Skip to main content
SpringerLink
Log in

Smoking and Variation in the Hispanic Paradox: A Comparison of Low Birthweight Across 33 US States

  • Published:
Population Research and Policy Review Aims and scope Submit manuscript

Abstract

The Hispanic Paradox in birth outcomes is well documented for the US as a whole, but little work has considered geographic variation underlying the national pattern. This inquiry is important given the rapid growth of the Hispanic population and its geographic dispersion. Using birth records data from 2014 through 2016, we document state variation in birthweight differentials between US-born white women and the three Hispanic populations with the largest numbers of births: US-born Mexican women, foreign-born Mexican women, and foreign-born Central and South American women. Our analyses reveal substantial geographic variation in Hispanic immigrant–white low-birthweight disparities. For example, Hispanic immigrants in Southeastern states and in some states from other regions have reduced risk of low birthweight relative to whites, consistent with a “Hispanic Paradox.” A significant portion of Hispanic immigrants’ birthweight advantage in these states is explained by lower rates of smoking relative to whites. However, Hispanic immigrants have higher rates of low birthweight in California and several other Western states. The different state patterns are largely driven by geographic variation in smoking among whites, rather than geographic differences in Hispanic immigrants’ birthweights. In contrast, US-born Mexicans generally have similar or slightly higher odds of low birthweight than whites across the US. Overall, we show that the Hispanic Paradox in birthweight varies quite dramatically by state, driven by geographic variation in low birthweight among whites associated with white smoking disparities across states.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Source US Natality File 2014–2016, N = 6,823,979

Fig. 2

Source US Natality File 2014–2016

Fig. 3

Source US Natality File 2014–2016

Similar content being viewed by others

Notes

  1. Past research also finds evidence that the negative health effects of low educational attainment may be less pronounced for Hispanics, specifically Mexicans and Central and South Americans, than for whites (Acevedo-Garcia et al. 2007; Goldman et al. 2006; Turra and Goldman 2007).

  2. California and Arizona enacted rigorous policies against smoking in the 1990s (Siegel 2002). For example, smoke free workplaces in California have been shown to reduce smoking rates and the effects of secondhand smoke (Fichtenberg and Glantz 2002; Moskowitz et al. 2000). Media campaigns against smoking in both states have also had considerable success (Levy et al. 2004).

  3. We use the concept of “adequacy” of prenatal care based on Kotelchuck’s work (1994).

  4. Most states excluded have structurally missing data, such as Georgia and New Jersey, were missing data on smoking.

  5. We observed minor variation in missingness by state. Missingness is most common in California (3.6%) and Massachusetts (3.0%), and least common in Nebraska (0.1%) and Iowa (0.1%). We found no clear ethnic pattern of missingness in California. US-born whites are most commonly missing information (5.5%); US-born Mexicans (1.6%), foreign-born Mexicans (2.8%), and Central and South Americans (4.5%) have lower rates of missingness.

  6. We include missing information as inadequate to account for missing cases in accordance with Kotelchuck’s original index (1994). We found that classifying missing in this manner did not substantially change the results from using listwise deletion or multiple imputation. Percentage of missing cases does not substantively vary by ethnicity. Cases missing information have similar risk of low birthweight to cases in the inadequate care category with complete information in prenatal care.

  7. We observed a divergent pattern in California, in which controlling for sociodemographic differences leads to increased odds of low birthweight for Hispanic groups relative to whites. We found that this pattern is robust to different methods and years of data.

  8. We also ran bivariate logit models, stratified by ethnicity–nativity. These models observed similar patterns. In many instances, relationships observed were stronger in the adjusted models. This supplemental analysis demonstrates that geographic variation in the observed sociodemographic characteristics does not drive the patterns observed in this paper.

References

  • Acevedo-Garcia, D., Soobader, M.-J., & Berkman, L. F. (2007). Low birthweight among US Hispanic/Latino subgroups: The effect of maternal foreign-born status and education. Social Science & Medicine, 65(12), 2503–2516.

    Article  Google Scholar 

  • Almeida, J., Mulready-Ward, C., Bettegowda, V. R., & Ahluwalia, I. B. (2014). Racial/ethnic and nativity differences in birth outcomes among mothers in New York City: The role of social ties and social support. Maternal and Child Health Journal, 18(1), 90–100.

