted a collaborative practice agreement between a psychiatric pharmacist, a psychiatric pharmacy resident, and primary care physicians at the Center for Community Health, a safety-net clinic providing comprehensive care to the homeless in Skid Row, Los Angeles, CA, USA. From July 2009 to February 2010, 36 (75%) of the 48 patients referred to the psychiatric pharmacy resident met the criteria for the chart review. Twenty-six (54%) were seen for regular follow-up care over 7 months. Most referrals were for depression, bipolar disorder, and posttraumatic stress disorder. The types of drug therapy problems, pharmacist interventions, and clinical mental health outcomes are discussed.     

Lower Rates of Preterm Birth in Women of Arab Ancestry: An Epidemiologic Paradox—Michigan, 1993–2002

Objective: Preterm birth (PTB), <37 weeks gestation, occurs in 12.1% of live births annually and is associated with significant morbidity and mortality in the United States. Racial/ethnic subgroups are disproportionately affected by PTB. Michigan is home to one of the largest Arab-American communities in the country; however, little is known about PTB in this population. This study examined the maternal demographic profile and risk factors of preterm birth (PTB) among foreign-born and US-born women of Arab ancestry relative to US-born Whites in Michigan. Methods: Using Michigan Vital Statistics data, we examined correlates of PTB for primiparous U.S.-born white (n = 205,749), U.S.-born Arab (n=1,697), and foreign-born Arab (n=5,997) women who had had a live-born singleton infant during 1993–2002. We examined variables commonly reported to be associated with PTB, including mother's age and education; insurance type; marital status of parents; receipt of prenatal care; mother's chronic hypertension, diabetes, and tobacco use; and infant sex. Results: Foreign-born Arabs are less educated and more likely to be on Medicaid, and they receive less prenatal care than US-born Whites. Prevalence of PTB was 8.5, 8.0, and 7.5% for US-born Whites, US-born Arabs, and foreign-born Arabs, respectively. Pregnancy-related hypertension was the only predictor of PTB that these three groups had in common: Adjusted Odds Ratio (AOR)=2.1 (95% Confidence Interval (CI)=1.99, 2.21), AOR=2.6 (95% CI=1.24, 5.51), and AOR=2.6 (95% CI=1.55, 4.31) for US-born whites, US-born Arabs, and foreign-born Arabs, respectively. Conclusions: Foreign-born Arab women in Michigan have a higher-risk maternal demographic profile than that of their US-born white counterparts; however, their prevalence of PTB is lower, which is consistent with the epidemiologic paradox reported among foreign-born Hispanic women.     

Associations Between Acculturation and Weight,Diet Quality,and Physical Activity Among Latina Breast Cancer Survivors: The ¡Mi Vida Saludable! Study

BackgroundAmong Latinos, greater acculturation to the United States (US) is associated with risk of obesity and obesity-related comorbidities. Less is known about the associations between acculturation and obesity-related modifiable risk factors, such as diet quality and physical activity (PA) among Latina breast cancer survivors.ObjectiveThe aim of this study was to explore associations between acculturation and weight status, diet quality, and PA among Latina breast cancer survivors.DesignThis is a cross-sectional secondary analysis of baseline data on demographic and clinical characteristics, acculturation, anthropometric measures, diet quality, and PA collected from Latina breast cancer survivors enrolled in the ¡Mi Vida Saludable! (My Healthy Life) behavioral diet and PA intervention trial.Participants/settingParticipants were Latina women (n = 167) residing in New York City, with a medical history of stage 0 to III breast cancer, no evidence of recurrent or metastatic disease, and at least 90 days post cancer treatment who participated in the ¡Mi Vida Saludable! randomized controlled trial between July 2016 and October 2018.Main outcome measuresAcculturation status was measured by the Short Acculturation Scale for Hispanics score, language preference, place of birth, and duration of US residence. Weight, height, and waist and hip circumferences were measured at an in-person clinic visit. Diet information was collected via 3 telephone-based 24-hour dietary recalls and PA information was collected via staff administered 7-day recalls.Statistical analyses performedLinear regression models examined associations between acculturation and weight status, diet quality, and PA.ResultsBased on the Short Acculturation Scale for Hispanics acculturation score, more acculturated compared with less acculturated Latinas were younger in age, more educated, and had higher annual household incomes (all, P < .05). Compared with Spanish-speaking Latinas, English-speaking Latinas had larger waist circumference (103 vs 96.1 cm; P = .01) and poorer-quality diets (Healthy Eating Index 2015 scores, 57.3 vs 71.5; P < .001). Greater levels of acculturation were also associated with higher levels of leisure walking at a moderate-to-vigorous intensity (265.8 vs 179.0 min/wk; P =.04).ConclusionsGreater levels of acculturation were associated with higher central obesity and poorer-quality diets. Future lifestyle modification trials tailored to the unique role of acculturation on adopting behavior change recommendations is a promising next step in this line of research.     

