Orientations to motherhood and male partner support among women in Mexico and Mexican-origin women in the United States

Effects of sociocultural stressors on maternal responsivity and the infant behavioral and neuroendocrine response to stress in families of Mexican descent

Maternal stress is consistently linked to alterations in maternal behavior and infant neurodevelopmental outcomes. As the Latino population grows in the U.S., it is increasingly important to understand how culturally relevant factors affect this relationship. This study aimed to address the role of sociocultural stressors on maternal sensitivity and markers of infant emotional regulation and the neuroendocrine response to stress in mother/infant dyads of Mexican descent. Pregnant women of Mexican descent (n = 115) were recruited during early pregnancy and followed until their infants were 6 months old. Mothers completed measures of sociocultural stressors (acculturative stress and discrimination) at pre and postnatal time points. At 6 months, dyads underwent the Still Face procedure. Mothers were observed for behaviors exhibiting maternal responsivity, while negative vocalizations were observed in infants. Salivary cortisol was also collected from infants. Maternal responsivity was a salient risk factor for alterations in infant emotional regulation and cortisol activity. Postnatal experiences of discrimination were also negatively associated with infant negative affect. This work highlights maternal responsivity and points to a potential role for experiences of discrimination in the response to stress in the mother/child dyad that may have consequences for the development of emotional regulation in infants of Mexican descent.

Social Determinants of Health Among Pregnant Hispanic Women and Associated Psychological Outcomes

BACKGROUND

There has been a concerning surge in maternal mortality among Hispanic women in recent years. Compromised mental health is present in nearly half of all maternal deaths, and risk factors include poor social support and depression.

OBJECTIVE

Among Hispanic women who were born in the USA versus those not born in the USA, we sought to describe and compare social determinants of health and maternal psychological outcomes.

METHODS

Hispanic pregnant women (n = 579) were recruited from two clinics in Tampa, FL, and completed various questionnaires related to social determinants of health, depression, stress, and social support.

STATISTICAL ANALYSIS

Descriptive statistics, t-tests, and chi-square analyses were used to compare relationships between maternal nativity and subsequent psychosocial outcomes. Pearson correlations were used to explore associations between variables.

RESULTS

Hispanic pregnant women who were not born in the USA had lower incomes (χ2 = 5.68, p = 0.018, df = 1), were more likely to be unemployed (χ2 = 8.12, p = 0.004, df = 1), and were more likely to be married (χ2 = 4.79, p = 0.029, df = 1) when compared with those born in the USA. Those not born in the USA reported lower social support (t = 3.92, p<0.001), specifically the tangible (t = 4.18, p < 0.001) and emotional support subscales (t = 4.4, p<0.001). When compared with those born in the USA, foreign-born Hispanic women reported less stress (t = 3.23, p = 0.001) and depression (t = 3.3, p = 0.002).

CONCLUSION

Pregnant Hispanic women not born in the USA are at increased risk for suboptimal social determinants of health, including less social support. US-born women were more stressed and depressed and had higher BMIs.

Discrimination as a Moderator of the Effects of Acculturation and Cultural Values on Mental Health Among Pregnant and Postpartum Latina Women

It is important to consider how identity, culture, and social adversity influence maternal mental health among Latina women both because this community faces unique cultural stressors and also because factors that undermine women's mental health during pregnancy and postpartum could have injurious consequences that cascade across generations. This study uses data from a questionnaire administered to Latina pregnant and postpartum women in Southern California, examining cultural orientation, discrimination, and mental health. Results demonstrate mental health benefits for both American and Latino cultural orientations, but the latter's benefit of lower anxiety was only apparent with high discrimination. American and Latino cultural values systems had opposite relationships with depression, with the latter protective and also positively associated with happiness. More traditional gender roles values were associated with greater perceived stress and lower happiness. Different aspects of familism had opposite effects as obligation was associated with less anxiety and referent (defining oneself communally with kin) with more. Results suggest that social adversity and cultural identity and values influence maternal psychology. This study makes a unique contribution by integrating anthropological and biopsychosocial methods and theories towards addressing an issue of public-health importance.

Prenatal Neighborhood Ethnocultural Context and the Mental Health of Mothers and Children in Low-Income Mexican American Families

Socioeconomically disadvantaged neighborhoods increase the risk for poor mental health among residents, yet protective factors may operate alongside risk. This study evaluated the influence of the prenatal neighborhood ethnocultural context on child behavior problems and maternal depressive symptoms. Prenatal maternal role expectations, prenatal culture-specific stress, and postpartum depression (PPD) symptoms were evaluated as mediators. Participants included 322 low-income, Mexican American mother-child dyads. Women (Mage  = 27.8) reported on proposed mediators, maternal depressive symptoms, and child behavior problems at 4.5 years. Neighborhood Latinx concentration was obtained from census data. Higher Latinx concentration predicted fewer maternal depressive symptoms and child behavior problems, mediated through role expectations and PPD symptoms. Results suggest prenatal neighborhood context to impact later maternal and child mental health.

