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Children of Immigrants: Health, Adjustment, and Public Assistance (1999)

Chapter: 5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women

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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

CHAPTER 5
Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women

Nancy S. Landale, R.S. Oropesa, and Bridget K. Gorman

In recent years a number of studies have documented an epidemiological paradox. As initially framed (Guendelman, 1988; Markides and Coreil, 1986; Williams et al., 1986), the paradox was that rates of low birthweight and infant mortality are comparable for Mexican-origin and white infants, despite the much poorer socioeconomic profile of the former group. Subsequent studies (e.g., Guendelman et al., 1990; Scribner and Dwyer, 1989) have revealed another puzzling pattern within the Mexican-origin population, namely that the health outcomes of infants of foreign-born mothers are superior to those of infants of native-born mothers. Both sets of findings are contrary to expectations based on the risk factors emphasized in traditional biomedical models of public health (Scribner, 1996). They are also inconsistent with the classic assimilation model of immigrant adjustment (Park, 1950), which posits that the outcomes of immigrant groups improve the longer they reside in the United States.

In the current era of high rates of immigration and renewed interest in understanding both the current situations and the long-term trajectories of immigrant groups, this epidemiological paradox has generated widespread attention. Yet despite the diversity of post-1965 immigrants to the United States (Portes and Rumbaut, 1996), studies of immigrants' reproductive outcomes have focused primarily on the Mexican-origin population. Stud-

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

ies have not systematically assessed the health outcomes of infants of immigrant women from other national origins (see Cabral et al., 1990; Rumbaut and Weeks, 1989, 1996; and Singh and Yu, 1996, for exceptions). Thus, the extent to which the epidemiological paradox is characteristic of most or only a few immigrant groups has not been established.

The present study addresses this issue using data from the 1989, 1990, and 1991 Linked Birth/Infant Death Datasets (U.S. Department of Health and Human Services, 1995). The relationship between maternal nativity (U.S. versus foreign birthplace) and infant health is examined in a number of Latino and Asian groups, including Mexicans, Cubans, Puerto Ricans,1 Central/ South Americans, Chinese, Filipinos, Japanese, and other Asian/ Pacific Islanders.

BACKGROUND

Over the past several decades, both the number and the diversity of U.S. immigrants have increased sharply (Portes and Rumbaut, 1996). Since the mid-1980s, about 1 million legal immigrants have been admitted to the United States each year (U.S. Immigration and Naturalization Service, 1996). These new immigrants have come primarily from countries in Asia and Latin America. In 1993, for example, about 40 percent were from Asia and 37 percent were from Latin America and the Caribbean. The major Asian source countries are mainland China, the Philippines, Vietnam, India, and Korea. Major origin countries in Latin America and the Caribbean include Mexico, the Dominican Republic, and El Salvador.

The recency of immigration from Asia and Latin America is evident in the high proportion of U.S.-born infants who have foreign-born mothers. Although 18 percent of all U.S. births are to foreign-born women, 62 percent of Latino births and 85 per-

1  

Puerto Ricans are not an immigrant group per se because of the commonwealth status of the island of Puerto Rico. Nonetheless, because they are one of the largest Hispanic groups in the United States, we include them in the analysis for comparative purposes. For Puerto Ricans the ''foreign born" are those born in Puerto Rico.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

cent of Asian/Pacific Islander births are to women who were themselves born outside this country (Ventura et al., 1995). These figures attest to the importance of understanding how immigrant status and the assimilation process among immigrants affect the health of infants and children.

Immigration, Assimilation, and Infant Health

Understanding the health outcomes observed among the offspring of immigrants requires attention to several interrelated aspects of the immigration and settlement process. First, given the well-documented relationship between socioeconomic position and health (Williams and Collins, 1995), the implications of the sources of immigration for the socioeconomic status of the immigrant population must be considered. There are striking differences in the educational attainment and skill levels of immigrants from various origin countries at the time of their arrival in the United States. The upper stratum of foreign-born groups tends to have higher educational and occupational attainment than the average for the native-born U.S. population. This category is comprised of Asian immigrants from India, Taiwan, Iran, Hong Kong, the Philippines, Japan, Korea, and China (Rumbaut, 1994). In the lower stratum are immigrants from Latin American and Caribbean countries, such as Mexico, El Salvador, Guatemala, and the Dominican Republic, who have low levels of educational attainment and tend to work in low-wage unskilled jobs. These divergent profiles stem from differences across origin countries in economic development and population composition. The type of immigrant flow (e.g., unskilled labor migration versus "brain drain" migration) also affects the socioeconomic composition of immigrants from various source countries.

In addition to their characteristics at time of arrival in this country, the way in which immigrants adapt to U.S. society affects the health and well-being of their children. The adaptation of immigrants traditionally has been studied within an assimilation framework which posits that immigrants will become increasingly similar to the native population as they spend more time in this country (Park, 1950; Gordon, 1964). Eventually, often after several generations, immigrants lose their socioeconomic

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

and cultural distinctiveness. Because immigrants occupy the lower rungs of the socioeconomic ladder more often than not, the assimilation framework implies that immigrants (and their children) will initially experience a health disadvantage, which will decline with duration of residence (for the foreign born) and generation in the United States.

For a number of reasons (see Massey, 1995; Zhou, 1997), the patterns observed among recent immigrants are sometimes inconsistent with expectations based on the assimilation framework. One reason is the socioeconomic diversity of post-1965 immigrants. A significant number of immigrants are highly educated and skilled and thus attain high-status positions and middle-class lifestyles quickly upon arrival in the United States (Zhou, 1997). Although such immigrants experience social and cultural adjustments, the barriers they encounter are very different from those faced by immigrants who arrive with little human or financial capital. Thus, the nature of the assimilation process may differ substantially according to the resources immigrants possess at the time of immigration.

A related reason for departures from the classic assimilation pattern is that recent immigrants arrived in this country during a period of restricted economic growth and rising income inequality (Massey, 1995). In particular, opportunities for upward mobility are limited for those with little education and few skills. Thus, immigrants with low skill levels, like U.S.-born minority groups, face structural barriers to achievement. Their assimilation into the middle-class mainstream is also impeded by settlement in impoverished neighborhoods that lack resources and have extensive social problems.

The assimilation framework has also been challenged with respect to its assumptions about the role of origin cultures. The traditional theory presumed that forsaking the home culture was a necessary part of the process of Americanization, which ultimately improved the situation of immigrant groups. However, recent research shows that immigrant cultures often have protective features that contribute to the well-being of the foreign born and their offspring (Guendelman, 1988; Guendelman et al., 1990; Guendelman and Abrams, 1995; Rumbaut and Weeks, 1996; Rumbaut 1997; Scribner and Dwyer, 1989; Scribner, 1996). Fur-

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

thermore, opportunities for biculturalism have increased for some immigrant groups (e.g., Mexicans) with the growth of ethnic communities in areas that receive an ongoing stream of new immigrants (Massey, 1995).

The epidemiological paradox is part of a growing set of research results that are contrary to the classic assimilation framework. In the following section we discuss possible explanations of the finding that the infants of foreign-born mothers are healthier at birth than the infants of native-born mothers.

