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OBJECTIVES: This study investigated the birth outcomes of Japanese Americans, focusing on the role of the mother's place of birth. METHODS: Single live births to US-resident Japanese American mothers (n = 37,941) were selected from the 1983 through 1987 US linked live birth-infant death files. RESULTS: US-born mothers were more likely than foreign-born mothers to be less than 18 years old and not married, to start prenatal care early, and to more adequately use prenatal care. Infants of foreign-born Japanese Americans had a slightly lower risk of low birthweight. No significant differences were found between nativity groups for very low birthweight or neonatal, postneonatal, and infant mortality. The mortality rates of infants of US-born (6.2) and foreign-born (5.4) Japanese American women were below the US Year 2000 objective but still exceeded Japan's 1990 rate (4.6). However, low-birthweight percentages of the US-born group (5.7%) and the foreign-born group (5.0%) were similar to that of Japan (5.5%). CONCLUSIONS: The infants of foreign-born Japanese-American women exhibited modestly better low-birthweight percentages than those of US-born Japanese Americans. This finding supports theories of the healthy immigrant. [ABSTRACT FROM AUTHOR]

Hawaii vital record data for 1979 through 1990 were analyzed to examine potentially differing relationships between maternal and infant risks and outcomes in native Hawaiian and White infants. Despite high rates of inadequate prenatal care and teenage and unmarried childbearing, the Hawaiian low-birth-weight rate was below the US average. Hawaiian infants experienced an elevated risk of mortality, particularly among those of normal birthweight during the postneonatal period. Public health initiatives to reduce infant mortality must go beyond preventing teenage pregnancy and low birthweight to address Hawaiian infants' unique pattern of risk factors and the social and economic environment in which such risks abound.

Objectives: We examined the pregnancy outcomes of three ethnic groups: African-American Blacks, non-Hispanic Whites, and Filipinos. In an attempt to reduce ethnic dissimilarities in parental employment and access to health care, this investigation compared the single-live-birth outcomes of married, adult women who resided in the state of Hawaii and who indicated that their spouse was on active-duty status in the US military., Methods: The data for this study were obtained from the 1979-1989 Hawaii vital-record file that provides linked live birth-infant death information. Multiple logistic regression was used to calculate odds ratios for the independent effects of maternal factors on low birthweight and neonatal mortality., Results: Significant differences in maternal age, maternal education, paternal education, parity, hospital of delivery, and use of prenatal care were observed among the ethnic groups. The results of a logistic regression analysis of low birthweight indicated significantly higher risks for Filipinos and Blacks compared with Whites. For very low birthweight, only an increased risk for Blacks was observed. No ethnic differences in neonatal mortality were found., Conclusions: This investigation revealed more comparable infant mortality experiences among the ethnic groups in spite of persistent birthweight differences.

OBJECTIVES: This study examined the predictors of 3 patterns of prenatal care use (no care, late initiation of care, and inadequate use after early initiation) for 4 Asian American ethnic groups in the United States. METHODS: Single live births to US resident mothers of Chinese, Japanese, Korean, and Vietnamese ancestry (n = 273 604) were selected from the 1992-1996 US natality files. Logistic regression was used to analyze the effects of maternal characteristics on the 3 use measures. RESULTS: Korean Americans and Vietnamese Americans had the lowest levels of prenatal care use. Young or single motherhood, high parity for age, and low educational attainment were the main risk factors for low use. CONCLUSIONS: Considerable variability exists in prenatal care use among Asian American ethnic groups. [ABSTRACT FROM AUTHOR]

