An Annotated Bibliographyof Research on Health Risks and Low

Birthweight Among Latinosby David A. Lopez, Ph.D.

Working Paper No. 29November 1996

An Annotated Bibliographyof Research on Health Risks and Low

Birthweight Among Latinosby David A. Lopez, Ph.D.

Working Paper No. 29November 1996

The Julian Samora Research Institute is committed to the generation, transmission, andapplication of knowledge to serve the needs of Latino communities in the Midwest. To this end, ithas organized a number of publication initiatives to facilitate the timely dissemination of currentresearch and information relevant to Latinos. The Julian Samora Research Institute ResearchReport Series (RR) publishes monograph length reports of original empirical research on Latinosin the nation conducted by the Institute’s faculty affiliates and research associates, and/or projectsfunded by grants to the Institute.

Michigan State UniversityEast Lansing, Michigan

Julian Samora Research InstituteRefugio I. Rochín, DirectorDanny Layne, Layout Editor

Lucinda Briones, Copy Manager

SUGGESTED CITATION

Lopez, David A. (Dr.) An Annotated Bibliography of Research on Health Risks and LowBirthweight Among Latinos, JSRI Working Paper #29, The Julian Samora Research Institute,Michigan State University, East Lansing, Michigan, November 1996.

About this Paper:

This annotated bibliography is based on Dr. Lopez’s dissertation entitled “Low Birthweight, Infant Mortality,Acculturation, and Nutrition: An Explanation of Between Group Differences Among Latinos.” In reviewing theliterature, it became clear to the author that the subject was “distended.” Sources ranged from the fields of medicine,s o c i o l o g y, psychology, anthropology, health, and nutrition. There was no comprehensive reference that addressedlow birthweight in the context of Latino culture or national origin. This publication seeks to provide that source.

About the Author: Dr. David A. Lopez

Dr. David A. Lopez is an Assistant Professor in Sociology at Creighton University in Omaha,Neb. He specializes in racial and ethnic relations with a particular emphasis on Latino healthissues. He is also involved in research on differential misdemeanor sentencing of Latinos in theMidwest. Prior to coming to Creighton, Dr. Lopez was a post-doctoral fellow at JSRI at MSU.

He earned his Bachelor's degree at the University of California, Santa Barbara, his Master'sdegree at Oakland University, and his Ph.D. at Michigan State. His dissertation focused on thevariations among Latinos’ low birth weights, infant mortality, acculturation, and nutrition.

An Annotated Bibliography of Research on Health Risksand Low Birthweight Among Latinos

Table of Contents

Introduction ..........................................................................................................1

Infant Mortality and Birthweight ......................................................................2

Low Birthweight and Latinos ..............................................................................3

Acculturation, Latinos, and Birthweight Studies ..............................................7

Acculturation Processes ......................................................................................9

Differential Socioeconomic Conditions Among Latinos ................................11

Food Habits, Nutrition, and Culture ................................................................12

The HHANES as a Research Tool ....................................................................13

Conclusion ..........................................................................................................14

References ..........................................................................................................15

Introduction

The goal of this bibliography is to provide adocument that will assist research on low birthweightamong Latinos. It is my hope that this bibliographycan function at least as a “starting point” for thoseinterested in the topic. The bibliography is divided bysubject matter. The primary focus of this bibliographyis on Latinos and this is reflected in the literatureselected for the bibliography.

This bibliography will be of interest primarily tothose with research questions related to the culturaldimensions of low birthweight among Latinos.H o w e v e r, for those interested in a preliminaryexploration of articles related to low birthweight andinfant mortality, citations are included that discussthis relationship. This bibliography will also be of useto those interested in comparisons among certainsocial and economic characteristics of the Latinosubgroups. The discussion of the Hispanic Health andNutrition Examination Survey, 1982-84, should behelpful for those who may be considering using thisdata set in their own research.

One problem that I experienced in researchinglow birthweight among Latinos, was the limitedamount of research that exists on the subject.Although there is a substantial amount of research onthe phenomenon of low birthweight in general (mostin the biomedical fields), little pertained explicitly toLatinos. Furthermore, there is a scarcity of data setsthat include birthweight measures for Latinos. It iseven more difficult to find birthweight data thatbifurcates Latinos by race and ethnicity. Clearly, moreand improved data need to be generated in this area.

The bibliography begins with literature relatingto infant mortality and birthweight. Given thephysiological nature of these pregnancy outcomes, ageneral understanding of biomedical factors relatedthese phenomena is of value to the researcher interested in these subjects. The literature addresses

infant mortality rates by race and ethnicity, riskfactors associated with infant mortality, and causalfactors associated with infant mortality. The literaturein this section also points out the interrelationshipbetween infant mortality and birthweight.

The second section discusses birthweight andLatinos by sub-groups. This section presents datawhich reflects Latino heterogeneity in lowbirthweight outcomes. Data is also given on outcomesfor African Americans and Non-Latino Whites forcomparison purposes.

A discussion of acculturation as related toLatinos and birthweight follows the above mentionedsection. Here I present studies that have incorporatedculture and acculturation as part of their explanationfor birthweight outcomes among Latinos. T h eissue of acculturation is one that requires somefurther discussion.

In the dissertation, I devoted a complete chapterto the topic of acculturation. I did this because, atleast in sociology, the concept of acculturation is onethat although much has been written about it, little isknown about it. Various measures have beenproposed. For example, language and nativity arecommonly used measures of acculturation. However,a definitive measure does not exist. I viewacculturation as a process. This section presentsliterature related to explaining acculturation as aprocess. Following this section on acculturation is arelated section on the differential socioeconomicconditions of Latino subgroups.

The next section discusses food habits andnutrition as related to culture. An important annex tothis section is, the Hispanic Health and NutritionExamination Survey, 1982-84 (HHANES), discussedas a research tool. The limitations and strengths of theHHANES are addressed.

An Annotated Bibliography of Research onHealth Risks and Low Birthweight Among Latinos

Infant Mortality and Birthweight

The research on infant mortality and birthweightto date suggests that a clear relationship existsbetween the two. Low birthweight babies are morelikely to die than babies who are not born lowbirthweight. Furthermore, there are specificindicators of low birthweight (e.g., gender, birthorder, mother’s age and education, and access toprenatal care). Male low birthweight babies tend todie more often than comparable female babies.Fullterm babies weigh more than preterm babies.First-born low birthweight babies are more likely todie than second-born low birthweight babies. Young,undereducated mothers who do not have access toprenatal care are more likely to have low birthweightbabies and babies who die. Little literature exists thatspecifically discusses infant mortality and Latinos.As such, there was even less research that bifurcatedLatinos by ethnic group for infant mortality.

