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  • 标题:The Effects of Acculturation on Asthma Burden in a Community Sample of Mexican American Schoolchildren
  • 本地全文:下载
  • 作者:Molly A. Martin ; Madeleine U. Shalowitz ; Tod Mijanovich
  • 期刊名称:American journal of public health
  • 印刷版ISSN:0090-0036
  • 出版年度:2007
  • 卷号:97
  • 期号:7
  • 页码:1290-1296
  • DOI:10.2105/AJPH.2006.092239
  • 语种:English
  • 出版社:American Public Health Association
  • 摘要:Objectives. We sought to determine whether low acculturation among Mexican American caregivers protects their children against asthma. Methods. Data were obtained from an observational study of urban pediatric asthma. Dependent variables were children’s diagnosed asthma and total (diagnosed plus possible) asthma. Regression models were controlled for caregivers’ level of acculturation, education, marital status, depression, life stress, and social support and children’s insurance. Results. Caregivers’ level of acculturation was associated with children’s diagnosed asthma ( P = .025) and total asthma ( P = .078) in bivariate analyses. In multivariate models, protective effects of caregivers’ level of acculturation were mediated by the other covariates. Independent predictors of increased diagnosed asthma included caregivers’ life stress (odds ratio [OR] = 1.12, P = .005) and children’s insurance, both public (OR = 4.71, P = .009) and private (OR = 2.87, P = .071). Only caregiver’s life stress predicted increased total asthma (OR = 1.21, P = .001). Conclusions. The protective effect of caregivers’ level of acculturation on diagnosed and total asthma for Mexican American children was mediated by social factors, especially caregivers’ life stress. Among acculturation measures, foreign birth was more predictive of disease status than was language use or years in country. Increased acculturation among immigrant groups does not appear to lead to greater asthma risk. Asthma prevalence and mortality rates are increasing among Mexican American children, making asthma a significant health problem for this population. 1 , 2 Mexican American children have lower asthma prevalence rates than do non-Hispanic Whites and Blacks, 1 , 3 despite disproportionate numbers of Mexican Americans living in poverty, having low education levels, and lacking health insurance. 4 , 5 Many Mexican Americans are immigrants, with 40% reporting they were born in Mexico. 6 The better relative health outcomes of newly immigrated Mexican Americans compared with other ethnic groups at equal social disadvantage is often called the “Hispanic paradox.” 7 This paradox is frequently attributed to the low acculturation of healthy immigrants; that is, people who have not yet adopted the mainstream attitudes and behaviors of US culture appear to have some protection from adverse health outcomes. 7 11 For infant mortality rates and child immunization status, this protection appears to continue across generations, 12 15 and preliminary evidence suggests this may be true for children with asthma as well. 16 Acculturation is defined as a process of culture learning and behavioral adaptation that takes place when individuals are exposed to a new culture. 17 , 18 As part of this process, individuals may undergo changes in language use, cognitive style, personality, identity, attitude, and stress level. 17 In the United States, low acculturation is often represented by the use of a language other than English, having been born outside the United States, or having lived a relatively short time in the United States. Low acculturation levels among US Hispanics with low socioeconomic status have been linked to lower infant mortality rates, better immunization status, higher life expectancy, lower mortality from cardiovascular disease and cancer, and less cigarette smoking and drug use. 7 , 8 , 12 15 Some have challenged these outcomes, suggesting that culture serves mainly as a proxy for access to care 19 and that attributing health outcomes to acculturation risks cultural stereotyping and inaccuracy. 20 Preliminary studies of acculturation and asthma by Eldeiarawi et al. 21 and Holguin et al. 22 showed that Mexican American adults and children born in Mexico had lower diagnosed asthma rates than those born in the United States. Using data from the Mexican American sample of the Social Factors and the Environment in Pediatric Asthma Study, we sought to determine whether low acculturation levels among caregivers protected their children against diagnosed asthma and total (diagnosed plus possible) asthma burden. We operationalized acculturation to include care-givers’ preferred language for the interview, country of origin, and the number of years they had lived in the United States. We also tested whether caregivers’ social support, life stress, and depression (all of which have been shown capable of individually contributing to asthma prevalence in children) 23 31 mediated the relationship between caregivers’ level of acculturation and asthma burden in children.
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