Elena Fuentes-Afflick

To compare the association between neighborhood Latino immigrant concentration and infant mortality by maternal nativity among singleton births to Mexican-origin women in Los Angeles County. Information about births, infant deaths, and infant and maternal characteristics were obtained from geocoded Los Angeles County vital statistics records (2002–2005). Linked data on neighborhood characteristics (census tracts) were obtained from the 2000 census. Logistic regression models were used to predict infant mortality while accounting for spatial clustering by census tract. Two-thirds of births to Mexican-origin mothers were to foreign-born women. Foreign-born mothers were older, had less education, and were more likely to have delivery costs paid by Medicaid than US-born mothers. Infants born to foreign-born women had a lower infant mortality rates than infants born to US-born women (3.8/1,000 live births vs. 4.6, p = .002). Among infants of foreign-born mothers, the odds of infant mortality increased with increasing immigrant concentration (OR 1.29; 95 % CI 1.01–1.66). There was a similar pattern of association between immigrant concentration and mortality for infants of US-born mothers (OR 1.29; 95 % CI 0.99–1.67). In Los Angeles County, the odds of infant mortality among foreign-born Mexican-origin Latina were higher in higher-density immigrant neighborhoods, with a similar trend among US-born mothers. Thus, living in immigrant enclaves likely does not help to explain the lower than expected infant mortality rate among infants born to Latina women. Instead, higher neighborhood Latino immigrant concentration may indicate a neighborhood with characteristics that negatively impact maternal and infant health for Latinos.

A commentary on Santos' article, "Explaining Scholarship Addressing Hispanic Children’s Issues."

To assess the relationship between immigration status and use of health services among Latina women. From 2001 to 2004, information on immigration status and use of health services was collected from 710 Latina women in the San Francisco Bay Area. The dependent variable was use of health services during the previous 12 months, which we defined as use of preventive health, dental, urgent care, and emergency services. The primary independent variable was self-reported immigration status, which we categorized as undocumented immigrant, documented immigrant, or citizen. More than half of the women were undocumented immigrants, one quarter were documented immigrants, and 18% were citizens. Forty percent of women were uninsured, one third had no preventive health visits in the previous year, and 58% had not used dental services. In adjusted logistic regression analyses, undocumented Latinas were 60% less likely and documented Latinas were 46% less likely to have dental visits in the previous year, relative to citizens. Health insurance status was independently associated with all four health service outcomes. Uninsured women were less likely to use preventive health, dental, or urgent care services compared with privately insured women. In addition, publicly insured women were less likely to use dental care and more likely to use emergency care than privately insured women. Immigration and health insurance status were associated with use of preventive and nonpreventive services among Latina women in the San Francisco Bay Area. Clinical and policy efforts must address the barriers to care that affect Latina immigrants, particularly undocumented women.

To assess risk factors for macrosomic infant birth among Latina women. Prospective study of Latina women recruited during pregnancy from prenatal clinic at San Francisco General Hospital. Information was obtained through a structured interview and review of medical records. A total of 11% of women delivered macrosomic infants (birth weight >4000 g). In unadjusted analyses, significant risk factors for macrosomia included older maternal age, increasing gravidity, previous history of macrosomic birth and pre-pregnancy overweight. After adjusting for confounders using multivariate analyses, older mothers (10-year increments) had an elevated risk of macrosomia (odds ratio (OR) 2.59; 95% confidence interval (CI) 1.28 to 5.24). Efforts to reduce macrosomia in Latina women should focus on older mothers.

Acculturation is associated with an elevated risk of obesity among older Latinos, but the relationship between acculturation and body mass among childbearing Latina women has not been adequately studied. We analyzed data from 313 pregnant Latina women at San Francisco General Hospital. The dependent variable was prepregnancy body mass index (BMI), categorized as underweight (or=30). The independent variables were acculturation metrics, measured by acculturation index score, degree of Americanization, national origin subgroup, and the number of years residing in the United States. One third of women were overweight, and one fifth were obese. Education (OR 0.88, 95% CI 0.81-0.96) was inversely associated with overweight, after adjusting for confounding variables. Longer residence in the United States (OR 1.08 for each additional year residing in the United States, 95% CI 1.02-1.15), older age (OR 1.08, 95% CI 1.01-1.16), and higher gravidity, the total number of pregnancies (OR 1.41, 95% CI 1.09-1.84), were significantly associated with obesity. One measure of acculturation, length of time residing in the United States, was associated with obesity among childbearing Latina women. Efforts to reduce the prevalence of overweight and obesity in Latina women should not target recent immigrants but instead focus on long-term immigrants as well as women who are older and have low educational attainment and high gravidity.