Nonresponse in follow-back surveys of ethnic minority groups: an analysis of the Puerto Rican Maternal and Infant Health Study

Selective migration and infant mortality among Puerto Ricans

OBJECTIVE

This study examines the implications of migration to the United States for infant mortality among Puerto Rican mothers born in Puerto Rico. The roles of selective migration and duration of US residence are assessed.

METHOD

Using survey data collected from mothers of infants sampled from computerized birth and infant death records of six US vital statistics reporting areas and Puerto Rico, we estimate logistic regression models of infant mortality among the sampled infants. These models provide a baseline for comparison with fixed-effects models based on all births within each mother's history.

RESULTS

Logistic regression models for sampled infants show that the risk of infant mortality is lower for migrant women than for nonmigrant women in Puerto Rico until the migrants have lived in the United States for a substantial period of time. Fixed-effects models indicate that once unmeasured stable characteristics of the mother are controlled, early migrants do not differ from nonmigrants with respect to the risk of infant death. Both sets of models demonstrate that as mothers' exposure to the US mainland increases, the risk of infant mortality rises.

CONCLUSIONS

Selective migration plays a role in the relatively low risk of infant mortality among recent Puerto Rican migrants to the United States. Migrants appear to be selected on qualities that contribute to favorable health outcomes for their offspring, but those qualities are later lost with exposure to life in the United States.

The Pregnancy Risk Assessment Monitoring System (PRAMS): current methods and evaluation of 2001 response rates

OBJECTIVES

Our objectives were to describe the methodology of the Pregnancy Risk Assessment Monitoring System (PRAMS), examine recent response rates, determine characteristics associated with response, and track response patterns over time.

METHODS

PRAMS is a mixed-mode surveillance system, using mail and telephone surveys. Rates for response, contact, cooperation, and refusal were computed for 2001. Logistic regression was used to examine the relationship between maternal and infant characteristics and the likelihood of response. Response patterns from 1996 to 2001 were compared for nine states.

RESULTS

The median response rate for the 23 states in 2001 was 76% (range: 49% to 84%). Cooperation rates ranged from 86% to 97% (median 91%); contact rates ranged from 58% to 93% (median 82%). Response rates were higher for women who were older, white, married, had more education, were first-time mothers, received early prenatal care, and had a normal birthweight infant. Education level was the most consistent predictor of response, followed by marital status and maternal race. From 1996 to 2001, response to the initial mailing decreased in all states compared, but the decrease was offset by increases in mail follow-up and telephone response rates. Overall response rates remained unchanged.

CONCLUSIONS

The PRAMS mail/telephone methodology is an effective means of reaching most recent mothers in the 23 states examined, but some population subgroups are more difficult to reach than others. Through more intensive follow-up efforts, PRAMS states have been able to maintain high response rates over time despite decreases in response to the initial mailing.

What does skin color have to do with infant health? An analysis of low birth weight among mainland and island Puerto Ricans

This study investigates the relationship between maternal skin tone and low birth weight among Puerto Ricans, a group with a complex ancestry and skin tones that range from very light to very dark. Using data from a representative sample of Puerto Rican mothers, we assess whether skin tone has different implications for low birth weight in three geographic areas (Puerto Rico; New York City; other eastern states). The analysis shows that skin tone is unrelated to low birth weight in Puerto Rico and New York City. However, in the other eastern states in our sample, mothers with dark skin have a high risk of bearing a low birth-weight infant, relative to mothers with light skin. We interpret our findings in light of differences in the social meaning of phenotypic differences across locales.

Structure, process, and satisfaction with obstetricians: an analysis of mainland Puerto Ricans

This study examines various dimensions of satisfaction with obstetricians among mainland Puerto Ricans using data from a survey administered to a representative sample of 1,219 Puerto Rican mothers. The results indicate that the majority of Puerto Rican women are satisfied with their obstetricians, but they are not typically "extremely" satisfied. Moreover, satisfaction is influenced by the structure of care, the process of care, and the outcome of care. Two aspects of process that are especially important are the continuity and content of care. Although satisfaction is not generally associated with the ethnicity or the gender of physicians, some evidence suggests that patients who utilize public facilities or lack continuity of care tend to be more satisfied if they have a female physician.