Engaging Latino parents: An outcome evaluation of the Academia de Cultura Latina Para Padres

Social capital interventions have been linked to various health and well-being outcomes in children and families. This study evaluated the Academia de Cultura Latina Para Padres (ACLP), a grass roots women-led parent engagement program that aimed to increase its participants' understanding and access to information about their children's education to support their academic success. Cross-sectional data were collected from 100 Latino caregivers who were on average 40.3 (SD = 12.12) years old, participated in the ACLP program between September and November 2019, and had at least one child or grandchild who attended Rosa Parks Elementary School in San Diego, California. A paired t test and multiple linear regression were conducted to compare the participants' scores on a pretest and posttest. A thematic analysis approach was also used to code participant responses to open-ended workshop satisfaction questionnaires. Participants scored significantly higher on the posttest after participating in the ACLP program, and although we did not find a significant relationship between the participants' attendance and posttests, we found a significant relationship between their positive ratings of the workshops and posttest scores. Findings from this study can inform future parent involvement programs, strategies for community engagement and practice with Latino caregivers, and research.

Racial/Ethnic Differences in Unwanted Pregnancy: Moderation by Sexual Orientation

OBJECTIVE

To explore sexual orientation disparities in unwanted pregnancy by race/ethnicity.

BACKGROUND

Previous research has documented that sexual-minority women (SMW) are more likely to report unplanned pregnancy than heterosexual women, and that Black and Latina women are more likely to report unplanned pregnancy than White women. No research has examined how pregnancy intention varies at the intersection of these two identities.

METHOD

Data come from the pregnancy roster data in Waves IV and Wave V subsample in the National Longitudinal Study of Adolescent to Adult Health. We used pregnancy as the unit of analysis (n=10,845) and multilevel logistic regression models to account for clustering of pregnancies within women. Per pregnancy, women were asked if they "wanted" to be pregnant at the time of pregnancy. We conducted models stratified by race/ethnicity, as well as models stratified by sexual identity.

RESULTS

Among White women, sexual-minority women were more likely to describe their pregnancy as unwanted than were their heterosexual counterparts. Conversely, among Black and Latina women, sexual-minority women were less likely to describe their pregnancy as unwanted than were their heterosexual counterparts. Results stratified by sexual identity underscore these contrasting patterns: Among heterosexual women, White women were less likely to describe their pregnancies as unwanted compared to Black and Latina women; among sexual-minority women, White women were more likely to describe their pregnancy as unwanted than were Black and Latina women.

CONCLUSION

Traditional race/ethnicity trends in pregnancy intention (i.e., greater unwanted pregnancy among Black/Latina than White women) are reversed among sexual-minority women.

Exploring associations between perinatal depression, anxiety, and urinary oxytocin levels in Latinas

Perinatal depression has been associated with lower oxytocin (OT) levels. However, few studies have explored this topic in relation to Latinas who are at high risk of perinatal depression. The objective of this study was to explore these associations in Latinas. A total of 108 Latinas in the third trimester of pregnancy participated in the study. Depression and urinary OT levels were assessed in pregnancy and 6 weeks postpartum. Nonparametric tests were implemented to test the proposed associations. Results revealed that 28% of the participants had probable depression in pregnancy, and 23% at 6 weeks postpartum. OT levels significantly decreased from prenatal to postpartum in the whole sample; however, participants with probable prenatal depression did not exhibit a significant change in OT levels. Participants who were depressed or anxious at 6 weeks postpartum exhibited persistently higher mean OT levels over time. A distinct pattern of higher levels of OT in depressed Latinas suggests that OT levels may be an important neuroendocrine factor contributing to depressive and anxious symptoms.

Undocumented Motherhood: Gender, Maternal Identity, and the Politics of Health Care

Undocumented Mexican immigrants have had to regularly confront a prohibiting health care system despite alienation, marginalization, and the threat of deportation. In this article, I explore the impact of political exclusion and alienating discourses on the health habitus of undocumented Mexican mothers through the narrative of one mother, Marta Garza, who finds herself at the painful intersection of political and medical alienation. Marta's narrative reflects an analytical framework that centers undocumented motherhood as a space of necessary resilience and strain, wherein she is forced to advocate for her children's health despite prohibitive barriers and dangerous potential consequences.

Men's Confrontation with Pregnancy from Women's Point of View: an Ethno Phenomenological Approach

Introduction: In providing pregnancy services, particular attention is given to the mother and her infant and comparatively less consideration is paid to men’s role. This study aimed to explore how Iranian men are confronted with pregnancy from pregnant women’s point of view.

Methods: This study was conducted, using an ethno-phenomenological approach. 25 Pregnant women were recruited via purposeful sampling from health centers, hospitals, and private obstetric clinics in Mashhad, Iran. In-depth semi-structured interviews (n=25), vignettes, (n=13) as well as observation were used for data collection. The data were organized with MAXQDA software version 10 and analyzed, using van Manen descriptive- interpretive phenomenological approach.

Results: The main theme which emerged was: "adaptation, skillfulness and self-actualization of man in confrontation with pregnancy". This was derived from two themes: 1) "spouse's emotional engagement" subthemes spouse’s emotional confrontation with pregnancy occurrence, man's sentimentality following being an expectant father, husband`s confrontation with wife's motherhood, man's emotional excitement, seeing the symptoms of fetal survival, husband's gender orientation and 2)"Concentration, vigilance and active efforts of spouse during pregnancy" subthemes managing wife towards successful pregnancy, efforts to acquire paternal skills and pregnancy as an issue to expand spouse's mental horizons.

Conclusion: Besides an overwhelming sense of emotion, men tend to be supportive in managing successful pregnancy. As an opportunity window pregnancy seems to develop thinking, vision and horizons of life among men and increases their responsibility. By promoting male participation in pregnancy, important steps could be taken to improve maternal and infant health using spouses` support approach.

