Health of Post-Institutionalized Haitian Children Adopted to the United States

OBJECTIVES

Haiti remains a principal placement country for intercountry adoptees to the United States. This project reports the health status of children adopted from Haiti arriving to the U.S. and compares them to intercountry adoptees from other regions.

METHODS

A retrospective chart review was conducted of adoptees placed in the U.S. from Haiti (n=87), age and sex matched with intercountry adoptees placed in the U.S. from Asia (n=87) and Latin America (n=87) between January 2010 and November 2019. Data on immunization status, contagious diseases, and nutrition and growth were analyzed via linear, logistic, and multinomial regression.

RESULTS

After adjusting for age, sex, and standardized height, children adopted from Haiti, compared to adoptees from Latin America and Asia, demonstrated a lack of immunity to hepatitis B (OR=5.89;6.87), increased immunity to hepatitis A (OR=0.38;0.30), infection by two or more parasites (OR=8.43;38.48), high lead levels (OR=23.79;7.04), and anemia (OR=15.25;9.18). Unexpectedly, children adopted from Haiti had greater standardized height (-1.28 vs. -1.82 and -2.13) and standardized weight (-0.32 vs. -0.57 and -1.57) than their counterparts from Latin America and Asia.

CONCLUSIONS

Children adopted from Haiti face complex medical challenges undoubtedly related to the country's low socioeconomic status (SES) and the impact of recurrent natural disasters and governmental neglect on public health infrastructure. Appropriate care is critical in preventing and avoiding transmission of infectious diseases in adoptees and family members. The high incidence of anemia and elevated lead levels may further exacerbate the developmental effects of early institutional deprivation.

Reared-apart/reared-together Chinese twins and virtual twins: Evolving research program and general intelligence findings

China's One-Child Policy (1979-2015) limited rural families to two children and urban families to one child. This practice, which led to the abandonment of hundreds of thousands of female infants, is indirectly responsible for the separate placement of infant twins. The availability of this sample launched the first prospective study of these pairs. Participants include families and twins comprising 15 monozygotic (MZA) pairs and 7 dizygotic (DZA) pairs from countries throughout the world. The research program is described, and the initial wave of IQ scores for MZA and DZA twin pairs is examined in the first comprehensive report from this study. The twins' mean age at participation was 9.41 years (SD = 6.36), and their ages ranged from 3.19 to 24.98 years. Informative contrasts with adopted-together Chinese twins and virtual twins (same-age unrelated individuals reared together) highlight shared genetic and environmental effects on intellectual development. Applied directions based on findings from these novel samples are described.

Genes and the intergenerational transmission of BMI and obesity

This paper compares the strength of intergenerational transmission of body mass index (BMI) and obesity in a sample of adoptees relative to a matched sample of biological children with similar observable characteristics. We find that BMI and obesity are strongly correlated among biological parent-child pairs, but there are no significant intergenerational associations in these health traits among adoptive parent-child pairs. The intergenerational elasticity of BMI for children to their parents is 0.2 in the matched biological sample, but indistinguishable from zero for adopted children with a standard error more than three times as large as the coefficient. Under reasonable assumptions, these findings indicate that the intergenerational transmission of BMI and obesity occurs primarily through genetic mechanisms. Additional analyses of transmission rates by parental gender and among step-parents and step-children support this conclusion. The role of determinants of BMI and obesity in the household environment in relation to our findings is discussed. Given the negative consequences of obesity on earnings and other economic measures, our results suggest that the genetic transmission of weight problems contributes substantially to intergenerational persistence in economic outcomes.

