Maternal and Child Health Journal

, Volume 20, Issue 6, pp 1151–1160 | Cite as

Acculturation and Adverse Birth Outcomes in a Predominantly Puerto Rican Population

  • Veronica Barcelona de Mendoza
  • Emily Harville
  • Katherine Theall
  • Pierre Buekens
  • Lisa Chasan-Taber


Introduction Latinas in the United States on average have poorer birth outcomes than Whites, yet considerable heterogeneity exists within Latinas. Puerto Ricans have some of the highest rates of adverse outcomes and are understudied. The goal of this study was to determine if acculturation was associated with adverse birth outcomes in a predominantly Puerto Rican population. Methods We conducted a secondary analysis of Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011. A convenience sample of pregnant Latina women were recruited from a tertiary care hospital in Massachusetts. Acculturation was measured in early pregnancy; directly via the Psychological Acculturation Scale, and via proxies of language preference and generation in the United States. Birth outcomes (gestational age and birthweight) were abstracted from medical records (n = 1362). Results After adjustment, psychological acculturation, language preference, and generation was not associated with odds of preterm birth. However, every unit increase in psychological acculturation score was associated with an increase in gestational age of 0.22 weeks (SE = 0.1, p = 0.04) among all births. Women who preferred to speak Spanish (β = −0.39, SE = 0.2, p = 0.02) and who were first generation in the US (β = −0.33, SE = 0.1, p = 0.02) had significantly lower gestational ages than women who preferred English or who were later generation, respectively. Similarly, women who were first generation had babies who weighed 76.11 g less (SE = 35.2, p = 0.03) than women who were later generation. Discussion We observed a small, but statistically significant adverse impact of low acculturation on gestational age and birthweight in this predominantly Puerto Rican population.


Acculturation Latino Preterm birth Small-for-gestational-age 



This project was supported by the Training Grant in Reproductive Epidemiology from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (T32 HD057780), and the Maternal and Child Health Epidemiology Doctoral Training Program, Human Resources Services Administration/Maternal Child Health Bureau (T03MC07649). Proyecto Buena Salud was supported by a National Institutes of Health grant (NIH R01DK064902).

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflicts of interest.