"I'm used to doing it by myself": exploring self-reliance in pregnancy

BACKGROUND

Self-reliance (the need to rely on one's own efforts and abilities) is cited as a potential coping strategy for decreased or absent social support during pregnancy. Little data exists on how women view self-reliance in pregnancy.

METHODS

We recruited women from urban, walk-in pregnancy testing clinics from June 2014-June 2015. Women aged 16 to 44 and at less than 24 weeks gestational age were eligible. Participants completed an enrollment survey and in-person, semi-structured interviews. We used framework analysis to identify key concepts and assess thematic relationships.

RESULTS

Eighty-four English-speaking women completed qualitative interviews. Participants averaged 26 years of age and 7 weeks estimated gestational age. Most identified as Black (54%) or Hispanic (20%), were unemployed or homemakers (52%), unmarried (92%), and had at least one child (67%). Most did not intend to get pregnant (61%) and planned to continue their pregnancy and parent (65%). We identified self-reliance as a prevalent concept that almost half (48%) of participants discussed in relationship to their pregnancy. Self-reliance in pregnancy consisted of several subthemes: 1) past experiences, 2) expectations of motherhood, 3) financial independence, 4) decision making, and 5) parenting.

CONCLUSIONS

Self-reliance is an important aspect of women's reproductive lives and is threaded through women's past and current thoughts, feelings, experiences and decisions about pregnancy. Women's belief in their own self-reliance as well as a recognition of the limits of self-reliance merits further research, especially as a potential strategy to cope with decreased or absent social support during pregnancy.

Mental Health Among Latina Farmworkers and Other Employed Latinas in North Carolina

The mental health of Latinas with manual occupations, particularly those employed in agriculture, is a public health concern. The goals of this analysis were to describe the mental health of Latina farmworkers, and to compare their mental health with that of other Latina manual workers. Participants included 35 employed Latina farmworkers, 35 employed non-farmworkers, and 25 unemployed non-farmworkers who completed interviews in 2012. Measures included stress, anxiety, depressive symptoms, elevated depressive symptoms, and risk for alcohol dependence. Farmworkers had greater stress and anxiety than did employed and unemployed non-farmworkers. Employed Latinas, whether farmworkers or in other occupations, had greater stress and anxiety than unemployed Latinas. Depressive symptoms, although high, did not differ significantly by occupation and employment. Few were at risk for alcohol dependence. Concrete steps are needed to address the mental health of Latina farmworkers, and to continue documentation of mental health concerns and their causes in this population.

Economic Hardship and Depression Among Women in Latino Farmworker Families

Farmworker family members risk poor mental health due to stressors including poverty, relocation, and documentation status. This paper explores the relationship between farm-work related stressors and depressive symptoms in women of Latino farmworker families. 248 mothers of young children completed fixed-response interviews in Spanish. Measures included the Center for Epidemiologic Studies-Depression Scale, Migrant Farmworker Stress Inventory, and USDA Household Food Security Survey Module. Bivariate analyses indicated greater depressive symptoms with more economic hardship, more farm work-related stressors, greater age, and being unmarried. In multivariable logistic regression, economic hardship remained the only factor associated with depressive symptoms. Greater economic hardship, but not general farm work-related stress, is a main factor associated with depression in women of Latino farmworker families. Maternal depression can have consequences for both mothers and families. Mental health services for women in farmworker families should be targeted to those with the greatest economic challenges.

Work and health among Latina mothers in farmworker families

BACKGROUND

Work organization is important for the health of vulnerable workers, particularly women. This analysis describes work organization for Latinas in farmworker families and delineates the associations of work organization with health indicators.

METHODS

Up to 220 Latina women in farmworker families completed interviews from October 2012 to July 2013. Interviews addressed job structure, job demand, job control, and job support. Health measures included stress, depressive symptoms, physical activity, family conflict, and family economic security.

RESULTS

Three fifths of the women were employed. Several work organization dimensions, including shift, psychological demand, work safety climate, and benefits, were associated with participant health as expected, on the basis of the work organization and job demands-control-support models.

CONCLUSIONS

Research should address women's health and specific work responsibilities. Occupational safety policy must consider the importance of work organization in the health of vulnerable workers.

Eat, play, view, sleep: Exploring Mexican American mothers' perceptions of decision making for four behaviors associated with childhood obesity risk

OBJECTIVE

This mixed methods study sought to understand who makes decisions about whether preschool-aged Mexican American children engage in eating, outdoor play, sleep, and screen time behaviors.

METHODS

Forty Mexican American mothers of children ages 3-4 participated in two interviews, during which both closed- and open-ended questions elicited perceptions of who made decisions for the four behaviors, as well as who was present, mealtime rules, and food choice values. Interviews were transcribed, coded for emergent themes, and compared across participants.

RESULTS

Participants generally perceived themselves to be primary decision makers for all four behaviors; however, food decisions often seemed to be made collaboratively with the child. Fathers were most likely to participate in evening television decisions. Other family members were rarely mentioned. Selecting foods that children liked was a strong food choice value, while cost was rarely mentioned. Participants appeared to have low perceived control over their child's behaviors relative to their perceived roles in decision making.