Objectives. We examined potential synergistic effects of racial and socio-economic inequality associated with small-for-gestational-age (SGA) birth. Methods. Electronic medical records from singleton births to White and Black women in 10 US states and the District of Columbia (n = 121 758) were linked to state-level indicators of structural racism, including the ratios of Blacks to Whites who were employed, were incarcerated, and had a bachelor's or higher degree. We used state-level Gini coefficients to assess income inequality. Generalized estimating equations models were used to quantify the adjusted odds of SGA birth associated with each indicator and the joint effects of structural racism and income inequality. Results. Structural racism indicators were associated with higher odds of SGA birth, and similar effects were observed for both races. The joint effects of racial and income inequality were significantly associated with SGA birth only when levels of both were high; in areas with high inequality levels, adjusted odds ratios ranged from 1.81 to 2.11 for the 3 structural racism indicators. Conclusions. High levels of racial inequality and socioeconomic inequality appear to increase the risk of SGA birth, particularly when they co-occur. [ABSTRACT FROM AUTHOR]

Objectives. We identified potential determinants and cause-specific sources of excess infant mortality among Native Hawaiians. Methods. We compared infant mortality rates among Native Hawaiians and Whites by using data from the 2002 to 2009 Hawaii State Linked Birth/Infant Death Cohort File. We evaluated the components of excess infant mortality by age and underlying cause of death as well as maternal sociodemographic, behavioral, and chronic condition disparities. Results. The Native Hawaiian infant mortality rate was more than twice that for Whites (7.9 vs 3.5/1000 live births). Excess Native Hawaiian infant mortality was equally apportioned to neonatal and postneonatal deaths. Preterm-related causes of death accounted for 43.9% of the infant mortality disparity, followed by sudden unexpected infant death (21.6%) and injury (5.6%). In multivariable models, maternal educational inequality accounted for the largest portion of the neonatal mortality disparity (20.9%); younger maternal age (12.2%) and smoking (9.5%) were the only significant contributors to the postneonatal mortality disparity. Conclusions. Addressing educational inequalities, promoting safe sleep practices, and reducing smoking among Native Hawaiian mothers would help to eliminate excess infant mortality. [ABSTRACT FROM AUTHOR]

Objectives. We assessed the prevalence and adjusted odds of 4 types of disability among 7 groups of older Asian American/Pacific Islander (AAPI) sub-populations, both separately and aggregated, compared with non-Hispanic Whites. Methods. Data were from the nationally representative 2006 American Community Survey, which included institutionalized and community-dwelling Hawaiian/Pacific Islander (n = 524), Vietnamese (n = 2357), Korean (n = 2082), Japanese (n=3230), Filipino (n=5109), Asian Indian (n = 2942), Chinese (n = 6034), and non-Hispanic White (n = 641177) individuals aged 55 years and older. The weighted prevalence, population estimates, and odds ratios of 4 types of disability (functional limitations, limitations in activities of daily living, cognitive problems, and blindness or deafness) were reported for each group. Results. Disability rates in older adults varied more among AAPI subpopulations than between non-Hispanic Whites and the aggregated Asian group. Asian older adults had, on average, better disability outcomes than did non-Hispanic Whites. Conclusions. This study provides the strongest evidence to date that exclusion of institutionalized older adults minimizes disparities in disabilities between Asians and Whites. The aggregation of Asians into one group obscures substantial subgroup variability and fails to identify the most vulnerable groups (e.g., Hawaiian/Pacific Islanders and Vietnamese). (Am J Public Health. 2011;101:94-100.) [ABSTRACT FROM AUTHOR]

Objectives. We examined mortality patterns across the lifespan of Native Hawaiians and compared mortality disparities across races. Methods. We determined the age-specific and age-adjusted mortality rates of Native Hawaiians from 1990 to 2000 by using national census and vital registration data. Results. Among Native Hawaiians aged younger than 1 year, expected deaths were 15% lower than for Blacks and 50% higher than for Whites. Among older adults, Native Hawaiians had higher rates of mortality compared with the general population, particularly in 1990 and 1995. Crude death rates for Native Hawaiians were similar to those for Blacks in 1990 and 1995 but were 20% lower than those for Blacks by 2000. Crude death rates for Native Hawaiians were 30% higher than for Whites in 1990 and 1995 and more than 40% higher than for Whites in 2000. Conclusions. Compared with Whites, Native Hawaiians and Blacks face similar challenges regarding infant and early-life mortality and increasing risks of mortality in mid-life and early old age. Our analyses document a need for renewed efforts to identify the determinants of ill health and commitment to address them. [ABSTRACT FROM AUTHOR]

