CHAPTER 5
Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women

Nancy S. Landale, R.S. Oropesa, and Bridget K. Gorman

In recent years a number of studies have documented an epidemiological paradox. As initially framed (Guendelman, 1988; Markides and Coreil, 1986; Williams et al., 1986), the paradox was that rates of low birthweight and infant mortality are comparable for Mexican-origin and white infants, despite the much poorer socioeconomic profile of the former group. Subsequent studies (e.g., Guendelman et al., 1990; Scribner and Dwyer, 1989) have revealed another puzzling pattern within the Mexican-origin population, namely that the health outcomes of infants of foreign-born mothers are superior to those of infants of native-born mothers. Both sets of findings are contrary to expectations based on the risk factors emphasized in traditional biomedical models of public health (Scribner, 1996). They are also inconsistent with the classic assimilation model of immigrant adjustment (Park, 1950), which posits that the outcomes of immigrant groups improve the longer they reside in the United States.

In the current era of high rates of immigration and renewed interest in understanding both the current situations and the long-term trajectories of immigrant groups, this epidemiological paradox has generated widespread attention. Yet despite the diversity of post-1965 immigrants to the United States (Portes and Rumbaut, 1996), studies of immigrants' reproductive outcomes have focused primarily on the Mexican-origin population. Stud-



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Children of Immigrants: Health, Adjustment, and Public Assistance CHAPTER 5 Immigration and Infant Health: Birth Outcomes of Immigrant and Native-Born Women Nancy S. Landale, R.S. Oropesa, and Bridget K. Gorman In recent years a number of studies have documented an epidemiological paradox. As initially framed (Guendelman, 1988; Markides and Coreil, 1986; Williams et al., 1986), the paradox was that rates of low birthweight and infant mortality are comparable for Mexican-origin and white infants, despite the much poorer socioeconomic profile of the former group. Subsequent studies (e.g., Guendelman et al., 1990; Scribner and Dwyer, 1989) have revealed another puzzling pattern within the Mexican-origin population, namely that the health outcomes of infants of foreign-born mothers are superior to those of infants of native-born mothers. Both sets of findings are contrary to expectations based on the risk factors emphasized in traditional biomedical models of public health (Scribner, 1996). They are also inconsistent with the classic assimilation model of immigrant adjustment (Park, 1950), which posits that the outcomes of immigrant groups improve the longer they reside in the United States. In the current era of high rates of immigration and renewed interest in understanding both the current situations and the long-term trajectories of immigrant groups, this epidemiological paradox has generated widespread attention. Yet despite the diversity of post-1965 immigrants to the United States (Portes and Rumbaut, 1996), studies of immigrants' reproductive outcomes have focused primarily on the Mexican-origin population. Stud-

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Children of Immigrants: Health, Adjustment, and Public Assistance ies have not systematically assessed the health outcomes of infants of immigrant women from other national origins (see Cabral et al., 1990; Rumbaut and Weeks, 1989, 1996; and Singh and Yu, 1996, for exceptions). Thus, the extent to which the epidemiological paradox is characteristic of most or only a few immigrant groups has not been established. The present study addresses this issue using data from the 1989, 1990, and 1991 Linked Birth/Infant Death Datasets (U.S. Department of Health and Human Services, 1995). The relationship between maternal nativity (U.S. versus foreign birthplace) and infant health is examined in a number of Latino and Asian groups, including Mexicans, Cubans, Puerto Ricans,1 Central/ South Americans, Chinese, Filipinos, Japanese, and other Asian/ Pacific Islanders. BACKGROUND Over the past several decades, both the number and the diversity of U.S. immigrants have increased sharply (Portes and Rumbaut, 1996). Since the mid-1980s, about 1 million legal immigrants have been admitted to the United States each year (U.S. Immigration and Naturalization Service, 1996). These new immigrants have come primarily from countries in Asia and Latin America. In 1993, for example, about 40 percent were from Asia and 37 percent were from Latin America and the Caribbean. The major Asian source countries are mainland China, the Philippines, Vietnam, India, and Korea. Major origin countries in Latin America and the Caribbean include Mexico, the Dominican Republic, and El Salvador. The recency of immigration from Asia and Latin America is evident in the high proportion of U.S.-born infants who have foreign-born mothers. Although 18 percent of all U.S. births are to foreign-born women, 62 percent of Latino births and 85 per- 1   Puerto Ricans are not an immigrant group per se because of the commonwealth status of the island of Puerto Rico. Nonetheless, because they are one of the largest Hispanic groups in the United States, we include them in the analysis for comparative purposes. For Puerto Ricans the ''foreign born" are those born in Puerto Rico.