COSSMHO (National Coalition of HispanicHealth and Human Services)1994 Profiles of Health: Documenting Health and

Establishing Priorities.Washington, D.C.: COSSMHO.

Among other health statistics, this publicationfound that in Brooklyn, (where 83% of the Latinosare Puerto Rican), the infant mortality rate was 12.3per 1,000 in the population. In Los Angeles, (where76% of the Latinos are Mexican), the infant mortalityrate was 6.9 per 1,000 in the population. The findingssuggest that Puerto Rican infants have a higher rateof infant mortality than do Mexican infants. This issignificant for Puerto Ricans also have the highestrate of low birthweight among Latinos.

From the MMWR1993 “Infant Mortality—United States, 1990.”

Ethnicity and Disease 3:427-31

This report found the infant mortality rate for theUnited States to be 9.2 infants per 1,000 births. T h erate for Non-Latino Whites was 7.6 per 1,000 in thepopulation and the rate for African Americans was18.0 per 1,000 in the population. The data was derivedfrom the National Center for Health Statistics and theCenter for Disease Control. For the total population,

disorders relating to short gestation and lowbirthweight were the third leading causes of death.For African American infants, disorders relating toshort gestation and low birthweight were the firstleading causes of death. In 1987 (the most recent dataat the time of the study), 95% of infant deaths werelow birthweight babies. A problem with the statisticsof this study is that they do not include Latinos.

Health United States 1990 1992 Public Health Service. Centers for Disease

Control. National Center for HealthStatistics. Hyattsville, Maryland: U.S.Department of Health and Human Services.

This source is an analysis of the state of health inthe United States and addresses differences by raceand ethnicity. It was found that the infant mortalityrates for 1,000 in the population for Mexicans was8.8, for Cubans 8.0, and for Puerto Ricans, 12.3. Thestudy demonstrates the heterogeneous nature of theLatino Population.

Hogue, Carol, J. R., James W. Buehler,Lilo T. Strauss, and Jack C. Smith1987 “Overview of National Infant Mortality

Surveillance (NIMS) Project — Designs,Methods, Results.” Public Health Reports102:126-37.

The authors collected data from 50 states, NewYork City, the district of Columbia and Puerto Rico.Data consisted of birth and death certificates forinfants born in 1980 and who died in the first year oflife. For the 1980 cohort (all races), it was found that97.6% of the infants per 1,000 live births were lowbirthweight infants. Six risk factors for infantmortality were identified. These factors were: gender,gestational age, live birth order, maternal age,maternal education, and prenatal care. According tothe authors, more low birthweight males died thanlow birthweight females. As gestational ageincreased, birthweight increased. As birthweightincreased, infant mortality decreased. Lowbirthweight infants born second had the lowest infantmortality rate among low birthweight infants. Forinfants over 2,500 grams, those born first had thelowest infant mortality rate. The infant mortality ratedecreased as the age of mothers increased through 34years of age. However, the infant mortality rateincreased for births to mothers over 35 years of age.

Infant mortality associated with younger females isrelated primarily to low birthweight. As maternaleducation increased, the infant mortality ratedecreased. When prenatal care was received in thefirst trimester of pregnancy, the infant mortality ratewas substantially lower. The researchers argued thatthe most effective method of reducing infant mortalityis to reduce low birthweight. One major criticism ofthe study is that it does not include Latinos.

Rumbaut, Ruben G. and John R. Weeks1993 “Ethnicity, Nativity, and the Paradox of

Perinatal Health and Morbidity: An Analysisof Sociocultural and Biomedical CausalFactors.” Paper Presented at the AnnualMeeting of the American SociologicalAssociation. Miami, Florida. Aug. 15, 1993.

Using data from the San Diego ComprehensivePerinatal Program, 1989-1991, In a multivariateanalysis, the authors found that the secondarybiomedical variable of previous live births was thebest predictor of infant health outcomes. This is tosay, that being born later put an infant more at risk forinfant mortality. The sample included Asians, Latinos(not subgrouped), Non-Latino Whites, and AfricanAmericans. These findings appear contradictory tothe Hogue et al. (1987) study which found that first-born low birthweight babies were more at risk forinfant mortality than second-born low birthweightbabies. The difference in the studies is that Hogue etal. (1987) looked at low birthweight births where thisstudy looked at births in general.

Taffel, S.1 9 8 0 “Maternal Weight Gain and the Outcome of

P r e g n a n c y.” Vital and Health Statistics U . S .Department of Health and Human Services.Publication (PHS) 86-1922. Washington, D.C.

The study found that women who gained lessthan 21 pounds during pregnancy were 2.3 timesmore likely to have a low birthweight infant.Additionally, it was found that these infants were 1.5times more likely to experience infant mortality. Thedata was drawn form a national sample.

The Future of Children1995 Center for the Future of Children. Los Altos,

Calif.: The David and Lucile PackardFoundation.

Statement of Purpose: “The primary focus of T h eFuture of Children is to disseminate timelyinformation on major issues related to children’s well-being, with special emphasis on providing objectiveanalysis and evaluation, translating existingknowledge into effective programs and policies, andpromoting constructive institutional change. Inattempting to achieve these objectives, we aret a rgeting a multidisciplinary audience of nationalleaders, including policymakers, practitioners,legislators, executives, and professionals in the publicand private sectors. This publication is intended tocomplement, not duplicate, the kind of technicalanalysis found in academic journals and the generalcoverage of children’s issues by the popular press andspecial interest groups.”

This publication is very useful for those interestedin childhood welfare, development, health, education,and a variety of other social, medical, andpsychological issues. Each issue changes its theme.For example, Volume 5, Number 2, focused on themany threats to the health, development, andeducational attainment of children. Volume 5,Number 3, focused on early childhood developmentprograms and how they influence future development.This journal is very useful for it approaches a topicfrom several fields and perspectives.

Low Birthweight and Latinos

The literature suggests that Mexicans andCubans have the lowest rate of low birthweightamong Latinos and Puerto Ricans have the highest.Heterogeneity exists among Latinos and their lowbirthweight outcomes. This information is importantbecause it means that each Latino subgroup has itsown distinct set of circumstances that may contributeto these outcomes. It should be noted that several riskfactors effect low birthweight. Some of these factorsare physiological and some are social. However, it isdifficult to separate the physical from the social. Forexample, the rate of low birthweight babies is greaterfor those born preterm than full term (physiologicalcorrelate). The likelihood of having a preterm baby iseffected by social correlates (e.g., mother’s age, loweducation, and smoking). The intersection of thesecorrelates is reflected in the studies reviewed.

Becerra, Jose E., Carol J. R. Hogue, Hani K.Atrash, and Nilsa Perez1991 “Infant Mortality Among Hispanics: A

Portrait of Heterogeneity.” Journal of theAmerican Medical Association 265:217-21.