Explanations of the Epidemiological Paradox

A number of factors potentially contribute to variations in infants' health by mothers' nativity status. An obvious first candidate is differences in the socioeconomic status (SES) of native-and foreign-born mothers (Williams and Collins, 1995). Previous studies documented that differences in the birth outcomes of native-and foreign-born Mexican-origin women are contrary to a socioeconomic model—that is, outcomes are better for foreign-born women, who generally have lower education and income than the native born. In addition, the pattern of superior birth outcomes among the foreign born holds in models in which SES is controlled.

The other explanatory factor emphasized in studies of racial/ ethnic disparities in health is medical care. However, in studies of Mexicans the findings for prenatal care parallel those for SES: rates of low birthweight and infant mortality are lower for the foreign born, despite the fact that they receive less adequate prenatal care. Thus, research on birth outcomes in the largest immigrant group calls into question the prevailing public health model that focuses on the importance of SES and medical care.

Alternative explanations of the health advantage of foreign-born infants include the selective migration of healthier mothers to the United States and the protective influence of origin cultures (Guendelman, 1988). Although the former explanation has received little empirical study because of data limitations, the latter has been the focus of considerable research attention (Cobas et al., 1996; Collins and Shay, 1994; Guendelman, 1988; Guendelman et al., 1990; Guendelman and Abrams, 1995;

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

Rumbaut and Weeks, 1996; Scribner and Dwyer, 1989; Scribner, 1996). In particular, scholars have attempted to identify the behavioral mechanisms through which immigrant cultures (especially the Mexican culture) affect infant health. Included among the explanations offered are better nutrition, less smoking and drinking, and greater social support. As cultural norms erode with time in the United States, the beneficial health practices of immigrants apparently weaken.

How these various determinants of infant health operate for immigrant groups other than Mexican Americans is not well known. In the following sections we summarize our analyses of the effect of maternal nativity on low birthweight and infant mortality among non-Latino whites, non-Latino blacks, Mexicans, Cubans, Puerto Ricans, Central/South Americans, Chinese, Filipinos, Japanese, and other Asian/Pacific Islanders.

FINDINGS

Although the majority of infants born in the United States have non-Latino white or non-Latino black mothers, a growing share of U.S. births are to Latino or Asian women. During the period from 1989 through 1991, 14.2 percent of all U.S. births were to Latino women, with Mexicans constituting 9.1 percent. About 3.5 percent of newborns had Asian mothers. Given the recency of immigration from many Latin American and Asian countries, it is not surprising that a substantial share of the Latino and Asian women giving birth were foreign born. For non-Latino white and non-Latino black infants, the percentages with foreign-born mothers are relatively low—4.0 and 6.4, respectively.2 But with the exception of Puerto Rican and Japanese infants, foreign-born mothers predominate in the Latino and Asian groups considered in our study. Among Latinos the share of births to foreign-born mothers was 62 percent among Mexicans, 79 percent among Cubans, and 96 percent among Central/South Americans. Among

2  

These numbers and those presented in all subsequent tables and figures are based on data from the 1989-1991 Linked Birth/Infant Death Datasets. The analysis is restricted to singleton births. See Appendix 5A for a full description of the datasets, sample, and variables.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

Asian infants, about 86 percent of Filipinos, 89 percent of Chinese, and 94 percent of other Asian/Pacific Islanders had mothers born outside the United States.

The high proportion of births to foreign-born women in these groups illustrates the growing importance of understanding the impact of immigration on children born in the United States, who are U.S. citizens at birth regardless of their parents' citizenship status. A critical aspect of children's well-being at birth is their physical health, which is commonly measured for infants by rates of low birthweight and infant mortality.3 In Figure 5-1 the percentage low birthweight is shown for infants of native-born and foreign-born women from each racial/ethnic group. With the exception of Japanese and other Asian/Pacific Islanders, the pattern is consistent with the epidemiological paradox in that the offspring of foreign-born mothers have more favorable birth-weights than the offspring of native-born mothers.4 Although the magnitude of the nativity difference in low birthweight is small for some groups (e.g., Puerto Ricans, Cubans, Central/South Americans), in others it is more substantial. For example, among Mexican-origin infants, the percentage of low-birthweight infants for those with foreign-born mothers is 4.1, compared to 5.4 for infants with native-born mothers. The figures for the offspring of foreign-and native-born Chinese mothers are 3.8 and 4.8, respec-

3  

Low birthweight is defined as a weight at birth of less than 2,500 grams. Infant mortality is defined as death during the first year of life.

4  

 The other Asian/Pacific Islander group is heterogeneous with respect to national origins. It includes such diverse groups as Asian Indians, Koreans, Samoans, Vietnamese, and Guamanians. The 1989-1991 Linked Birth/Infant Death Datasets do not include information with which to distinguish these various national-origin groups, but such information is available for a subset of reporting states in the 1992-1994 National Center for Health Statistics (NCHS) Natality Files. Based on the 1992-1994 data, rates of low birthweight for singleton infants of foreign-born mothers for subgoups within the other Asian/Pacific Islander category are 9.33 for Asian Indians, 3.85 for Koreans, 4.22 for Samoans, 5.23 for Vietnamese, and 6.90 for Guamanians. Rates of low birthweight for infants of native-born mothers could not be calculated for these groups because of an insufficient number of cases. Because the 1992-1994 NCHS Natality Files are restricted to birth certificate data, rates of infant mortality also cannot be calculated for these Asian groups.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

FIGURE 5-1 Nativity differences in low birthweight by ethnicity.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

tively. Although data for blacks are presented largely for comparative purposes, the maternal nativity differential in low birthweight for blacks (8.0 versus 11.8) is striking.

Also evident in Figure 5-1 are large ethnic differentials in low birthweight. Indeed, the ethnic differentials are of considerably greater magnitude than the differences by maternal nativity. Of the groups considered, non-Latino blacks have a markedly higher percentage of low-weight births than all other groups. Puerto Ricans and Filipinos also stand out for their higher-than-average rates of low birthweight. Additionally, despite the slight health advantage of infants of foreign-born mothers compared to infants of native-born mothers within most ethnic groups, offspring of foreign-born women have higher rates of low birthweight than offspring of native-born non-Latino white women in the majority of ethnic groups (i.e., non-Latino blacks, Puerto Ricans, Central/ South Americans, Filipinos, Japanese, and other Asian/Pacific Islanders). It is only among Mexicans and the Chinese that immigrants' offspring have lower rates of low birthweight than the offspring of native-born non-Latino whites.5

In additional analyses (summarized in Table 5A-2) we decomposed low birthweight into its two component parts: prematurity (< 2,500 grams and less than 37 weeks' gestation) and intrauterine growth retardation (< 2,500 grams and weeks' gestation).6 For prematurity all groups show a pattern consistent with the epidemiological paradox: the rate of prematurity is higher for infants of native-born mothers than for infants of foreign-born mothers. The rate of intrauterine growth retardation is higher for infants of native-born mothers than for non-Latino whites, non-Latino blacks, and all Latino groups. For Asians the role of maternal nativity is more variable. Low birthweight caused by

5  

The rate for infants of foreign-born Cuban women is essentially the same as that for native non-Latino women (4.4 versus 4.5).