CONCLUSIONS

Mothers may be the primary audience for obesity prevention messages for preschool-aged, Mexican American children; however, health promotion programs may need to increase mothers' awareness of their control over children's behaviors. Understanding how children's behaviors are regulated is an important aspect of obesity prevention for low-income, Mexican American children.

A blessing I can't afford: factors underlying the paradox of happiness about unintended pregnancy

An unresolved paradox in the measurement and interpretation of unintended pregnancy is that women frequently report feeling happy about pregnancies they also classify as unintended (i.e. they have incongruent intentions and feelings). This study explores the underlying reasons why women profess such happiness and how these relate to their motivations to avoid pregnancy. Between September 2013 and February 2014, semi-structured in-depth interviews were conducted with 27 women (8 white, 19 Latina) selected from a longitudinal study measuring prospective pregnancy intentions and feelings among 403 women in Austin, Texas. Women were selected for interview on the basis of wanting no more children and consistently professing either happiness (n = 17) or unhappiness (n = 10) at the prospect of pregnancy. Interviews were coded and analyzed following the principles of grounded theory. We found that it is possible for women to express happiness at the idea of pregnancy while simultaneously earnestly trying to prevent conception. Happiness at the idea of an unintended pregnancy was explained as the result of deep and heartfelt feelings about children taking precedence over practical considerations, the perception that the psychosocial stress resulting from another child would be low, and the ability to rationalize an unintended pregnancy as the result of fate or God's plan. The major exception to the sincerity of professed happiness was that conveyed as a result of social pressure despite truly negative feelings, predominantly expressed by foreign-born Latina women. Overall, equating incongruence with ambivalence about avoiding conception may undermine the sincerity of women's intentions and their desires for highly-effective contraception. At the same time, unintended pregnancies that are greeted with happiness may have different implications for maternal and child health outcomes compared to pregnancies that are greeted with unhappiness. Identifying which unintended pregnancies are most likely to result in adverse outcomes is a target for future research.

Work organization and health among immigrant women: Latina manual workers in North Carolina

OBJECTIVES

We sought to describe work organization attributes for employed immigrant Latinas and determine associations of work organization with physical health, mental health, and health-related quality of life.

METHODS

We conducted a cross-sectional survey with 319 employed Latinas in western North Carolina (2009-2011). Measures included job demands (heavy load, awkward posture, psychological demand), decision latitude (skill variety, job control), support (supervisor control, safety climate), musculoskeletal symptoms, mental health (depressive symptoms), and mental (MCS) and physical component score (PCS) health-related quality of life.

RESULTS

Three fifths reported musculoskeletal symptoms. Mean scores for depression, MCS, and PCS were 6.2 (SE = 0.2), 38.3 (SE = 0.5), and 42.8 (SE = 0.3), respectively. Greater job demands (heavy load, awkward posture, greater psychological demand) were associated with more musculoskeletal and depressive symptoms and worse MCS. Less decision latitude (lower skill variety, job control) was associated with more musculoskeletal and depressive symptoms. Greater support (supervisor's power and safety climate) was associated with fewer depressive symptoms and better MCS.

CONCLUSIONS

Work organization should be considered to improve occupational health of vulnerable women workers. Additional research should delineate the links between work organization and health among vulnerable workers.

Preterm delivery among first-time Mexico-born mothers: a binational population-based comparison of deliveries in California and Mexico

BACKGROUND

While studies have attributed the favourable birth outcomes of Mexico-born mothers in the USA to a 'healthy immigrant effect' that confers protection to immigrants, a comparison of immigrants with the source population in Mexico has been lacking. We compared preterm delivery (PTD) rates of Mexico-born immigrants who delivered in California with Mexico-born women who delivered in Mexico (WIMX) and with a subgroup who delivered in the five top immigrant sending states in Mexico.

METHODS

Using 2009 birth records, we selected all live-born singletons of primiparous WIMX (699 129) and immigrants in California (33 251). We examined the unadjusted and adjusted association between place of delivery and any PTD (<37 weeks gestation), including PTD subcategories (early, moderate, late), using relative risks (RR) and 95% CIs. Multivariate models controlled for demographic and health system characteristics.

RESULTS

PTD rates were higher among immigrants in California (6.7%) than WIMX (5.8%) and compared to women in the sending states (5.5%). The unadjusted risk of any PTD (RR=1.17 (1.12 to 1.22)), early/moderate PTD (<34 weeks gestation; RR=1.27 (1.18 to 1.38)) and late PTD (34-36 weeks; RR=1.14 (1.08 to 1.19)) was higher for immigrants than for WIMX and remained higher when controlling for age, education and healthcare variables. Birth weight <1500 g was also higher among immigrants (RR=1.27 (1.14 to 1.44)). Similar patterns were observed when comparing women in the sending states.

CONCLUSIONS

We found no evidence of a 'healthy immigrant effect'. Further research must assess the comparability of gestational-age data in Mexican and Californian birth certificates.

Unintended births among adult immigrant and U.S.-born Mexican women in the Los Angeles Mommy and Baby (LAMB) survey

BACKGROUND

Unintended births are especially frequent among minority women. Predictors of unintended births among adult Mexican women living in the United States are poorly characterized.

METHODS

Data are from vital statistics and the 2005 Los Angeles Mommy and Baby (LAMB) survey, a population-based study of women delivering a live birth in Los Angeles County, California (n = 1,214). Multivariable logistic regression assessed the relation of unintended birth with acculturation variables adjusting for background and psychosocial characteristics. Multinomial models assessed these relations for women with an unintended birth who did and did not use contraception.