This study, using the 1983 and 1984 Linked Birthand Infant Death Data Sets, found low birthweightsof 4.1% for Mexicans, 4.0% for Cubans, and 6.6%for Puerto Ricans. The percentage of low birthweightbabies for all Latinos was 4.6 and for Non-LatinoWhites 4.0. The authors argue that although betternutrition, family dynamics, and low rates of smokingand alcohol use have been suggested as explanationsfor the low incidence of low birthweight amongLatinos (compared to Non-Latino Whites), they donot completely explain the difference between theLatino outcome and the outcome for Non-LatinoWhites. This work supports the proposition thatacculturation to the Anglo culture may have anegative effect on pregnancy outcomes.

Brooks-Gunn, J., Marie C. McCormick, andMargaret C. Heagarty1989 “Preventing Infant Mortality and Morbidity:

Developmental Perspectives.” AmericanJournal Orthopsychiatry 58:288-96.

The authors identified possible causes of lowbirthweight to be demographic risks, medical risksduring pregnancy, behavioral and environmentalrisks, health care risks, and physical factors that haveyet to be determined. The study, in summarizingother research, suggests that environmental stress, nosocial support, work patterns during pregnancy,maternal health habits, and poor prenatal care werepredictors of low birthweight. The article concludedthat access to prenatal care and maternal educationprograms are needed to reduce the incidence of lowbirthweight. However, the study does not considerthe possible effects of race or ethnicity on differentiallow birthweight outcomes.

CDC (Centers for Disease Control)1993 Monthly Vital Statistics Report 9:41.

This statistical document found low birthweightfor Mexicans to be 5.5%, Cubans 5.7%, and PuertoRicans 9.0%. The percentage for all Latinos was 6.1and for Non-Latino Whites the percentage was 5.6.The statistics example the heterogeneity in lowbirthweight outcomes among Latinos.

Dowling, Patrick T. and Michael Fisher1987 “Maternal Factors and Low Birthweight

Infants: A Comparison of Blacks withMexican Americans.” Journal of FamilyPractice 25:153-58.

This Chicago area study which reviewed medicalrecords found that Mexicans had a low birthweightpercentage of 5.9. The results were contrary to whatwould be expected given the socioeconomicconditions of Mexican Americans. The authors suggestthat the results may be due to some “protectivesociocultural effect” and selective immigration.

Guendelman, Sylvia1995 “High-Risk, Good Outcomes: The Health

Paradox of Latina Mothers and Infants.”Chicano/Latinos Policy Project (CLPP)Working Paper 1(4). Institute or the Studyof Social Change at the University ofCalifornia at Berkeley.

In this paper, Guendelman presents severalstudies that have attempted to explain the lowbirthweight outcomes for at-risk Mexican Americans.The author suggests that studies have focused on fourhypotheses: (1) selective migration results in morehealthy mothers, (2) protective factors associatedwith Mexican culture may facilitate positivepregnancy outcomes, (3) infant deaths duringpregnancy may decease the numbers of weak newborn babies, (4) Infant deaths are under reported.There are two main criticisms of this paper. One, thepaper only considers Mexican Americans. This doesnot take into consideration subgroup comparisonsamong Latinos. This is related to the secondcriticism, and this is that the author is onlyconsidering low birthweight in general, not lowbirthweight controlling for gestation length. Mydissertation, using the Hispanic Health andExamination Survey, 1982-84, indicated that whencontrolling for gestation length, Puerto Ricansactually had better outcomes for low birthweight thanMexicans. This means that the issue is not so muchone of low birthweight, but one of premature birth.

Hayes-Bautista, David E.1992 “Latino Health Indicators and the

Underclass Model: From Paradox to NewPolicy Models.” Pp. 32-47 in Health Policyand the Hispanic edited by Antonio Furino.Boulder: Westview.

This study found that Latinos had the lowestincidence of low birthweight births in Los AngelesCounty (5.32%). The author states that the rate of lowbirthweight of Latinas is half the rate of AfricanAmericans and slightly better than Non-LatinoWhites. The data is pertinent to Mexican Americanssince the majority of Latinos living in the LosAngeles area are of Mexican descent.

Health United States 19901992 Public Health Service. Centers for Disease

Control. National Center for HealthStatistics. Hyattsville, Maryland: U.S.Department of Health and Human Services.

The publication found that low birthweightamong Mexicans, Central and South Americans, andCubans ranged from 5.6% to 6.0% (although they donot identify which group is at the high or low ends ofthe percentages). Low birthweight among PuertoRicans was found to be 9.4% and among Non-LatinoWhites 5.7%. The data demonstrate Latinoheterogeneity in low birthweight outcomes.

Kramer, Michael1987 “Determinants of Low BirthWeight:

Methodological Assessment and Meta-Analysis.” Bulletin of World HealthOrganization 5:663-737.

In a meta-analysis of French and English studiesconducted between 1970 and 1984, the author foundthat low weight gain during pregnancy increased therate of intrauterine growth retardation (IUGR). IUGRis positively correlated with low birthweight andinfant mortality. IUGR was greater for women whowere undernourished and for women from countriesthat experienced food shortages. These women wereprimarily from developing countries which hadseasonal food shortages.

Lopez, David A. 1996 “Low Birthweight, Infant Mortality,

Acculturation, and Nutrition: AnExplanation of Between Group DifferencesAmong Latinos.” Ph.D. Dissertation,Department of Sociology, Michigan StateUniversity East Lansing, Michigan.

This study provides an analysis of the correlates oflow birthweight among Latinos, Non-Latino W h i t e s ,and African Americans with its primary focus onLatinos. Low birthweight was defined as weighing lessthan 2,500 grams at birth. The study tested twohypotheses. Hypothesis one proposed that the nutrientintake of Puerto Rican women is less than the nutrientintake of Mexican and Cuban women. Hypothesis twoproposed that nutritional intake effects low birthweightoutcomes more for Puerto Rican women than Mexicanand Cuban women. The Hispanic Health and NutritionExamination Survey, 1982-84, served at the study’sdata source. The data contained information onnutritional intake for the Latino subgroups, lowbirthweight outcomes among the Latino subgroups,and social and economic information. Severalmultivariate statistics were used to test the hypotheses.The hypotheses were not supported. Puerto Ricans arenot undernourished as compared to Mexicans andCubans. However, differential patterns in nutritionalintake were found to exist among the Latinosubgroups. Differences were also found in lowbirthweight outcomes. Puerto Ricans had the highestrate of preterm low birthweight followed by Cubans.Mexicans had the lowest rate of preterm lowbirthweight. It is argued that Puerto Ricans have a highrate of preterm low birthweight because of poor socialand economic conditions and a history of healtha ffecting conditions related to their patriarchaldependency on the United States. It is suggested thatthe Cubans who are having the preterm lowbirthweight babies are those who are recentimmigrants to the United States. It is proposed that thepositive outcomes for Mexicans is due to the Mexicanexperience which is a function of their particularhistorical circumstances. That is, they maintainculinary and cultural practices which affect theirnutrient intake. It is further suggested that the Mexicanexperience promotes an environment that results inpositive low birthweight outcomes.