6  

Intrauterine growth retardation has been defined in a number of different ways in the literature. Our purpose here is to distinguish low birthweight due to inadequate gestation from that caused by other causes. However, some definitions of intrauterine growth retardation (e.g., less than the tenth percentile for gestational age) classify a nontrivial share of infants weighing 2,500 grams or more as growth retarded.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

intrauterine growth retardation is more common among infants of native-born mothers than infants of foreign-born mothers among the Chinese and Filipinos; however, the magnitude of the maternal nativity differential is much smaller than that for pre-maturity for both groups. Among the Japanese and other Asian/ Pacific Islanders, infants of foreign-born mothers have higher rates of intrauterine growth retardation than infants of native-born mothers.

Figure 5-2 shows rates of infant mortality (deaths per 1,000 live births) by maternal nativity for each racial/ethnic group. For all groups except the Japanese the infant mortality rate is lower for children of immigrants than for children of the native born, although it is only slightly lower in some ethnic groups (e.g., Central/South Americans, Chinese). Among Latinos and Asians the largest differences are evident for Mexicans (5.3 versus 6.6 per 1,000) and Filipinos (4.8 versus 6.8 per 1,000). The infant mortality rate is also much lower for the offspring of black immigrants than for the offspring of black natives (10.5 versus 12.9 per 1,000). In contrast to the pattern for birthweight, infants of foreign-born mothers in almost all ethnic groups have lower rates of infant mortality than infants of native non-Latino white mothers. Blacks and Puerto Ricans are the only groups for which the infant mortality rate for children of foreign-born mothers is higher than that of children for native non-Latino white mothers.

Separate analyses (summarized in Table 5A-2) of neonatal mortality (death under 28 days of age) and postneonatal mortality (death between 28 days and one year of age) revealed a less consistent pattern. While the rate of neonatal mortality is lower for infants of foreign-born mothers than infants of native-born mothers for some groups (non-Latino whites, non-Latino blacks, Mexicans, Cubans, and Filipinos), for others (Central/South Americans, Chinese, Japanese, other Asian/Pacific Islanders) it is higher. In contrast, the postneonatal mortality rate is lower for immigrants' children than for natives' children for all groups except Cubans. Neonatal mortality is affected more by factors outside a mother's control (e.g., preexisting biological conditions of the mother, access to high-quality medical care) than is post-neonatal mortality. Postneonatal death is generally affected more

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

FIGURE 5-2 Nativity differences in infant mortality by ethnicity.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

by socioeconomic and environmental factors that may vary more regularly with the mother's nativity status (Samuels, 1986).

Antecedent and Mediating Variables

How can the better reproductive outcomes of foreign-born women compared to native-born women be explained? To answer this question it is necessary to understand the causes of low birthweight and infant mortality and to determine how immigrant and native women differ with respect to important risk factors. Despite extensive research, the determinants of low birthweight are poorly understood (Shiono and Behrman, 1995). Nonetheless, there is widespread agreement that low birthweight owing to intrauterine growth retardation has somewhat different causes than low birthweight owing to preterm birth. There appear to be three major risk factors for low birthweight due to poor intrauterine growth: smoking during pregnancy, low maternal weight gain during pregnancy, and low prepregnancy weight (Kramer, 1987). Other factors (e.g., maternal age, maternal education, parity, infant sex, prior low-birthweight birth) have important direct and indirect influences on intrauterine growth but play a smaller role in accounting for variations. Less is known about the risk factors for preterm delivery. Factors with well-established causal effects are prepregnancy weight, prior history of prematurity or spontaneous abortion, in utero exposure to diethylstilbestrol, and smoking during pregnancy (Kramer, 1987).

Low birthweight is both a pregnancy outcome and a determinant of other pregnancy outcomes, such as infant death. In fact, low birthweight is the major determinant of neonatal mortality, accounting for two-thirds of neonatal deaths (Samuels, 1986). Thus, the risk factors for low birthweight have an indirect causal impact on neonatal mortality. Although low birthweight is also associated with postneonatal death, the relationship is weaker than in the neonatal period. Congenital anomalies, maternal demographic and socioeconomic characteristics (e.g., age, parity, education), and access to health care are especially important risk factors for postneonatal death.

The multiple risk factors for low birthweight and infant mortality are perhaps best understood in terms of a conceptual frame-

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

work that distinguishes between antecedent and intervening variables. Antecedent variables are characteristics of the mother that influence her lifestyle and the medical care she receives during pregnancy, which in turn affect pregnancy outcomes. Antecedent factors available in the Linked Birth/Infant Death Datasets and considered in our analysis include maternal race/ethnicity, nativity, age, marital status, and education. Intervening variables are maternal behaviors that more directly affect reproductive outcomes, including smoking, drinking, nutritional intake (measured by weight gain during pregnancy),7 and use of prenatal care. Also included in our analyses as control variables are the gender and birth order of the infant. A complete list of the variables and coding procedures is provided in Appendix 5A.

The most consistent differences in antecedent factors between native and foreign-born mothers pertain to age and marital status (see Table 5A-2). In most of the racial/ethnic groups, native-born mothers are more likely to be young (less than 20) and single than are foreign-born mothers. Nativity differences in education (the only indicator of socioeconomic status in our data) are more variable across ethnic groups. The pattern for Central/South Americans, the Chinese, and other Asian/Pacific Islanders is consistent with that revealed here and elsewhere for Mexicans: the foreign born have lower levels of educational attainment than the native born.8 In contrast, among non-Latino whites, non-Latino blacks, Puerto Ricans, Cubans, and Filipinos, foreign-born mothers have more education than native-born mothers.9 Thus, in the latter groups the more favorable birth outcomes of the foreign born are not at odds with a socioeconomic model.

Figure 5-3 presents information on the intervening variables. The data for smoking show that native-born mothers are substan-

7  

Ideally, the mother's prepregnancy weight would be controlled in models estimating the effect of weight gain during pregnancy on low birthweight. Unfortunately, there is no measure of prepregnancy weight in the 1989-1991 Linked Birth/ Infant Death Datasets.

8  

Foreign-born Japanese mothers also have slightly lower levels of educational attainment that native-born Japanese mothers.

9  

The nativity difference in maternal education is small, however, for Puerto Ricans and Cubans.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

FIGURE 5-3 Nativity differences in intevening variables by ethnicity for smoking.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

Alcohol.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

Weight gain less than 22 pounds.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

Inadequate prenatal care.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

tially more likely to have smoked during pregnancy than are foreign-born mothers. For example, 8.0 percent of native-born Mexican mothers smoked while pregnant, compared to 2.5 percent of foreign-born Mexican mothers. The percentages for native and foreign-born Chinese mothers are 6.3 and 1.6, respectively. Given that smoking is one of the most important risk factors for low birthweight, this pattern undoubtedly contributes to the higher rate of low birthweight among infants of the native born compared to infants of the foreign born. Although the pattern for drinking is generally in the same direction (with the exception of the Japanese), the nativity differences are more moderate. Additionally, prior studies have demonstrated that drinking is a weaker predictor of infant birthweight than is smoking (Chomitz et al., 1995).