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Children of Immigrants: Health, Adjustment, and Public Assistance cent of Asian/Pacific Islander births are to women who were themselves born outside this country (Ventura et al., 1995). These figures attest to the importance of understanding how immigrant status and the assimilation process among immigrants affect the health of infants and children. Immigration, Assimilation, and Infant Health Understanding the health outcomes observed among the offspring of immigrants requires attention to several interrelated aspects of the immigration and settlement process. First, given the well-documented relationship between socioeconomic position and health (Williams and Collins, 1995), the implications of the sources of immigration for the socioeconomic status of the immigrant population must be considered. There are striking differences in the educational attainment and skill levels of immigrants from various origin countries at the time of their arrival in the United States. The upper stratum of foreign-born groups tends to have higher educational and occupational attainment than the average for the native-born U.S. population. This category is comprised of Asian immigrants from India, Taiwan, Iran, Hong Kong, the Philippines, Japan, Korea, and China (Rumbaut, 1994). In the lower stratum are immigrants from Latin American and Caribbean countries, such as Mexico, El Salvador, Guatemala, and the Dominican Republic, who have low levels of educational attainment and tend to work in low-wage unskilled jobs. These divergent profiles stem from differences across origin countries in economic development and population composition. The type of immigrant flow (e.g., unskilled labor migration versus "brain drain" migration) also affects the socioeconomic composition of immigrants from various source countries. In addition to their characteristics at time of arrival in this country, the way in which immigrants adapt to U.S. society affects the health and well-being of their children. The adaptation of immigrants traditionally has been studied within an assimilation framework which posits that immigrants will become increasingly similar to the native population as they spend more time in this country (Park, 1950; Gordon, 1964). Eventually, often after several generations, immigrants lose their socioeconomic

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Children of Immigrants: Health, Adjustment, and Public Assistance and cultural distinctiveness. Because immigrants occupy the lower rungs of the socioeconomic ladder more often than not, the assimilation framework implies that immigrants (and their children) will initially experience a health disadvantage, which will decline with duration of residence (for the foreign born) and generation in the United States. For a number of reasons (see Massey, 1995; Zhou, 1997), the patterns observed among recent immigrants are sometimes inconsistent with expectations based on the assimilation framework. One reason is the socioeconomic diversity of post-1965 immigrants. A significant number of immigrants are highly educated and skilled and thus attain high-status positions and middle-class lifestyles quickly upon arrival in the United States (Zhou, 1997). Although such immigrants experience social and cultural adjustments, the barriers they encounter are very different from those faced by immigrants who arrive with little human or financial capital. Thus, the nature of the assimilation process may differ substantially according to the resources immigrants possess at the time of immigration. A related reason for departures from the classic assimilation pattern is that recent immigrants arrived in this country during a period of restricted economic growth and rising income inequality (Massey, 1995). In particular, opportunities for upward mobility are limited for those with little education and few skills. Thus, immigrants with low skill levels, like U.S.-born minority groups, face structural barriers to achievement. Their assimilation into the middle-class mainstream is also impeded by settlement in impoverished neighborhoods that lack resources and have extensive social problems. The assimilation framework has also been challenged with respect to its assumptions about the role of origin cultures. The traditional theory presumed that forsaking the home culture was a necessary part of the process of Americanization, which ultimately improved the situation of immigrant groups. However, recent research shows that immigrant cultures often have protective features that contribute to the well-being of the foreign born and their offspring (Guendelman, 1988; Guendelman et al., 1990; Guendelman and Abrams, 1995; Rumbaut and Weeks, 1996; Rumbaut 1997; Scribner and Dwyer, 1989; Scribner, 1996). Fur-