“And I look down and he is gone”: Narrating autism,elopement and wandering in Los Angeles

‘Wandering’ and ‘elopement’ have been identified as common in autism, affecting half of all diagnosed children ages four to ten, yet families rarely receive advice from practitioners even after the fact. Family perspectives have been missing from the literature as well as from public health and policy debates on how and when to respond to this problem. The problem of ‘wandering’ and ‘elopement’ reveals a complex intersection of larger issues encountered by families of children with autism. To consider these issues, this article examines ‘wandering’ and ‘elopement’ from the perspectives of African American mothers of children with autism, an underrepresented group in autism research. We consider how the mothers experience these behaviors and the response to these behaviors by professionals, such as service coordinators and law enforcement personnel working within various jurisdictions that become involved with the problem. We analyze the mothers' narratives about ‘wandering’ and ‘elopement’ drawn from ethnographic interviews that were collected between October 1, 2009 and August 31, 2012. These interviews were part of a larger project on disparities in autism diagnosis and services that followed a cohort of 25 four to ten-year old children. Drawing on narrative, phenomenological and interpretive traditions, we trace the mothers' developing understandings of ‘wandering’ and ‘elopement’ over time, and show how these understandings become elaborated and transformed. This article provides a nuanced, moment-to-moment and longitudinal picture of the mothers' experiences of ‘wandering’ and ‘elopement’ that enriches the cross-sectional view of large-scale surveys about the problem and contributes unique insights at the family and community levels. Implications for professional awareness, clinical practice and service provision are also suggested.     

The reporting of crime and violence in the Los Angeles Times: is there a public health perspective?

The authors examine how crime and violence is reported and framed by the Los Angeles Times. Using a public health perspective, we examine whether health-oriented variables, such as causal factors and societal effects of crimes, are present in crime news stories. The classic stereotyping of crime and violence framing is strongly present in the Times. We discuss what changes would be useful to provide news consumers with a more accurate picture of crime in their community.     

The Paradox of Discrimination,the “Aloha Spirit,” and Symptoms of Depression in Hawai‘i

It remains to be determined whether the “aloha spirit” is a cultural resource that influences psychological well-being in Hawai‘i. Thus, the purpose of this study is to investigate whether the aloha spirit is associated with levels of psychological distress and the risk of depression, while taking into account various risk factors. Data for this study were drawn from an anonymous survey of undergraduate students (N = 1,028) at the University of Hawai‘i. Regression results revealed that having learned the aloha spirit was associated with significantly lower levels (b = −1.76; P < .01) of psychological distress and a reduced odds of depression (OR = .69; P < .01) over and above the effects of perceived discrimination, local identity, levels of ethnic identification, race/ethnicity, immigrant status, duration of residence in Hawai‘i, and other sociodemographic factors. In contrast, everyday discrimination was associated with significantly higher levels (b = 0.41; P < .001) of psychological distress and a greater odds of depression (OR = 1.08; P < .001). Together, these findings highlight the paradox of discrimination and the aloha spirit in Hawai‘i by documenting their distinct relationships with mental health. Overall, this study contributes to medical and public health research on mental health disparities during the transition to adulthood by delving into the social context of daily life in the understudied, multicultural location of Hawai‘i.     

Peer Reviewed: Increasing Prevalence of Gestational Diabetes and Pregnancy-Related Hypertension in Los Angeles County,California, 1991–2003

Introduction

Gestational diabetes and pregnancy-related hypertension can lead to adverse health effects in mothers and infants. We assessed recent trends in the rates of these conditions in Los Angeles County, California.

Methods

Hospital discharge data were used to identify all women aged 15–54 years who resided in the county, had a singleton delivery from 1991 through 2003, and had gestational diabetes or pregnancy-related hypertension listed as a discharge diagnosis at the time of delivery. The prevalence of each condition was calculated by calendar year, race/ethnicity, and age group. Temporal trends in the rates were assessed by using negative binomial regression models, controlling for race/ethnicity and age. Separate models were run for each racial/ethnic and age group.

Results

The age-adjusted prevalence of gestational diabetes increased more than threefold (from 14.5 cases per 1000 women in 1991 to 47.9 cases per 1000 in 2003). The age-adjusted prevalence of pregnancy-related hypertension also increased (from 40.5 cases per 1000 in 1991 to 54.4 cases per 1000 in 2003). In the multivariable regression analysis, the annual rate increase for gestational diabetes was 8.3% overall and was highest among Hispanics (9.9%). The annual rate increase for pregnancy-related hypertension was 2.8% overall and was highest among blacks (4.8%).

Conclusion

The rates of gestational diabetes and pregnancy-related hypertension are increasing in Los Angeles County. Further research is needed to determine the causes of the observed increases and the growing racial/ethnic disparities in those rates.     