Nativity differences in maternal weight gain and prenatal care also are shown in Figure 5-3. Insufficient weight gain during pregnancy (less than 22 pounds) is an indicator of inadequate nutritional intake, which may affect intrauterine growth. Surprisingly, foreign-born women are generally more likely than native-born women to not gain sufficient weight during pregnancy. This is the case for all Latino and Asian groups, although in some cases the nativity difference is small. The pattern for prenatal care is highly inconsistent across racial/ethnic groups. Native-born blacks, Puerto Ricans, Cubans, and Filipinos are more likely to receive inadequate prenatal care (as measured by the Kessner Index) than their foreign-born counterparts. For all remaining groups the opposite pattern holds. However, Mexicans and Central/South Americans are the only groups in which the foreign born are substantially more likely to receive inadequate prenatal care than the native born (21.9 versus 13.3 percent for Mexicans; 15.6 versus 10.7 percent for Central/South Americans).

Multivariate Models

Low Birthweight

Can differences between immigrants and natives in infant birthweights be explained in terms of the risk factors identified

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

above? To address this question we estimated multivariate models in which all antecedent and intervening variables were controlled (see Table 5A-3).10 For most ethnic groups the predictors are related to infant birthweight in the expected direction. Nonetheless, net of all predictors, infants of foreign-born mothers continue to have a lower risk of low birthweight than infants of native-born mothers for all groups except Cubans, Japanese, and other Asian/Pacific Islanders. The risk factors that exhibit the most consistent relationships with low birthweight across ethnic groups are advanced maternal age (35+), single motherhood, first-birth status, maternal smoking, low maternal weight gain, and inadequate prenatal care. Maternal education is generally related to birthweight in the expected negative direction, but education appears to have weaker and less consistent effects than the other predictors in the multivariate models.

Figure 5-4 shows predicted rates of low birthweight calculated from the models in Table 5A-3. Both a best-case scenario and a worst-case scenario are shown for each racial/ethnic group. The best-case scenario shows predicted rates for female infants with the most favorable characteristics (i.e., second, third, or fourth children of 20- to 34-year-old married mothers with some college who received adequate prenatal care, did not smoke or drink, and gained at least 22 pounds during pregnancy). The worst-case scenario presents predicted rates for female infants with the least favorable characteristics (i.e., first children of single mothers less than 20 years of age who did not complete high school and who received inadequate prenatal care, smoked, drank, and gained less than 22 pounds during pregnancy).11

Under the best-case scenario, nativity differences in the percentages of low-birthweight infants are generally small. The largest nativity difference is for non-Latino blacks, for whom the

10  

Alcohol consumption was included in the equations for all groups except the Chinese and Japanese because there were too few cases in which the women drank alcohol during pregnancy to include drinking as a variable.

11  

Although women ages 35 and over exhibit poorer birth outcomes in our multivariate models of low birthweight than women under age 20, we use the latter group in calculating the predicted probabilities because first births to women age 35+ are very uncommon in the groups examined.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

FIGURE 5-4 Predicted percentage of low-birthweight infants: best- and worse-case scenarios.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

rates of low birthweight for infants with native-and foreign-born mothers are 5.0 and 3.8, respectively. Under the worst-case scenario, nativity differences are much greater for some ethnic groups, especially non-Latino blacks, Mexicans, and the Chinese. For example, the percentage of low-birthweight babies among high-risk Mexican infants of native-born mothers is 28.2, compared to 22.3 for comparable Mexican infants with foreign-born mothers. Nonetheless, Figure 5-4 makes clear that under the worst-case scenario racial/ethnic differences in low birthweight are greater than differences by maternal nativity.

Infant Mortality

Controlling for the full set of antecedent and intervening variables (see Table 5A-4), infants of foreign-born mothers continue to have a low risk of death compared to infants of native-born mothers (with the exception of the Chinese and Japanese). As was the case for low birthweight, single motherhood, smoking, low maternal weight gain during pregnancy, and inadequate prenatal care increase the risk of infant mortality. Maternal age and birth order have less consistent effects on infant mortality than on birthweight, and male infants are at higher risk of death than female infants even though they have a more favorable birthweight distribution. For most groups, education is negatively related to the risk of infant death, but the relationship is generally not strong.

Figure 5-5 illustrates the magnitude of the nativity differentials in low birthweight, controlling for the full set of covariates. Predicted rates of infant mortality are calculated from the equations in Table 5A-4, with best-and worst-case scenarios identical to those discussed previously for birthweight. Under the best-case scenario, rates of infant mortality are very low and nativity differentials are slight (although generally in the expected direction). Under the worst-case scenario, nativity differentials are more substantial. For example, among non-Latino whites, the infant mortality rates for infants of native-and foreign-born mothers, respectively, are 30.6 and 25.9 per 1,000. For Mexicans and Filipinos, comparable figures are 20.2 versus 15.7 and 74.7 versus 70.5. Nonetheless, it is apparent once again that the nativity dif-

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

FIGURE 5-5 Predicted infant mortality rate: best- and worse-case scenarios.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

ferences in infant mortality are small relative to the differences by race/ethnicity.12

IMPLICATIONS FOR FUTURE RESEARCH

Investigations of the impact of immigration on reproductive health face several challenges, the most notable of which are due to limitations of existing data. There are few representative national datasets on reproductive health with sufficient cases in specific national-origin groups to permit investigation. Moreover, the largest national datasets (NCHS Natality Files and the Linked Birth/Infant Death Datasets) are based on birth and death certificates, which contain limited information. While the analysis presented here advances our understanding of the effects of maternal nativity on infant health, only a subset of the potentially important explanatory variables was considered because of the limitations of the Linked Birth/Infant Death Datasets. For example, although we were able to include a measure of maternal education as a control for socioeconomic status, family income was not available in the data file. With incomplete information on socioeconomic status, socioeconomic differences between native-and foreign-born women cannot be ruled out as an explanation of the nativity differentials remaining in our multivariate models.

The Linked Birth/Infant Death Datasets, like many national datasets, include information on mothers' birthplaces but not information with which to ascertain the generational status of native-born mothers—that is, we cannot distinguish the native born of foreign parentage from the native born of native parentage. Furthermore, duration of residence in the United States cannot be determined for the foreign born. Our understanding of how immigration and settlement in the United States affect reproductive health would be greatly enhanced if the outcomes of the foreign born, the native born of foreign parentage, and the native born of native parentage could be compared. In addition,

12  

Table 5A-5 provides additional models of infant mortality in which low birthweight owing to prematurity and intrauterine growth retardation are controlled.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

the effects of exposure to the U.S. social context on the health beliefs and behaviors of immigrants could be better understood if newly arrived immigrants could be distinguished from those with greater duration of residence in the United States.