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Children of Immigrants: Health, Adjustment, and Public Assistance thermore, opportunities for biculturalism have increased for some immigrant groups (e.g., Mexicans) with the growth of ethnic communities in areas that receive an ongoing stream of new immigrants (Massey, 1995). The epidemiological paradox is part of a growing set of research results that are contrary to the classic assimilation framework. In the following section we discuss possible explanations of the finding that the infants of foreign-born mothers are healthier at birth than the infants of native-born mothers. Explanations of the Epidemiological Paradox A number of factors potentially contribute to variations in infants' health by mothers' nativity status. An obvious first candidate is differences in the socioeconomic status (SES) of native-and foreign-born mothers (Williams and Collins, 1995). Previous studies documented that differences in the birth outcomes of native-and foreign-born Mexican-origin women are contrary to a socioeconomic model—that is, outcomes are better for foreign-born women, who generally have lower education and income than the native born. In addition, the pattern of superior birth outcomes among the foreign born holds in models in which SES is controlled. The other explanatory factor emphasized in studies of racial/ ethnic disparities in health is medical care. However, in studies of Mexicans the findings for prenatal care parallel those for SES: rates of low birthweight and infant mortality are lower for the foreign born, despite the fact that they receive less adequate prenatal care. Thus, research on birth outcomes in the largest immigrant group calls into question the prevailing public health model that focuses on the importance of SES and medical care. Alternative explanations of the health advantage of foreign-born infants include the selective migration of healthier mothers to the United States and the protective influence of origin cultures (Guendelman, 1988). Although the former explanation has received little empirical study because of data limitations, the latter has been the focus of considerable research attention (Cobas et al., 1996; Collins and Shay, 1994; Guendelman, 1988; Guendelman et al., 1990; Guendelman and Abrams, 1995;

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Children of Immigrants: Health, Adjustment, and Public Assistance Rumbaut and Weeks, 1996; Scribner and Dwyer, 1989; Scribner, 1996). In particular, scholars have attempted to identify the behavioral mechanisms through which immigrant cultures (especially the Mexican culture) affect infant health. Included among the explanations offered are better nutrition, less smoking and drinking, and greater social support. As cultural norms erode with time in the United States, the beneficial health practices of immigrants apparently weaken. How these various determinants of infant health operate for immigrant groups other than Mexican Americans is not well known. In the following sections we summarize our analyses of the effect of maternal nativity on low birthweight and infant mortality among non-Latino whites, non-Latino blacks, Mexicans, Cubans, Puerto Ricans, Central/South Americans, Chinese, Filipinos, Japanese, and other Asian/Pacific Islanders. FINDINGS Although the majority of infants born in the United States have non-Latino white or non-Latino black mothers, a growing share of U.S. births are to Latino or Asian women. During the period from 1989 through 1991, 14.2 percent of all U.S. births were to Latino women, with Mexicans constituting 9.1 percent. About 3.5 percent of newborns had Asian mothers. Given the recency of immigration from many Latin American and Asian countries, it is not surprising that a substantial share of the Latino and Asian women giving birth were foreign born. For non-Latino white and non-Latino black infants, the percentages with foreign-born mothers are relatively low—4.0 and 6.4, respectively.2 But with the exception of Puerto Rican and Japanese infants, foreign-born mothers predominate in the Latino and Asian groups considered in our study. Among Latinos the share of births to foreign-born mothers was 62 percent among Mexicans, 79 percent among Cubans, and 96 percent among Central/South Americans. Among 2   These numbers and those presented in all subsequent tables and figures are based on data from the 1989-1991 Linked Birth/Infant Death Datasets. The analysis is restricted to singleton births. See Appendix 5A for a full description of the datasets, sample, and variables.