Objectives. We explored whether the introduction of 3 lifesaving innovations introduced between 1989 and 1996 increased, decreased, or had no effect on disparities in Black--White mortality in the United States through 2006. Methods. Centers for Disease Control and Prevention data were used to assess disease-, age-, gender-, and race-specific changes in mortality after the introduction of highly active anti-retroviral therapy (HAART) for treatment of HIV, surfactants for neonatal respiratory distress syndrome, and Medicare reimbursement of mammography screening for breast cancer. Results. Disparities in Black--White mortality from HIV significantly increased after the introduction of HAART, surfactant therapy, and reimbursement for screening mammography. Between 1989 and 2006, these circumstances may have accounted for an estimated 22441 potentially avoidable deaths among Blacks. Conclusions. These descriptive data contribute to the formulation of the hypothesis that federal laws promote increased disparities in Black--White mortality by inadvertently favoring Whites with respect to access to lifesaving innovations. Failure of legislation to address known social factors is a plausible explanation, at least in part, for the observed findings. Further research is necessary to test this hypothesis, including analytic epidemiological studies designed a priori to do so. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We examined characteristics and birth outcomes of Asian/Pacific Islander (API) mothers to determine whether differences in outcomes existed between mothers of single race/ethnicity and multiple race/ethnicity. METHODS: We used data from California and Hawaii birth certificates from 2003 through 2005 to describe variation in birth outcomes for API subgroups by self-reported maternal race/ethnicity (single versus multiple race or API subgroup), and we also compared these outcomes to those of non-Hispanic White women. RESULTS: Low birthweight (LBW) and preterm birth (PTB) varied more among API subgroups than between mothers of single versus multiple race/ethnicity. After adjustment for sociodemographic and behavioral risk factors, API mothers of multiple race/ethnicity had outcomes similar to mothers of single race/ethnicity, with exceptions for multiple-race/ethnicity Chinese (higher PTB), Filipino (lower LBW and PTB), and Thai (higher LBW) subgroups. Compared with single-race non-Hispanic Whites, adverse outcomes were elevated for most API subgroups: only single-race/ethnicity Korean mothers had lower rates of both LBW (3.4%) and PTB (5.6%); single-race/ethnicity Cambodian, Laotian, and Marshallese mothers had the highest rates of both LBW (8.8%, 9.2%, and 8.4%, respectively) and PTB (14.0%, 13.7%, and 18.8%, respectively). CONCLUSIONS: Strategies to improve birth outcomes for API mothers should consider variations in risk by API subgroup and multiple race/ethnicity. [ABSTRACT FROM AUTHOR]

We sought to estimate the accuracy, relative to maternal medical records, of perinatal risk factors recorded on fetal death certificates. We conducted a validation study of fetal death certificates among women who experienced fetal deaths between 1996 and 2001. The number of previous births, established diabetes, chronic hypertension, maternal fever, performance of autopsy, anencephaly, and Down syndrome had very high accuracy, while placental cord conditions and other chromosomal abnormalities were reported inaccurately. Additional population-based studies are needed to identify strategies to improve fetal death certificate data. [ABSTRACT FROM AUTHOR]