FINDINGS

Forty-one percent of women reported an unintended birth. Being a long-term immigrant and U.S.-born were positively associated with unintended birth compared with shorter term immigrants, but the adjusted relation was significant only for U.S.-born women (odds ratio [OR], 2.01; 95% CI, 1.19-3.39). Women reporting an unintended birth were younger, unmarried, and higher parity. If using contraception, the odds of unintended birth were increased for cohabiting women, those with high education, and those with greater stress during pregnancy. When not using contraception and reporting an unintended birth, women also have no usual place for health care, have depressive symptoms during pregnancy, and are dissatisfied with partner support.

CONCLUSIONS

Women's background and psychosocial characteristics were central to explaining unintended birth among immigrant women but less so for U.S.-born Mexican mothers. Interventions to improve birth intentions should not only target effective contraception, but also important social determinants.

Musculoskeletal and neurological injuries associated with work organization among immigrant Latino women manual workers in North Carolina

BACKGROUND

This analysis examines the associations of work organization attributes among Latino women in manual occupations with musculoskeletal and neurological injuries.

METHODS

Participants included 234 women in western North Carolina. Outcome measures included epicondylitis, rotator cuff syndrome, back pain, and carpal tunnel syndrome. Independent measures included indicators of job demand, job control, and job support, as well as personal characteristics.

RESULTS

Latina workers commonly experienced epicondylitis, rotator cuff syndrome, back pain, and CTS. Awkward posture and decision latitude were associated with epicondylitis. Rotator cuff syndrome was associated with awkward posture and psychological demand. Awkward posture and psychological demand, and decreased skill variety and job control were related to CTS.

CONCLUSIONS

Work organization factors are potentially important for musculoskeletal and neurological injury among vulnerable workers. Research is required to understand the associations of work and health outcomes of these women. Policy initiatives need to consider how work organization affects health.

Are Latina women ambivalent about pregnancies they are trying to prevent? Evidence from the Border Contraceptive Access Study

CONTEXT

Women's retrospective reports of their feelings about a pregnancy and of its intendedness are often inconsistent, particularly among Latinas. Interpretation of this incongruence as ambivalence overlooks the possibility that happiness about the prospect of pregnancy and desire to prevent pregnancy need not be mutually exclusive.

METHODS

Data from the 2006-2008 Border Contraceptive Access Study--a prospective study of 956 Latina oral contraceptive users aged 18-44 in El Paso, Texas--were used to compare women's planned pill use and childbearing intentions with their feelings about a possible pregnancy. Associations between women's feelings and their perceptions of their partner's feelings were examined using logistic regression. Prospective and retrospective intentions and feelings were compared among women who became pregnant during the study.

RESULTS

Forty-one percent of women who planned to use the pill for at least another year and 34% of those who wanted no more children said they would feel very or somewhat happy about becoming pregnant in the next three months. Perceiving that a male partner would feel very upset about a pregnancy was negatively associated with happiness about the pregnancy among both women who planned to continue pill use and those who wanted no more children (coefficients, -4.4 and -3.9, respectively). Of the 36 women who became pregnant during the study, 24 reported feeling very happy about the pregnancy in retrospect, while only 14 had prospectively reported feeling happy about a possible pregnancy.

CONCLUSION

Intentions and happiness appear to be distinct concepts for this sample of Latina women.

Prenatal expectations in Mexican American women: development of a culturally sensitive measure

Prenatal expectations describe various domains a woman envisions in preparation for her role as a new mother and influence how women transition into the maternal role. Although the maternal role is strongly influenced by the prevailing familial and sociocultural context, research characterizing prenatal expectations in ethnic minority and low-income women is lacking. As part of the largest growing minority group in the USA, Latina mothers represent an important group to study. Two hundred and ten low-income Mexican American women were administered the Prenatal Experiences Scale for Mexican Americans (PESMA) that was adapted to capture specific cultural aspects of prenatal expectations. Measures of current support, prenatal depressive symptoms, and other sociodemographic characteristics were also completed to assess validity. Exploratory factor analysis identified three underlying factors of prenatal expectations: paternal support, family support, and maternal role fulfillment. Associations among these subscales and demographic and cultural variables were conducted to characterize women who reported higher and lower levels of expectations. The PESMA demonstrated good concurrent validity when compared to measures of social support, prenatal depressive symptoms, and other sociodemographic constructs. A culturally sensitive measure of prenatal expectations is an important step towards a better understanding of how Mexican American women transition to the maternal role and identify culturally specific targets for interventions to promote maternal health.

Household structure, family ties, and psychological distress among U.S.-born and immigrant Latino women

Latino women endorse the highest rates of past-month depressive symptoms relative to Latino men and non-Latino White men and women. Yet, research into the specific domains of family life that reduce or engender psychological distress among Latinas is sparse. We examine the hypothesis that indicators of household structure and family ties will relate to psychological distress among Latinas in the United States, and that these associations will vary by nativity status. We employed nationally representative data of Latina adults (N = 1,427) from the National Latino and Asian American Study. Nativity-stratified regression analyses revealed that strained family ties (i.e., family burden, family cultural conflict) were associated with greater levels of past-month psychological distress for both U.S.-born and immigrant Latinas. Yet, the effect of household structures on psychological distress differed by nativity status. Adjusting for sociodemographic factors, lower levels of household income were associated with greater psychological distress; and having children in the household was associated with lower levels of psychological distress among U.S.-born Latinas. In contrast, for immigrant Latinas, being out of the labor force was associated with greater levels of psychological distress. Results suggest that dynamics of both the household and family context predict differential as well as similar mental-health outcomes across segments of the Latina population in the United States. These findings underscore the need to understand the pathways by which different facets of family life-structural and social domains-relate to mental-health status among subgroups of Latinas. Our results also have implications for the development of tailored interventions to meet the specific needs of Latinas.