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Children of Immigrants: Health, Adjustment, and Public Assistance Asian infants, about 86 percent of Filipinos, 89 percent of Chinese, and 94 percent of other Asian/Pacific Islanders had mothers born outside the United States. The high proportion of births to foreign-born women in these groups illustrates the growing importance of understanding the impact of immigration on children born in the United States, who are U.S. citizens at birth regardless of their parents' citizenship status. A critical aspect of children's well-being at birth is their physical health, which is commonly measured for infants by rates of low birthweight and infant mortality.3 In Figure 5-1 the percentage low birthweight is shown for infants of native-born and foreign-born women from each racial/ethnic group. With the exception of Japanese and other Asian/Pacific Islanders, the pattern is consistent with the epidemiological paradox in that the offspring of foreign-born mothers have more favorable birth-weights than the offspring of native-born mothers.4 Although the magnitude of the nativity difference in low birthweight is small for some groups (e.g., Puerto Ricans, Cubans, Central/South Americans), in others it is more substantial. For example, among Mexican-origin infants, the percentage of low-birthweight infants for those with foreign-born mothers is 4.1, compared to 5.4 for infants with native-born mothers. The figures for the offspring of foreign-and native-born Chinese mothers are 3.8 and 4.8, respec- 3   Low birthweight is defined as a weight at birth of less than 2,500 grams. Infant mortality is defined as death during the first year of life. 4    The other Asian/Pacific Islander group is heterogeneous with respect to national origins. It includes such diverse groups as Asian Indians, Koreans, Samoans, Vietnamese, and Guamanians. The 1989-1991 Linked Birth/Infant Death Datasets do not include information with which to distinguish these various national-origin groups, but such information is available for a subset of reporting states in the 1992-1994 National Center for Health Statistics (NCHS) Natality Files. Based on the 1992-1994 data, rates of low birthweight for singleton infants of foreign-born mothers for subgoups within the other Asian/Pacific Islander category are 9.33 for Asian Indians, 3.85 for Koreans, 4.22 for Samoans, 5.23 for Vietnamese, and 6.90 for Guamanians. Rates of low birthweight for infants of native-born mothers could not be calculated for these groups because of an insufficient number of cases. Because the 1992-1994 NCHS Natality Files are restricted to birth certificate data, rates of infant mortality also cannot be calculated for these Asian groups.

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Children of Immigrants: Health, Adjustment, and Public Assistance FIGURE 5-1 Nativity differences in low birthweight by ethnicity.

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Children of Immigrants: Health, Adjustment, and Public Assistance tively. Although data for blacks are presented largely for comparative purposes, the maternal nativity differential in low birthweight for blacks (8.0 versus 11.8) is striking. Also evident in Figure 5-1 are large ethnic differentials in low birthweight. Indeed, the ethnic differentials are of considerably greater magnitude than the differences by maternal nativity. Of the groups considered, non-Latino blacks have a markedly higher percentage of low-weight births than all other groups. Puerto Ricans and Filipinos also stand out for their higher-than-average rates of low birthweight. Additionally, despite the slight health advantage of infants of foreign-born mothers compared to infants of native-born mothers within most ethnic groups, offspring of foreign-born women have higher rates of low birthweight than offspring of native-born non-Latino white women in the majority of ethnic groups (i.e., non-Latino blacks, Puerto Ricans, Central/ South Americans, Filipinos, Japanese, and other Asian/Pacific Islanders). It is only among Mexicans and the Chinese that immigrants' offspring have lower rates of low birthweight than the offspring of native-born non-Latino whites.5 In additional analyses (summarized in Table 5A-2) we decomposed low birthweight into its two component parts: prematurity (< 2,500 grams and less than 37 weeks' gestation) and intrauterine growth retardation (< 2,500 grams and weeks' gestation).6 For prematurity all groups show a pattern consistent with the epidemiological paradox: the rate of prematurity is higher for infants of native-born mothers than for infants of foreign-born mothers. The rate of intrauterine growth retardation is higher for infants of native-born mothers than for non-Latino whites, non-Latino blacks, and all Latino groups. For Asians the role of maternal nativity is more variable. Low birthweight caused by 5   The rate for infants of foreign-born Cuban women is essentially the same as that for native non-Latino women (4.4 versus 4.5). 6   Intrauterine growth retardation has been defined in a number of different ways in the literature. Our purpose here is to distinguish low birthweight due to inadequate gestation from that caused by other causes. However, some definitions of intrauterine growth retardation (e.g., less than the tenth percentile for gestational age) classify a nontrivial share of infants weighing 2,500 grams or more as growth retarded.

