Contraceptive practices and fertility among Southeast Asian,black, and white mothers attending a maternal infant care program

Abstract

The purpose of this analysis was to determine if there were differences in selected fertility characteristics including parity, pregnancy spacing, age at first pregnancy, age of menarche, breastfeeding postpartum, and contraceptive practices among white, black, Hmong, and other Southeast Asian mothers attending a maternal infant care program in Minneapolis, Minnesota, during 1980–82.

White and black mothers were younger than the Hmong and other Asian mothers. The lowest mean age of first pregnancy was among blacks. Ages of first pregnancy were similar for whites, Hmong, and other Asians, although the mean age of menarche was approximately two years later for Hmong and other Southeast Asian mothers compared to the white and black mothers.

Based on self reports at the first postpartum visit one month after delivery, 39 per cent of the whites and 25 per cent of the blacks were breastfeeding. In comparison 8.7 per cent of the Hmong and 17 per cent of the other southeast Asian mothers were breastfeeding.

Maternal age and age at first pregnancy were significant predictors of parity for whites, blacks, Hmong, and the other Southeast Asians. Ever‐use of contraception was a significant predictor of parity only for Hmong.

The highest proportion of ever‐users of contraception was among the white mothers (80 per cent) followed by the blacks (69.3 per cent) and other Asian mothers (34.8 per cent). Hmong mothers had the lowest proportion having used contraception (17.1 per cent).     

Maternal cigarette smoking, Down syndrome in live births, and infant race.

Previous studies have suggested that maternal smoking is negatively associated with a Down syndrome live birth. We analyzed the data of the U.S. Perinatal Collaborative Study in a search for racial variation in Down syndrome risk factors. There were 22 cases in 25,346 live births to smoking mothers (4/10,780 blacks, 18/13,320 whites, and 0/1,246 other races) and 42/29,130 live births to nonsmoking mothers (24/14,665 blacks, 14/11,694 whites, and 4/2,771 others). The crude overall rates per 1,000 live births were 0.4 in black smokers and 1.6 in black nonsmokers but 1.4 in white smokers and 1.2 in white non-smokers. Adjusted for maternal age, the summary relative risk for a Down syndrome live birth to a smoking mother was 0.2 in blacks (95% interval 0.1-0.7) but 1.2 in whites (95% interval 0.6-2.5). Stratification on variables associated with socioeconomic status or gestational age at time of entry into the study did not alter the racial difference. A comparison of smokers with those who never smoked revealed essentially the same trends. Among all nonsmokers the ratio of the maternal age-adjusted risks for a Down syndrome live birth in whites compared with blacks was 0.7 (95% interval 0.3-1.3), and among all smokers this ratio was 3.6 (95% interval 1.3-9.9). If the results are not attributable to statistical fluctuation or undetected confounding, then differences in the probability of intrauterine survival of the Down syndrome fetus would appear to be one plausible explanation for the difference.     

Age at menarche, at first intercourse, and at first pregnancy

Data from an urban sample of American women of reproductive ages demonstrate that age at menarche is correlated with age at first intercourse, that age at first intercourse is correlated with age at first pregnancy, and that menarche is therefore correlated with age at first pregnancy. This applied to both blacks and whites when examined for the early years of the reproductive cycle. Girls with early menarche, compared to those with late menarche, are more than twice as likely to have had intercourse by age 16, and almost twice as likely to have given birth or had a pregnancy terminated by age 18. It is therefore useful to think of the timing of menarche as an indicator of the probability of early intercourse and early childbearing.     

Cross-country variation in interracial marriage: a USA–Canada comparison of metropolitan areas

While black–white intermarriage is uncommon in the USA, blacks in Canada are just as likely to marry whites as to marry blacks. Asians, in contrast, are more likely to marry whites in the USA than in Canada. We test the claim that high rates of interracial marriage are indicative of high levels of social integration against Peter Blau's ‘macrostructural’ thesis that relative group size is the key to explaining differences in intermarriage rates across marriage markets. Using micro-data drawn from the American Community Survey and the Canadian census, we demonstrate that the relative size of racial groups accounts for over two-thirds of the USA–Canada difference in black–white unions and largely explains the cross-country difference in Asian–white unions. Under broadly similar social and economic conditions, a large enough difference in relative group size can become the predominant determinant of group differences in the prevalence of interracial unions.     