Latina adolescents' perceptions of their male partners' influences on childbearing: findings from a qualitative study in California

Teenage births among Latina women living in the USA remain higher than any other racial/ethnic group. This study explored the role that male partners play in the occurrence of pregnancy and their influence on teenage mothers' future plans in a sample of women pregnant with their first child. Qualitative analysis revealed that partners played a significant role in the use of contraception, timing and desire for pregnancy and young women's post-pregnancy plans for education, work and childrearing. Men's older age, concerns about contraceptive use and fertility, reluctance to use condoms, and readiness for parenthood put their partners at increased risk for pregnancy. More acculturated men were supportive of young women's educational goals in many cases, whereas less acculturated males subscribed to more rigid gender roles which required that their partners remain at home after the birth of their child. These findings have important implications for programmes that seek to reduce teenage pregnancy in the US Latino population.

Interethnic mating and risk for preterm birth among Arab-American mothers: evidence from the Arab-American Birth Outcomes Study

Arab ethnicity (AE) mothers have lower preterm birth (PTB) risk than white mothers. Little is known about the determinants of PTB among AE women or the role of interethnic mating in shaping PTB risk among this group. We assessed the relationship between interethnic mating and risk for PTB, very PTB, and late PTB among AE mothers. Data was collected for all births (N = 21,621) to AE women in Michigan between 2000 and 2005. Self-reported ancestry was used to determine paternal AE as well as to identify AE mothers. We used bivariate chi-square tests and multivariable logistic regression to assess the relationship between paternal non-AE and risk for PTB, very PTB, and late PTB among AE mothers. All analyses were also conducted among non-Arab white mothers as a control. Among AE mothers, paternal non-Arab ethnicity was associated with higher risk of PTB (OR = 1.18, 95% CI = 1.06, 1.30) and late PTB (OR = 1.24, 95% CI = 1.20, 1.38) compared to paternal Arab ethnicity. Paternal non-Arab ethnicity was not associated with risk for any outcome among non-Arab white mothers. Future studies could assess the causal mechanisms underlying the association between interethnic mating and risk for PTB.

Suicide among Arab-Americans

Background

Arab-American (AA) populations in the US are exposed to discrimination and acculturative stress—two factors that have been associated with higher suicide risk. However, prior work suggests that socially oriented norms and behaviors, which characterize recent immigrant ethnic groups, may be protective against suicide risk. Here we explored suicide rates and their determinants among AAs in Michigan, the state with the largest proportion of AAs in the US.

Methodology/Principal Findings

ICD-9/10 underlying cause of death codes were used to identify suicide deaths from among all deaths in Michigan between 1990 and 2007. Data from the 2000 U.S. Census were collected for population denominators. Age-adjusted suicide rates among AAs and non-ethnic whites were calculated by gender using the direct method of standardization. We also stratified by residence inside or outside of Wayne County (WC), the county with the largest AA population in the state. Suicide rates were 25.10 per 100,000 per year among men and 6.40 per 100,000 per year among women in Michigan from 1990 to 2007. AA men had a 51% lower suicide rate and AA women had a 33% lower rate than non-ethnic white men and women, respectively. The suicide rate among AA men in WC was 29% lower than in all other counties, while the rate among AA women in WC was 20% lower than in all other counties. Among non-ethnic whites, the suicide rate in WC was higher compared to all other counties among both men (12%) and women (16%).

Conclusions/Significance

Suicide rates were higher among non-ethnic white men and women compared to AA men and women in both contexts. Arab ethnicity may protect against suicide in both sexes, but more so among men. Additionally, ethnic density may protect against suicide among Arab-Americans.

Risky sexual behaviors among Hispanic young adults in South Florida: nativity, age at immigration and gender differences

CONTEXT

U.S. Hispanics are disadvantaged compared with whites in regard to sexual health, particularly early sexual initiation and contraceptive use. It is unclear whether differences in nativity and immigration are associated with risky sexual behaviors.

METHODS

Data collected between 1998 and 2000 from a community sample in South Florida were analyzed to examine sexual behaviors among 709 Hispanic individuals aged 18-23. Associations between nativity and age at immigration and sexual behaviors were assessed separately by gender using chi-square tests and analyses of covariance.

RESULTS

Smaller proportions of sexually experienced women who had immigrated to the United States before age six than of similar U.S.-born women reported having had vaginal sex (83% vs. 91%) and oral sex (71% vs. 86%) in the past year. Compared with U.S.-born women, those who had immigrated at age six or older reported lower levels of oral sex (66% vs. 86% of those with sexual experience) and drug use in conjunction with sex in the past year (mean score, 1.2 vs. 1.6 on a scale of 1-5), and a lower average lifetime number of sexual partners (2.0 vs. 3.7 in the sample overall). Immigrant men were no less likely than U.S.-born men to engage in risky sexual behavior.