    Article  Google Scholar 

  • Araújo, B. Y., & Borrell, L. N. (2006). Understanding the link between discrimination, mental health outcomes, and life chances among Latinos. Hispanic Journal of Behavioral Sciences, 28(2), 245–266.

    Article  Google Scholar 

  • Behrman, J. R., & Rosenzweig, M. R. (2004). Returns to birthweight. Review of Economics and Statistics, 86(2), 586–601.

    Article  Google Scholar 

  • Brazil, N. (2015). Spatial variation in the Hispanic Paradox: Mortality rates in new and established Hispanic US destinations. Population, Space and Place, 23(1), 1–17.

    Google Scholar 

  • Breen, R., Karlson, K. B., & Holm, A. (2013). Total, direct, and indirect effects in logit and probit models. Sociological Methods & Research, 42(2), 164–191.

    Article  Google Scholar 

  • Brunello, G., Fort, M., Schneeweis, N., & Winter-Ebmer, R. (2016). The causal effect of education on health: What is the role of health behaviors? Health Economics, 25(3), 314–336.

    Article  Google Scholar 

  • Buekens, P., Notzon, F., Kotelchuck, M., & Wilcox, A. (2000). Why do Mexican Americans give birth to few low-birth-weight infants? American Journal of Epidemiology, 152(4), 347–351.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2016). User Guide to the 2014 Natality File. Department of Health and Human Services.  

  • Centers for Disease Control and Prevention. (2017a). User guide to the 2015 natality file. Department of Health and Human Services.

  • Centers for Disease Control and Prevention. (2017b). State Tobacco Activities Tracking and Evaluation (STATE) System. Atlanta: Centers for Disease Control and Prevention. Retrieved from https://nccd.cdc.gov/STATESystem/rdPage.aspx?rdReport=OSH_State.CustomReports.

  • Centers for Disease Control and Prevention. (2018). User guide to the 2016 natality file. Department of Health and Human Services.

  • Conley, D., & Bennett, N. G. (2001). Birth weight and income: Interactions across generations. Journal of Health and Social Behavior, 42(4), 450–465.

    Article  Google Scholar 

  • Donahue, S. M., Kleinman, K. P., Gillman, M. W., & Oken, E. (2010). Trends in birth weight and gestational length among singleton term births in the United States: 1990–2005. Obstetrics and Gynecology, 115(2 Pt 1), 357–364.

    Article  Google Scholar 

  • Fenelon, A. (2013a). Geographic divergence in mortality in the United States. Population and Development Review, 39(4), 611–634.

    Article  Google Scholar 

  • Fenelon, A. (2013b). Revisiting the Hispanic mortality advantage in the United States: The role of smoking. Social Science & Medicine, 82, 1–9.

    Article  Google Scholar 

  • Fenelon, A. (2017). Rethinking the Hispanic Paradox: The mortality experience of Mexican immigrants in traditional gateways and new destinations. International Migration Review, 51(3), 567–599.

    Article  Google Scholar 

  • Fenelon, A., & Preston, S. H. (2012). Estimating smoking-attributable mortality in the United States. Demography, 49(3), 797–818.

    Article  Google Scholar 

  • Fichtenberg, C. M., & Glantz, S. A. (2002). Effect of smoke-free workplaces on smoking behaviour: Systematic review. BMJ, 325(7357), 188.

    Article  Google Scholar 

  • Frank, R., Akresh, I. R., & Lu, B. (2010). Latino immigrants and the US racial order how and where do they fit in? American Sociological Review, 75(3), 378–401.

    Article  Google Scholar 

  • Frisbie, W. P. (2005). Infant mortality. In D.L. Poston, M. Micklin (eds.), Handbook of Population (pp. 251–282). Springer, New York.

    Chapter  Google Scholar 

  • Fuentes-Afflick, E., Hessol, N. A., & Pérez-Stable, E. J. (1999). Testing the epidemiologic paradox of low birth weight in Latinos. Archives of Pediatrics & Adolescent Medicine, 153(2), 147–153.

    Article  Google Scholar 

  • Goldman, N., Kimbro, R. T., Turra, C. M., & Pebley, A. R. (2006). Socioeconomic gradients in health for white and Mexican-origin populations. American Journal of Public Health, 96(12), 2186–2193.