Additionally, studies would benefit from the collection of detailed data on acculturation, social support, health beliefs, and health practices. Such data would allow researchers to examine the effects of immigration on health within the broader context of immigrant women's lives and to examine more fully the relationship between acculturation and the loss of protective behaviors. In short, much richer data are needed on a variety of U.S. immigrant groups in order to fully understand the epidemiological paradox. Collection of such data should be a higher priority than further analysis of the incomplete datasets available at the present time.

CONCLUSIONS

Our study adds further support to a growing literature documenting superior reproductive health outcomes among immigrants compared to native-born women. In almost all of the ethnic groups we examined, the rates of low birthweight and infant mortality were lower for the offspring of immigrants than for the offspring of the native born. At the same time, the magnitude of the nativity differential was in many cases quite small. In fact, Mexicans, the group that has been the focus of most studies of the epidemiological paradox, exhibit larger nativity differentials than most other ethnic groups. Thus, although foreign-born women have better reproductive health outcomes than native-born women, the differences are in many cases so small that they should not be given undue attention.

The generational composition of the native-born population of an ethnic group depends in large part on the recency of immigration from the origin country. For more recent immigrant groups, such as Central/South Americans, the native-born population is largely composed of the offspring of immigrants, who are still undergoing the assimilation process. For groups with a longer history in the United States, such as Mexicans, the native

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

born are more heavily weighted toward the native born of native parentage. Without information on the generational composition of the native born, the extent to which ethnic differences in the magnitude of the nativity differentials in infant health are due to this factor cannot be determined.

Native-born mothers are more likely to be young and single than are foreign-born mothers, and both of these characteristics are related to poor infant health. These high-risk attributes are counterbalanced in some groups by higher educational attainment among native-born mothers. However, the effect of education on birthweight and infant mortality is fairly weak and varies across ethnic groups, although it is generally in the expected direction. Prenatal care utilization also fails to provide an explanation of the health advantage of the infants of immigrants: in some groups, immigrants have better reproductive health outcomes despite less adequate prenatal care, while in others there is little difference in the use of prenatal care between immigrants and natives.

Our analysis, like others (Cobas et al., 1996; Guendelman et al., 1990; Guendelman and Abrams, 1995; Rumbaut and Weeks, 1996), suggests that lifestyle factors play a major role in immigrant-native differentials in infant health. In particular, there are striking differences in smoking by maternal nativity, and smoking is one of the strongest predictors of low birthweight. Similarly, alcohol consumption is higher for the native born, and several studies show that drug use and consumption of unhealthy foods increase with each generation in the United States (Cabral et al., 1990; Guendelman and Abrams, 1995). Precisely why the native born are more likely to adopt unhealthy habits is an issue in need of further study.

Finally, although we have focused on nativity differences in infant health within ethnic groups, it should be noted that ethnic differences in birthweight and infant mortality are large and persist in multivariate analyses (i.e., models based on pooled data from all ethnic groups that include dummy variables for each ethnic group). Ethnicity remains an elusive ''black box," and ethnic differences that remain in multivariate models are often explained in terms of vague concepts such as "culture." Further attention to the complex set of characteristics, beliefs, and health practices

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

underlying ethnic differences in infant health would contribute to our understanding of the effects of immigration on children's well-being.

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Chomitz, V.R., L.W.Y. Cheung, and E. Lieberman 1995 The role of lifestyle in preventing low birth weight. The Future of Children 5:121-138.

Cobas, J.A., H. Balcazar, M.B. Benin, V. Keith, and Y. Chong 1996 Acculturation and low-birthweight infants among Latino women: A reanalysis of HHANES data with structural equation models. American Journal of Public Health 86:394-396.

Collins, J.W., and D.K. Shay 1994 Prevalence of low birth weight among Hispanic infants with United States-born and foreign-born mothers: The effect of urban poverty. American Journal of Epidemiology 139:184-192.


Gordon, M.M. 1964 Assimilation in American Life. New York: Oxford University Press.

Guendelman, S. 1988 Sociocultural factors in Hispanic pregnancy outcomes. In Developing Public Health Social Work Programs to Prevent Low Birthweight and Infant Mortality: High Risk Populations and Outreach, C.J. Morton and R.G. Hirsch, eds. Berkeley: University of California Press.

Guendelman, S., and B. Abrams 1995 Dietary intake among Mexican-American women: Generational differences and a comparison with white non-Hispanic women. American Journal of Public Health 85:20-25.

Guendelman, S., J.B. Gould, M. Hudes, and B. Eskenazi 1990 Generational differences in perinatal health among the Mexican American population: Findings from the HHANES 1982-1984. American Journal of Public Health 80(Suppl.):61-65.


Kessner, D.M., J. Singer, E.C. Kalk, and E.R. Schlesinger 1973 Methodology: New York City Analysis. In Infant Death: An Analysis by Maternal Risk and Health Care. Washington, D.C.: National Academy of Sciences.

Kramer, M.S. 1987 Determinants of low birthweight: Methodological assessment and meta-analysis. Bulletin of the World Health Organization 65:663-737.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

Markides, K.S., and J. Coreil 1986 The health of Hispanics in the southwestern United States: An epidemiological paradox. Public Health Reports 101:253-265.

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Rumbaut, R.G., and J.R. Weeks 1989 Infant health among Indochinese refugees: Patterns of infant mortality, birthweight, and prenatal care in comparative perspective. Research in the Sociology of Health Care 8:137-196.

1996 Unraveling a public health enigma: Why do immigrants experience superior perinatal outcomes? Research in the Sociology of Health Care 13B:337-391.


Samuels, B. 1986 Infant mortality and low birth weight among minority groups in the United States: A review of the literature. In Report of the Secretary's Task Force on Black and Minority Health, vol. VI. Bethesda, Md.: National Institutes of Health.

Scribner, R. 1996 Editorial: Paradox as paradigm—the health outcomes of Mexican Americans. American Journal of Public Health 86:303-305.

Scribner, R., and J.H. Dwyer 1989 Acculturation and low birthweight among Latinos in the Hispanic HANES. American Journal of Public Health 79:1263-1267.

Shiono, P.H., and R.E. Behrman 1995 Low birth weight: Analysis and recommendations. The Future of Children 5:4-18.

Singh, G.K., and S.M. Yu 1996 Adverse pregnancy outcomes: Differences between US-and foreign-born women in major racial and ethnic groups. American Journal of Public Health 86:837-843.


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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

U.S. Immigration and Naturalization Service 1996 1994 Statistical Yearbook of the Immigration and Naturalization Service . Washington, D.C.: U.S. Government Printing Office.

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Williams, D.R., and C. Collins 1995 US socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology 21:349-386.

Williams, R.L., N.J. Binkin, and E.J. Clingman 1986 Pregnancy outcomes among Spanish-surname women in California. American Journal of Public Health 76:387-391.