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Children of Immigrants: Health, Adjustment, and Public Assistance intrauterine growth retardation is more common among infants of native-born mothers than infants of foreign-born mothers among the Chinese and Filipinos; however, the magnitude of the maternal nativity differential is much smaller than that for pre-maturity for both groups. Among the Japanese and other Asian/ Pacific Islanders, infants of foreign-born mothers have higher rates of intrauterine growth retardation than infants of native-born mothers. Figure 5-2 shows rates of infant mortality (deaths per 1,000 live births) by maternal nativity for each racial/ethnic group. For all groups except the Japanese the infant mortality rate is lower for children of immigrants than for children of the native born, although it is only slightly lower in some ethnic groups (e.g., Central/South Americans, Chinese). Among Latinos and Asians the largest differences are evident for Mexicans (5.3 versus 6.6 per 1,000) and Filipinos (4.8 versus 6.8 per 1,000). The infant mortality rate is also much lower for the offspring of black immigrants than for the offspring of black natives (10.5 versus 12.9 per 1,000). In contrast to the pattern for birthweight, infants of foreign-born mothers in almost all ethnic groups have lower rates of infant mortality than infants of native non-Latino white mothers. Blacks and Puerto Ricans are the only groups for which the infant mortality rate for children of foreign-born mothers is higher than that of children for native non-Latino white mothers. Separate analyses (summarized in Table 5A-2) of neonatal mortality (death under 28 days of age) and postneonatal mortality (death between 28 days and one year of age) revealed a less consistent pattern. While the rate of neonatal mortality is lower for infants of foreign-born mothers than infants of native-born mothers for some groups (non-Latino whites, non-Latino blacks, Mexicans, Cubans, and Filipinos), for others (Central/South Americans, Chinese, Japanese, other Asian/Pacific Islanders) it is higher. In contrast, the postneonatal mortality rate is lower for immigrants' children than for natives' children for all groups except Cubans. Neonatal mortality is affected more by factors outside a mother's control (e.g., preexisting biological conditions of the mother, access to high-quality medical care) than is post-neonatal mortality. Postneonatal death is generally affected more

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Children of Immigrants: Health, Adjustment, and Public Assistance FIGURE 5-2 Nativity differences in infant mortality by ethnicity.

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Children of Immigrants: Health, Adjustment, and Public Assistance Table 5A-2

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Children of Immigrants: Health, Adjustment, and Public Assistance TABLE 5A-2 Maternal and Infant Characteristics by Nativity and Race/Ethnicity: 1989-1991 Linked Birth/Infant Death Datasets   Non-Latino White Non-Latino Black   NB FB NB FB Outcomes         Low birthweight 4.47 3.87 11.85 8.05 Preterm 2.57 2.18 7.41 5.36 Intrauterine growth retarded 1.90 1.70 4.44 2.69 Infant mortality 5.8 4.6 12.9 10.5 Neonatal 3.2 2.5 7.3 6.5 Postneonatal 2.6 2.1 5.6 4.0 Maternal Characteristics         Age (years)         < 20 9.99 4.14 24.74 7.53 20-34 80.68 81.57 69.75 79.03 35+ 9.33 14.29 5.51 13.44 Education         < High school 15.15 12.57 30.50 21.08 High school 39.6 33.63 43.34 38.89 Some college 45.24 53.8 26.16 40.03 Single 16.92 9.89 68.25 42.86 34.55 Infant Characteristics         Birth order         1 42.95 42.91 37.93 40.45 2-4 54.47 53.48 55.71 53.88 5+ 2.58 3.61 6.36 5.68 Male 51.28 51.37 50.80 50.78 Health Behaviors         Smoked 21.31 12.51 16.09 3.98 Drank 3.5 3.28 3.80 1.49 Weight gain <22 1b. 19.59 19.06 32.57 29.04 Prenatal Care         Adequate 77.23 74.71 50.94 53.75 Intermediate 18.22 19.23 32.82 33.51 Inadequate 4.55 6.06 16.23 12.74 No. of cases 654,108 27,187 158,117 10,782