Health of Hmong in Thailand: Risk factors,morbidity and mortality in comparison with other ethnic groups

Demographic and health conditions among Hmong in Thailand were examined in comparison with other ethnic groups which closely resemble the ethnic origins of Southeast Asian refugees in the U.S. Thailand Hmong have very large extended family households, very high birth rates, low use of contraception, very young age at first marriage, and, compared with other highland minorities, relatively low infant and crude mortality rates. Hmong use of tobacco and alcohol and other stimulants is lower than other ethnic groups, and is much more frequent among men than among women. Opium was used by 15% of the men in the surveyed village, lower than among another highland group, but higher than in surveyed lowland villages. Fewer illnesses were reported by Hmong in the 7 days prior to survey than in other rural groups. Relatively low Hmong morbidity and mortality as compared with other highland ethnic groups may be associated with low use of tobacco and alcohol, and with the sharing of child care responsibilities within the large Hmong extended family households]This is the revised version of a paper presented at the Psychosocial Workshop of the Population Association of America Annual Meeting, Boston, 27 March 1985. Research was supported by National Science Foundation grant BNS 7914093, and by the East-West Center. Opinions expressed are those of the author.     

Comparisons for Body Mass Index and Body Fat Percent Among Puerto Ricans,Blacks, Whites and Asians Living in the New York City Area

The latest data (NHANES III) from the National Center for Health Statistics (NCHS) show that the black population has the highest proportion of overweight among all adult populations in the United States. The present study compared the body mass index (BMI) and body fat percent from dual-photon absorptiometry in 1,324 healthy adults aged 18 to 107 years recruited from four ethnic groups in the New York City area; 523 whites, 280 blacks, 267 Asians and 254 Puerto Ricans. Puerto Ricans had the largest BMI and the largest percent of subjects with body weight more than 120% of their ideal weight, and the largest fat percent of the four ethnic groups: 76% of Puerto Rican males had fat percent above the median value for white males (fat percent = 19.6%) and 95% of Puerto Rican females had fat percent above the median for white females (fat percent = 30.8%). Asians had the smallest BMI, but 63% of them had fat percent above the median values for whites in each gender. Puerto Ricans also had the largest waist-to-hip ratios among the four ethnic groups. In blacks, the percent of subjects with fat percent larger than the median for whites was slightly smaller than that for Puerto Ricans, 64% and 82% of males and females respectively. These results differ from the latest NCHS data and show that Puerto Ricans in this sample are heavier and fatter than blacks.     

Initial screening transferrin saturation values, serum ferritin concentrations, and HFE genotypes in whites and blacks in the Hemochromatosis and Iron Overload Screening Study

We compared initial screening data of 44,082 white and 27,124 black Hemochromatosis and Iron Overload Screening (HEIRS) Study participants. Each underwent serum transferrin saturation (TfSat) and ferritin (SF) measurements without regard to fasting, and HFE C282Y and H63D genotyping. Elevated measurements were defined as: TfSat more than 50% (men), more than 45% (women); and SF more than 300 ng/ml (men), more than 200 ng/ml (women). Mean TfSat and percentages of participants with elevated TfSat were significantly greater in whites than in blacks. Mean SF and percentages of participants with elevated SF were significantly greater in blacks than in whites. TfSat and SF varied by gender and age in whites and blacks. Prevalences of genotypes that included either C282Y or H63D were significantly greater in whites than in blacks. The prevalence of elevated TfSat and SF plus genotypes C282Y/C282Y, C282Y/H63D, or H63D/H63D was 0.006 in whites and 0.0003 in blacks. Among whites with HFE C282Y homozygosity, 76.8% of men and 46.9% of women had elevated TfSat and SF values. Three black participants had HFE C282Y homozygosity; one had elevated TfSat and SF values. Possible explanations for differences in TfSat and SF in whites and blacks and pertinence to the detection of hemochromatosis, iron overload, and other disorders with similar phenotypes are discussed.     

