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MICASA: Region of Birth and Reproductive Health

MICASA: Region of Birth and Reproductive Health. Stephen A. McCurdy, MD MPH Professor and Director UCD Master of Public Health (MPH) Program Department of Public Health Sciences University of California, Davis School of Medicine. MICASA: Reproductive Health.

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MICASA: Region of Birth and Reproductive Health

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  1. MICASA: Region of Birth and Reproductive Health Stephen A. McCurdy, MD MPH Professor and Director UCD Master of Public Health (MPH) Program Department of Public Health Sciences University of California, Davis School of Medicine

  2. MICASA: Reproductive Health MICASA: Mexican Immigration to California: Agricultural Safety and Acculturation Aim: Characterize occupational and general health in immigrant Hispanic population Mendota

  3. MICASA: Reproductive Health MICASA Study Site Mendota: Central Valley agricultural community Population 9,791 in 2005; 97% Hispanic One-third below federal poverty level Mendota

  4. MICASA: Reproductive Health Immigration 12.9% of US population are foreign-born 1,062,040 legal permanent residencies (LPRs) (2011) Greatest source (13.4%) is Mexico 11.5 million undocumented immigrants 59% born in Mexico

  5. MICASA: Reproductive Health Where do immigrants go? Employment: Agriculture Low entrance barriers Location: Rural California is destination for ~20% of LPRs Employment, social networks Resource-poor

  6. MICASA: Reproductive Health Agricultural Environment Highly productive and diverse California produces over 350 crops with a market value of $26.6 billion in cash receipts in 2011 (Iowa is in second place, with $21 billion in 2011) California leads the nation in major production categories: field crops, vegetables and melons, livestock and dairy, nursery products. [USDA, NASS 2011]

  7. MICASA: Reproductive Health Hispanic Paradox Hispanics have better health outcomes (for some conditions) than do Non-Hispanic Whites, despite SES disadvantage Coronary heart disease mortality Reproductive health outcomes Not seen for diabetes, obesity

  8. MICASA: Reproductive Health Hispanic Paradox AKA “Latina epidemiologic paradox” when applied to reproductive health outcomes Low birth weight Small for gestational age (SGA) Pre-term birth

  9. MICASA: Reproductive Health Latina Epidemiologic Paradox Not seen in all Hispanic groups Protective effect is strongest in Mexico-born with low educational attainment.

  10. MICASA: Reproductive Health Lifestyle factors affecting reproductive health: Age of sexual debut Lifetime number of sexual partners Use of protective measures Acculturation affects these factors

  11. MICASA: Reproductive Health Acculturation affects lifestyle Increased acculturation associated with . . . Earlier sexual debut (mean 19.0 vs. 15.9 y) in pregnant women at SJ County health clinic Increased likelihood of multiple lifetime sexual partners [Kasirye, et al. . Ethn Dis. 2005;15(4):733-739]

  12. MICASA: Reproductive Health Aim: Descriptive: Examine selected reproductive health outcomes in relation to area of birth and other demographic characteristics. Analytic: Test hypotheses that acculturation, depression, perceived stress, and family support affect reproductive outcomes.

  13. MICASA: Reproductive Health Methods: Multistage sampling of FW households (> 1 adult working > 45 days in agriculture in prior year 467 (65%) of eligible households Baseline interview 1/2006 – 4/2007 Follow-up interview (74%) 11/2008 – 2/2010 (Limit to persons born in Mexico or Cent. Am)

  14. MICASA: Reproductive Health Results (Demographics): 399 women 407 men Total: 806 556 born in Mexico 250 born in CA (90% from El Salvador)

  15. MICASA: Reproductive Health Results (Demographics): Median ages ranged from 39 y (Mexican men) to 34 y (CA men and women) Median ages at immigration ranged from 20 y (Mexican men) to 24 y (CA women) > 90% low acculturation Median time in current domicile 3 y

  16. MICASA: Reproductive Health Results (Demographics): 95% married or cohabiting Marriage prevalence ranged from 47% (CA women) to 76% (Mexican men)

  17. MICASA: Reproductive Health Results (Sexual debut and partners): Median age at sexual debut ranged from 16 y (CA men) to 18 y (women) Median number of lifetime sexual partners was 1 for women, 2 (for Mexican men) and 3 (for CA men) Sexually transmitted diseases rare (<3.7%) > 75% of women had Pap within 1 year

  18. MICASA: Reproductive Health Results (Contraception): Men: 45.2% (Mexican); 46.7% (CA) Women: 68.7% (Mexican); 53.9% (CA) Men less likely to use contraception; more likely to use poorly effective methods (condom)

  19. MICASA: Reproductive Health Results (Contraception): 75% of women “mostly” or “very” confident about ability to use contraception in next 6 mo. Major reason for non-use “don’t want to” or current or desired pregnancy 1 woman and 13 men cited partner’s wish as reason for non-use

  20. MICASA: Reproductive Health Results (Contraception): Among persons at risk for unintended pregnancy at study entrance . . . Men had 2x (CA) to 4x (Mex) increased odds for non-use of contraception compared towomen CA women had 2x increased odds for non-use of contraception compared to Mexican women.

  21. MICASA: Reproductive Health Results (Pregnancy): Median 3 pregnancies reported on baseline survey—no relation with region of birth 84 interim pregnancies (i.e., following baseline and reported on follow-up survey) Desire for interim pregnancy modestly higher among CA women (NS)

  22. MICASA: Reproductive Health Summary and conclusions: MICASA population (vs. US) . . . Later sexual debut than US-born Contraception use comparable to US Greater total fertility (3 for CA, 4 for Mexico) 1.9 for US women, 2.2 for US Hisp

  23. MICASA: Reproductive Health Summary and conclusions: Men (vs women) . . . Moderately older and more years in US Earlier sexual debut; more partners Lower use of contraception; less effective methods More likely married

  24. MICASA: Reproductive Health Summary and conclusions: Central America (vs Mexico) . . . Fewer years in US Earlier sexual debut (esp. among men) Lower use of contraception amongwomen Lower odds of being married

  25. MICASA: Reproductive Health Summary and conclusions: Strengths: Community-based study of important population Few data Strong community engagement

  26. MICASA: Reproductive Health Summary and conclusions: Limitations: Single California community—may not apply to dissimilar groups and locations Limited depth of inquiry (space limits) Questionnaire responses—no validation

  27. MICASA: Reproductive Health Public health implications: Lifestyle factors brought from sending country may persist, especially in cultural enclaves Homogeneity of groups may facilitate development of effective interventions Attention to men, who have higher-risk profile than women

  28. Thanks and Acknowledgments City of Mendota, CA and MICASA participants Marc B. Schenker, MD MPH (MICASA PI) Teresa Barcellos, MD, PhD cand. Maria Stoecklin-Marois, PhD Daniel J. Tancredi, PhD Tamara Hennessy-Burt, MS National Institute for Occupational Safety and Health The California Endowment

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