Personality disorders in adopted versus non-adopted adults

The goal of this epidemiological study was to investigate lifetime history and odds ratios of personality disorders in adopted and non-adopted adults using a nationally representative sample. Data, drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), were compared in adopted (n=378) versus non-adopted (n=42,503) adults to estimate the odds of seven personality disorders using logistic regression analyses. The seven personality disorders were histrionic, antisocial, avoidant, paranoid, schizoid, obsessive-compulsive, and dependent personality disorder. Adoptees had a 1.81-fold increase in the odds of any personality disorder compared with non-adoptees. Adoptees had increased odds of histrionic, antisocial, avoidant, paranoid, schizoid, and obsessive-compulsive personality disorder compared with non-adoptees. Two risk factors associated with lifetime history of a personality disorder in adoptees compared to non-adoptees were (1) being in the age cohort 18-29 years (but no difference in the age 30-44 cohort), using the age 45 or older cohort as the reference and (2) having 12 years of education (but no difference in higher education groups), using the 0-11 years of education as the reference. These findings support the higher rates of personality disorders among adoptees compared to non-adoptees.

Adoptees' contact with birth parents in emerging adulthood: the role of adoption communication and attachment to adoptive parents

As adoptees transition to adulthood, their roles in the family may shift, providing them with opportunities to have increasing autonomy in their decisions about contact and initiating conversations about adoption. Research has often focused more on adoptees as children, yet in emerging adulthood, there are important shifts in the life roles and relationships of adoptees during which adoptive parents continue to be meaningful. This study examined associations among attachment and communication within the adoptive family during adulthood with emerging adult adoptees' experience of birth family contact (frequency of and satisfaction with birth family contact), in a sample of 167 emerging adults with varied contact with birth family (from no contact to frequent contact). Results suggest that perceptions of secure parent-child attachment relationships, as well as sensitive and open communication with adoptive parents about adoption, continue to be important for emerging adult adoptees and lead to greater satisfaction for adoptees with birth parent contact-regardless of whether adoptees actually have birth family contact. In particular, positive family communication about adoption during adulthood was predictive of satisfaction with birth parent contact. Limitations and implications are discussed.

Genetic mechanisms in the intergenerational transmission of health

This paper uses a sample of adoptees to study the genetic mechanisms underlying intergenerational associations in chronic health conditions. I begin by estimating baseline intergenerational models with a sample of approximately 125,000 parent-child pairs, and find that children with a parent who has a specific chronic health condition are at least 100% more likely to have the same condition themselves. To assess the role of genetic mechanisms in generating these strong correlations, I estimate models using a sample of approximately 2400 adoptees, and find that genetic transmission accounts for only 20-30% of the baseline associations. As falsification tests, I repeat this exercise using health measures with externally established levels of genetic determination (height and chicken pox), and the results suggest that comparisons of biological and adopted children are a valid method of isolating genetic effects in this sample. Finally, to corroborate these adoptee-based estimates, I examine health correlations among monozygotic twins, which provide an upper bound estimate of genetic influences, and find a similarly modest role for genetic transmission. I conclude that intergenerational health transmission is an important hindrance to overall socioeconomic mobility, but that the majority of transmission occurs through environmental factors or gene-environment interactions, leaving scope for interventions to effectively mitigate health persistence.

Potential Selective Responding in a Parent Questionnaire Study of Post-Institutionalized Children

Selective responding bias, though under-researched, is of particular concern in the study of post-institutionalized children because many studies rely on mailed questionnaires and response rates are often low. The current study addresses the impact of selective responding in a single wave of data collection and in a multi-wave study. Participants were 121 parents from a larger four-wave study of post-institutionalized children, identified as Never Responders, Previous Responders (but not to the current wave), or Wave 4 Responders. Parents were telephoned and asked about their adopted child's family, school, peer, and behavioral adjustment. The children (47% male) ranged in age from 2 to 20 years (M = 10.79, SD = 4.59) and had been adopted between 5 and 54 months of age (M = 15.49, SD = 9.94). There were no differences in parent ratings of adjustment for a single wave of data collection; however, participants who never responded reported poorer family and peer adjustment than those who had responded to at least one wave of data collection. Within a single wave of data collection, there was no evidence that selective responding contributes much bias. Over a multi-wave study, however, results may under-represent adjustment difficulties, especially with family and friends.