Correlates of Acculturation Among Hispanic Women

1. Correlates of Acculturation Among Hispanic Women Carrie J. Wales, Oregon Health & Sciences University Kenneth D. Rosenberg, MD, MPH, Oregon Department of Human Services, Office of Family Health Alfredo P. Sandoval, MS, MBA, Oregon Department of Human Services, Office of Family Health

2. Background • Health status may change as immigrants acculturate • Oregon PRAMS data was used to explore perinatal health outcomes among Hispanic women in Oregon by acculturation status

3. Oregon PRAMS • PRAMS (Pregnancy Risk Assessment Monitoring System) • A postpartum population-based survey asking Oregon women about attitudes and behaviors before, during and after pregnancy • Administered by the Office of Family Health, Oregon Department of Human Services • Over-samples racial and ethnic minorities

4. Goals • To identify domains in which perinatal outcomes vary according to acculturation status • To find significant differences between women with higher levels of acculturation and lower levels of acculturation

5. Methods • Combined Oregon PRAMS data from 2000-2001 • Included only Hispanic women (n=1120) • 62 women did not have information on language in which survey was completed and were excluded from analysis

6. Methods • Divided women into three categories of acculturation status: • Low acculturation: foreign-born and completed survey in Spanish (n=716, 64%) • Intermediate: foreign-born and completed survey in Spanish or native-born and completed survey in English (n=111, 9.9%) • High acculturation: native-born and completed survey in English (n=231, 20.6%)

7. Methods • Used SPSS to tabulate unweighted counts and weighted percentages of women’s responses to 138 questions or birth certificate variables • Used SUDAAN to perform chi-square tests for trend • A p-value of less than 0.05 was used to determine significance

8. having firearms, stored loaded and unlocked, in the home feeling as though they were discriminated against by health care workers experiencing stressful life events not receiving important prenatal care advice not breastfeeding their babies alcohol and tobacco consumption having an unintended pregnancy etc. Results Higher levels of acculturation were associated with adverse outcomes and risk factors including:

9. putting their baby to sleep on its side or stomach receiving inadequate dental care having less health insurance receiving late prenatal care not using birth control before pregnancy having lower income levels (< $20,000/yr) having lower education levels (< 12 years) etc. Results Lower levels of acculturation were associated with adverse outcomes and risk factors such as:

10. Results - Examples Question 6: Just before you got pregnant, did you have health insurance that covered prenatal care? Chi-Square = 139.32, p < 0.001 Question 70: Are any firearms now kept in or around your home? Include those kept in your home, in a garage, outdoor storage area, car, truck or other motor vehicle. Chi-Square = 28.58, p , 0.001

11. Discussion & Conclusions • Although Hispanic women with the highest level of acculturation have positive demographic characteristics such as more education, higher levels of income, smaller family sizes, and better health insurance coverage, they tend to experience a wider variety of risk factors and adverse health outcomes than do Hispanic women in the lower levels of acculturation.

12. Discussion & Conclusions • It has been hypothesized that as immigrants acculturate, their health status declines possibly due to exposure to US mainstream culture and to the decline in protective native cultural behaviors. • We need to know more about the health disparities related to acculturation among Hispanic women in order to improve public health practice in Oregon.

13. Acknowledgments • Tina Kent • Centers for Disease Control and Prevention (CDC) • Maternal and Child Health Bureau, DHHS • For more information, please contact: • Carrie Wales Kenneth Rosenberg, MD, MPH Graduate Student Intern Maternal & Child Health Epidemiologist Oregon Health & Science University Oregon Department of Human Services walesca@ohsu.eduken.d.rosenberg@state.or.us 971-673-0237