Zhou, M. 1997 Growing up American: The challenge confronting immigrant children and children of immigrants. Annual Review of Sociology 23:63-95.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

APPENDIX 5A: DESCRIPTION OF SAMPLE AND DATA

The 1989-1991 Linked Birth/Infant Death Datasets, created by the National Center for Health Statistics, consist of birth certificate data for the birth cohorts of 1989, 1990, and 1991 and death certificate data for infants in those birth cohorts who died before their first birthdays. All births and infant deaths that occurred in the United States to U.S. residents and U.S. nonresidents are included. The file does not include (1) U.S.-born infants who died outside the United States, (2) deaths to foreign-born infants that occurred in the United States, and (3) births and deaths that occurred outside the United States to U.S. residents. In the 1989 file, infants born that year who died before their first birthdays in 1989 or 1990 are included as infant deaths. Similarly, infants born in 1990 who died before their first birthdays in 1990 or 1991 are included as infant deaths in the 1990 file. Infant deaths are defined in a comparable manner for the 1991 birth cohort.

The separate Linked Birth/Infant Death Datasets for the 1989, 1990, and 1991 birth cohorts were pooled for our analysis in order to obtain sufficient cases in each ethnic group. The pooled file includes a 10 percent random sample of non-Latino white and non-Latino black births and all births in other racial/ethnic groups. In addition, several restrictions were imposed on the pooled file prior to its use for our analysis. First, consistent with most studies of low birthweight and infant mortality, we include only singleton births. Second, based on maternal ethnicity, only infants of non-Latino white, non-Latino black, Mexican, Cuban, Puerto Rican, Central/South American, Chinese, Filipino, Japanese, and other Asian/Pacific Islander origins are included. Third, because comparisons of infants of native and foreign-born mothers are of primary interest in our study, we restricted our analytic sample to infants whose mothers were either born in the United States or born outside the United States and its territories. The only exception is Puerto Ricans, who are included and defined as foreign born if their mother was born in Puerto Rico. Because infant mortality is likely to be underestimated for births to nonresidents of the United States (who may return home after giving birth), births to nonresident mothers are excluded. Finally, cases with missing data on any of the independent variables con-

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

sidered in our analysis were excluded, with the following exception: for variables with more than 5 percent of cases with missing data (smoking, drinking, and weight gain during pregnancy), cases with missing data were included and a missing data indicator was entered into all multivariate models. Table 5A-1 lists the variables included in our analysis and provides information on coding.

TABLE 5A-1 Coding Scheme for Variables Included in Analyses of Low Birthweight and Infant Mortality

Variable

Codes

Low birthweight

2,500+ grams (reference)

< 2,500 grams

Infant mortality

Survived until first birthday (reference)

Died before first birthday

Race/ethnicity

Non-Hispanic white

Non-Hispanic black

Mexican

Puerto Rican

Cuban

Central/South American

Chinese

Japanese

Filipino

Other Asian/Pacific Islander

Maternal birthplace

Native born (reference)

Foreign born (for Puerto Ricans, born in Puerto Rico)

Maternal age

< 20

20-34 (reference)

35+

Maternal marital status

Married (reference)

Single

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

Variable

Codes

Maternal education

Less than high school

High school graduate (reference)

Some college

Birth order of infant

1

2-4 (reference)

5+

Gender of infant

Female (reference)

Male

Prenatal care (Kessner Indexa)

Adequate (reference)

Intermediate

Inadequate

Mother smoked during pregnancy

No (reference)

Yes

Mother drank alcohol during pregnancy

No (reference)

Yes

Weight gain during pregnancy

22+ 1b. (reference)

< 22 1b.

a The Kessner Index is based on information on the month that prenatal care began and the number of prenatal care visits (adjusting for length of gestation). The Kessner Index rates prenatal care as adequate, intermediate, or inadequate. To be classified as adequate, prenatal care must begin in the first trimester of pregnancy and consist of at least nine prenatal care visits for a normal-length pregnancy (36 or more weeks; Kessner et al., 1994).

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

Table 5A-2

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

TABLE 5A-2 Maternal and Infant Characteristics by Nativity and Race/Ethnicity: 1989-1991 Linked Birth/Infant Death Datasets

 

Non-Latino White

Non-Latino Black

 

NB

FB

NB

FB

Outcomes

 

 

 

 

Low birthweight

4.47

3.87

11.85

8.05

Preterm

2.57

2.18

7.41

5.36

Intrauterine growth retarded

1.90

1.70

4.44

2.69

Infant mortality

5.8

4.6

12.9

10.5

Neonatal

3.2

2.5

7.3

6.5

Postneonatal

2.6

2.1

5.6

4.0

Maternal Characteristics

 

 

 

 

Age (years)

 

 

 

 

< 20

9.99

4.14

24.74

7.53

20-34

80.68

81.57

69.75

79.03

35+

9.33

14.29

5.51

13.44

Education

 

 

 

 

< High school

15.15

12.57

30.50

21.08

High school

39.6

33.63

43.34

38.89

Some college

45.24

53.8

26.16

40.03

Single 16.92

9.89

68.25

42.86

34.55

Infant Characteristics

 

 

 

 

Birth order

 

 

 

 

1

42.95

42.91

37.93

40.45

2-4

54.47

53.48

55.71

53.88

5+

2.58

3.61

6.36

5.68

Male

51.28

51.37

50.80

50.78

Health Behaviors

 

 

 

 

Smoked

21.31

12.51

16.09

3.98

Drank

3.5

3.28

3.80

1.49

Weight gain <22 1b.

19.59

19.06

32.57

29.04

Prenatal Care

 

 

 

 

Adequate

77.23

74.71

50.94

53.75

Intermediate

18.22

19.23

32.82

33.51

Inadequate

4.55

6.06

16.23

12.74

No. of cases

654,108

27,187

158,117

10,782

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

 

Mexican

Puerto Rican

Cuban

 

NB

FB

NB

FB

NB

FB

Outcomes

 

 

 

 

 

 

Low birthweight

5.38

4.14

7.91

7.46

4.71

4.4

Preterm

3.13

2.32

4.6

4.30

2.89

2.74

Intrauterine growth retarded

2.25

1.82

3.31

3.16

1.81

1.66

Infant mortality

6.6

5.3

7.8

7.0

5.3

4.7

Neonatal

3.5

3.1

4.3

4.5

3.8

3.1

Postneonatal

3.1

2.1

3.4

2.5

1.5

1.5

Maternal Characteristics

 

 

 

 

 

 

Age (years)

 

 

 

 

 

 

< 20

24.08

13.74

26.08

16.63

18.14

4.39

20-34

70.43

78.49

70.58

75.11

78.49

83.88

35+

5.50

7.77

3.34

8.27

3.37

11.73

Education

 

 

 

 

 

 

< High school

41.34

73.59

41.85

42.18

22.18

16.03

High school

39.46

17.94

36.35

33.37

32.69

34.60

Some college

19.20

8.47

21.8

24.45

45.13

49.37

Single 16.92

33.07

56.73

53.4

25.21

16.05

 

Infant Characteristics

 

 

 

 

 

 

Birth order

 

 

 

 

 

 

1

39.06

35.96

44.45

35.06

54.09

39.81

2-4

55.27

55.39

52.03

57.82

44.45

58.15

5+

5.67

8.65

3.52

7.11

1.46

2.04

Male

51.11

51.03

50.85

50.89

51.79

51.44

Health Behaviors

 

 

 

 

 

 

Smoked

8.03

2.48

16.09

11.24

9.44

5.57

Drank

2.06

.57

2.99

2.89

1.76

.69

Weight gain < 22 lb.