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Children of Immigrants: Health, Adjustment, and Public Assistance   Mexican Puerto Rican Cuban   NB FB NB FB NB FB Outcomes             Low birthweight 5.38 4.14 7.91 7.46 4.71 4.4 Preterm 3.13 2.32 4.6 4.30 2.89 2.74 Intrauterine growth retarded 2.25 1.82 3.31 3.16 1.81 1.66 Infant mortality 6.6 5.3 7.8 7.0 5.3 4.7 Neonatal 3.5 3.1 4.3 4.5 3.8 3.1 Postneonatal 3.1 2.1 3.4 2.5 1.5 1.5 Maternal Characteristics             Age (years)             < 20 24.08 13.74 26.08 16.63 18.14 4.39 20-34 70.43 78.49 70.58 75.11 78.49 83.88 35+ 5.50 7.77 3.34 8.27 3.37 11.73 Education             < High school 41.34 73.59 41.85 42.18 22.18 16.03 High school 39.46 17.94 36.35 33.37 32.69 34.60 Some college 19.20 8.47 21.8 24.45 45.13 49.37 Single 16.92 33.07 56.73 53.4 25.21 16.05   Infant Characteristics             Birth order             1 39.06 35.96 44.45 35.06 54.09 39.81 2-4 55.27 55.39 52.03 57.82 44.45 58.15 5+ 5.67 8.65 3.52 7.11 1.46 2.04 Male 51.11 51.03 50.85 50.89 51.79 51.44 Health Behaviors             Smoked 8.03 2.48 16.09 11.24 9.44 5.57 Drank 2.06 .57 2.99 2.89 1.76 .69 Weight gain < 22 lb. 26.11 32.21 25.52 28.28 16.64 18.67 Prenatal Care             Adequate 55.54 39.76 50.68 53.42 73.15 77.80 Intermediate 31.18 38.38 34.51 33.17 21.39 18.58 Inadequate 13.28 21.86 14.81 13.41 5.47 3.63 No. of cases 381,168 618,290 80,045 57,580 6,565 24,261

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Children of Immigrants: Health, Adjustment, and Public Assistance   Central/S. American Chinese   NB FB NB FB Outcomes         Low birthweight 5.17 4.78 4.81 3.8 Preterm 3.07 2.76 2.82 1.89 Intrauterine growth retarded 2.09 2.02 1.99 1.91 Infant mortality 5.2 5.0 4.6 4.3 Neonatal 2.6 3.0 1.4 2.1 Postneonatal 2.5 2.1 3.2 2.3 Maternal Characteristics         Age (years)         < 20 26.14 8.31 2.69 .67 20-34 70.16 80.8 71.68 80.79 35+ 3.70 10.88 25.63 18.54 Education         < High school 26.72 44.80 3.85 16.04 High school 35.09 33.06 11.67 29.55 Some college 38.19 22.14 84.49 54.41 Single 40.10 41.01 9.54 3.26 Infant Characteristics         Birth order         1 59.07 38.52 49.94 52.61 2-4 39.17 56.60 48.88 46.47 5+ 1.75 4.88 1.19 .91 Male 50.21 51.16 51.12 52.12 Health Behaviors         Smoked 8.79 2.80 6.26 1.60 Drank 2.33 .84 3.06 1.11 Weight gain <22 1b. 21.20 26.17 20.13 22.01 Prenatal Care         Adequate 59.48 48.33 82.92 72.49 Intermediate 29.79 36.07 14.70 22.65 Inadequate 10.73 15.60 2.39 4.86 No. of cases 9,075 200,172 6,240 52,837 NOTE: NB, native born; FB, foreign born.

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Children of Immigrants: Health, Adjustment, and Public Assistance   Filipino Japanese Other Asian/Pacific Islander   NB FB NB FB NB FB Outcomes             Low birthweight 6.89 6.10 5.01 4.96 5.30 5.73 Preterm 3.88 3.24 2.54 2.21 3.09 2.82 Intrauterine growth retarded 3.00 2.86 2.47 2.75 2.21 2.91 Infant mortality 6.8 4.8 3.7 3.7 6.2 5.3 Neonatal 3.2 2.9 1.6 1.8 2.6 2.9 Postneonatal 3.6 2.0 2.1 1.9 3.6 2.5 Maternal Characteristics             Age (years)             < 20 18.39 3.49 3.82 .86 12.33 5.79 20-34 74.84 76.80 74.33 79.11 75.9 81.36 35+ 6.78 19.71 21.85 20.03 11.77 12.85 Education             < High school 15.05 8.94 3.05 2.49 13.01 26.36 High school 42.64 22.15 22.53 25.71 30.96 28.81 Some college 42.31 68.91 74.42 71.80 56.03 44.83 Single 32.04 12.34 12.46 5.09 22.69 11.06 Infant Characteristics             Birth order             1 48.16 43.66 48.76 49.79 50.33 41.71 2-4 49.12 54.19 50.22 49.26 46.92 50.27 5+ 2.72 2.16 1.02 .95 2.75 8.01 Male 50.92 52.02 51.26 51.38 51.44 51.39 Health Behaviors             Smoked 12.40 3.07 9.52 5.79 12.01 3.25 Drank 2.02 .75 1.70 2.92 2.38 .90 Weight gain < 22 lb. 19.49 22.61 24.54 30.46 20.0 27.97 Prenatal Care             Adequate 63.39 67.99 79.77 78.15 68.59 61.93 Intermediate 28.34 25.31 16.83 17.57 22.39 28.07 Inadequate 8.27 6.70 3.39 4.29 9.02 10.00 No. of cases 9,426 59,079 12,029 10,941 10,748 177,374