Mendoza, Fernando S., Stephanie J. Ventura,R. Burciaga Valdez, Ricardo O. Castillo,Laura Escoto Saldivar, Katherine Baisden,and Reynaldo Martorell1 9 9 1 “Selected Measures of Health Status for

Mexican American, Mainland Puerto Rican,and Cuban American Children.” Journal ofthe American Medical A s s o c i a t i o n 2 1 : 9 8 - 1 0 9 .

Using data from the 1987 National Vi t a lStatistics System and the Hispanic Health andExamination Survey, 1982-84, the authors found lowbirthweight percentages of 6.2 for Latinos and 5.6 forNon-Latino Whites. Low birthweight for Latinossubgroups were 5.7% for Mexicans, 5.9% forCubans, and 9.3% for Puerto Ricans. The studyindicates the heterogeneous nature of low birthweightamong the Latino subgroups.

Michielutte, Robert, J. M. Ernest, Mary LouMoore, Paul J. Meis, Penny C. Sharp, H. BradleyWells, and Paul A. Buescher1992 “A Comparison of Risk Assessment Models

for Term and Preterm Low Birthweight.”Preventive Medicine 21:98-109.

This study’s sample consisted of 25,758 lowbirthweight singleton births form 20 counties inNorth Carolina. Data was collected from physicianrecords. These records included socioeconomic,physical, and medical history factors associated withlow birthweight. The majority of the subjects wereclients of Public Health Clinics. Preterm lowbirthweight was defined as less than 37 weeksgestation and weighing less than 2,500 grams. Termlow birthweight was defined as 37 or more weeksgestation and weighing less than 2,500 grams at birth.1,722 births were preterm low birthweight and 1,098births were term low birthweight. Adolescents weremore likely to have preterm low birthweight infantsbut less likely to have term low birthweight infants.Mothers with low educational levels had a higher rateof low birthweight babies. More African Americanshad low birthweight infants than Non-Latino Whites.Women who smoked had a higher rate of lowbirthweight infants. Previous premature/lowbirthweight births increased the rate of lowbirthweight. Weight under 100 pounds increased

preterm low birthweight. For term low birthweight,shorter, heavier women, and taller, lighter, women,and shorter, lighter women were more at risk for lowbirthweight. The study offers some excellent insightsinto the issue of preterm low birthweight and termlow birthweight. However, the study is limited toNorth Carolina.

Rumbaut, Ruben G. and John R. Weeks1989 “Infant Mortality Among Indochinese

Refugees: Patterns of Infant Mortality,Birthweight and Prenatal Care inComparative Perspective.” Research in theSociology of Health Care 8:137-96.

In a San Diego area study, Non-Latino Whiteshad a low birthweight percentage of 5.1 as comparedto a percentage of 5.2 for Latinos. The study focusedon the Indochinese population and suggests thatethnicity factors and language explain most of thelow birthweight among the Indochinese living in SanDiego. An analysis of the differences betweenLatinos and Non-Latino Whites is not provided.

U.S. Bureau of the Census1992 Statistical Abstract of the United States

1 9 9 2 : (112th edition). Washington D.C.:U.S. Government Printing Office.

This statistical document found low birthweightrates for Mexicans of 5.6%, Cubans 5.8%, and PuertoRicans 9.5%. The rate for all Latinos was 6.2% andthe rate for Non-Latino Whites was 5.7%. The lowbirthweight rate for African Americans was 13.2%.The statistics highlight Latino heterogeneity in lowbirthweight outcomes.

Ventura, S. and J. Martin1991 Advance Report of Final Nativity Statistics,

1991. Monthly Vital Statistics Report, Vol.42, No. 35. Hyattsville, Maryland: U.S.Department of Health and Human Services.

The authors found low birthweight rates of 6.1%for Latinos and 5.7% for Non-Latino Whites. Inaccounting for group heterogeneity, low birthweightrates were 4.8% for Cubans and 7.9% for PuertoRicans. The findings demonstrate the heterogeneitythat exist among Latinos in low birthweight outcomes.

Acculturation, Latinos, and Birthweight Studies

The degree to which one acculturates may effecttheir behavior. A change in behavior can have aneffect on health outcomes. Low birth weight is ahealth outcome and this may be effected byacculturation. The literature on acculturation and lowbirthweight suggests that acculturation is detrimentalto positive pregnancy outcomes (i.el., results inhigher a higher incidence of low birthweight).However, there is one critical issue in this discussion,and that is “what exactly is acculturation?” Ins o c i o l o g y, there is no agreed upon method ofmeasuring acculturation. Furthermore, someresearchers would use the term acculturation, but notreally define what they mean by acculturation. Theonly measure I had in discussing acculturationprocesses was socioeconomic data. The point here isthat the concept of acculturation is one that is notagreed upon and the researcher who usesacculturation as part of their paradigm should fullyarticulate what they mean by acculturation.

Balcazar, Hector1993 “Mexican Americans’ Intrauterine Growth

Retardation and Maternal Risk Factors.”Ethnicity and Disease 3:169-75.

This article examined maternal risk andpregnancy outcomes among Mexican A m e r i c a n s .Using non-married status, low education, young ageat delivery, at least one pregnancy complication,recent illness, at least one labor complication, and noprenatal care as risk factors, it was found thatMexican Americans had a lower risk for intrauterinegrowth retardation (IUGR) than did Non-LatinoWhites. Also, in the sample of 25,289 ArizonanMexican Americans, mothers born in the U.S. were1.21 times more likely to have an infant born withIUGR than an infant born to a mother from Mexico.The findings support the argument that acculturationmay contribute to negative pregnancy outcomes.

Borges, Guiherme, Malaquias Lopez-Cervantes,Ma Elena Medina-Mora, Roberto Tapia-Conyer,and Francisco Garrido1993 “Alcohol Consumption, Low Birthweight,

and Preterm Delivery in the NationalAddiction Survey.” International Journal ofthe Addictions 28:355-68.

In this study, using the National A d d i c t i o nSurvey of Mexico, the authors found an incidence oflow birthweight among their sample (N=5,234) of3.2%. Women who suffered from A l c o h o lDependence Syndrome were at very high risk of lowbirthweight and preterm delivery (odds ratio=12.1).The data on low birthweight was obtained ininterviews and was based on mother’s recollection.The results of the study suggest that since U.S.women smoke more than Mexican women, womenfrom Mexico who acculturate to Anglo culture maybe more at risk for negative pregnancy outcomes.