CONCLUSIONS

Given the diversity of nativity and immigration histories among Hispanics in the United States, it is important that research examine both factors. An understanding of their joint association with sexual activity, plus the conditioning effects of gender, could help professionals to develop effective education and prevention programs for young people who are at risk for engaging in potentially dangerous sexual behavior.

Differences in contraceptive use across generations of migration among women of Mexican origin

OBJECTIVES

To explore differences in contraceptive use among women of Mexican origin across generations of migration.

METHODS

Logit models were used to assess contraceptive use among 1,830 women of Mexican origin in Cycles 5 (1995) and 6 (2002) of the National Survey of Family Growth (NSFG). Analyses were stratified by age. Initial models controlled for survey year and underlying differences across generations of migration in age and parity; subsequent models added a range of potential mediating variables. Models account for significant interactions between generation of migration and parity.

RESULTS

Among women under age 30 who have not yet had any children, women in their twenties with parity 3 or more, and women 30 or older with parity 1 or 2, those born in the US are much more likely to use contraception than immigrant women. For other levels of parity, there are no significant differences in contraceptive use across generations of migration. Generational differences in marital status, socio-economic status, health insurance coverage, and catholic religiosity did little to mediate the association between generation of migration and contraceptive use.

CONCLUSIONS

Among women of Mexican origin, patterns of contraceptive use among first-generation immigrants and women of generation 1.5 are similar to those of women in Mexico, with very low rates of contraceptive use among young women who have not yet had a child. Further research is needed to investigate the extent to which this pattern is due to fertility preferences, contraceptive access, or concerns about side effects and infertility. Patterns of contraceptive use appear to change more slowly with acculturation than many other factors, such as education, income, and work force participation.

Mexican women in California: differentials in maternal morbidity between foreign and US-born populations

In the US, the majority of deaths and serious complications of pregnancy occur during childbirth and are largely preventable. We conducted a population-based study to assess disparities in maternal health between Mexican-born and Mexican-American women residing in California and to evaluate the extent to which immigrants have better outcomes. Mothers in these two populations deliver 40% of infants in the state. We compared maternal mortality ratios and maternal morbidities during labour and delivery in the two populations using linked 1996-98 hospital discharge and birth certificate data files. For maternal morbidities, we calculated frequencies and observed and adjusted odds (OR) ratios using pre-existing maternal health, sociodemographic characteristics and quality of health care as covariates. Approximately 19% of Mexican-born women suffered a maternal disorder compared with 21% of Mexican-American women (Observed OR = 0.89, [95% CI 0.88, 0.90]). Despite their lower education and relative poverty, Mexican-born women still experienced a lower odds of any maternal morbidity than Mexican-American women, after adjusting for covariates (OR = 0.92, [95% CI 0.90, 0.93]). These findings suggest a paradox of more favourable outcomes among Mexican immigrants similar to that found with birth outcomes. Nevertheless, the positive aggregate outcome of Mexican-born women did not extend to maternal mortality, nor to certain conditions associated with suboptimal intrapartum obstetric care.

“Una Mujer Trabaja Doble Aquí”: Vignette-Based Focus Groups on Stress and Work for Latina Blue-Collar Women in Eastern North Carolina

Latina women are a growing percentage of the working population, and very little is known about their health needs and interests. The purpose of this article is to share qualitative research results gathered from Latina women with a particular focus on exploring stress and health. This project was a substudy of Health Works in the Community, a 5-year CDC-funded multiple risk-factor reduction trial using participatory action research approaches to address smoking, healthy eating, stress, and physical activity among blue-collar women from 12 manufacturing work sites in rural, eastern North Carolina. Five focus groups were conducted with trained, bilingual facilitators using a vignettebased moderator guide that appeared particularly effective with this population. Results from the focus groups are used to make recommendations for future research with Latinas and for developing effective work-site-based interventions to address issues of stress and health within this population.

Contemporary Mothering in a Diverse Society

The contextual and environmental factors that may affect mothering and perceptions of the maternal role in today's increasingly diverse society are described. Following a historical overview of the development of maternal role theory within the nursing literature, the influence of images and myths in Western society, race/ethnicity, cultural background, and employment status are discussed. Guidelines for nursing interventions that allow for individual and cultural differences are provided.

Infertility among low-income Latinos

OBJECTIVE

To explore the experience of infertility among low-income Latinos.

DESIGN

Ethnographic qualitative interview study.

SETTING

Academic research environment.

PATIENT(S)

One hundred eighteen Latinos who sought medical care for infertility.

INTERVENTION(S)

Tape-recorded interviews with 88 women and 30 men were transcribed and analyzed for emergent themes.

MAIN OUTCOME MEASURE(S)

Cultural beliefs regarding fertility and infertility, the value placed on having children, access to and use of health care resources, and non-biomedical approaches to having children.

RESULT(S)

Latino women and men believed that children were the basis of the marital relationship and that childless marriages were considered a failure. No couples had the economic resources to pursue medical treatment beyond a basic level. A difference was found in approaches to infertility treatment between women raised in the United States and those raised elsewhere, with those raised in the United States being more assertive in seeking care. Women frequently saw practitioners of Western biomedicine and humoral medicine. Women reported that they would continue trying to conceive until they reached menopause.

