RESUMO
BACKGROUND: Mexican-origin women breastfeed at similar rates as white women in the United States, yet they usually breastfeed for less time. In our study, we seek to identify differences in Mexican-origin women's breastfeeding intentions, initiation, continuation, and supplementation across nativity and country-of-education groups. METHODS: The data are from a prospective cohort study of postpartum women ages 18 to 44 recruited from 8 Texas hospitals. We included 1235 Mexican-origin women who were born and educated in either Texas or Mexico. Women were interviewed at delivery and at 3, 6, 12, 18, and 24 months post partum. Breastfeeding intentions and initiation were reported at baseline, continuation was collected at each interview, and weeks until supplementation was assessed for both solids and formula. Women were classified into 3 categories: born and educated in Mexico, born and educated in the United States, and born in Mexico and educated in the United States. RESULTS: Breastfeeding initiation and continuation varied by nativity and country of birth, although all women reported similar breastfeeding intentions. Women born and educated in Mexico initiated and continued breastfeeding in higher proportions than women born and educated in the United States. Mexican-born and US-educated women formed an intermediate group. Early supplementation with formula and solid foods was similar across groups, and early supplementation with formula negatively impacted duration across all groups. CONCLUSIONS: Nativity and country of education are important predictors of breastfeeding and should be assessed in pediatric and postpartum settings to tailor breastfeeding support. Support is especially warranted among US-born women, and additional educational interventions should be developed to forestall early supplementation with formula across all acculturation groups.
Assuntos
Aleitamento Materno/etnologia , Aculturação , Adulto , Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Suplementos Nutricionais/estatística & dados numéricos , Escolaridade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/estatística & dados numéricos , Humanos , Fórmulas Infantis/estatística & dados numéricos , Recém-Nascido , Intenção , México/etnologia , Mães/educação , Estudos Prospectivos , Texas , Fatores de Tempo , Estados UnidosRESUMO
I reexamine the epidemiological paradox of lower overall infant mortality rates in the Mexican-origin population relative to U.S.-born non-Hispanic whites using the 1995-2002 U.S. NCHS linked cohort birth-infant death files. A comparison of infant mortality rates among U.S.-born non-Hispanic white and Mexican-origin mothers by maternal age reveals an infant survival advantage at younger maternal ages when compared with non-Hispanic whites, which is consistent with the Hispanic infant mortality paradox. However, this is accompanied by higher infant mortality at older ages for Mexican-origin women, which is consistent with the weathering framework. These patterns vary by nativity of the mother and do not change when rates are adjusted for risk factors. The relative infant survival disadvantage among Mexican-origin infants born to older mothers may be attributed to differences in the socioeconomic attributes of U.S.-born non-Hispanic white and Mexican-origin women.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Mortalidade Infantil/tendências , Idade Materna , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México/etnologia , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To estimate differences in continuation of oral contraceptive pills (OCPs) between U.S. resident women obtaining pills in U.S. family planning clinics compared with over-the-counter in Mexican pharmacies. METHODS: In El Paso, Texas, we recruited 514 OCP users who obtained pills over the counter from a Mexican pharmacy and 532 who obtained OCPs by prescription from a family planning clinic in El Paso. A baseline interview was followed by three consecutive surveys over 9 months. We asked about date of last supply, number of pill packs obtained, how long they planned to continue use, and experience of side effects. Retention was 90%, with only 105 women lost to follow-up. RESULTS: In a multivariable Cox proportional hazards model, discontinuation was higher for women who obtained pills in El Paso clinics compared with those who obtained their pills without a prescription in Mexico (hazard ratio 1.6, 95% confidence interval [CI] 1.1-2.3). Considering the number of pill packs dispensed to clinic users, discontinuation rates were higher (hazard ratio 1.8, 95% CI 1.2-2.7) for clinic users who received one to five pill packs. However, there was no difference in discontinuation between clinic users receiving six or more pill packs and users obtaining pills without a prescription. CONCLUSION: Results suggest providing OCP users with more pill packs and removing the prescription requirement would lead to increased continuation.
Assuntos
Anticoncepcionais Orais , Acessibilidade aos Serviços de Saúde , Medicamentos sem Prescrição , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , México , Modelos de Riscos Proporcionais , Texas , Adulto JovemRESUMO
Recent research suggests that the favorable mortality outcomes for the Mexican immigrant population in the United States may largely be attributable to selective out-migration among Mexican immigrants, resulting in artificially low recorded death rates for the Mexican-origin population. In this paper we calculate detailed age-specific infant mortality rates by maternal race/ethnicity and nativity for two important reasons: (1) it is extremely unlikely that women of Mexican origin would migrate to Mexico with newborn babies, especially if the infants were only afew hours or afew days old; and (2) more than 50% of all infant deaths in the United States occur during the first week of life, when the chances of out-migration are very small. We use concatenated data from the U.S. linked birth and infant death cohort files from 1995 to 2000, which provides us with over 20 million births and more than 150,000 infant deaths to analyze. Our results clearly show that first-hour, first-day, and first-week mortality rates among infants born in the United States to Mexican immigrant women are about 10% lower than those experienced by infants of non-Hispanic, white U.S.-born women. It is extremely unlikely that such favorable rates are artificially caused by the out-migration of Mexican-origin women and infants, as we demonstrate with a simulation exercise. Further, infants born to U.S.-born Mexican American women exhibit rates of mortality that are statistically equal to those of non-Hispanic white women during the first weeks of life and fare considerably better than infants born to non-Hispanic black women, with whom they share similar socioeconomic profiles. These patterns are all consistent with the definition of the epidemiologic paradox as originally proposed by Markides and Coreil (1986).