Comparison of Cardiovascular Risk Factors in Obese Blacks and Whites

Blacks are known to have higher blood pressure levels, a higher prevalence of hypertension, and higher body weights than whites. However, the interrelationships of these and other cardiac risk factors have not been analyzed in an obese population. We compared blood pressure (BP) and lipid levels in 174 obese blacks and 939 obese white patients who were entering a weight loss program; we also assessed the effects of weight loss on these factors. Prevalence of treated hypertension was similar in blacks and whites (28% vs. 25%, respectively). In patients not taking BP medication, black women weighed more (108 kg) than white women (102 kg) and black and white males' weights were similar (135 kg vs. 131 kg). Systolic and diastolic BP were similar in black and white women; black males had similar SBP but a significantly lower DBP than white males (83 mmHg vs. 89 mmHg, respectively). Lipid levels were similar in black and white women except black women had lower triglycerides (1.30 mmol/L) than white women (1.58 mmol/L, p<0.05); and black males compared to white males had significantly lower total cholesterol (4.76 mmol/L vs. 5.56 mmol/L), LDL-cholesterol (3.15 mmol/L vs. 3.52 mmol/L) and triglycerides (1.31 mmol/L vs. 2.17 mmol/L, p<0.05). Adult-onset obesity adversely affected a number of cardiovascular risk factors in whites, but not in blacks. Blacks lost significantly less weight (?13 kg) than whites (?19 kg). However, controlling for the difference in weight loss, blacks sustained comparable improvement in lipids and blood pressure, except for TC/HDL-C (whites improved significantly more, ?0.36 kg/m2, than blacks, 0.03 kg/m2). Thus, the impact of obesity on cardiovascular risk factors seems ameliorated in blacks com-pared to whites.     

Duration between marriage and first birth and marital instability

This paper considers whether marital instability varies by the duration between marriage and 1st birth among ever-married white and black American women. Analysis of data from the June 1985 Current Population Survey suggests that the duration between marriage and 1st birth has a generally monotonic relationship with the probability of white women separating or divorcing from their 1st marriage; the relationship has remained relatively constant over time. For blacks, no consistent association is found between marital dissolution and the duration between marriage and 1st birth. Black women having a premarital conception and postmarital birth and those having their 1st birth during their 2nd year of marriage have a similarly high risk of dissolution. Conversely, blacks having their 1st birth 8-12 or 25-42 months after marrying have a low probability of dissolution. Childless women and those with premarital births generally has the greatest probability of marital disruption for whites. Racial differences may occur because blacks view the 1st birth and marriage differently than whites. That is, because blacks are much more likely to have premarital births and to have a shorter duration between marriage and 1st birth, blacks and whites in the same 1st birth interval category may be dissimilar and have different values resulting in a differential effect of the timing of the 1st birth on marital instability by race. Caution is needed when interpreting the pattern of association between delayed childbearing (and to a lesser extent, births occuring a few years after marriage) and marital instability. Results for whites were similar at each marriage duration and it is assumed delayed childbearing was not a result of marital instability. Marital instability was expected to have its strongest effect on the timing of the 1st birth during the 1st years of marriage. Marital instability may be partially responsible for the delaying of childbearing among blacks. However, blacks who delay but are married at 1st birth have a relatively low risk of separating or divorcing.     

Explaining racial disparities in access to employment benefits

This research examines disparities in access to pension and health insurance plans between white, blacks, Latino and Asian workers in the American labour force. Using data from the 2006 March Supplement of the Current Population Survey, the analysis reveals that Latino workers are the most disadvantaged and white workers are the most advantaged. The entire gap in likelihood of receiving benefits between whites and Asians, and a substantial portion of the gap between whites and blacks, can be accounted for by socio-demographic and employment-related variables, but only a small portion of the gap between whites and Latinos can be attributed to such variables. The findings suggest that reliance on earnings for estimation of inequality underestimates the economic gap between racial groups. Explanations for disparities in access to employment benefits are offered and the relevance of the findings to other societies is discussed.     