Objectives. We investigated trends in prenatal care use and its association with low birthweight in a developing country. Methods. We examined data from 2 southeast Brazilian cohort surveys, 1 conducted in 1978-1979 and the other in 1994. Results. Socioeconomic inequalities in prenatal care use increased during the 15-year period of 1979-1994. Although prenatal care use increases paralleled increases in low birthweight rate during this period, having no prenatal care was associated with higher risk of low birthweight in both surveys. Inadequate prenatal care use was also associated with higher risk of low birthweight in 1978-1979 only. Conclusions. Increasing low birthweight rates among women who adequately used prenatal care may be causing a bias by reducing the estimates of the effect of inadequate prenatal care use on low birthweight rates. (Am J Public Health. 2004; 94:1366-1371). [ABSTRACT FROM AUTHOR]

OBJECTIVES: We examined trends and racial disparities (White, African American) in trimester of prenatal care initiation and adequacy of prenatal care utilization for US women and specific high-risk subgroups, e.g., unmarried, young, or less-educated mothers. METHODS: Data from 1981-1998 US natality files on singleton live births to US resident mothers were examined. RESULTS: Overall, early and adequate use of care improved for both racial groups, and racial disparities in prenatal care use have been markedly reduced, except for some young mothers. CONCLUSIONS: While improvements are evident, it is doubtful that the Healthy People 2000 objective for prenatal care will soon be attained for African Americans or Whites. Further efforts are needed to understand influences on and to address barriers to prenatal care. [ABSTRACT FROM AUTHOR]

Objectives. This study examines differentials in mean birthweight and the risk for low birthweight among various Asian-American groups in New York State (n = 499 377). Methods. Using resident singleton live-birth records from New York State for 1985 and 1986, Asian-American births were compared with Black, American Indian, and White births. Multivariate ordinary least squares and logistic regression models were used to analyze ethnic differences. Results. Compared with White births, the expected mean difference in birthweight was -115 g for Chinese, -235 g for Japanese, -164 g for Filipinos, -120 g for Blacks, and 74 g for American Indians. The risk for low birthweight was 45% higher for Filipinos and 49% higher for Blacks as compared with Whites. Conclusions. Results of this study suggest substantial heterogeneity in mean birthweight and risk for low birthweight among ethnic groups in general and the major Asian-American groups in particular. Interestingly, after controlling for ethnic differences in sociodemographic risk factors, Filipinos appear to resemble Blacks much more closely than they do their Japanese and Chinese counterparts with respect to risk for low birthweight. [ABSTRACT FROM AUTHOR]

Objectives. This study assessed the relationship between incomplete birth certificates and infant mortality. Methods. Birth certificates from California (n = 538 945) were assessed in regard to underreporting of 13 predictors of perinatal outcomes and mortality. Results. Of the birth certificates studied, 7.25% were incomplete. Underreporting was most common in the case of women at high risk for poor perinatal outcomes and infants dying within the first day. Increasing numbers of unreported items were shown to be associated with corresponding increases in neonatal and postneonatal mortality rates. Conclusions. Incomplete birth certificates provide an important marker for identifying high-risk women and vulnerable infants. Because data "cleaning" will result in the removal of mothers and infants at highest risk, birth certificate analyses should include incomplete records. (Am J Public Health. 2002;92:79-81) [ABSTRACT FROM AUTHOR]

The article focuses on a method aimed at identifying and correcting "problem" gestational age and birthweight values on fetal death records. It aims to encourage states to use quality assurance procedures to improve vital records data. Although the annual number of fetal deaths in the U.S. exceeds the number of neonatal deaths, much of the published research on the risk factors for poor pregnancy outcomes is based on live births. Accurate assessments of temporal changes in perinatal health status as well as evaluations of related interventions and policy initiatives, are enhanced by the availability of good-quality fetal death data. It has been suggested that trends toward the increased reporting of deliveries of less than 500g as live births, rather than fetal deaths, or not reporting at all, may partially underlie the apparent lack of improvement in low-birthweight rates in parts of the United States. The existing variation among states, both in requirements for fetal death reporting and in the quality of fetal death data, precludes an unambiguous interpretation of these trends and therefore hinders valid appraisals of national efforts to reduce low-birthweight and preterm birthrates.