Mexican-Americans' use of prenatal care and its relationship to maternal risk factors and pregnancy outcome.

We evaluate the adequacy of prenatal care use and the association of use to a series of maternal risk factors and pregnancy outcomes, such as low birthweight, preterm delivery, and macrosomia in both Mexican-Americans and non-Hispanic whites in Arizona. The data came from all live-birth certificates from 1986 and 1987 for a total of 101,202 (26,826 Mexican-Americans). We evaluated the adequacy of prenatal care using a redesigned index that accounts for three factors: the month when prenatal care began, the number of prenatal care visits, and the duration of pregnancy. From this index we identified six prenatal care groups: intensive, adequate, intermediate, inadequate, no-care, and missing/unknown. Overall, we observed ethnic differences in patterns of prenatal care use, social profiles, and medical risk factors. Non-Hispanic whites, compared to Mexican-Americans, showed a greater risk for low birthweight and preterm delivery in those groups receiving poor prenatal care versus those who received adequate care. Within Mexican-Americans the risk of low birthweight was not the same for all subgroups. A higher overall prevalence of preterm delivery and macrosomia in comparison to low birthweight occurred in Mexican-Americans. We discuss the implications of the results for the identification, interpretation, evaluation, and public health significance of perinatal health problems of Mexican-Americans.

Classification schemes of small-for-gestational age and type of intrauterine growth retardation and its implications to early neonatal mortality.

Classification of small-for-gestational age (SGA) and pattern of intrauterine growth retardation (IUGR) and their relationship to early neonatal mortality (first 3 days) were studied in a population of 9201 full-term infants in a maternal and child center in Mexico City. SGA infants were classified on the basis of two methods: one, using the tenth percentile of a birth weight (BW) by gestational age reference growth distribution, and the other, using a cut-off point of birth weight of 2900 g. Crown-heel length (CHL) and Rohrer's ponderal index (PI = BW/CHL3) were used to classify patterns of proportionate and disproportionate IUGR. Overall, infants classified as SGA and type of IUGR had an increased risk of death in comparison to full-term appropriate-weight infants. IUGR proportionate infants with short CHL had a significantly greater mortality than disproportionate IUGR infants with normal CHL. A slightly but not significantly greater mortality was observed for IUGR disproportionate versus proportionate using PI regardless of the method of SGA used. The combination of misclassification for SGA and for type of IUGR were examined relative to the availability of gestational age and the uses of data for clinical management versus research. It is concluded that hospitals may tolerate misclassification of SGA but should pay close attention in assessing the pattern of IUGR when evaluating the mortality of newborn term infants.

Use of anthropometric indicators and maternal risk factors to evaluate intrauterine growth retardation in infants weighing more than 2500 grams at birth.

The overall objectives of this study were to characterize the patterns of IUGR of infants weighing more than 2500 g at birth and to identify pregnancy-related risk factors associated with IUGR. A total of 195 term newborns were studied from a Pediatric Hospital in the city of Hermosillo, Sonora, Mexico. The experimental group consisted of 140 newborns whose birth weights ranged between 2500 and 3200 g. A total of 55 non-IUGR infants were included in the control group whose birth weights were between 3200 and 4000 g. IUGR was evaluated based on the fetal growth ratio method defined as the observed birth weight at a given gestational age to the mean birth weight using a sex-specific reference growth standard. Overall, 35% of infants weighing between 2500-3200 g showed patterns of IUGR. These patterns of underweight were associated with lower values in several of the anthropometric indicators and proportionality ratios used. Of all the maternal risk factors evaluated only previous history of low birth weight was found to be statistically significant between IUGR and non-IUGR groups, after adjustment of several control variables. Further analysis of IUGR infants with maternal history of low birth weight demonstrated significantly lower mean values for a variety of anthropometric indicators in comparison to non-IUGR infants without maternal history of low birth weight.

Interpretative views on Hispanics' perinatal problems of low birth weight and prenatal care.

From a public health perspective, there is a need to recognize that Hispanics, and in particular Mexican Americans, are a very heterogeneous group. They represent all shades of acculturation, education, income, and citizenship status. As this minority group continues to increase in numbers, pertinent information about their perinatal health problems in the context of their sociocultural characteristics will be required. This review examines critically the recent literature related to low birth weight and prenatal care and suggests alternative ways to address these perinatal health issues. Low birth weight is examined in the context of the problem of intrauterine growth retardation and the potential mechanisms and consequences of different types of growth limitation in utero which have not been studied in this population. The use of prenatal care by Mexican American women and its association with birth weight is examined as an indication of maternal behavior or as a health care intervention. The implications for public health policy are discussed in relation to the identification, interpretation, and evaluation of these perinatal health issues in this minority population.