Regression analysis of "current status" life tables on duration of breastfeeding in Sri Lanka

Provided that women report the dates of their children's births with reasonable accuracy, it is possible to derive good estimates of the duration of breastfeeding from women's breastfeeding status at the time of the interview. This paper illustrates the application of conventional regression techniques to the analysis of breastfeeding rates derived in this manner. Construction of current status rates is explained and a comparison between open interval, closed interval, and current status breastfeeding life tables is presented, indicating the extent of bias to which tables of the former types are open. Birth-weighted rates are used for WFS data from Sri Lanka; the variables entered into the regression equation include parity, educational level, residence, work experience since marriage and use of contraception since the birth. Contraception is not found to influence net breastfeeding rates in the 1st interval (1-16 months), although it is about as prevalent as in later intervals. The positive coefficients at intervals beyond the 1st also imply that contraceptive use is not a substitute for lactation in Sri Lanka or not a predominant one. Lifetime urban residence is associated with short durations of breastfeeding, and being an urban migrant is associated with intermediate durations relative to those of rural women. The effects of residence on breastfeeding are especially pronounced in the 1st interval. By parity as by contraception, differences in breastfeeding rates are not significant at short durations but become so with time as lower parity women reach pregnancy. Patterns by age are similar, but less sharp. Middle school attendance and work at home are both strongly associated with with lactation behavior, the former negatively and the latter to about an equal degree positively. Working outside the home seems not to influence breastfeeding to any great extent. In the multiple attribute regressions, middle schooling depresses breastfeeding durations about as strongly as lifetime urban residence relative to women who are rural and uneducated. Being at parity 5 or above or working at home almost as sharply increases durations. The use of contraception has slightly smaller positive effects. The patterns suggest that as Sri Lankan women become increasingly well educated and urban, and as family sizes decline, durations of breastfeeding will decline. Equally important however, even among better educated urban wives, breastfeeding continues longer than is typical of western countries.     

Sunshine,fertility and racial disparities

This research investigates the effect of sun exposure on fertility, with a special focus on how its effects and consequences for birth outcomes may differ by race. Sun exposure is a key mechanism for obtaining Vitamin D, but this process is inhibited by skin pigmentation. Vitamin D has been linked to male and female fertility and risk of miscarriage, and Vitamin D deficiency is more prevalent among blacks than whites. Using 1989–2004 individual live births data from the Natality Detail Files, county-level, monthly conceptions are estimated as a function of monthly solar insolation, temperature and humidity, as well as month, time and location fixed effects and controls. Insolation has positive, statistically significant effects on fertility for both non-Hispanic blacks and whites, but the effects are stronger and the pattern of effect different for black mothers than white mothers. Poisson estimates from the main model suggest that a 1 kWh increase in average daily insolation in the conception month – approximately the difference in sunshine experienced in the typical September vs. October – increases non-Hispanic black conceptions by 1% and non-Hispanic white conceptions by 0.6%. Allowing insolation's effect to differ by maternal characteristic suggests that the racial differences are not being driven by differences in socioeconomic status (SES). Models that allow for more complicated timing of insolation's effect further suggest that insolation pushes black (white) conceptions into the unfavorable (favorable) season of birth. These estimated effects and our decomposition analyses suggest that insolation – and the implied Vitamin D deficiency underlying its effect–helps explain why black conceptions are more likely to display a seasonal pattern that is disadvantageous to birth outcomes.     

The Effect of Breast‐Feeding with and without Formula Use on the Risk of Obesity at 4 Years of Age

Objective: To determine the minimal duration of breast‐feeding required to protect against later obesity, whether the concurrent use of formula lessened any protective effect of breast‐feeding, and what maternal or child characteristics might modify the association between breast‐feeding and child obesity. Research Methods and Procedures: This was a retrospective cohort study. Participants were 73, 458 white and black low‐income children followed from birth through 4 years of age. Obesity at age 4 years was defined as measured BMI ≥ 95th percentile. Feeding exposure was based on breast‐feeding duration and the age of formula initiation. Covariates were obtained from the children's birth certificates. Results: At age 4 years, the prevalence of obesity was 11.5%. Only 16% of children were breast‐fed 8 weeks or longer. Breast‐feeding was associated with a reduced risk of obesity only in white children whose mothers had not smoked in pregnancy. In this subgroup, the reduction in obesity risk (adjusted odds ratio, 95% confidence interval), compared with those never breast‐fed, occurred only for children who were breast‐fed at least 16 weeks without formula (0.71, 0.56 to 0.92) or at least 26 weeks with concurrent formula (0.70, 0.61 to 0.81). Among whites whose mothers smoked in pregnancy and among blacks, breast‐feeding was not associated with a reduced risk of obesity at age 4 years. Discussion: In a population of low‐income children, breast‐feeding was associated with a reduced risk of obesity at age 4 years only among whites whose mothers did not smoke in pregnancy and only when breast‐feeding continued for at least 16 weeks without formula or at least 26 weeks with formula.     