  1. 1.
    Abraido-Lanza, A., White, K., & Vasques, E. (2004). Immigrant populations and health. In N. Anderson (Ed.), Encyclopedia of health and behavior (pp. 533–537). Newbury Park, CA: Sage.Google Scholar
  2. 2.
    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 and Medicine, 65(12), 2503–2516.CrossRefPubMedGoogle Scholar
  3. 3.
    Alexander, G. R., Kogan, M. D., & Himes, J. H. (1999). 1994–1996 U.S. singleton birth weight percentiles for gestational age by race, Hispanic origin, and gender. Maternal and Child Health Journal, 3(4), 225–231.CrossRefPubMedGoogle Scholar
  4. 4.
    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. doi:10.1007/s10995-013-1238-5.CrossRefPubMedGoogle Scholar
  5. 5.
    Bethel, J. W., Walsh, J., & Schenker, M. B. (2011). Preterm, low-birth-weight deliveries, and farmwork among Latinas in California. Journal of Occupational and Environmental Medicine/American College of Occupational and Environmental Medicine, 53(12), 1466–1471. doi:10.1097/JOM.0b013e3182379fda.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Campos, B., Dunkel Schetter, C., Walsh, J. A., & Schenker, M. (2007). Sharpening the focus on acculturative change: ARSMA-II, stress, pregnancy anxiety and infant birthweight in recently immigrated Latinas. Hispanic Journal of Behavioral Sciences, 29, 209–224.CrossRefGoogle Scholar
  7. 7.
    Cervantes, R. C., Padilla, A. M., Napper, L. E., & Goldbach, J. T. (2013). Acculturation-related stress and mental health outcomes among three generations of Hispanic adolescents. Hispanic Journal of Behavioral Sciences, 35(4), 451–468.CrossRefGoogle Scholar
  8. 8.
    Chasan-Taber, L., Fortner, R. T., Gollenberg, A., Buonnaccorsi, J., Dole, N., & Markenson, G. (2010). A prospective cohort study of modifiable risk factors for gestational diabetes among Hispanic women: Design and baseline characteristics. Journal of Women’s Health, 19(1), 117–124. doi:10.1089/jwh.2009.1416.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Coonrod, D. V., Bay, R. C., & Balcazar, H. (2004). Ethnicity, acculturation and obstetric outcomes. Different risk factor profiles in low- and high-acculturation Hispanics and in white non-Hispanics. The Journal of Reproductive Medicine, 49(1), 17–22.PubMedGoogle Scholar
  10. 10.
    D’Anna-Hernandez, K. L., Hoffman, M. C., Zerbe, G. O., Coussons-Read, M., Ross, R. G., & Laudenslager, M. L. (2012). Acculturation, maternal cortisol, and birth outcomes in women of Mexican descent. Psychosomatic Medicine, 74(3), 296–304. doi:10.1097/PSY.0b013e318244fbde.CrossRefPubMedGoogle Scholar
  11. 11.
    Duany, J. (2002). Mobile livelihoods: The sociocultural practices of circular migrants between Puerto Rico and the United States. International Migration Review, 36(2), 355–388. doi:10.1111/j.1747-7379.2002.tb00085.x.CrossRefGoogle Scholar
  12. 12.
    Eitle, T. M., Wahl, A. M., & Aranda, E. (2009). Immigrant generation, selective acculturation, and alcohol use among Latina/o adolescents. Social Science Research, 38(3), 732–742.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Engel, T., Alexander, G. R., & Leland, N. L. (1995). Pregnancy outcomes of U.S.-born Puerto Ricans: The role of maternal nativity status. American Journal of Preventive Medicine, 11(1), 34–39.PubMedGoogle Scholar
  14. 14.
    Giurgescu, C., McFarlin, B. L., Lomax, J., Craddock, C., & Albrecht, A. (2011). Racial discrimination and the black-white gap in adverse birth outcomes: A review. Journal of Midwifery & Women’s Health, 56(4), 362–370. doi:10.1111/j.1542-2011.2011.00034.x.CrossRefGoogle Scholar
  15. 15.
    Hunt, L. M., Schneider, S., & Comer, B. (2004). Should “acculturation” be a variable in health research? A critical review of research on US Hispanics. Social Science & Medicine, 59(5), 973–986. doi:10.1016/j.socscimed.2003.12.009.CrossRefGoogle Scholar
  16. 16.
    Jones, M. E., Kubelka, S., & Bond, M. L. (2001). Acculturation status, birth outcomes, and family planning compliance among Hispanic teens. The Journal of School Nursing: The Official Publication of the National Association of School Nurses, 17(2), 83–89.CrossRefGoogle Scholar
  17. 17.
    Kaufman, J. S., MacLehose, R. F., Torrone, E. A., & Savitz, D. A. (2011). A flexible Bayesian hierarchical model of preterm birth risk among US Hispanic subgroups in relation to maternal nativity and education. BMC Medical Research Methodology, 11, 51. doi:10.1186/1471-2288-11-51.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Landale, N. S., Oropesa, R. S., Llanes, D., & Gorman, B. K. (1999). Does Americanization have adverse effects on health? Stress, health habits and infant outcomes among Puerto Ricans. Social Forces, 78(2), 613–641.CrossRefGoogle Scholar
  19. 19.
    Lee, P. H. (2014). Is a cutoff of 10% appropriate for the change-in-estimate criterion of confounder identification? Journal of Epidemiology/Japan Epidemiological Association, 24(2), 161–167. doi:10.2188/jea.JE20130062.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Leslie, J. C., Diehl, S. J., & Galvin, S. L. (2006). A comparison of birth outcomes among US-born and non-US-born Hispanic women in North Carolina. Maternal and Child Health Journal, 10(1), 33–38. doi:10.1007/s10995-005-0028-0.CrossRefPubMedGoogle Scholar
  21. 21.
    March of Dimes. (2013). Preterm labor and birth. Retrieved from Accessed 27 August 2015.
  22. 22.
    Marin, G., & Gamba, R. J. (1996). A new measurement of acculturation for Hispanics: The bidimensional acculturation scale for Hispanics (BAS). Hispanic Journal of Behavioral Sciences, 18(3), 297–316.CrossRefGoogle Scholar
  23. 23.
    Marin, G., Sabogal, F., Marin, B. V., Otero-Sabogal, R., & Perez-Stable, E. J. (1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences, 9(2), 183–205.CrossRefGoogle Scholar