    Article  Google Scholar 

  • Haas, S. A. (2006). Health selection and the process of social stratification: The effect of childhood health on socioeconomic attainment. Journal of Health and Social Behavior, 47(4), 339–354.

    Article  Google Scholar 

  • Heaman, M., Bayrampour, H., Kingston, D., Blondel, B., Gissler, M., Roth, C., Alexander, S., Gagnon, A. (2013). Migrant women's utilization of prenatal care: a systematic review. Maternal and Child Health Journal, 17(5), 816–836

    Article  Google Scholar 

  • Hummer, R. A., Biegler, M., De Turk, P. B., Forbes, D., Frisbie, W. P., Hong, Y., et al. (1999). Race/ethnicity, nativity, and infant mortality in the United States. Social Forces, 77(3), 1083–1117.

    Article  Google Scholar 

  • Hummer, R. A., & Hernandez, E. M. (2013). The effect of educational attainment on adult mortality in the United States. Population Bulletin, 68(1), 1–16.

    Google Scholar 

  • Hummer, R. A., Powers, D. A., Pullum, S. G., Gossman, G. L., & Frisbie, W. P. (2007). Paradox found (again): Infant mortality among the Mexican-origin population in the United States. Demography, 44(3), 441–457.

    Article  Google Scholar 

  • Karlson, K. B., & Holm, A. (2011). Decomposing primary and secondary effects: A new decomposition method. Research in Social Stratification and Mobility, 29(2), 221–237.

    Article  Google Scholar 

  • Karlson, K. B., Holm, A., & Breen, R. (2012). Comparing regression coefficients between same-sample nested models using logit and probit a new method. Sociological Methodology, 42(1), 286–313.

    Article  Google Scholar 

  • Kenny, L. C., Lavender, T., McNamee, R., O’Neill, S. M., Mills, T., & Khashan, A. S. (2013). Advanced maternal age and adverse pregnancy outcome: Evidence from a large contemporary cohort. PLoS ONE, 8(2), e56583.

    Article  Google Scholar 

  • Kohler, U., Karlson, K. B., & Holm, A. (2011). Comparing coefficients of nested nonlinear probability models. Stata Journal, 11(3), 420–438.

    Article  Google Scholar 

  • Kotelchuck, M. (1994). An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. American Journal of Public Health, 84(9), 1414–1420.

    Article  Google Scholar 

  • Kozuki, N., Lee, A. C., Silveira, M. F., Sania, A., Vogel, J. P., Adair, L., et al. (2013). The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: A meta-analysis. BMC Public Health, 13(3), 1.

    Google Scholar 

  • Krans, E. E., & Davis, M. M. (2012). Preventing low birthweight: 25 years, prenatal risk, and the failure to reinvent prenatal care. American Journal of Obstetrics and Gynecology, 206(5), 398–403.

    Article  Google Scholar 

  • Lariscy, J. T., Hummer, R. A., & Hayward, M. D. (2015). Hispanic older adult mortality in the United States: New estimates and an assessment of factors shaping the Hispanic paradox. Demography, 52(1), 1–14.

    Article  Google Scholar 

  • Leslie, J. C., Galvin, S. L., Diehl, S. J., Bennett, T. A., & Buescher, P. A. (2003). Infant mortality, low birth weight, and prematurity among Hispanic, white, and African American women in North Carolina. American Journal of Obstetrics and Gynecology, 188(5), 1238–1240.

    Article  Google Scholar 

  • Levy, D. T., Chaloupka, F., & Gitchell, J. (2004). The effects of tobacco control policies on smoking rates: A tobacco control scorecard. Journal of Public Health Management and Practice, 10(4), 338–353.

    Article  Google Scholar 

  • Lhila, A., & Long, S. (2012). What is driving the black–white difference in low birthweight in the US? Health Economics, 21(3), 301–315.

    Article  Google Scholar 

  • Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior. https://doi.org/10.2307/2626958.

    Article  Google Scholar 

  • Markides, K. S., & Coreil, J. (1986). The health of Hispanics in the southwestern United States: An epidemiologic paradox. Public Health Reports, 101(3), 253.