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Children of Immigrants: Health, Adjustment, and Public Assistance TABLE 5A-3 Odds Ratios from Logistic Regression Models of Low Birthweight, by Race/Ethnicity: 1989-1991 Linked Birth/Infant Death Datasets   Non-Latino White Non-Latino Black Mexican Puerto Rican Maternal Characteristics         Foreign born .929 .743 .733 .950 Age (years)         < 20 .907 .890 1.049 .975 20-34 — — — — 5+ 1.456 1.273 1.518 1.411 Education         < High school 1.209 1.094 1.025 1.096 High school — — — — Some college .834 .952 .942 .952 Single 1.193 1.203 1.206 1.289 Infant Characteristics         Birth order         1 1.729 1.300 1.538 1.344 2-4 — — — — 5+ .896 1.072 .973 1.278 Male .850 .802 .932 .885 Health Behaviors         Smoked 1.986 1.758 1.773 1.623 Drank 1.123 1.496 1.112 1.328 Weight gain < 22 lb. 2.985 2.606 2.423 2.592 Prenatal care         Adequate — — — — Intermediate 1.330 1.151 1.137 1.044 Inadequate 1.830 1.690 1.530 1.617 No. of cases 681,295 168,899 999,458 137,625 NOTE: NB, native born; FB, foreign born.

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Children of Immigrants: Health, Adjustment, and Public Assistance   Cuban Central/ South American Chinese Filipino Japanese Other Asian/ Pacific Islander Maternal Characteristics             Foreign born 1.011 .946 .778 .927 1.009 1.157 Age (years)             <20 .874 1.127 1.130 1.189 .871 1.249 20-34 — — — — — — 5+ 1.376 1.539 1.363 1.529 1.124 1.375 Education             < High school 1.160 1.003 1.072 .976 .801 1.029 High school — — — — — — Some college .901 .993 .868 1.028 1.010 .956 Single 1.376 1.230 1.332 1.195 1.208 1.196 Infant Characteristics             Birth order             1 1.487 1.498 1.446 1.579 1.553 1.596 2-4 — — — — — — 5+ 1.121 .917 .843 .928 .770 .716 Male .896 .891 .878 .899 .838 .857 Health Behaviors             Smoked 1.987 1.537 2.120 1.498 2.608 1.459 Drank .946 1.015 .754 1.001 .923 1.309 Weight gain < 22 lb. 2.995 2.498 2.351 2.567 2.641 2.351 Prenatal care             Adequate — — — — — — Intermediate 1.089 1.031 1.143 1.297 1.215 1.131 Inadequate 1.914 1.378 1.573 1.648 1.442 1.335 No. of cases 30,826 209,247 59,077 68,505 22,970 188,122

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Children of Immigrants: Health, Adjustment, and Public Assistance TABLE 5A-4 Odds Ratios from Logistic Regression Models of Infant Mortality by Race/Ethnicity, 1989-1991 Linked Birth/Infant Death Datasets   Non-Latino White Non-Latino Black Mexican Puerto Rican Maternal Characteristics         Foreign born .841 .924 .976 .871 Age (years)         < 20 1.103 .920 1.160 1.292 20-34 — — — — 35+ .998 .998 1.257 1.437 Education         < High school 1.265 1.108 1.068 1.132 High school — — — — Some college .880 .997 .933 1.077 Single 1.411 1.185 1.585 1.108 Infant Characteristics         Birth order         1 .975 1.197 .899 1.001 2-4 — — — — 5+ 1.052 1.145 1.145 1.427 Male 1.305 1.132 1.283 1.183 Health Behaviors         Smoked 1.308 1.299 1.575 1.227 Drank .868 1.166 .940 1.366 Weight gain < 22 1b. 2.813 2.699 2.086 2.690 Prenatal Care         Adequate — — — — Intermediate 1.345 1.073 0.967 0.980 Inadequate 1.859 1.574 1.192 1.608 No. of cases 681,295 168,899 999,458 137,625

