摘要：We propose a transdisciplinary, life span framework for examining the underlying cause of the observed intergenerational decline in health among Hispanic Americans. We focus on acculturation, and we posit that acculturation-related processes in first-generation Hispanic immigrant mothers may affect the intrauterine development of an unborn child, via the process of fetal programming, to produce phenotypic effects that may alter the susceptibility for noncommunicable chronic diseases. In this manner, an intergenerational cascade of perpetuation may become established. Our framework may shed light on the biological, behavioral, and social causes of intergenerational cycles of vulnerability among immigrant minority groups, with public health and policy implications for primary prevention and intervention. The public health significance of addressing the issue of health and health disparities in Hispanics, the largest ethnic minority in the United States 1 and an especially disenfranchised segment of American society, 2 is well established. The fact that the majority of Hispanic Americans are immigrants or the children of immigrants, 3 coupled with the robust epidemiologic observation that Hispanic immigrants in the United States exhibit a progressive decline in health over time 4–11 and across generations, 5,12–20 has justified a particular focus on how postimmigration conditions affect health in this population. The negative consequences of acculturation have commonly been invoked to explain this phenomenon, and several studies in Hispanic Americans have established associations between measures of acculturation and adverse health outcomes. 21–24 The prevailing paradigm posits the deleterious effect of acculturation on health is a consequence of the biological embedding of its psychological and behavioral sequelae, such as excess psychological stress, 25–27 declining social ties, 28,29 and adoption of unhealthy diets and other behaviors. 30–36 This paradigm, as currently formulated, may account for the observed decline in first-generation immigrant health associated with length of residence in the United States. However, a major shortcoming is that it does not adequately explain the intergenerational aspect of the observed health decline. We sought to address this important limitation. In this article, we articulate a novel framework that is grounded in principles from evolutionary and developmental biology, and we integrate the concepts of biological embedding of life experiences and fetal origins of health and disease risk. We propose that the origins of the observed intergenerational health decline among Hispanic Americans might be traced back to as early as the intrauterine period of life, at which time the effects of acculturation could be transmitted from a mother to her as-yet-unborn child via the process of fetal programming. This process might produce phenotypic alterations in the structure and function of cells, tissues, and organ systems that increase the offspring’s susceptibility for developing many of the health disorders that are disproportionately prevalent among Hispanic Americans. In this manner, an intergenerational cascade of perpetuation of the deleterious consequences of acculturation on health might become established. Our framework also addresses the proximate causal pathway by highlighting the tripartite role of maternal–placental–fetal endocrine, immune, and oxidative-state–related biological processes, such as sensors, transducers, and effectors of acculturation-related states and conditions on the developing fetus. The plausibility of our formulation was supported by empirical evidence in the general population that the same psychological and behavioral processes associated with acculturation (e.g., stress, diet) are also known to affect biological processes implicated in fetal programming. 37 Moreover, studies in pregnant Hispanic women demonstrate that maternal acculturation is associated with the same psychological, behavioral, and biological processes during gestation that are implicated in the process of fetal programming. 30,33,38–41 In this way, we suggest that the fetal programming perspective potentially offers a parsimonious explanation for the observed intergenerational decline in Hispanic American health, and also reconciles the apparent contradiction between the observations in this population that disease risk increases across generations despite improvements in life conditions.