26.11

32.21

25.52

28.28

16.64

18.67

Prenatal Care

 

 

 

 

 

 

Adequate

55.54

39.76

50.68

53.42

73.15

77.80

Intermediate

31.18

38.38

34.51

33.17

21.39

18.58

Inadequate

13.28

21.86

14.81

13.41

5.47

3.63

No. of cases

381,168

618,290

80,045

57,580

6,565

24,261

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

 

Central/S. American

Chinese

 

NB

FB

NB

FB

Outcomes

 

 

 

 

Low birthweight

5.17

4.78

4.81

3.8

Preterm

3.07

2.76

2.82

1.89

Intrauterine growth retarded

2.09

2.02

1.99

1.91

Infant mortality

5.2

5.0

4.6

4.3

Neonatal

2.6

3.0

1.4

2.1

Postneonatal

2.5

2.1

3.2

2.3

Maternal Characteristics

 

 

 

 

Age (years)

 

 

 

 

< 20

26.14

8.31

2.69

.67

20-34

70.16

80.8

71.68

80.79

35+

3.70

10.88

25.63

18.54

Education

 

 

 

 

< High school

26.72

44.80

3.85

16.04

High school

35.09

33.06

11.67

29.55

Some college

38.19

22.14

84.49

54.41

Single

40.10

41.01

9.54

3.26

Infant Characteristics

 

 

 

 

Birth order

 

 

 

 

1

59.07

38.52

49.94

52.61

2-4

39.17

56.60

48.88

46.47

5+

1.75

4.88

1.19

.91

Male

50.21

51.16

51.12

52.12

Health Behaviors

 

 

 

 

Smoked

8.79

2.80

6.26

1.60

Drank

2.33

.84

3.06

1.11

Weight gain <22 1b.

21.20

26.17

20.13

22.01

Prenatal Care

 

 

 

 

Adequate

59.48

48.33

82.92

72.49

Intermediate

29.79

36.07

14.70

22.65

Inadequate

10.73

15.60

2.39

4.86

No. of cases

9,075

200,172

6,240

52,837

NOTE: NB, native born; FB, foreign born.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

 

Filipino

Japanese

Other Asian/Pacific Islander

 

NB

FB

NB

FB

NB

FB

Outcomes

 

 

 

 

 

 

Low birthweight

6.89

6.10

5.01

4.96

5.30

5.73

Preterm

3.88

3.24

2.54

2.21

3.09

2.82

Intrauterine growth retarded

3.00

2.86

2.47

2.75

2.21

2.91

Infant mortality

6.8

4.8

3.7

3.7

6.2

5.3

Neonatal

3.2

2.9

1.6

1.8

2.6

2.9

Postneonatal

3.6

2.0

2.1

1.9

3.6

2.5

Maternal Characteristics

 

 

 

 

 

 

Age (years)

 

 

 

 

 

 

< 20

18.39

3.49

3.82

.86

12.33

5.79

20-34

74.84

76.80

74.33

79.11

75.9

81.36

35+

6.78

19.71

21.85

20.03

11.77

12.85

Education

 

 

 

 

 

 

< High school

15.05

8.94

3.05

2.49

13.01

26.36

High school

42.64

22.15

22.53

25.71

30.96

28.81

Some college

42.31

68.91

74.42

71.80

56.03

44.83

Single

32.04

12.34

12.46

5.09

22.69

11.06

Infant Characteristics

 

 

 

 

 

 

Birth order

 

 

 

 

 

 

1

48.16

43.66

48.76

49.79

50.33

41.71

2-4

49.12

54.19

50.22

49.26

46.92

50.27

5+

2.72

2.16

1.02

.95

2.75

8.01

Male

50.92

52.02

51.26

51.38

51.44

51.39

Health Behaviors

 

 

 

 

 

 

Smoked

12.40

3.07

9.52

5.79

12.01

3.25

Drank

2.02

.75

1.70

2.92

2.38

.90

Weight gain < 22 lb.

19.49

22.61

24.54

30.46

20.0

27.97

Prenatal Care

 

 

 

 

 

 

Adequate

63.39

67.99

79.77

78.15

68.59

61.93

Intermediate

28.34

25.31

16.83

17.57

22.39

28.07

Inadequate

8.27

6.70

3.39

4.29

9.02

10.00

No. of cases

9,426

59,079

12,029

10,941

10,748

177,374

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

TABLE 5A-3 Odds Ratios from Logistic Regression Models of Low Birthweight, by Race/Ethnicity: 1989-1991 Linked Birth/Infant Death Datasets

 

Non-Latino White

Non-Latino Black

Mexican

Puerto Rican

Maternal Characteristics

 

 

 

 

Foreign born

.929

.743

.733

.950

Age (years)

 

 

 

 

< 20

.907

.890

1.049

.975

20-34

5+

1.456

1.273

1.518

1.411

Education

 

 

 

 

< High school

1.209

1.094

1.025

1.096

High school

Some college

.834

.952

.942

.952

Single

1.193

1.203

1.206

1.289

Infant Characteristics

 

 

 

 

Birth order

 

 

 

 

1

1.729

1.300

1.538

1.344

2-4

5+

.896

1.072

.973

1.278

Male

.850

.802

.932

.885

Health Behaviors

 

 

 

 

Smoked

1.986

1.758

1.773

1.623

Drank

1.123

1.496

1.112

1.328

Weight gain < 22 lb.

2.985

2.606

2.423

2.592

Prenatal care

 

 

 

 

Adequate

Intermediate

1.330

1.151

1.137

1.044

Inadequate

1.830

1.690

1.530

1.617

No. of cases

681,295

168,899

999,458

137,625

NOTE: NB, native born; FB, foreign born.

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

 

Cuban

Central/ South American

Chinese

Filipino

Japanese

Other Asian/ Pacific Islander

Maternal Characteristics

 

 

 

 

 

 

Foreign born

1.011

.946

.778

.927

1.009

1.157

Age (years)

 

 

 

 

 

 

<20

.874

1.127

1.130

1.189

.871

1.249

20-34

5+

1.376

1.539

1.363

1.529

1.124

1.375

Education

 

 

 

 

 

 

< High school

1.160

1.003

1.072

.976

.801

1.029

High school

Some college

.901

.993

.868

1.028

1.010

.956

Single

1.376

1.230

1.332

1.195

1.208

1.196

Infant Characteristics

 

 

 

 

 

 

Birth order

 

 

 

 

 

 

1

1.487

1.498

1.446

1.579

1.553

1.596

2-4

5+

1.121

.917

.843

.928

.770

.716

Male

.896

.891

.878

.899

.838

.857

Health Behaviors

 

 

 

 

 

 

Smoked

1.987

1.537

2.120

1.498

2.608

1.459

Drank

.946

1.015

.754

1.001

.923

1.309

Weight gain < 22 lb.

