The Health Benefits of Hispanic Communities for Non-Hispanic Mothers and Infants: Another Hispanic Paradox

摘要

Objectives. In the United States, Hispanic mothers have birth outcomes comparable to those of White mothers despite lower socioeconomic status. The contextual effects of Hispanic neighborhoods may partially explain this “Hispanic paradox.” We investigated whether this benefit extends to other ethnic groups. Methods. We used multilevel logistic regression to investigate whether the county-level percentage of Hispanic residents is associated with infant mortality, low birth weight, preterm delivery, and smoking during pregnancy in 581?151 Black and 2?274?247 White non-Hispanic mothers from the US Linked Birth and Infant Death Data Set, 2000. Results. For White and Black mothers, relative to living in counties with 0.00%–0.99% of Hispanic residents, living in counties with 50.00% or more of Hispanic residents was associated with an 80.00% reduction in the odds of smoking, an infant mortality reduction of approximately one third, and a modest reduction in the risks of preterm delivery and low birth weight. Conclusions. The health benefits of living in Hispanic areas appear to bridge ethnic divides, resulting in better birth outcomes even for those of non-Hispanic origin. The US Hispanic population is predicted to double by 2050, by which time it will constitute nearly one third of the total US population. 1 In the process, the characteristics of many communities will change, and this has potential implications for public health. Neighborhood socioeconomic context and many other characteristics of communities, such as the physical environment and social cohesion, are known to have an impact on the health of residents. 2–5 The US Hispanic population has rates of infant mortality and low birth weight (LBW) that are comparable to those of non-Hispanic US Whites 6 despite Hispanic mothers being more likely to live in socioeconomically deprived areas and to have low socioeconomic status. 7 This well-known phenomenon is termed the “Hispanic paradox.” 8 Potential explanations for it include the selective migration of healthy women, 8 social support and access to kin networks, 9 and the promotion of healthier behaviors in Hispanic cultures. 10 Recent research also suggests that high Hispanic density, that is, a high proportion of Hispanic residents in a community, is associated with better pregnancy outcomes (lower infant mortality and higher birth weight) and lower pregnancy smoking rates for Hispanics, regardless of their individual socioeconomic status or health-related behaviors. 11–13 Explanations offered for these protective effects of Hispanic density include the ideas that Hispanic neighborhoods may act as enclaves that protect people from stigma and prejudice, 14,15 may increase social support, and may lower communication costs because of the shared culture and language. 13 Interestingly, US-born mothers of Hispanic origin receive greater reductions in risk of infant mortality 11 and smoking during pregnancy 12 from living in areas of high Hispanic density than do immigrant mothers. Similarly US-born mothers of Mexican origin have been shown to have infants with lower rates of LBW when they live in immigrant enclaves. 13 Second- or later-generation Hispanic mothers are generally more acculturated and more likely to adopt the social and cultural norms of the dominant society instead of, or in addition to, the culture of their ethnic origin. 16 Thus it appears that the benefits of living in Hispanic communities may be strongest for US-born Hispanic mothers. This raises the question of whether the salutary benefits of living in Hispanic communities are restricted to those of Hispanic heritage or whether they extend to other ethnic groups living in those communities. The only studies we are aware of that have investigated the impact of Hispanic density on birth outcomes among non-Hispanic and multiethnic population samples focused on birth weight. Morenoff found that, after adjusting for each individual resident’s ethnicity, there was a nonsignificant positive association of the percentage of Mexican Americans living in Chicago, Illinois, neighborhood clusters with higher birth weight for mothers of all ethnicities. 17 By contrast, Masi et al. 18 found that higher Hispanic density measured at the level of census tracts in Chicago had an adverse association with birth weight and risk of preterm birth for White but not Black mothers, and Peak and Weeks 19 found that the proportion of Hispanic residents in census block groups was associated with an increased risk of LBW for non-Hispanic White mothers living in San Diego, California. The limited evidence so far suggests that living in communities with higher proportions of Hispanic people might be associated with reduced risk of some, but not all, maternal and infant health outcomes for some non-Hispanics in some places. We previously examined the impact of Hispanic density on Hispanic maternal and infant health using a nationally representative sample from the US Lin