Those ubiquitous fertility trends: United States, 1945-1979

1970-79 US fertility trends among differnet racial, regional, age, educational, parity, and socioeconomic subgroups in the population were examined, using own children data from the 1976 Survey of Income and Education (SIE) and the March Current Population Surveys (CPS) from 1968-80. In addition, cross-sectional differences in fertility for the subgroups were compared for 1970 and 1976, using multiple regression analysis. 1st, the appropriateness of using fertility rates obtained from own children data was assessed by comparing fertility rates obtained from the SIE data with those derived from vital statistic and census data. The comparative analysis confirmed that the SIE data yielded an accurate estimate of period fertility rates for currently married women, provided the subgroup samples were sufficiently large. CPS fertility estimates were also judged to be accurate if data from 3 adjacent survey years was pooled to increase sample size. Fertility trends for 5 educational groups were assessed separately for 1967-73. During this periold, there was a marked decline in fertility for all 5 groups; for the group with 5-8 years of education the decline was only 14%, but for the other 4 groups, which included women with 9-16 or more years of education, the decline in fertility ranged from 26-29%. In assessing the 1970-76 trends, the sample was restricted to own children, aged 3 years or less, of currently married women, under 40 years of age. Among whites, there was an overall 20% decline in fertility between 1970-76 and an overall fertility increase of about 2% between 1976-79. These trends were observed in all 28 white subgroups. A similar pattern was observed for blacks. There was an overall fertility decline of 24% between 1970-76, and this decline was apparent for all subgroups except women with college degrees. Betwen 1976-79, black fertility rates, unlike white rates, continued to decline, but the rate of decline was only 3%. Furthermore, the decline in almost all the black subgroups was markedly less than in the 1970-76 periold, and for many of the subgroups the trend was reversed and fertility increased. In summary, the fertility trends noted for 1970-79 were pervasive for almost all the subgroups for both blacks and whites; i.e., there was a marked decline in fertility between 1970-76 and than a reversal or slowing down of the decline during the 1976-79 for all black and white subgroups. Cross-sectional fertility differences in the subgroups in 1970 and in 1979 were quite similar, and fertility rates differed markedly for the separate subgroups. These differences do not, of course, explain the pervasive trends observed in the analysis of the fertility rates over time. A similar study assessing fertility trends among subgroups for the early 1940's through the late 1960s also revealed the pervasive nature of period fertility trends. Demographers have not as yet been able to explain these shifts in fertility that cut across all subgroups in the US and which also characterize the period fertility rates in other developed countries. Tables provided information on 1) total fertility rates by educational level and by geographical region for 1945-1975; 2) % change in number of own children less than 3 years of age among women under age 40 by maternal age, maternal education, initial parity, geographical region, and husband's income; and 3) mean number of own children less than 3 years of age among women under age 40 by maternal age, education, parity, region, and husband's income.     

Racial/ethnic differences in body fatness among children and adolescents

Background: Although the BMI is widely used as a measure of adiposity, it is a measure of excess weight, and its association with body fatness may differ across racial or ethnic groups. Objective: To determine whether differences in body fatness between white, black, Hispanic, and Asian children vary by BMI‐for‐age, and whether the accuracy of overweight (BMI‐for‐age ≥ Centers for Disease Control and Prevention (CDC) 95th percentile) as an indicator of excess adiposity varies by race/ethnicity. Methods and Procedures: Total body dual‐energy X‐ray absorptiometry (DXA) provided estimates of %body fat among 1,104 healthy 5‐ to 18‐year‐olds. Results: At equivalent levels of BMI‐for‐age, black children had less (mean, 3%) body fatness than white children, and Asian girls had slightly higher (1%) levels of %body fat than white girls. These differences, however, varied by BMI‐for‐age, with the excess body fatness of Asians evident only among relatively thin children. The ability of overweight to identify girls with excess body fatness also varied by race/ethnicity. Of the girls with excess body fatness, 89% (24/27) of black girls, but only 50% (8/16) of Asian girls, were overweight (P = 0.03). Furthermore, the proportion of overweight girls who had excess body fatness varied from 62% (8/13) among Asians to 100% (13/13) among whites. Discussion: There are racial or ethnic differences in body fatness among children, but these differences vary by BMI‐for‐age. If race/ethnicity differences in body fatness among adults also vary by BMI, it may be difficult to develop race‐specific BMI cut points to identify equivalent levels of %body fat.     