Fenster, Laura and Molly J. Coye1990 “Birthweight of Infants Born to Hispanic

Women Employed in Agriculture.” Archivesof Environmental Health 45:46-52.

Using Hospital Birth Records, the researchersfound that only 1.8% of the infants born to a sampleof Latinas employed in agriculture in California(N=1,040) were born low birthweight. The authorsargue that agricultural work did not increase theincidence of low birthweight and this may be due toselective migration (i.e., those who immigrate arephysically strong and healthy).

Garcia Coll, Cynthia T.1990 “Developmental Outcome of Minority

Infants: A Process-oriented Look into OurBeginnings.” Child Development 61:270-89.

In this article, the author suggests that there areimportant influences on the developmental outcomeof minority children. These influences are culturalbeliefs and practices of caregiving, health carepractices and statuses, family structure, socio-economic forces, and biological factors. T h e s efactors can influence how an individual develops andthe environment in which they develop.Development over the life span is effected by thesecharacteristics which in turn can effect healthoutcomes. Low birthweight is a health outcome. Thearticle suggests that the lower rates of infantmortality and low birthweight for MexicanAmericans is puzzling given their lowersocioeconomic status which points out the possibilityof some type of protective factors in the MexicanAmerican population regarding children andchildbearing practices.

Gaviria, Moises, Gwen Stern, andStephen L. Schensul1 9 8 2 “Sociocultural Factors and Perinatal Health in

a Mexican American Community.” Journal ofthe National Medical Association 74:983-89.

In a sample of 89 women from the Chicago area,this study found that recent arrivals to the UnitedStates (immigrated in previous two years) soughtprenatal care later than long term arrivals (been in theUnited States more than two years). The studysuggests that more recent arrivals may be less likelyto utilize “modern” prenatal care and rely more on“traditional” forms of prenatal care (i.e., those rootedin culture). Regarding culture, the study discusses apostpartum practice called cuarentena. In thispractice, the mother has a 40 day rest periodfollowing delivery. During this time, the motherfocuses on her and her newborn’s health. This mayinclude, but not be limited to, nutritional practices. Inthe study, 60% of the mothers were planning onobserving the cuarentena.

Rueschenberg, Erich J. and Raymond Buriel1985 “Mexican American Family Functioning

and Acculturation: A Family SystemsPerspective.” Pp. 15-25 in HispanicPsychology: Critical Issues in Theory andResearch edited by Amando M. Padilla.Thousand Oaks: Sage.

In a study on acculturation and the internal andexternal functioning of Mexican families (N=45), theauthors used measures of acculturation whichincluded language preference and proficiency,generational status, and recency of immigration. Thestudy found that acculturation increased as familymembers became more involved in U.S. society. Thestudy suggests that involvement in U.S. society (e.g.,family members working) changed the family’sculture.

Rumbaut, Ruben G. and John R. Weeks1993 “Ethnicity, Nativity, and the Paradox of

Perinatal Health and Morbidity: An Analysisof Sociocultural and biomedical CausalFactors.” Paper Presented at the AnnualMeeting of the American SociologicalAssociation. Miami, Florida. Aug. 15, 1993.

The authors found that foreign born Latinos hadbetter low birthweight outcomes than Latinos born inthe United States. Foreign born Latinos had lowbirthweight rates of 1.9% and Latinos born in theUnited States had low birthweight rates of 4.1%. Thestudy suggests that acculturation results in poorerhealth outcomes. The results were part of the SanDiego Comprehensive Perinatal Program.

Scribner, Richard and James H. Dwyer1 9 8 9 “Acculturation and Low Birthweight A m o n g

Latinos in the Hispanic HHANES. A m e r i c a nJournal of Public Health 7 9 : 1 2 6 3 - 6 7 .

This study is one of the most often citedregarding acculturation and low birthweight. Usingthe Hispanic Health and Nutrition ExaminationSurvey, 1982-84, the researchers found that a higheracculturation index (using language, nativity andethnic identification as measures) resulted in higherrates of low birthweight. The rate of low birthweightfor Mexicans was 4.1%. A problem with this study isthat is only looks at Mexicans regarding lowbirthweight outcomes. In other words, it does notconduct subgroup comparisons among Latinos.

Weinman, Maxine L. and Peggy B. Smith1 9 9 4 “U.S. and Mexico-born Hispanic Te e n

Mothers: A Descriptive Study of Factors thatRelate to Postpartum Compliance.” H i s p a n i cJournal of Behavioral Sciences 1 6 : 1 8 6 - 9 4 .

In a study of U.S. born and Mexican bornadolescent Latina mothers, the authors found that forboth groups postpartum follow-up was minimal(17.3% of a sample of 289). The researchers suggestthat the two groups were more similar than different.This similarity may be a result of persistent culturalnorms regarding pregnancy and childbirth. T h eauthors argue that many Mexican Americans preferthe traditional assistance of pateras (midwives) tomodern medicine.

Acculturation Processes

It is my view that acculturation is a process thatinvolves several variables. These variables includefamily roles, gender roles, and socioeconomicvariables. It is my belief that when family and genderroles change, then so does culture. I have a sense thatchanges in gender roles are a result of socioeconomicconditions and these socioeconomic conditions varyby group. On the other hand, what I am notsuggesting is that socioeconomic conditions directlychange culture. However, socioeconomic conditionsare the only variables that can really be measured inmy analysis of culture. Although it can behypothesized that socioeconomic conditions mayeffect family and gender roles and this effects culture,there is no definitive process of measuring thistheoretical relationship. Related to the discussion ofculture is the role history plays in culture. The historyof Mexicans, Cubans, and Puerto Ricans is diverse.Each group’s culture is the result of their distinctcircumstances. The Mexican experience is one ofconquest and economic exploitation. The Cubanexperience is one of Cold War international politics.The Puerto Rican experience is one of dependencyand patriarchy. I argue that history can be used to linkculture to acculturation and the historical periods andtime can be used to understand acculturation.

Baca-Zinn, Maxine1994 “Mexican-Heritage Families in the United

States.” Pp. 161-72 in Handbook ofHispanic Cultures in the United States:Sociology edited by Felix Padilla. Houston:Arte Publico Press.