Mexican Americans' intrauterine growth retardation and maternal risk factors.

This study was designed to evaluate the prevalence of intrauterine growth retardation (IUGR) in Mexican Americans compared to non-Hispanic whites in Arizona. Data were compiled from birth certificates documenting live births in 1986 and 1987. A total of 25,289 Mexican-American and 71,139 white newborns were classified by IUGR. Two methods of IUGR classification were used: the fetal growth ratio (FGR) and the 10th percentile of birthweight by gestational age. A reference growth-distribution data set from the state of California was used to determine IUGR vs non-IUGR newborns. Maternal risk factors were also used to compare IUGR and non-IUGR samples. Overall, Mexican Americans had a lower risk (OR: 0.91) for IUGR than did whites, after controlling for maternal risk factors. Regardless of the IUGR classification method used, more than 88% of IUGR infants were born at term, and more than 60% of IUGR infants had birthweights equal to or greater than 2500 g. Maternal risk factors significantly discriminated between IUGR and non-IUGR infants. Finally, after controlling for maternal risk factors, US-born Mexican mothers were 1.21 times more likely to have an IUGR infant than were Mexico-born mothers. The problem of IUGR and its determinants in Mexican Americans deserves attention in clinical settings.

Determinants of birth-weight outcomes among Mexican-American women: examining conflicting results about acculturation.

In this article, we describe a comprehensive model for exploring the determinants of birth-weight outcomes among Mexican-American women from the Arizona Perinatal Acculturation Project. Data for this article came from a longitudinal study consisting of two phases. In phase one, a detailed prenatal survey was administered to 500 pregnant women. Phase two consisted of a postnatal survey administered to the women at least three months after they delivered (N = 269). Subjects who provided data were recruited from two health care agencies. Separate model building processes were conducted for a continuous measure of birth weight, and a dichotomous indicator of low-moderate birth weight (<2900 grams) using multiple linear and logistic regression analyses, respectively. The potential predictor variables for the models were divided into twelve predictor sets. The results showed that both final models included a combination of biological/behavioral factors, as well as protective sociocultural factor indicators. Acculturation status, one of the primary variables of interest in the study was found to be important for predicting birth weight and low-moderate birth weight. This result did not change when low birth weight (<2500 grams) infants were removed from the analyses. Low acculturation status was found to be associated with better birth-weight outcomes than high acculturation status. Surprisingly, length of US residence had an opposite effect in predicting both birth-weight indicators when compared to acculturation status. These results suggest that the relationships between acculturation and birth outcomes should be redefined to take into account the complexity of the phenomenon of acculturation in addition to the measurement of an array of family and sociocultural factors.

Acculturation and breast-feeding intention and practice in Hispanic women on the US-Mexico border.

OBJECTIVES: To explore the extent to which acculturation indicators predict both breast-feeding history and intentions among Mexican-American mothers having their first births, and among those having subsequent births. DESIGN: Cross-sectional survey in a hospital post-partum unit. METHODS: 3,036 Hispanic women were interviewed post-partum in their hospital room. A survey was administered in English or Spanish, and included questions about prenatal care, diet, work exposures, contraceptive use, and breast-feeding history and intentions. For the purposes of this study, acculturation was measured using a series of indicators including language spoken at home, language ability, country of birth, and country in which last schooling was received. RESULTS: Previous breast-feeding was significantly associated with educational attainment, speaking both English and Spanish at home, having had prenatal care during the previous pregnancy, and with both country variables (country of birth and country where finished school). Women with less education, women who were single, and women who did not receive any prenatal care were less likely to intend to breast-feed than were women with a college education, women with a partner, and women who received any prenatal care. Women born in Mexico (for multiparous women), or having finished school in Mexico (for primiparous women), were more likely to intend to breast-feed. CONCLUSIONS: Acculturation is associated with breast-feeding history and intention to breast-feed. Acculturation is a complex construct and traditional measures of acculturation based on language preference may not be as useful on the US-Mexico border. It is recommended that further study be conducted to determine what factors prevent women from breast-feeding, even though they intend to do so, especially in multi-cultural communities like those around the US-Mexico border.

Smoking, acculturation and family cohesion in Mexican-American women.

