Smoking and Variation in the Hispanic Paradox: A Comparison of Low Birthweight Across 33 US States
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.
KeywordsBirthweight Decomposition Hispanic Paradox Smoking States Vital statistics
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.
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