Sequential aspects of spontaneous abortion: maternal age, parity, and pregnancy compensation artifact

At least 3 hypotheses predict that spontaneous abortion risk differs during reporductive history: genuine maternal age effects change individual risks; genuine birth order effects change individual risks; and variant individual risks, which are really independent of both age and parity, produce an artifactual association of risk with age in populations of women. The availability of large numbers of reproductive histories recorded on magnetic tape by the Collaborative Study on Cerebral Palsy provides an opportunity to weigh these hypotheses. Information was gathered between mid-1959 and mid-1966 by 13 hospitals, mostly east of the Mississippi. Random samples of essentially all women registering in the obstetric clinics of the collaborating institutions entered the study. Generally, these women came from poorer urban areas. Data are taken from the interviews at 1st registrations only. At this time, women had prior reproductive histories of varying lengths. The data are analyzed to yield broad comparative evaluations of the maternal age, parity, and artifact hypotheses. When the logit transforms of abortion risks were regressed on maternal age, the linear component was positive and significant at the 1% level in every ethnic group. In all categories except blacks, the fit to such a simple model was quite adequate. Fit in the case of the blacks was disturbed by the high rate among 13-year olds and the low rate among 37-year olds. The 37-year old black sample was the only one to depart markedly from the trend of increased risk at high age. Primary analysis of birth order defects used Slater's (1962) rank order statistic on a group of histories. In every ethnic category the observed mean value of Slater's statistic exceeds its expected value of 0.5; every standardized deviation has a negligibly small probability when tested against the normal distribution. The conclusin is that spontaneous abortions tend to come late in a reproductive history. The white data showed a definite trend contrary to expectation under the pregnancy compensation hypothesis. Although not significant in the "o" (liveborn) versus "x" (abortion) contrast, the lowering trent in maternal age with prior abortion experience was signifixant for the longer histories. Equally surprising was the apparent positive finding in the black data. In sum, the data clearly showed that among women with histories mixing spontaneous abortions and live births, risk of abortion was greater at higher parity. Although the women sampled tended to be young, and increase of risk with age was demonstrated in the white sample. These effects were not because of sample biases. Black age effects were possibly confounded with pregnancy compensation artifact which can mimic aging influence in unselected samples.     

Changing racial boundaries and mixed unions: the case of second-generation Filipino Americans

I examine an understudied topic of intermarriage – nonwhite mixed unions. Drawing on a study of second-generation Filipino Americans, I compare how respondents in inter-ethnic (those partnered with other Asians) and nonwhite interracial (i.e. Latino, black, and non-Asian bi-racial) unions perceive racial boundaries, or their ‘racial schemas’. I argue that mixed unions can change how partners view racial boundaries. Drawing on phenotype, culture, and power position, both inter-ethnically and nonwhite interracially partnered respondents viewed themselves as different from whites. However, they differed in how they constructed nonwhite boundaries. Respondents in inter-ethnic unions drew on their Asian identity to distinguish themselves from Latinos and blacks, while informants in nonwhite interracial unions highlighted their Filipino identity to distance themselves from East Asians and align themselves with Latinos and blacks. These findings show that marriage affects racial boundary development and that mixed unions impact individuals’ racial incorporation.     