CONCLUSION(S)

Infertility is a devastating experience for Latinos that has far-reaching effects, both on women and men individually and on the couple relationship.

Motivations for pregnancy planning among Mexican immigrant women in North Carolina

OBJECTIVES

To enhance understanding of 1) Mexican immigrant women's attitudes toward planning their pregnancies and the factors that influence their fertility preferences, and 2) the effect of migration on their pregnancy planning decisions.

METHODS

Qualitative in-depth interviews were conducted with 11 Mexican immigrant women living in North Carolina. Participants were recruited by means of snowball sampling. Interviews were conducted in Spanish in the women's homes. Interviewing and analysis were conducted iteratively to allow emerging themes and interpretations to be developed and validated in subsequent interviews.

RESULTS

The women were strongly motivated to plan their pregnancies. Their primary considerations in pregnancy planning were their ability to give their children a good life and their ability to enjoy their families. Individual personal aspirations did not emerge as an important consideration. Migration intensified the women's felt need to plan their pregnancies.

CONCLUSIONS

The Mexican immigrant women in this study had a strong familistic orientation. Far from diminishing their interest in planning their pregnancies, however, the high value they placed on family was their primary motivation for pregnancy planning. Migration to the U.S. intensified their felt need to plan their pregnancies. Understanding of the women's motivations for family planning may help health care providers better address the family planning needs of Mexican immigrant women.

Social Support in Mexican American Childbearing Women

Because the Mexican American population in the United States is increasing, nurses will inevitably come into contact with members of this cultural group. Social support is essential for women to adapt to the demands of the perinatal period, and Mexican American childbearing women face particular challenges in obtaining social support. In this article, traditional roles and social support in Mexican American families are described, the challenges of delivering prenatal care within these traditions are discussed, and strategies for nursing intervention are offered.

Social disparities in maternal morbidity during labor and delivery between Mexican-born and US-born White Californians, 1996-1998

OBJECTIVES

To assess maternal health disparities, we compared maternal morbidities during labor and delivery among Mexican-born and US-born White, non-Latina women residing in California.

METHODS

This population-based study used linked hospital discharge and birth certificate data for 1996-1998 (862,723 deliveries). We calculated the frequency, and observed and adjusted odds ratios for obstetric complications. Covariates included maternal age, parity, education, prenatal care initiation and payment source, and hospital quality of care.

RESULTS

Approximately 1 in 5 deliveries resulted in a obstetric complication. After control for covariates, Mexican-born women were significantly less likely to have 1 or more maternal morbidities than White, non-Latina women but more likely to have complications that reflect the quality of intrapartum care.

CONCLUSIONS

Maternal morbidities during labor and delivery are a substantial burden for women in California. The favorable overall outcome of Mexican-born women over US-born White, non-Latinas is surprising given their lower educational attainment, relative poverty, and greater barriers to health care access. The favorable outcomes obscure vulnerabilities in those complications that are sensitive to the quality of intrapartum care.

The Latina paradox: an opportunity for restructuring prenatal care delivery

Latina mothers in the United States enjoy surprisingly favorable birth outcomes despite their social disadvantages. This "Latina paradox" is particularly evident among Mexican-born women. The social and cultural factors that contribute to this paradox are maintained by community networks--informal systems of prenatal care that are composed of family, friends, community members, and lay health workers. This informal system confers protective factors that provide a behavioral context for healthy births. US-born Latinas are losing this protection, although it could be maintained with the support of community-based informal care systems. We recommend steps to harness the benefits of informal systems of prenatal care in Latino communities to meet the increasing needs of pregnant Latina women.

Creating continuity through mutual assistance: intergenerational reciprocity in four ethnic groups

OBJECTIVES

Our purpose is to examine how culture-specific conceptions of mutual assistance in four ethnic groups reflect the nature of social exchange and its role in creating continuity.

METHODS

We conducted five in-depth interviews over a 5-year period with 270 respondents aged 50 and up (59 African Americans, 85 Latinos, 78 Filipino Americans, and 48 Cambodian Americans). We asked both open-ended and semistructured questions to determine how respondents viewed their role in mutual assistance in the family.

RESULTS

Mutual assistance was a critical element in intergenerational relations in all four groups, as it represented continuity within the family and was a part of a broader cultural ethos of family relationships. There were differences between groups in overall approach to mutual assistance, the factors to which they assigned the greatest importance, and the degree of dissatisfaction expressed over family relationships.

DISCUSSION

Social exchange can be viewed not only as a means by which those who are old maintain power but as a major vehicle for perpetuating continuity across the generations. When social exchange breaks down, elders suffer from loss of power as expressed through role loss. Elders must have a negotiable commodity to exchange as well as the flexibility to adjust to changes in the extended family. Maintaining continuity of the family in the face of disruptive threats poses a particular challenge for elders.

Acculturation and perinatal outcomes in Mexican immigrant childbearing women: an integrative review

Despite several sociocultural factors associated with increased risk for low birth weight and infant mortality, the rate for infants born to first-generation and less acculturated Mexican immigrant women is the same as that of non-Hispanic whites, and half that of African Americans with similar risks. It appears that sociocultural rather than genetic variables are the primary factors associated with this phenomenon. Higher levels of acculturation to North American values and lifestyle in Mexican American childbearing women have been correlated with poor perinatal outcomes, including low birth weight. Acculturation is emerging as an important variable that should be considered when providing health care to Mexican immigrant childbearing women and their families.