In discussing modern trends in the MexicanAmerican family, Baca-Zinn argues that the familyshould be viewed within the larger context ofadaptation to social and economic conditions. Shesuggests that traditional Mexican family values ofclose relationships and male domination are notdeviant, but are adaptive measures in an ofteninhospitable social environment. In short, an analysisof the family has to consider culture in relation tosocial structure. The modern Mexican family tends tohave a lower socioeconomic status than Non-LatinoWhites, are more likely to be married and marry at ayounger age than Non-Latino Whites, and havehigher fertility rates and larger families than Non-Latino Whites. The intersection between culture andstructure is seen in the interaction between migration,

extended family, and economic conditions. ManyMexicans who migrate to the U.S. already havefamily in the U.S. These families form the basis foran extended family network. In times of economicadjustment, the extended family may assistfinancially and help with child care. Gender roles aredirectly related to a discussion of the family. Genderroles are connected to the degree of acculturation ofthe family because in Latino culture, women areassociated with the propagation of culture. As genderroles change, so does the nature of the family andculture transforms. The connection between genderroles, family and culture can be analyzed in lookingat the Mexican experience. Historically forMexicans, the primary task of women was to care fortheir family and accept subordination. Baca-Zinnsuggests that as more Mexican women entered theworkplace, egalitarianism increased in Mexicanfamilies. This move toward egalitarianism wasdriven by economic imperatives. Although elementsof patriarchy still do exist in attitudes toward familyand gender roles, the author argues, some socialconditions seem to be connected with more equalityfor wives. The relationship between gender rolesprovides a basis for a comparison of acculturationamong the Latino subgroups.

Bean, Frank D. and Marta Tienda1987 The Hispanic Population in the United

States. New York: Sage.

This book proposes that historical and socialprocesses significantly effect cultural identity. Theseprocesses are interactive and impact contemporarysocial and economic conditions of Latinos. Theseconditions can effect cultural identity. History andsocial circumstances assist in the interpretation of thediverse acculturation experiences and socioeconomicstatus of Latinos.

Habermas, Jurgen1976 Legitimation Crisis. London: Heinemann.

In this book, Habermas discusses crisis as relatedto two integration systems; social and system. T h esystem integration system is representative of thedominant society. It seeks to control and dictate thes o c i e t y. The social system is related to culture, it isbased on symbols. Society is always evolving. T h i sevolution is based on what best functions for thedominant society. However, what is best for thedominant society is not necessarily best for all

members of that society and this leads to conflict.Conflict arises because groups in society seek tomaintain their social system and they do this through“life-worlds.” Life-worlds are the symbols, rituals, andtraditions of a culture. Life-worlds facilitate and allowfor intergenerational communication and thetransmission of a cultural identity. Life-worlds developa person’s sense of self. Life-worlds are borne out ofh i s t o r y. As histories vary, so do life-worlds.

Hernandez, Jose1994 “Hispanics Blend Diversity.” Pp. 17-34 in

Handbook of Hispanic Cultures in theUnited States: Sociology edited by FelixPadilla. Houston: Arte Publico Press.

Hernandez discusses five stages of A n g l o -American policy that had ramifications for Latinos inthe United States. These stages are (1) occupation ofconquered lands, (2) internal colonization, (3)restricted citizenship, (4) external colonization, and(5) oppression in an global economy. Mexicans,Cubans, and Puerto Ricans have different historiesbased on their experiences at any one of these stages.These experiences are related to issues of conquestand occupation, economic exploitation, andimmigration. Contemporary Cuban socioeconomicconditions for Latino subgroups can be traced back totheir differential histories.

James, Sherman A.1993 “Racial and Ethnic Differences in Infant

Mortality and Low Birthweight: APsychosocial Critique.” American Journalof Preventive Medicine 9:130-6.

James argues that there is an unexplained factorthat contributes to the low rate of low birthweightamong Mexicans. He suggests that this factor may bepsychological in nature and positive psychologicalbenefits are derived from a Mexican culturalorientation steeped in symbols. James proposes thatthis orientation results in positive health outcomes.James’argument is consistent with Habermas’(1976)discussion of life-worlds, particularly the emphasison symbols in the maintenance of culture.

Magana, Aizita and Noreen M. Clark1995 “Examining a Paradox: Does Religiosity

Contribute to Positive Birth Outcomes inMexican American Populations?” HealthEducation Quarterly 22:96-109.

The authors write that the Virgin of Guadalupe isa religious symbol that provides strength, warmth,and power to Mexicans and particularly to Mexicanwomen. This, they argue, is due to the connection ofthe Vi rgin of Guadalupe with motherhood. T h eVirgin of Guadalupe is representative of maternalstrength, the protection of children, and life itself.Magana and Clark suggest that it is this symbol thatcontributes to the positive birth outcomes forMexicans. They argue that because of the maternalassociation with the Virgin of Guadalupe, Mexicanwomen are more likely to engage in health behaviorsthat will result in positive pregnancy outcomes. Theauthors suggest that women who proscribe to thepower of the symbol of the Lady of Guadalupe, in aneffort to emulate her, will avoid smoking and alcohol,be modest in their sexual relationships, and maintaina diet based on traditional foods.

Marin, Gerado and Barbara VanOss Marin1 9 9 1 R e s e a rch with Hispanic Populations.

Newbury Park: Sage.

Marin and Marin recognize that Latinoheterogeneity exists, but argue that common values areshared due to a common language, historical roots ofSpanish colonization,and the shared religion of RomanCatholicism. The authors suggest that issues related toallocentrism, simpatia, familialism, statuses, personalspace, time orientation, and gender roles, reflect valuesthat are common to all Latinos. Allocentrism is a formof collectivism in which the needs of the “in group”of are primary concern. Simpatia is related toallocentrism and promotes behaviors that facilitatecongenial social relationships. Familialism is ap e r s o n ’s strong identification and attachment to theirfamilies. This attachment is characterized by loyalty,r e c i p r o c i t y, and solidarity among family members.Regarding status relationships, the authors suggest thatLatinos subscribe to notions about power distancewhich dictate that there are individuals in society whohave power due to inherited or acquired traits orcharacteristics. Marin and Marin also argue thatLatinos are more comfortable being in close physicalproximity with others than are Non-Latino W h i t e s .The authors further suggest that Latinos are presenttime oriented and flexible in their attitudes towardtime. In discussing gender roles, Marin and Marinsuggest that much has been written about the Latinomale and machismo (i.e., assuming the role of beingstrong, in control, and the family provider).C o n v e r s e l y, Latino women have been characterized as

submissive and having no power or influence.H o w e v e r, the authors note, the issue of gender roles isin flux given the ever changing social and economiccircumstances of Latino families. Although Marin andM a r i n ’s discussion on Latino values appear to overgeneralize, it provides a basis in which to compared i fferences among Latino subgroups.

U.S. Bureau of the Census1 9 9 2 Statistical Abstract of the United States

1 9 9 2 : ( 112th edition). Washington, D.C.:U.S. Government Printing Off i c e .

The majority of the literature regardingacculturation and Latinos addresses MexicanAmericans. This is logical since the majority of Latinosin the U.S. are Mexican. According to the U.S. CensusBureau, 60.1% of the Latino population in the U.S. areMexican, 12.1% Puerto Rican, and 4.7% Cuban.

