Birth Outcome Measures and Infant Mortality

Recent studies have proposed alternative birth outcome measures as means of assessing infant mortality risk; nevertheless, there hasn’t yet been an integrated analysis of these approaches. We review 14 strategies, including various combinations of birth weight, gestational age, fetal growth rate, and Apgar scores—as predictors of early neonatal, late neonatal, and postneonatal mortality, and infant mortality. Using the NCHS linked birth/infant death file for 2001, we construct multivariate logit models and assess the associations between each of the 14 key birth outcome measures and four mortality outcomes. We find that all evaluated birth outcome measures are strong predictors, but Apgar scores are the strongest among all models for all outcomes, independent of birth weight and gestational age. Apgar scores’ predictive power is stronger for Mexican-, white-, and female-infants than for black- and male-infants. Second, all birth outcome measures remain significantly associated with mortality, but their predictive power reduces drastically over time. These findings suggest a rule of thumb for predicting infant mortality odds: when available, Apgar scores should always be included along with birth weight (or LBW status) and gestational age. Additionally, these findings argue for the continued study of low birthweight, gestational age, and Apgar scores as independently salient health outcomes.     

Nativity and Self‐Assessed Health among Pre‐Retirement Age Hispanics and Non‐Hispanic Whites1

Economic, social and familial resources are known to influence subjective health assessments. We examine the salience of nativity in determining how these resources influence self‐assessed health using a large, nationwide sample of Hispanic and non‐Hispanic white adults. The results indicate that while education, accumulated assets and marital status benefit the physical and emotional health of the native and foreign‐born, family resources and income are significant only for the native‐born. English language proficiency is a significant protective factor for both groups and is especially protective for immigrants. These surprising findings call into question previous studies stressing the positive role of the family in maintaining immigrant health.     

Neighborhood disadvantage, stress, and drug use among adults

This paper explores the relationships among neighborhood disadvantage, stress, and the likelihood of drug use in a sample of adults (N = 1,101). Using the 1995 Detroit Area Study in conjunction with tract-level data from the 1990 census, we find a positive relationship between neighborhood disadvantage and drug use, and this relationship remains statistically significant net of controls for individual-level socioeconomic status. Neighborhood disadvantage is moderately associated with drug related behaviors, indirectly through increased social stressors and higher levels of psychological distress among residents of disadvantaged neighborhoods. A residual effect of neighborhood disadvantage remains, net of a large number of socially relevant controls. Finally, results from interactive models suggest that the relationship between neighborhood disadvantage and drug use is most pronounced among individuals with lower incomes.     

Comparing Estimates of the Effects of Air Pollution on Human Mortality Obtained Using Different Regression Methodologies

Studies using regression techniques report their results using a variety of statistics. Evaluation of the consistency of findings, such as in a metaanalysis, requires calculating the statistical estimates of the effect reported in each study in a comparable manner. In this paper, we consider multiple linear regression, multiple Poisson regression, and logistic regression estimates. We present results that are needed to calculate, on a common basis, the slope of the regression function at a specified value, the elasticity function of the regression function at a specified value, the relative risk at a specified value, and the odds ratio at a specified value. We apply these results to studies of the association of daily mortality in an area to the daily air pollution level of ozone and PM₁₀. We calculate the estimated slope of the number of deaths per billion population associated with an increase of 1 ppb of ozone level in studies of daily mortality in three urban areas. These studies, in Los Angeles, New York, and St. Louis, produced very comparable results on a common basis, especially when compared to the coefficients as reported. We also calculated the estimated elasticity function of the daily mortality and daily PM₁₀ level for eight areas and found that the elasticities varied within a factor of roughly two, much less than the variability in the coefficients as reported.     

Acculturation and Acculturation Stress: A Social‐Epidemiological Approach to Mexican Migrant Farmworkers' Health1

Utilizing a cluster sampling design to maximize representativeness, we look at the health effects of acculturation and acculturation stressors among 1,001 adult migrant farmworkers in Fresno, California. Using self‐ratings of mental and physical health as well as the CES‐D depression scale, we find that the amount of time one spends in the United States, the level of English‐language usage, as well as the intensity of acculturation stresses that one reports, are all related to declines in health. In addition, acculturation stress has more deleterious effects on self‐rated health (both physical and mental) among the more highly acculturated.