OBJECTIVE: To compare the characteristics of smokers and non-smokers in a setting that includes predominately Mexican-American women, with particular attention to acculturation, nativity and family cohesion. DESIGN: Cross-sectional survey in a public hospital women's clinic. METHODS: A self-administered survey was completed by gynecologic patients. It assessed: demographics, acculturation, birthplace and family cohesion. Comparisons of ever/never smokers and current/non-smokers were made using chi-square tests. Stratified analysis was used to assess for confounding. RESULTS: Smoking was very common in the white non-Hispanic group (ever smoking 86%, current smoking 70%). High rates were also seen among certain subgroups of Mexican-American women: US-born (ever smoking 65%, current smoking 44%), high acculturation (ever smoking 57%, current smoking 40%) and those with less cohesive families (ever smoking 67%, current smoking 67%). Stratified analysis revealed that place of birth and family cohesion, controlling one for the other, had adjusted prevalence ratios for current smoking of 3.7 (95% CI 1.5, 9.0) and 3.2 (95% CI 1.3, 8.1) respectively. CONCLUSION: Very high rates of smoking were observed among white non-Hispanic patients and certain subgroups of Latino subjects in this population. In Latinos, being US-born and having membership in a less cohesive family unit were independently associated with smoking.

The effects of prenatal care utilization and maternal risk factors on pregnancy outcome between Mexican Americans and non-Hispanic whites.

This study evaluates the effects of prenatal care classification and levels of maternal risk status on pregnancy outcomes in Mexican Americans and non-Hispanic whites in Arizona. All live birth certificates from 1986 and 1987 were reviewed yielding a total population of 101,206 (26,827 Mexican Americans). The adequacy of prenatal care was evaluated based on an index that includes six prenatal care groups. Two levels of maternal risk status (low and high) were defined based on a series of maternal risk factors. Overall, Mexican Americans had a greater proportion of maternal risk factors and a greater proportion of mothers with inadequate or no prenatal care compared with non-Hispanic whites. Prematurity and macrosomia were more prevalent than low birthweight in Mexican Americans. Low-risk status and adequate prenatal care regardless of ethnicity were found to be associated with a lower prevalence of low birthweight and preterm delivery. Whites, however, had a greater variation in the prevalence of low birthweight associated with changes in prenatal care utilization and maternal risk status compared with Mexican Americans. Finally, logistic regression analysis showed an independent effect of prenatal care, maternal risk status, maternal age, and maternal birthplace in predicting the overall low birthweight rate in Mexican Americans. The implications of these results are discussed relative to the usefulness of prenatal care as a health-care intervention in Mexican Americans.

Acculturation and family functioning are related to health risks among pregnant Mexican American women.

The authors examined the independent and interactive effects of acculturation status and family cohesiveness on a series of psychosocial and medical risk factors of pregnancy among 500 women of Mexican origin. In general, both higher and lower levels of acculturation produced positive or negative psychosocial and healthcare consequences, and the operative relationships depended heavily on the particular outcome chosen. Higher levels of family cohesiveness tended to foster the most constructive health and psychosocial outcomes. However, in some circumstances higher levels of family cohesiveness resulted in less coping and a lower quality of prenatal care for less acculturated women. An important implication of this study is that psychosocial and health information can be obtained through assessments that identify different subgroups of Mexican American women and depend on women's level of acculturation and family cohesiveness. Culturally competent health practitioners or clinicians can conduct these assessments in a prenatal healthcare setting.

Mexicans and care for the terminally ill: family, hospice, and the church.

The structural barriers to the use of hospice services by minority groups have been widely discussed. The attitudes of these groups are less clearly delineated. A series of focus groups with Mexicans was held in Michigan and Arizona. The participants were between the ages of 45 and 64 or over as well as providers of services to Mexicans. Regardless of length of time in the United States, participants were low on acculturation scores. These groups found important attitudes about the roles of the family, hospice services, and spirituality and the church in providing care to terminally ill individuals.

Factors associated with work-related accidents and sickness among maquiladora workers: the case of Nogales, Sonora, Mexico.

The health problems of maquiladora workers were explored in a sample of 497 workers of Nogales, Sonora, Mexico. The workers were interviewed using a structured questionnaire containing four sections: a sociodemographic profile, occupational history, working conditions, and a health profile. Overall, 12.6 percent of the workers reported having an accident while working in the maquila, more than 40 percent of these requiring at least one day of disability, and 18.3 percent of workers reported having an episode of sickness/disease. More than 60 percent perceived health-related risks associated with working conditions. The presence of a doctor or nurse in the plant (odds ratio = 0.30), a perception of risk associated with working conditions (odds ratio = 1.85), and the plant offering information about work-related risks (odds ratio = 0.39) were among the significant predictors of work-related accidents and disease/sickness. The authors discuss the implications of these results for programs and policies to improve safety conditions in the maquiladora industry.