Differential Socioeconomic ConditionsAmong Latinos

Data on the social and economic characteristicsof the Latino subgroups demonstrate that the groupsare heterogenous in socioeconomic status (SES).Cubans tend to have a higher socioeconomic statusthan Mexicans and Puerto Ricans. The data onMexicans and Puerto Ricans is mixed in terms ofsocioeconomic status. The Oropesa and Landale(1995) study addresses generational effect on SES.SES indicators included income, education,occupation, poverty rate, and use of publicassistance. Immigration and place of birth areimportant factors behind SES conditions.

Oropesa, R. S. and Nancy S. Landale1995 “Immigrant Legacies: The Socioeconomic

Circumstances of Children by Ethnicity andGeneration in the United States (RevisedEdition).” Working Paper 95-01. PopulationResearch Institute. Pennsylvania StateUniversity.

The authors examined socioeconomic indicatorsfor three generations of Mexican, Cuban, and PuertoRican children (17 years of age and younger) using1990 U.S. Census data. Comparisons were made onthe socioeconomic indicators of median householdincome, poverty rate, educational attainment, andoccupational status. It was found that first, second, andthird generation Cubans had higher median incomes

than Mexicans and Puerto Ricans of the samegenerations, and first, second, and third generationMexicans had higher median incomes than PuertoRicans of the same generations. More first, second,and third generation Puerto Ricans were below thepoverty line and on public assistance than Cubans andMexicans of the same generations, and more firstsecond and third generation Mexicans were below thepoverty line and on public assistance than Cubans ofthe same generation.

More first, second, and third generation Cubanheads of households had college degrees than PuertoRicans. More second generation Puerto Ricans hadcollege degrees than Mexicans of the same generation.H o w e v e r, by the third generation, Mexicans andPuerto Ricans were about equal in the percentage ofheads of households with college degrees. T h eincrease in second to third generation heads ofhouseholds with college degrees is greater forMexicans than Puerto Ricans.

More first generation Puerto Ricans were in whitecollar occupations than Cubans and Mexicans of thesame generation and more first generation Cubans thanMexicans were in white collar occupations. However,by the second generation, Cubans overwhelminglyovertake Puerto Ricans in heads of households in whitecollar occupations. Mexicans slightly improve but stillremain behind Cubans and Puerto Ricans. By the thirdgeneration, Cubans minimally improve but were stillahead of Puerto Ricans and Mexicans, Puerto Ricansslightly improve, and Mexicans improve almost twiceas much from the second generation but were muchcloser to Puerto Ricans.

Ortiz, Vilma1994 “Women of Color: A Demographic

Overview.” Pp. 13-40 in Women of Color inU.S. Society edited by Maxine Baca-Zinnand Bonnie Thornton Dill. Philadelphia:Temple University Press.

Pedraza-Bailey, Silvia1985 Political and Economic Migrants in

America: Cubans and Mexicans. Austin:University of Texas Press.

This study found that Cubans were (1) moreeducated, (2) had more workers in skilled labor, (3)had more workers in professional occupations, and(4) had higher annual earnings than Mexicans.

Rumbaut, Ruben G.1995 “Immigrants from Latin America and the

Caribbean: A Socioeconomic Profile.”Statistical Brief No. 6. East Lansing: The Julian Samora Research Institute.

Rumbaut found (1) more Mexicans and PuertoRicans were below the poverty line than Cubans andmore Puerto Ricans were below the poverty line thanMexicans, (2) More Puerto Ricans were on publicassistance than Cubans and Mexicans and moreCubans were on public assistance than Mexicans, (3)the per capita income of Cubans is greater than thatof Puerto Ricans and Mexicans and the per capitaincome of Puerto Ricans is greater than that ofMexicans (4) Cubans were more educated thanMexicans and Puerto Ricans, and Puerto Ricans weremore educated than Mexicans.

U.S. Bureau of the Census1992 Statistical Abstract of the United States:

1992: (112th) edition). Washington, D. C.:U. S. Government Printing Office.

Regarding total family annual income, or mostincome ranges, Cubans were better off than Mexicansand Mexicans were better off than Puerto Ricans. Theonly exception were in the less than $5,000 rangewhere Cubans and Mexicans were even, the $10,000-$14,000 range where there were less Puerto Ricansthan Mexicans, and the $23,000-$49,000 rangewhere there were only slightly more Mexicans thanCubans. “Better off” means that there were a smallerproportion of the group in the lower ranges and ahigher proportion of the group in the higher ranges.

Regarding occupational distribution, Cubans tendto be in the higher status occupations (managerial andprofessional) while Mexicans tend to occupy thelower status occupations (operators, fabricators,laborers, farming, forestry, and fishing). PuertoRicans do better than Mexicans in the higher statusoccupations and had slightly less numbers in thelower status occupations. However, they did not fareas well as Cubans.

Food Habits, Nutrition, and Culture

The literature suggests that the foods people eatvary by culture. In other words, the diets ofMexicans, Cubans, and Puerto Ricans are found to beculture specific. Research also indicates that sincefood habits vary, then so do the types and amounts ofnutrients that are ingested.

Freedman, Robert L. 1977 “Nutritional Anthropology: An Overview.”

Pp. 1-23 in Nutrition and Anthropology inAction edited by Thomas K. Fitzgerald.Assen: van Gorcum.

In this chapter, Freedman presents the basicpremises and tenants of nutritional anthropology. Hedefines nutritional anthropology as the application ofanthropological data and methodology in addressingthe cultural aspects of problems associated withnutrition. The author views nutritional anthropologyas the study of the interdependent nature betweenculture and diet.

Guendelman S. and B. Abrams1994 “Dietary Intake and Patterns Among

Mexican American Women of ReproductiveAge.” Final Report to the California PolicySeminar. Berkeley, California.

Using the Hispanic Health and NutritionExamination Survey, 1982-84, and the NationalHealth and Nutrition Examination Survey, 1976-80,these researchers found that Mexican Americans hadhigher intakes of the nutrients of protein, folic acidand zinc as compared to Non-Latino Whites.

Johnston, Francis E. (editor)1987 Nutritional Anthropology. New York: Liss.

This book is a collection of studies and articles innutritional anthropology. The articles are an eclecticmix of interests. Johnston, in the opening editorialcomments, defines nutritional anthropology as “thatbranch of anthropology which deals with nutrition as aprocess and as a science… and brings anthropologicalconcerns to the study of food, and, since food isdefined culturally (rather than biologically), has apredominant social and cultural focus.” This book isgood for a sampling of the types of interests andresearch conducted by nutritional anthropologists.