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Children of Immigrants: Health, Adjustment, and Public Assistance   Cuban Central/ South American Chinese Filipino Japanese Other Asian/ Pacific Islander Maternal Characteristics             Foreign born .929 .890 1.106 .939 1.205 .909 Age (years)             < 20 .897 1.104 1.226 1.602 .993 1.100 20-34 — — — — — — 35+ 1.150 1.515 1.138 1.203 1.368 1.386 Education             < High school .795 1.087 1.040 .988 1.897 .785 High school — — — — — — Some college .671 .955 .913 .895 1.241 .766 Single 1.942 1.388 4.361 1.935 2.863 1.730 Infant Characteristics             Birth order             1 1.239 1.069 .795 .861 .698 .930 2-4 — — — — — — 5+ 1.863 1.045 1.881 1.429 .827 1.085 Male 1.202 1.246 1.247 1.154 1.066 1.150 Health Behaviors             Smoked 1.130 .595 .402 1.443 1.315 1.418 Drank 1.316 2.547 — 1.790 — .963 Weight gain < 22 lb. 4.607 2.119 1.978 2.551 1.013 1.966 Prenatal Care             Adequate — — — — — — Intermediate 0.965 0.858 1.101 1.360 1.216 1.093 Inadequate 1.240 1.258 1.100 1.766 .690 1.215 No. of cases 30,826 209,247 59,077 68,505 22,970 188,122

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Children of Immigrants: Health, Adjustment, and Public Assistance TABLE 5A-5 Odds Ratios from Logistic Regression Models of Infant Mortality by Race/Ethnicity, 1989-1991 Linked Birth/Infant Death Datasets   Non-Latino White Non-Latino Black Mexican Puerto Rican Maternal Characteristics         Foreign born .877 1.042 .907 .908 Age (years)         < 20 1.101 .935 1.110 1.295 20-34 — — — — 35+ .861 .876 1.026 1.205 Education         < High school 1.195 1.076 1.061 1.077 High school — — — — Some college .916 .994 .942 1.083 Single 1.292 1.094 1.459 .949 Infant Characteristics         Birth order         1 .789 1.086 .760 .878 2-4 — — — — 5+ 1.123 1.083 1.159 1.258 Male 1.331 1.209 1.277 1.218 Low birthweight         Preterm 25.446 18.157 29.937 24.257 Intrauterine growth retarded 6.205 3.423 8.118 5.579 Health Behaviors         Smoked 1.049 1.027 1.251 1.009 Drank .780 .931 .870 1.112 Weight gain < 22 1b. 1.691 1.607 1.335 1.624 Prenatal Care         Adequate — — — — Intermediate 1.209 1.019 .928 1.011 Inadequate 1.403 1.190 .990 1.298 No. of cases 681,295 168,899 999,458 137,625

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Children of Immigrants: Health, Adjustment, and Public Assistance   Cuban Central/ South American Chinese Filipino Japanese Other Asian/ Pacific Islander Maternal Characteristics             Foreign born .941 .949 1.193 .984 1.197 .884 Age (years)             < 20 .928 1.042 1.092 1.427 .788 .978 20-34 — — — — — — 35+ .917 1.202 1.019 .978 1.301 1.195 Education             < High school .738 1.092 1.018 .982 2.046 .790 High school — — — — — — Some college .715 .956 .941 .882 1.255 .767 Single 1.674 1.255 3.730 1.756 2.656 1.586 Infant Characteristics             Birth order             1 1.093 .897 .726 .733 .636 .781 2-4 — — — — — — 5+ 1.771 1.073 1.785 1.469 .881 1.213 Male 1.229 1.263 1.237 1.178 1.072 1.186 Low birthweight             Preterm 43.143 33.312 24.281 22.416 20.668 22.246 Intrauterine growth retarded 5.005 6.563 7.397 6.935 3.643 7.708 Health Behaviors             Smoked .855 .492 .295 1.214 .910 1.133 Drank 1.40 2.474 — 1.483 — .866 Weight gain < 22 lb. 2.359 1.274 1.301 1.570 .713 1.320 Prenatal Care             Adequate — — — — — — Intermediate .979 .866 1.059 1.255 1.160 1.044 Inadequate .733 1.10 .868 1.371 .518 1.075 No. of cases 30,826 209,247 59,077 68,505 22,970 188,122