    Google Scholar 

  • Markides, K. S., & Eschbach, K. (2011). Hispanic paradox in adult mortality in the United States. In R. G. Rogers, E. M. Crimmins (Eds.), International Handbook of Adult Mortality (pp. 227–240). Springer, New York.

    Chapter  Google Scholar 

  • Martin, J. A., Hamilton, B. E., Osterman, M., Driscoll, A. K., & Mathews, T. (2017). Births: Final data for 2015. National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 66(1), 1.

    Google Scholar 

  • Moskowitz, J. M., Lin, Z., & Hudes, E. S. (2000). The impact of workplace smoking ordinances in California on smoking cessation. American Journal of Public Health, 90(5), 757.

    Article  Google Scholar 

  • Landale, N. S., Oropesa, R. S., & Gorman, B. K. (1999). Immigration and infant health: Birth outcomes of immigrant and native-born women. In D. Hernandez (Ed.), Children of immigrants: Health, adjustment and public assistance (pp. 244–285). Washington, DC: National Academies Press.  

  • Nielsen, S. S., Dills, R. L., Glass, M., & Mueller, B. A. (2014). Accuracy of prenatal smoking data from Washington State birth certificates in a population-based sample with cotinine measurements. Annals of Epidemiology, 24(3), 236–239.

    Article  Google Scholar 

  • Northam, S., & Knapp, T. R. (2006). The reliability and validity of birth certificates. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35(1), 3–12.

    Article  Google Scholar 

  • Palloni, A. (2006). Reproducing inequalities: Luck, wallets, and the enduring effects of childhood health. Demography, 43(4), 587–615.

    Article  Google Scholar 

  • Parrado, E. A. (2011). How high is Hispanic/Mexican fertility in the United States? Immigration and tempo considerations. Demography, 48(3), 1059–1080.

    Google Scholar 

  • Petrou, S., Sach, T., & Davidson, L. (2001). The long-term costs of preterm birth and low birth weight: Results of a systematic review. Child: Care, Health and Development, 27(2), 97–115.

    Google Scholar 

  • Pinto-Martin, J., Whitaker, A., Feldman, J., Cnaan, A., Zhao, H., Rosen-Bloch, J., et al. (2004). Special education services and school performance in a regional cohort of low-birthweight infants at age nine. Paediatric and Perinatal Epidemiology, 18(2), 120–129.

    Article  Google Scholar 

  • Powers, D. A. (2016). Erosion of Advantage: Decomposing Differences in Infant Mortality Rates Among Older Non-Hispanic White and Mexican-Origin Mothers. Population Research and Policy Review, 35(1), 23–48

    Article  Google Scholar 

  • Reeves, S., & Bernstein, I. (2014). Effects of maternal tobacco-smoke exposure on fetal growth and neonatal size. Expert Review of Obstetrics & Gynecology, 3(6), 719–730.

    Article  Google Scholar 

  • Reichman, N. E. (2005). Low birth weight and school readiness. The Future of Children, 15(1), 91–116

    Article  Google Scholar 

  • Reichman, N. E., Hamilton, E. R., Hummer, R. A., & Padilla, Y. C. (2008). Racial and ethnic disparities in low birthweight among urban unmarried mothers. Maternal and Child Health Journal, 12(2), 204–215.

    Article  Google Scholar 

  • Reichman, N. E., & Kenney, G. M. (1998). Prenatal care, birth outcomes and newborn hospitalization costs: Patterns among Hispanics in New Jersey. Family Planning Perspectives, 30(3), 182–200.

    Article  Google Scholar 

  • Riosmena, F., & Massey, D. S. (2012). Pathways to El Norte: Origins, destinations, and characteristics of Mexican migrants to the United States. International Migration Review, 46(1), 3–36.

    Article  Google Scholar 

  • Sanchez-Vaznaugh, E. V., Braveman, P. A., Egerter, S., Marchi, K. S., Heck, K., & Curtis, M. (2016). Latina Birth Outcomes in California: Not so Paradoxical. Maternal and Child Health Journal, 20(9), 1–12.

    Article  Google Scholar 

  • Shah, P. S., & Knowledge Synthesis Group on determinants of preterm/low birthweight births. (2010). Paternal factors and low birthweight, preterm, and small for gestational age births: A systematic review. American Journal of Obstetrics and Gynecology, 202(2), 103–123.