[The tobacco industry's internal documents and smoking prevention in Spain]. / Los documentos internos de la industria tabaquera y la prevención del tabaquismo en España.

A 1998 agreement between several states in the USA and the tobacco industry made millions of pages of internal documents available to the public. Many of these documents contain information that the industry would have preferred to keep confidential. Systematic review of these internal documents constitutes a valuable resource for international tobacco control, since they are available on the Internet and can be accessed from anywhere in the world. These documents provide relevant and useful information to antismoking activists and researchers. To facilitate their use, the present article presents the electronic archives of the tobacco industry's documents, describes methods for conducting searches, and identifies the documents with information on the industry's tactics for manipulating Spanish politics and society for its own commercial interests during the 1970s, 1980s, and 1990s.

A profile of US-Mexico border mobility among a stratified random sample of Hispanics living in the El Paso-Juarez area.

Examination of border-specific characteristics such as trans-border mobility and transborder health service illuminates the heterogeneity of border Hispanics and may provide greater insight toward understanding differential health behaviors and status among these populations. In this study, we create a descriptive profile of the concept of trans-border mobility by exploring the relationship between mobility status and a series of demographic, economic and socio-cultural characteristics among mobile and non-mobile Hispanics living in the El Paso-Juarez border region. Using a two-stage stratified random sampling design, bilingual interviewers collected survey data from border residents (n = 1,002). Findings show that significant economic, cultural, and behavioral differences exist between mobile and non-mobile respondents. While non-mobile respondents were found to have higher social economic status than their mobile counterparts, mobility across the border was found to offer less acculturated and poorer Hispanics access to alternative sources of health care and other services.

Salud Para Su Corazon (health for your heart) community health worker model: community and clinical approaches for addressing cardiovascular disease risk reduction in Hispanics/Latinos.

This article describes 6 Salud Para Su Corazon (SPSC) family of programs that have addressed cardiovascular disease risk reduction in Hispanic communities facilitated by community health workers (CHWs) or Promotores de Salud (PS). A synopsis of the programs illustrates the designs and methodological approaches that combine community-based participatory research for 2 types of settings: community and clinical. Examples are provided as to how CHWs can serve as agents of change in these settings. A description is presented of a sustainability framework for the SPSC family of programs. Finally, implications are summarized for utilizing the SPSC CHW/PS model to inform ambulatory care management and policy.

Comparison of body composition by bioelectrical impedance analysis and dual-energy X-ray absorptiometry in Hispanic diabetics.

OBJECTIVE: The purpose of this study was to compare Tanita tetrapolar foot-to-foot bioelectrical impedance analysis (Model TBF-310, Tanita Corporation of America, Inc, Arlington Heights, IL; Tanita-BIA) and fan beam dual-energy X-ray absorptiometry (Hologic Discovery A v12.6, Waltham, MA; DXA) in diabetic patients. METHODS: Seventy Hispanic diabetic participants (23 male, 47 female; mean age: 53.03 ± 10.32 yrs; mean weight: 81.45 ± 17.65 kg; and mean body mass index: 31.40 ± 6.80 kg/m(2)) were selected from the Loma Linda University En Balance culturally-sensitive Spanish diabetes education program using the baseline data. RESULTS: DXA vs Tanita-BIA fat mass (FM), percent fat mass (%FM), and fat-free mass (FFM) were compared using Pearson's (FM: 0.96, %FM: 0.91, and FFM: 0.95), and Spearman's rank (FM: 0.94, %FM: 0.91, and FFM: 0.93) correlation coefficients. Bland-Altman analyses were also used to compare the difference (DXA - BIA) vs average of DXA and BIA results and showed general agreement between the two methods. When Tanita-BIA was regressed onto DXA, the adjusted R(2) was: FM=0.91; %FM=0.83; FFM=0.90. Gender combined concordance correlations with 95% confidence intervals were calculated using a bootstrap re-sampling of the data and found high associations [FM: 0.93 (95% CI: 0.89, 0.96)], [%FM: 0.86 (95% CI: 0.79, 0.90)], and [FFM: 0.93 (95% CI: 0.89, 0.96)]. CONCLUSION: Tanita-BIA may provide valid measures of fat, percent body fat and fat-free mass in Hispanic diabetics, and could be a convenient and practical approach for assessment in community-based research.