The Influence of Moxibustion on “Housanli” on GAS, MTL and Weight in Ganji Models of Rat

To explore the action mechanism of moxibustion on Zusanli (ST36) in treating malnutrition. Methods Infantile SD rats were divided into normal group, model group, comparison group and treatment group. Ganji models of rat were made by feeding high fat and high calorie food. Then they were treated with moxibustion on “Housali”. Results After the models being made, the appetite,weight, GAS and MTL were decreased. After two periods of treatment, they were all increased and were nearly turned to be normal level. Conclusion Moxibustion on Zusanli (ST36) can improve the appetite,weight, GAS and MTL in Ganji models of rat and regulate their digestive function.     

The Paradox of Realism and “Authenticity” in Entertainment-Education: A Study of Adolescents' Views About Anti-Drug Abuse Dramas

The successful use of drama as a vehicle to influence health-related attitudes and behaviors is credited to its ability to elicit an emotional experience and identification among audience members. This study investigated the views of adolescents regarding an entertainment-education (EE) component of their school's anti-drug program—a live performance of a professionally produced anti-drug abuse drama. The analysis draws mainly on data collected from 64 focus groups, conducted in 24 schools across Israel, and open-ended responses to questionnaires administered to more than 1,700 adolescents. The adolescents were generally entertained by the anti-drug abuse drama and moved by its “authenticity,” which emerged as a central construct in this study. Yet only a fraction identified with the characters and many remained unwilling to “tell” on a friend who uses drugs. Drawing on these findings, implications to EE theory and practice are discussed, particularly as they relate to the drama's perceived realism or “authenticity,” and its unintended effects.     

The Prevalence of Live Birth Down Syndrome in the Region of Primorsko-goranska County in Croatia, 1996–2005: The Impact of Screening and Amniocentesis

Objectives To investigate the prevalence of live birth Down syndrome (DS) in the region of Primorsko-goranska County (PGC) in Croatia from 1996 to 2005 and to evaluate the impact of second-trimester maternal serum screening (MSS) and amniocentesis on live birth DS prevalence. Methods Study was based on databases from the Department of Gynecology and Obstetrics, University Hospital Centre Rijeka, the Department of Biology and Medical Genetics, School of Medicine, University of Rijeka, and the Croatian National Institute of Public Health. The regional policy of prenatal diagnosis for DS includes amniocentesis for pregnant women aged 35 or over and MSS for younger women. We estimated live birth and total prevalence of DS and measured the proportion of pregnant women using MSS and amniocentesis. Trends of live birth and total prevalence of DS were tested by linear regression analysis. Results The live birth prevalence of DS was 1.4/1000 in the period 1996–2005. A decreasing, but nonsignificant, trend of prevalence was observed over time (P = 0.577). Women aged 35 or over represented 11.6% of all pregnant women included in the study. The proportion of women who had MSS was 33.9%. The proportion who underwent amniocentesis was 6.1%. Conclusions No marked decrease in prevalence of live birth DS was observed in the region of PGC during the last 10 years. The usage of MSS and amniocentesis was too low to have any significant impact on live birth DS prevalence. Women’s, as well as physician’s, knowledge and attitudes towards prenatal diagnosis of DS should be evaluated.     

Insulin and the “Thrifty” Woman: The Influence of Insulin During Pregnancy on Gestational Weight Gain and Postpartum Weight Retention

Objectives: To test Neel's hypothesis among pregnant women: a high maternal insulin concentration in early pregnancy increases the risk of weight gain, overweight, and obesity among nondiabetic, low-income gravidas of racial and ethnic minority groups from Camden, New Jersey. Methods: Fasting insulin was obtained from 461 gravidas at entry to prenatal care. Insulin quartile was related to rate of gestational weight gain and excess weight gain during pregnancy (90th percentile) and to retained weight and excess weight retention at 4–6 weeks postpartum (90th percentile). The relationship between excess retained weight and excessive insulin increase (90th percentile) was also examined. Results: Compared with gravidas with an insulin concentration in the lowest three quartiles, gravidas with the highest insulin quartile had a significantly higher rate of gestational weight gain (nonobese women only) and average weight retained postpartum (all women). Compared with an insulin concentration in the lowest three quartiles, the highest insulin quartile was associated with a 2.05-fold (95% confidence interval [CI] = 1.07–3.93) risk of an excessive rate of gestational weight gain and a 3.58-fold (95% CI = 1.87–6.84) risk of excess weight retained postpartum. Excess weight retained postpartum was linked to a 2.63-fold (95% CI = 1.00–6.89) risk of an excessive increase in insulin concentration postpartum. Conclusions: Our results support Neel's hypothesis and suggest that a high maternal insulin concentration is associated with increased gestational weight gain and increased weight retention postpartum. High insulin concentration may contribute to pregnancy-related changes in weight and thus may be linked to maternal overweight and obesity postpartum as well as to future risk of gestational and Type 2 diabetes mellitus.