2.995

2.498

2.351

2.567

2.641

2.351

Prenatal care

 

 

 

 

 

 

Adequate

Intermediate

1.089

1.031

1.143

1.297

1.215

1.131

Inadequate

1.914

1.378

1.573

1.648

1.442

1.335

No. of cases

30,826

209,247

59,077

68,505

22,970

188,122

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

TABLE 5A-4 Odds Ratios from Logistic Regression Models of Infant Mortality by Race/Ethnicity, 1989-1991 Linked Birth/Infant Death Datasets

 

Non-Latino White

Non-Latino Black

Mexican

Puerto Rican

Maternal Characteristics

 

 

 

 

Foreign born

.841

.924

.976

.871

Age (years)

 

 

 

 

< 20

1.103

.920

1.160

1.292

20-34

35+

.998

.998

1.257

1.437

Education

 

 

 

 

< High school

1.265

1.108

1.068

1.132

High school

Some college

.880

.997

.933

1.077

Single

1.411

1.185

1.585

1.108

Infant Characteristics

 

 

 

 

Birth order

 

 

 

 

1

.975

1.197

.899

1.001

2-4

5+

1.052

1.145

1.145

1.427

Male

1.305

1.132

1.283

1.183

Health Behaviors

 

 

 

 

Smoked

1.308

1.299

1.575

1.227

Drank

.868

1.166

.940

1.366

Weight gain < 22 1b.

2.813

2.699

2.086

2.690

Prenatal Care

 

 

 

 

Adequate

Intermediate

1.345

1.073

0.967

0.980

Inadequate

1.859

1.574

1.192

1.608

No. of cases

681,295

168,899

999,458

137,625

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

 

Cuban

Central/ South American

Chinese

Filipino

Japanese

Other Asian/ Pacific Islander

Maternal Characteristics

 

 

 

 

 

 

Foreign born

.929

.890

1.106

.939

1.205

.909

Age (years)

 

 

 

 

 

 

< 20

.897

1.104

1.226

1.602

.993

1.100

20-34

35+

1.150

1.515

1.138

1.203

1.368

1.386

Education

 

 

 

 

 

 

< High school

.795

1.087

1.040

.988

1.897

.785

High school

Some college

.671

.955

.913

.895

1.241

.766

Single

1.942

1.388

4.361

1.935

2.863

1.730

Infant Characteristics

 

 

 

 

 

 

Birth order

 

 

 

 

 

 

1

1.239

1.069

.795

.861

.698

.930

2-4

5+

1.863

1.045

1.881

1.429

.827

1.085

Male

1.202

1.246

1.247

1.154

1.066

1.150

Health Behaviors

 

 

 

 

 

 

Smoked

1.130

.595

.402

1.443

1.315

1.418

Drank

1.316

2.547

1.790

.963

Weight gain < 22 lb.

4.607

2.119

1.978

2.551

1.013

1.966

Prenatal Care

 

 

 

 

 

 

Adequate

Intermediate

0.965

0.858

1.101

1.360

1.216

1.093

Inadequate

1.240

1.258

1.100

1.766

.690

1.215

No. of cases

30,826

209,247

59,077

68,505

22,970

188,122

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

TABLE 5A-5 Odds Ratios from Logistic Regression Models of Infant Mortality by Race/Ethnicity, 1989-1991 Linked Birth/Infant Death Datasets

 

Non-Latino White

Non-Latino Black

Mexican

Puerto Rican

Maternal Characteristics

 

 

 

 

Foreign born

.877

1.042

.907

.908

Age (years)

 

 

 

 

< 20

1.101

.935

1.110

1.295

20-34

35+

.861

.876

1.026

1.205

Education

 

 

 

 

< High school

1.195

1.076

1.061

1.077

High school

Some college

.916

.994

.942

1.083

Single

1.292

1.094

1.459

.949

Infant Characteristics

 

 

 

 

Birth order

 

 

 

 

1

.789

1.086

.760

.878

2-4

5+

1.123

1.083

1.159

1.258

Male

1.331

1.209

1.277

1.218

Low birthweight

 

 

 

 

Preterm

25.446

18.157

29.937

24.257

Intrauterine growth retarded

6.205

3.423

8.118

5.579

Health Behaviors

 

 

 

 

Smoked

1.049

1.027

1.251

1.009

Drank

.780

.931

.870

1.112

Weight gain < 22 1b.

1.691

1.607

1.335

1.624

Prenatal Care

 

 

 

 

Adequate

Intermediate

1.209

1.019

.928

1.011

Inadequate

1.403

1.190

.990

1.298

No. of cases

681,295

168,899

999,458

137,625

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×

 

Cuban

Central/ South American

Chinese

Filipino

Japanese

Other Asian/ Pacific Islander

Maternal Characteristics

 

 

 

 

 

 

Foreign born

.941

.949

1.193

.984

1.197

.884

Age (years)

 

 

 

 

 

 

< 20

.928

1.042

1.092

1.427

.788

.978

20-34

35+

.917

1.202

1.019

.978

1.301

1.195

Education

 

 

 

 

 

 

< High school

.738

1.092

1.018

.982

2.046

.790

High school

Some college

.715

.956

.941

.882

1.255

.767

Single

1.674

1.255

3.730

1.756

2.656

1.586

Infant Characteristics

 

 

 

 

 

 

Birth order

 

 

 

 

 

 

1

1.093

.897

.726

.733

.636

.781

2-4

5+

1.771

1.073

1.785

1.469

.881

1.213

Male

1.229

1.263

1.237

1.178

1.072

1.186

Low birthweight

 

 

 

 

 

 

Preterm

43.143

33.312

24.281

22.416

20.668

22.246

Intrauterine growth retarded

5.005

6.563

7.397

6.935

3.643

7.708

Health Behaviors

 

 

 

 

 

 

Smoked

.855

.492

.295

1.214

.910

1.133

Drank

1.40

2.474

1.483

.866

Weight gain < 22 lb.

2.359

1.274

1.301

1.570

.713

1.320

Prenatal Care

 

 

 

 

 

 

Adequate

Intermediate

.979

.866

1.059

1.255

1.160

1.044

Inadequate

.733

1.10

.868

1.371

.518

1.075

No. of cases

30,826

209,247

59,077

68,505

22,970

188,122

Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
Page 244
Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
×
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Suggested Citation:"5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women." National Research Council. 1999. Children of Immigrants: Health, Adjustment, and Public Assistance. Washington, DC: The National Academies Press. doi: 10.17226/9592.
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Immigrant children and youth are the fastest-growing segment of the U.S. population, and so their prospects bear heavily on the well-being of the country. Children of Immigrants represents some of the very best and most extensive research efforts to date on the circumstances, health, and development of children in immigrant families and the delivery of health and social services to these children and their families.

This book presents new, detailed analyses of more than a dozen existing datasets that constitute a large share of the national system for monitoring the health and well-being of the U.S. population. Prior to these new analyses, few of these datasets had been used to assess the circumstances of children in immigrant families. The analyses enormously expand the available knowledge about the physical and mental health status and risk behaviors, educational experiences and outcomes, and socioeconomic and demographic circumstances of first- and second-generation immigrant children, compared with children with U.S.-born parents.

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