  24. 24.
    Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Mathews, T. J., Kirmeyer, S., & Osterman, M. J. (2012). Births: Final data for 2010. National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 61(1), 1–72.Google Scholar
  25. 25.
    McDonald, S. W., Kingston, D., Bayrampour, H., Dolan, S. M., & Tough, S. C. (2014). Cumulative psychosocial stress, coping resources, and preterm birth. Archives of Women’s Mental Health, 17(6), 559–568. doi:10.1007/s00737-014-0436-5.CrossRefPubMedGoogle Scholar
  26. 26.
    Osypuk, T. L., Bates, L. M., & Acevedo-Garcia, D. (2010). Another Mexican birthweight paradox? The role of residential enclaves and neighborhood poverty in the birthweight of Mexican-origin infants. Social Science & Medicine, 70(4), 550–560. doi:10.1016/j.socscimed.2009.10.034.CrossRefGoogle Scholar
  27. 27.
    Rosenberg, T. J., Raggio, T. P., & Chiasson, M. A. (2005). A further examination of the “epidemiologic paradox”: Birth outcomes among Latinas. Journal of the National Medical Association, 97(4), 550–556.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Rosenthal, L., Earnshaw, V. A., Lewis, T. T., Reid, A. E., Lewis, J. B., Stasko, E. C., et al. (2015). Changes in experiences with discrimination across pregnancy and postpartum: Age differences and consequences for mental health. American Journal of Public Health, 105(4), 686–693. doi:10.2105/AJPH.2014.301906.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Rothman, K. J., Greenland, S., & Lash, T. L. (2008). Validity in epidemiologic studies. In Modern epidemiology (3rd ed., pp. 128–147). Philadelphia, PA: Lippincott Williams & Wilkins.Google Scholar
  30. 30.
    Ruiz, R. J., Marti, C. N., Pickler, R., Murphey, C., Wommack, J., & Brown, C. E. (2012). Acculturation, depressive symptoms, estriol, progesterone, and preterm birth in Hispanic women. Archives of Women’s Mental Health, 15(1), 57–67. doi:10.1007/s00737-012-0258-2.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Ruiz, R. J., Stowe, R. P., Brown, A., & Wommack, J. (2012). Acculturation and biobehavioral profiles in pregnant women of Hispanic origin: Generational differences. Advances in Nursing Science (ANS), 35(3), E1–E10. doi:10.1097/ANS.0b013e3182626199.CrossRefGoogle Scholar
  32. 32.
    Ryder, A. G., Alden, L. E., & Paulhus, D. L. (2000). Is acculturation unidimensional or bidimensional? A head-to-head comparison in the prediction of personality, self-identity, and adjustment. Journal of Personality and Social Psychology, 79(1), 49–65.CrossRefPubMedGoogle Scholar
  33. 33.
    Schrier, I., & Platt, R. W. (2008). Reducing bias through directed acyclic graphs. BMC Medical Research Methodology, 8(70).Google Scholar
  34. 34.
    Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2003). Unequal treatment: Confronting racial and ethnic disparities in health care (with CD). In B. D. Smedley, A. Y. Stith, & A. R. Nelson (Eds.), Committee on understanding and eliminating racial and ethnic disparities in health care (1st ed.). Washington, DC: National Academy of Sciences.Google Scholar
  35. 35.
    Textor, J., Hardt, J., & Knuppel, S. (2011). Dagitty: A graphical tool for analyzing causal diagrams. Epidemiology, 22(5), 745.CrossRefPubMedGoogle Scholar
  36. 36.
    Thomson, M. D., & Hoffman-Goetz, L. (2009). Defining and measuring acculturation: A systematic review of public health studies with Hispanic populations in the United States. Social Science & Medicine, 69(7), 983–991. doi:10.1016/j.socscimed.2009.05.011.CrossRefGoogle Scholar
  37. 37.
    Tropp, L. R., Erkut, S., Coll, C. G., Alarcón, O., & Vázquez Garcia, H. A. (1999). Psychological acculturation: Development of a new measure for Puerto Ricans on the U.S. mainland. Educational and Psychological Measurement, 59(2), 351–367. doi:10.1177/00131649921969794.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Unger, J. B., Ritt-Olson, A., Wagner, K., Soto, D., & Baezconde-Garbanati, L. (2007). A comparison of acculturation measures among Hispanic/Latino adolescents. Journal of Youth and Adolescence, 36(4), 555–565.CrossRefGoogle Scholar
  39. 39.
    United States Census Bureau. (2009–2013). American community survey. Accessed 27 August 2015.
  40. 40.
    United States Census Bureau. (2014). U.S. Census Bureau projections show a slower growing, older, more diverse nation a half century from now. Accessed 27 August 2015.
  41. 41.
    Van Rompay, M. I., McKeown, N. M., Castaneda-Sceppa, C., Falcon, L. M., Ordovas, J. M., & Tucker, K. L. (2012). Acculturation and sociocultural influences on dietary intake and health status among Puerto Rican adults in Massachusetts. Journal of the Academy of Nutrition and Dietetics, 112(1), 64–74. doi:10.1016/j.jada.2011.08.049.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Woloshin, S., Schwartz, L. M., Katz, S. J., & Welch, H. G. (1997). Is language a barrier to the use of preventive services? Journal of General Internal Medicine, 12(8), 472–477.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    World Health Organization. (1992). International statistical classification of diseases and related health problems (10th revision ed.). Geneva: World Health Organization.Google Scholar
  44. 44.
    Zsembik, B. A., & Fennell, D. (2005). Ethnic variation in health and the determinants of health among Latinos. Social Science and Medicine, 61(1), 53–63.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansUSA
  2. 2.Department of Global Community Health and Behavioral SciencesTulane University School of Public Health and Tropical MedicineNew OrleansUSA
  3. 3.University of Massachusetts- Amherst, School of Public Health and Health SciencesAmherstUSA
  4. 4.Yale School of NursingOrangeUSA

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