The Latina paradox is robust, but not uniformly protective against adverse pregnancy outcomes. Latinas are at risk for poor birth outcomes like inappropriate weight gain, pregnancy-induced hypertension / eclampsia, and inappropriate gestational weight gain. Despite work indicating the importance of country of origin (nativity) for Latina health, minimal work has explored the role of nativity. Documentation status- another source of social stress- also differs across subgroups with implications for POs. Further, Latinas, particularly undocumented women, tend to reside in under-resourced neighborhoods, which puts them at risk for higher rates of food insecurity and increased risk of adverse POs. Our long-term goal is to develop successful interventions to promote the reproductive health of Latina women and their children over the life-course. The objective of this study is to identify how nativity and documentation status shape adverse PO (inappropriate maternal weight gain, pregnancy-induced hypertension (PIH)/eclampsia, PTB, term BW, small for gestational age (SGA)) and how the residential context exacerbates risk for adverse health. To accomplish this objective, we are partnering with Multnomah County Health Department (MCHD) to analyze data from the Citizen Alien Waived Emergent Medical (CAWEM) Plus program. It provides prenatal care to Medicaid-ineligible women including undocumented Latinas. Linking CAWEMPlus undocumented status with geocoded MCHD birth records (2009- 2014), we will undertake the following specific aims:
Aim 1 : Identify associations between nativity, documentation status and POs (inappropriate weight gain, PIH/eclampsia, PTB, term BW, SGA) among Latinas. The working hypotheses are that (a) foreign-born Latinas will have better POs than native-born; and (b) among the foreign-born, documented Latinas will have the most positive POs.
Aim 2 : Characterize the residential context (poverty level, food access) of documented versus undocumented Latina women. The working hypothesis is that undocumented Latina women live in higher poverty neighborhoods characterized by an unhealthy food environment (more fast food, fewer grocery stores).
Aim 3 : Identify joint effects of nativity, documentation status and neighborhood context on POs among Latina women. The working hypothesis is that among Latinas, neighborhood context mediates the relationship between nativity and immigration status and MCH outcomes. Summary:
Aim 1 will allow us to disentangle the independent effects of nativity and immigration status on MCH outcomes;
Aim 2 will help clarify the role of neighborhood context in shaping risk for adverse Latina outcomes;
and Aim 3 will specify differential area-induced vulnerabilities by nativity and documentation status. Impact: The results from the completion of this community-based participatory research project will inform program and policy interventions designed to improve Latina health. Further, disentangling the effects of nativity from documentation status can refine our intervention efforts to target the most vulnerable women to reduce maternal and child health disparities.

Public Health Relevance

The Latina paradox is robust, but not uniformly protective against adverse pregnancy outcomes. Specifically, pregnancy outcomes may differ by nativity and exposure to social stressors, including documentation status and unhealthy neighborhood food environments. Using a unique database, the Citizen Alien Waived Emergent Medical Plus program, and geocoded county birth records, this community-based participatory research project identifies how nativity and documentation status shape adverse pregnancy outcomes among Latinas in Multnomah County, Oregon and how neighborhood context exacerbates their risk for adverse health.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Health Disparities and Equity Promotion Study Section (HDEP)
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King, Rosalind B
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Portland State University
Public Health & Prev Medicine
Other Domestic Higher Education
United States
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