Fertility at low and high altitude in Central Nepal

Since the 1930s, a number of different studies have tended to show that fertility is lower at high altitude. The present investigation attempts to provide some answers to this question by examining completed fertility rate (CFR) in Highland and Lowland villages in Central Nepal and relating rate differences to age at menarche, age at 1st childbirth, age at 1st marriage, incidence of venereal disease, birth control (vasectomy or hysterectomy), length of postpartum amenorrhea, and breastfeeding. Data was obtained by direct questioning, and under-reporting of births thus cannot be excluded. Fertility histories were taken from post-menopausal women over the age of 45 years. Results indicate no significant difference in reported menarcheal ages between highlanders and lowlanders. Age at 1st marriage and 1st childbirth were both significantly later in highlanders. CFR was significantly lower in highlanders. It would appear that the reduced fertility rate at high altitude can be partly attributable to later age at marriage and later 1st childbirth. Other factors, e.g., husband absenteeism and remarriage have also been suggested as possible contributors to the observed difference. This paper presents the results of a multiple regression analysis using 9 dependent variables: ages of marriage, 1st childbirth and menarch, the average gap between pregnancies, the average amount of time the husband was away, the number of marriages, presence or absence of venereal disease at some time, whether birth control was practiced and altitude status. Average pregnancy gap, age at 1st childbirth and presence or absence of venereal disease were the only variables that independently made a significcant contribution to CFR variance. The increase in pregnancy gap may be related to longer periods of breastfeeding in high altitude women and there would be a concomitant delay in recommencement of menstruation. In testing the hypothesis, no difference is found in reported duration of breastfeeding or in postpartum amenorrhea. The age at marriage and age at 1st childbirth accounted for over 16% of the explained variance in CFR. Some of the observed difference in CFR can be explained by the difference in marital age but not by the interval between marriage and 1st childbirth, as it was very similar in both groups. The lower CFR among the high altitude population could be due to lowering of biological fecundity at high altitude, or simply a matter of choice. The difference might reflect human reproductive hormone differences between high and low altitude populations. Further research will be needed to determine whether or not differences in CFR can be explained by variation in these factors.     

The effect of race on the incidence of low birth weight: persistence of effect after controlling for socioeconomic, educational, marital, and risk status

The purpose of this study was to determine whether the elevated risk for low birth weight (LBW) infants among black mothers would persist when biologic, behavioral, and socioeconomic factors (as measured by socioeconomic status, level of education, and marital status) were controlled. It was found that the odds ratios for the risk of LBW for blacks/whites persisted above 1.5, regardless of what subgroups were used and what factors were controlled. The black/white odds ratios were, however, less than 2.0 when cigarette smoking was not a risk factor and higher than 2.0 when it was. In fact, the highest odds ratios, up to 2.65, occurred among the smoking group. These data suggest that smoking may have a more strongly negative effect among black than white pregnant mothers. In general, the effect of race on the LBW risk was much less strong than that of risk factors that can be influenced, such as adverse maternal practices.     

Trends of Abdominal Adiposity in White,Black, and Mexican‐American Adults, 1988 to 2000

Objective: To describe changes in the distribution of waist circumference (WC) and abdominal obesity (AO) in white, black, and Mexican‐American adults from 1988 through 2000. Research Methods and Procedures: Nationally representative cross‐sectional surveys of adults 20 to 79 years of age were examined using data from U.S. National Health and Nutrition Examination Surveys of 1988 to 1994 and 1999 to 2000. AO was defined as WC ≥102 cm in men and ≥88 cm in women. Results: There was a gradient of increasing WC and AO with increasing age in both study periods in whites and blacks. In men, the average increase between the study periods in overall WC in whites, blacks, and Mexican Americans were 3, 3.3, and 3.4 cm, respectively. The corresponding values in women were 2.4, 5.3, and 3.7 cm, respectively. In men, the percentage change in prevalence of AO between 1988 and 2000 ranged from 5.5% in Mexican‐American men to 8.2% in white men. In women, there was a 1.7% decrease in AO in Mexican Americans, whereas there was an increase of 6.3% for whites and 7% for blacks. Discussion: Despite increased understanding of the need for screening and treatment for obesity, this study indicates increasing prevalence of AO in white and black Americans. Without concerted effort to reduce the prevalence of overall obesity, the increasing prevalence of AO is likely to lead to increased prevalence of metabolic syndromes in the United States. Our results highlight the need to design evidence‐based programs that show promise for long‐term health behavior changes to facilitate the prevention of AO and related comorbidities.