    Article  Google Scholar 

  • Shaw, R. J., & Pickett, K. E. (2013). The health benefits of Hispanic communities for non-Hispanic mothers and infants: Another Hispanic paradox. American Journal of Public Health, 103(6), 1052–1057.

    Article  Google Scholar 

  • Shaw, R. J., Pickett, K. E., & Wilkinson, R. G. (2010). Ethnic density effects on birth outcomes and maternal smoking during pregnancy in the US linked birth and infant death data set. American Journal of Public Health, 100(4), 707–713.

    Article  Google Scholar 

  • Siegel, M. (2002). The effectiveness of state-level tobacco control interventions: A review of program implementation and behavioral outcomes. Annual Review of Public Health, 23(1), 45–71.

    Article  Google Scholar 

  • Silles, M. A. (2009). The causal effect of education on health: Evidence from the United Kingdom. Economics of Education Review, 28(1), 122–128.

    Article  Google Scholar 

  • Singh, G. K., & Yu, S. M. (1996). Adverse pregnancy outcomes: Differences between US-and foreign-born women in major US racial and ethnic groups. American Journal of Public Health, 86(6), 837–843.

    Article  Google Scholar 

  • Sobel, M. E. (1987). Direct and indirect effects in linear structural equation models. Sociological Methods & Research, 16(1), 155–176.

    Article  Google Scholar 

  • Turra, C. M., & Goldman, N. (2007). Socioeconomic differences in mortality among US adults: Insights into the Hispanic paradox. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 62(3), S184–S192.

    Article  Google Scholar 

  • Ventura, S. J. (1999). Using the birth certificate to monitor smoking during pregnancy. Public Health Reports, 114(1), 71.

    Article  Google Scholar 

  • Ventura, S. J., Hamilton, B. E., Mathews, T., & Chandra, A. (2003). Trends and variations in smoking during pregnancy and low birth weight: Evidence from the birth certificate, 1990–2000. Pediatrics, 111(Supplement 1), 1176–1180.

    Google Scholar 

  • Vinikoor, L. C., Messer, L. C., Laraia, B. A., & Kaufman, J. S. (2010). Reliability of variables on the North Carolina birth certificate: A comparison with directly queried values from a cohort study. Paediatric and Perinatal Epidemiology, 24(1), 102–112.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the Eunice Kennedy Shriver National Institute of Child Health and Human Development NICHD-funded P2C (HD050924) for general support; the NICHD-funded [T32] (HD007168) for training support; and the National Center for Health Statistics (NCHS) for making the birth cohort files available. The content of this manuscript is the sole responsibility of the authors and does not necessarily represent the official views of NICHD or NCHS.

Author information

Authors and Affiliations

  1. Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, Chapel Hill, NC, 27599, USA

    Samuel H. Fishman, S. Philip Morgan & Robert A. Hummer

  2. Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC, 27516, USA

    Samuel H. Fishman, S. Philip Morgan & Robert A. Hummer

Authors
  1. Samuel H. Fishman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Philip Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert A. Hummer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel H. Fishman.

Appendix

Appendix

See Tables 3, 4, 5, 6, 7, and 8.

Table 3 Descriptive statistics
Full size table
Table 4 Bivariate logit regressions of low birthweight on ethnicity–nativity, stratified by state (log odds/logits)
Full size table
Table 5 Adjusted logit regressions of low birthweight on ethnicity–nativity, stratified by state (log odds/logits)
Full size table
Table 6 Results from decomposition of residual and smoking-mediated (indirect) effects of ethnicity on low birthweight, stratified by state (log odds/logits)
Full size table
Table 7 Logit regression of low birthweight on states and select covariates, stratified by ethnicity–nativity (log odds/logits)
Full size table
Table 8 Frequency of births by ethnicity and state
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fishman, S.H., Morgan, S.P. & Hummer, R.A. Smoking and Variation in the Hispanic Paradox: A Comparison of Low Birthweight Across 33 US States. Popul Res Policy Rev 37, 795–824 (2018). https://doi.org/10.1007/s11113-018-9487-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11113-018-9487-z

Keywords

Search

Navigation