1968 Food and Man. New York: John Wiley andSons.

This book offers a general overview of therelationship between food and culture. It looks at therole of food in a historical context. The book alsoanalyzes the importance of food and nutrition asrelated to a society’s quality of life and standing inthe global community.

Marks, Gary, Melinda Garcia, and Julia M. Solis1990 “Health Risk Behaviors of Hispanics in the

United States: Findings from the HHANES,1982-84. American Journal of PublicHealth (Supplement) 80:29-26.

This study found subgroup differences in dietarypractices among Latinos. The authors used theHispanic Health and Nutrition Examination Survey,1982-84, as their data source. The authors created adiet index which measured two components. Onecomponent measured the degree to which one’s dietwas balanced, and one measured “junk food” intake.A balanced diet meant that the person was frequentlyconsuming foods from each food group (meats, dairy,fruits, vegetables, and grains). Candy, sodascontaining sugar, cake, cookies, sugar, etc., wereconsidered junk food. Cuban women had the bestscores on the balanced diet component, followed byMexican American women, with Puerto Ricanwomen having the lowest scores. This suggests thatMexican and Cuban women have much healthierdiets than Puerto Rican women. Regarding junk food,Mexican American women had the best scores (i.e.,they did not eat much junk food) followed byMexican American men. Puerto Rican men had theworse score for junk food intake (i.e., they had a highintake of junk food).

Romero Gwynn, Eunice and Douglas Gwynn1993 “Foods and Dietary Patterns of Latinos of

Mexican Descent: Monograph.” Universityof California Cooperative ExtensionDepartment of Nutrition Davis: Pilot Issue.

___________________.1994 “Foods and Dietary Acculturation Among

Hispanics” (in press) in Hispanic AmericanEncyclopedia. Davis: Arte Publico Press.

Using the Hispanic Health and NutritionExamination Survey, 1982-84, the authors analyzedthe data to determine if differences existed in foodconsumption. They evaluated the nutritional statusand food intake of several traditional and non-traditional foods. The researchers also examined foodpatterns of immigrant families from Mexico andMexicans born in the United States. This studyestablished heterogeneity in food habits amongLatinos. For example, it was found that Mexicans eatmore tortillas than bread and Cubans and PuertoRicans eat more bread than tortillas. Differences werealso found in frequency of consumption. For example,Romero Gywnn and Gwynn found that in the U.S.,87.7% of the Cubans and 86.4% of the Puerto Ricansdo not eat corn tortillas. However, 31.6% of theMexicans (approximately a third) eat corn tortillasdaily and 37.7% eat corn tortillas weekly.

The HHANES as a Research Tool

Hispanic Health and Nutrition ExaminationSurvey, 1982-841987 Public Health Service. Centers for Disease

Control. National Center for HealthStatistics. Hyattsville, Maryland: U.S.Department of Health and Human Services.

The Hispanic Health and Nutrition ExaminationSurvey (HHANES), 1982-84, data was collected bythe National Center for Health Statistics. The datacontains sixteen components with a particular focuson nutritional practices and physical health. Thesample in the HHANES consisted of three subgroupsof Latinos. These groups were Mexicans (fromTexas, Colorado, New Mexico, Arizona, andCalifornia), Cubans (from Dade County Florida), andPuerto Ricans (from the New York City and parts ofNew Jersey and Connecticut). The sample was amultistage, stratified, cluster of the three groups.

Limitations: The HHANES is limited becausethe data was collected 15 years ago. The measure ofacculturation is unsophisticated (based on languageand self identity). Also, acculturation was onlymeasured for Mexicans and not for Cubans andPuerto Ricans.

A precise measure of low birthweight is notoffered. The birthweight data is retrospective and isbased on the recollection of mothers. The HHANESdoes not use medical or birth records in calculatinglow birthweight. Gestation length is also based on therecollection of mothers. It is measured by mothersresponse to a question which read, “was the childborn earlier than expected, when expected, or laterthan expected.”

Data in the HHANES does not measure nutritionbased on Recommended Daily Allowances (RDA).This makes it difficult to compare data on nutritionwith other studies which use RDAs. Additionally,RDA is the most used nutritional measure in studiesrelated to nutrient intake recommendations forpregnant women.

The HHANES did not allow me to answer someof my research questions as well as I would havewanted. The main problem was in combining thecomponents of the HHANES. Data for nutrientintake was drawn from the Dietary Practices, FoodFrequency, and Total Nutrient Intake component ofthe HHANES. Data for low birthweight was drawnfrom the Chid History Questionnaire component ofthe HHANES. The Child History Questionnairecomponent does not identify adults by gender.Therefore, I had no way of directly testing thenutrient intake of Latinas in households with lowbirthweight babies. The Dietary Practices, FoodFrequency, and Total Nutrient Intake component dididentify adults by gender. I had to combine the twosets and match the Latina cases in the DietaryPractices, Food Frequency, and Total Nutrient Intakecomponent with the low birthweight cases. However,there was no way to know for sure if these womenwere the mothers of low birthweight babies. I had torely on proxy and infer that these Latinas were themothers of the low birthweight babies.

In the HHANES, respondents self identify aseither “Other, Mexican/Mexicano, MexicanAmerican, Chicano, Puerto Rican, Bourican, Cuban,Cuban American, Hispano, Latin American/Spanish,Spanish American, or Spanish/Spain.” This posesproblems for coding ethnic groups. For example,someone who is Mexican may self-identify as“Spanish” even though they descend from Mexico.As such, there is no precise method for ensuring thata Mexican is a Mexican, a Cuban a Cuban, etc.

Strengths: The HHANES is a national sample.Since the data is national, it does not limit theresearcher to one region of the country in conductinganalyses. Furthermore, the data includes Mexicans,Cubans, and Puerto Ricans. This allows the researcherto make subgroup comparisons among Latinos.

Conclusion

An interdependent relationship exists betweenvariables that effect low birthweight. However, itseems that the role of culture in effecting lowbirthweight has not been given its full due in thescientific community. I believe that culture is just asimportant as biomedical factors in considering lowbirthweight outcomes. I believe this because of theimportant role that culture has in effecting howpeople interact in their environment. Knowing thebiomedical effects upon low birthweight is only halfthe story. To fully understand the phenomenon of lowbirthweight, culture has to be considered. If only thebiomedical aspects of a group is addressed, thenresearchers are only focusing on the machinery ofbeing human, not what makes humans human.

What this bibliography points out, is that acomplicated issue like low birthweight can not beexamined in isolation. This lends support forinterdisciplinary approaches to research. With somuch information out there in so many differentfields and subfields, it is almost impossible for oneperson to be familiar with all that has been writtenabout a particular topic. Although this bibliography isnot all inclusive, it is my hope that it will make thejob of familiarity a little easier.

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