Effect of the EnBalance, a culturally and language-sensitive diabetes education program, on dietary changes and plasma lipid profile in Hispanic diabetics.

OBJECTIVE: To assess the effects of a language-sensitive diabetes education program on dietary changes and plasma lipid profiles. METHOD: Hispanic participants (n=13 males and 18 females, mean age = 54.00 + 10.68 years) participated in a 3-month health education study. Spearman correlation coefficients were used to evaluate correlations between dietary intake and laboratory measurements. RESULTS: There were significant decreases in serum total cholesterol (-16.07 mg/dl, P= 0.035), HDL cholesterol (-3.23 mg/dl, P = 0.01), LDL cholesterol (-11.71 mg/dl, P = 0.013) and dietary cholesterol (-79.22 mg, P = 0.03). No significant mean change was observed in triglyceride and total cholesterol/HDL ratio. There was also a reduction in body mass index (BMI) (-0.15 kg/m(2), P = 0.40), fasting glucose (-3.90 mg/dl, P = 0.43) and dual energy X-ray absorptiometry (DXA) total fat (-0.50, P = 0.97). Although not statistically significant, saturated fatty acids (-4.90 g, P = 0.19), polyunsaturated fatty acids (-3.31g, P = 0.11), and carbohydrate (-44.82 g, P = 0.22), decreased after three months. CONCLUSION: There were significant improvements in dietary intake and serum lipids after a three-month culture-specific diabetes education program.

The prevalence of intrauterine growth retardation in Mexican Americans.

This study evaluated the prevalence of intrauterine growth retardation in Mexican Americans compared with non-Hispanic Whites in the state of Arizona. Data came from all live birth certificates in 1986 and 1987. Rates of intrauterine growth retardation in Mexican-American and non-Hispanic White infants in Arizona were lower than those in White infants in California. Differences in patterns of the 10th percentile growth distribution curves were observed between infants born in Arizona and those born in California. Compared with non-Hispanic Whites, Mexican Americans had lower adjusted odds ratios for intrauterine growth retardation according to several maternal risk characteristics.

Retarded fetal growth patterns and early neonatal mortality in a Mexico City population.

The study reported here classified 9,660 newborn infants delivered at a maternal and child health center in Mexico City by length of gestation, presence or absence of growth retardation, and (in the case of growth-retarded infants) proportionate or disproportionate growth retardation in terms of the infants' weight and length. It was found that preterm infants (delivered before 38 weeks of gestation) had nine times the early neonatal mortality of term infants, irrespective of growth retardation patterns. Also, the type of fetal growth retardation involved (proportionate or disproportionate) in those cases where such retardation was present was found to have an impact on early neonatal mortality. That is, preterm and term infants classified as having proportionate growth retardation respectively exhibited 1.5 and 9.5 times the early neonatal mortality of preterm and term infants with disproportionate growth retardation. Among other things, these findings suggest a need for assessing types of growth retardation as well as etiologic factors when evaluating mortality risk in newborns.

PIP: Researchers used 1981-1983 data on 9660 infants born at the Maximino Avila Camacho Maternal and Child Health Center in Mexico City, Mexico to examine the relationship between early neonatal mortality (mortality in the 1st 3 days of life) and various retarded fetal growth patterns. Overall early neonatal mortality rate (ENMR) stood at 7.9/1000 live births. ENMR for premature infants was 37 and that of full term infants was 4.1 ENMR for all small for gestational age (SGA) infants (10th percentile by body weight according to US reference population) was 25.2 compared to 6 for adequate for gestational age (AGA) infants. Premature SGA infants had a significantly higher ENMR than all other groups (p.05; 161.7 vs. 14.7 full term SGA infants, 29 premature AGA infants, and 2.8 for AGA infants). Moreover premature and full term SGA infants had 58 and 5 times respectively the relative risk of early death than full term AGA infants. Full term SGA infants had a lower ENMR than did all premature infants (14.7 vs. 37). Further the ENMR for proportionately growth retarded full term SGA infants (10th percentile by crown heel) was 72.9 compared to 7.6 for the disproportionately growth retarded full term SGA infants (10th percentile by crown heel). The ENMRs for premature proportionate and disproportionate SGA infants were 74.3 and 48.6 respectively. Premature disproportionate SGA infants experienced the highest ENMR (208.3), but the full term disproportionate SGA infants experienced the lowest of any group with intrauterine growth retardation (7.6). In conclusion, the researchers pointed out the need to assess types of growth retardation and etiologic factors when determining mortality risk in neonates.