MICASA: Region of Birth and Reproductive Health

MICASA: Region of Birth and Reproductive Health

Stephen A. McCurdy, MD MPHProfessor and Director

UCD Master of Public Health (MPH) ProgramDepartment of Public Health Sciences

University of California, Davis School of Medicine

MICASA: Reproductive Health

MICASA: Mexican Immigration to California: Agricultural Safety and Acculturation

Aim: Characterize occupational and general health in immigrant Hispanic population Mendota


MICASA Study SiteMendota: Central Valley agricultural community

Population 9,791 in 2005; 97% Hispanic

One-third below federal poverty level

Mendota


Immigration12.9% of US population are foreign-born1,062,040 legal permanent residencies (LPRs) (2011)

Greatest source (13.4%) is Mexico11.5 million undocumented immigrants

59% born in Mexico


Where do immigrants go?

Employment: Agriculture

Low entrance barriers

Location: Rural

California is destination for ~20% of LPRs

Employment, social networks

Resource-poor


Agricultural Environment

Highly productive and diverseCalifornia produces over 350 crops with a market value of $26.6 billion in cash receipts in 2011 (Iowa is in second place, with $21 billion in 2011)California leads the nation in major production categories: field crops, vegetables and melons, livestock and dairy, nursery products.

[USDA, NASS 2011]


Hispanic Paradox

Hispanics have better health outcomes (for some conditions) than do Non-Hispanic Whites, despite SES disadvantage

Coronary heart disease mortality

Reproductive health outcomes

Not seen for diabetes, obesity


Hispanic Paradox

AKA “Latina epidemiologic paradox” when applied to reproductive health outcomes

Low birth weight

Small for gestational age (SGA)

Pre-term birth


Latina Epidemiologic Paradox

Not seen in all Hispanic groups

Protective effect is strongest in Mexico-born with low educational attainment.


Lifestyle factors affecting reproductive health:

Age of sexual debut

Lifetime number of sexual partners

Use of protective measures

Acculturation affects these factors


Acculturation affects lifestyle

Increased acculturation associated with . . .

Earlier sexual debut (mean 19.0 vs. 15.9 y) in pregnant women at SJ County health clinic

Increased likelihood of multiple lifetime sexual partners

[Kasirye, et al. . Ethn Dis. 2005;15(4):733-739]


Aim:

Descriptive: Examine selected reproductive health outcomes in relation to area of birth and other demographic characteristics.

Analytic: Test hypotheses that acculturation, depression, perceived stress, and family support affect reproductive outcomes.

MICASA: Reproductive HealthMethods:

Multistage sampling of FW households (> 1 adult working > 45 days in agriculture in prior year

467 (65%) of eligible households

Baseline interview 1/2006 – 4/2007

Follow-up interview (74%) 11/2008 – 2/2010

(Limit to persons born in Mexico or Cent. Am)


Results (Demographics):

399 women

407 men Total: 806

556 born in Mexico

250 born in CA (90% from El Salvador)



Median ages ranged from 39 y (Mexican men) to 34 y (CA men and women)

Median ages at immigration ranged from 20 y (Mexican men) to 24 y (CA women)

> 90% low acculturation

Median time in current domicile 3 y



95% married or cohabiting

Marriage prevalence ranged from 47% (CA women) to 76% (Mexican men)


Results (Sexual debut and partners):

Median age at sexual debut ranged from 16 y (CA men) to 18 y (women)

Median number of lifetime sexual partners was 1 for women, 2 (for Mexican men) and 3 (for CA men)

Sexually transmitted diseases rare (<3.7%)

> 75% of women had Pap within 1 year


Results (Contraception):

Men: 45.2% (Mexican); 46.7% (CA)

Women: 68.7% (Mexican); 53.9% (CA)

Men less likely to use contraception; more likely to use poorly effective methods (condom)



75% of women “mostly” or “very” confident about ability to use contraception in next 6 mo.

Major reason for non-use “don’t want to” or current or desired pregnancy

1 woman and 13 men cited partner’s wish as reason for non-use



Among persons at risk for unintended pregnancy at study entrance . . .

Men had 2x (CA) to 4x (Mex) increased odds for non-use of contraception compared to women

CA women had 2x increased odds for non-use of contraception compared to Mexican women.


Results (Pregnancy):

Median 3 pregnancies reported on baseline survey—no relation with region of birth

84 interim pregnancies (i.e., following baseline and reported on follow-up survey)

Desire for interim pregnancy modestly higher among CA women (NS)


Summary and conclusions:

MICASA population (vs. US) . . .

Later sexual debut than US-born

Contraception use comparable to US

Greater total fertility (3 for CA, 4 for Mexico)

1.9 for US women, 2.2 for US Hisp



Men (vs women) . . .

Moderately older and more years in US

Earlier sexual debut; more partners

Lower use of contraception; less effective methods

More likely married



Central America (vs Mexico) . . .

Fewer years in US

Earlier sexual debut (esp. among men)

Lower use of contraception among women

Lower odds of being married



Strengths:

Community-based study of important population

Few data

Strong community engagement



Limitations:

Single California community—may not apply to dissimilar groups and locations

Limited depth of inquiry (space limits)

Questionnaire responses—no validation


Public health implications:

Lifestyle factors brought from sending country may persist, especially in cultural enclaves

Homogeneity of groups may facilitate development of effective interventions

Attention to men, who have higher-risk profile than women

Thanks and Acknowledgments

City of Mendota, CA and MICASA participants

Marc B. Schenker, MD MPH (MICASA PI)

Teresa Barcellos, MD, PhD cand.

Maria Stoecklin-Marois, PhD

Daniel J. Tancredi, PhD

Tamara Hennessy-Burt, MS

National Institute for Occupational Safety and Health

The California Endowment

Documents

MICASA: Region of Birth and Reproductive Health