Three essays on the social and temporal dimensions of cardiovascular health among the Mexican-origin population in the United States

textThe size of the Mexican-origin population in the United States means that its health patterns have important implications for the country’s overall population health. Understanding how this population is woven into the country’s complex social patterning of health is critical to understanding current social disparities in health. Drawing on a health disparities perspective and nationally representative datasets, this dissertation addresses key gaps in the social demographic literature on the health of the Mexican-origin population through three empirical chapters that examine how multiple measures of cardiovascular health are distributed across diverse social status and temporal configurations. I first examine how the obesity epidemic has unfolded across multiple temporal (age, period, and cohort) and social dimensions (gender, nativity, and race) for the Mexican-origin population. I find that period rather than cohort forces have shaped the rise in obesity among the Mexican-origin population. Furthermore, the pronounced group differences in obesity prevalence have remained stable across periods and cohorts, with the exception of a growing nativity gap among Mexican-origin women, among whom obesity has increased faster for U.S.-born individuals compared with foreign-born individuals. I next address the intersection of two additional temporal and social determinants of health: duration of residence in the United States and educational attainment. Building on research documenting a weak relationship between education and health for Mexican immigrants, I assess whether duration of U.S. residence strengthens this association. The patterns vary by outcome, but generally indicate that negative education gradients in health are more pronounced for long-term Mexican immigrants than for recent Mexican immigrants and that the education gradients of long-term Mexican immigrants resemble those of U.S.-born Whites. I then engage the literature linking acculturation to poor health among Mexican immigrants. Acculturation models of immigrant health have come under critique for ignoring the structural determinants of health. I engage in this debate by using segmented assimilation theory—which emphasizes the role of structural factors—to examine whether education conditions the association between acculturation and health. I find support for the idea that the detrimental influence of acculturation on cardiovascular health is concentrated among Mexican immigrant adults with low levels of education.Sociolog

Maternal age at first birth and adolescent education in Brazil

BACKGROUND Brazil has witnessed dramatic changes in its fertility patterns in recent decades. The decline to below-replacement fertility has been accompanied by increases in the proportion of children born to young mothers. Yet we know little about the well-being of children born to young mothers in Brazil. OBJECTIVE Using data from the 2006 Pesquisa Nacional de Demografia e Saúde and a quasi-natural experimental approach, this study examines the implications of maternal age at first birth for the education of Brazilian adolescents. RESULTS We find that being born to a young mother is associated with educational disadvantages in adolescence, but that these disadvantages are attenuated once we account for mothers' selection into early childbearing. We also find that, in southern Brazil, adolescents born to young mothers have poorer educational outcomes compared with their peers born to older mothers, but that in northern Brazil no such disparities exist. CONCLUSIONS Adolescent educational disadvantages associated with being born to a young mother are not an artifact of selectivity, at least in southern Brazil. Regional variation in the effect of maternal age at first birth on adolescent education suggests the important role of the extended family and the father's presence as mechanisms through which disadvantages operate

Scars from a Previous Epidemic: Social Proximity to Zika and Fertility Intentions during the COVID-19 Pandemic

We examine whether women’s social proximity to Zika during the Zika epidemic predicts intentions to avoid a pregnancy because of the COVID-19 pandemic either directly or indirectly via subjective assessments of the pandemic. We apply path models on unique microdata from Brazil, the country most affected by Zika and an epicenter of COVID-19, to understand whether a novel infectious disease outbreak left lasting imprints shaping fertility intentions during a subsequent novel infectious disease outbreak. Findings show that Zika social proximity is associated with fertility intentions through an indirect path related to subjective assessment of the COVID-19 pandemic. These findings emerged regardless of whether a woman herself had or suspected she had Zika and speak to the transformative consequences of novel infectious disease outbreaks that go beyond mortality and health

School Enrollment Protects Brazilian Adolescents from Overweight and Obesity, Even for Siblings in the Same Household

Children and adolescents who live in Brazil, one of the most unequal countries in the world, are now among the heaviest in the world. Traditionally, researchers have paid scant attention to the role of adolescents’ own emerging socioeconomic characteristics, measured by whether they are in school or working, on their weight status. Using a nationally representative data set that includes anthropometric measures of the height and weight of all household members, this study, led by PRC faculty research associate Letícia Marteleto and former PRC trainee Molly Dondero, examines whether and how adolescents’ school and work experiences are associated with overweight and obesity in Brazil. They find that Brazilian adolescents who are enrolled in school—both those who work and those who do not—have the lowest probabilities of being overweight or obese. They argue for robust policies that promote school retention to minimize adolescents’ risk of overweight and obesity.Population Research Cente

Identifying hidden Zika hotspots in Pernambuco, Brazil: a spatial analysis

Northeast Brazil has the world's highest rate of Zika-related microcephaly. However, Zika case counts cannot accurately describe burden because mandatory reporting was only established when the epidemic was declining in the region.To advance the study of the Zika epidemic, we identified hotspots of Zika in Pernambuco state, Northeast Brazil, using Aedes-borne diseases (dengue, chikungunya and Zika) and microcephaly data. We used Kulldorff's Poisson purely spatial scan statistic to detect low- and high-risk clusters for Aedes-borne diseases (2014–2017) and for microcephaly (2015–2017), separately. Municipalities were classified according to a proposed gradient of Zika burden during the epidemic, based on the combination of cluster status in each analysis and considering the strength of the evidence.We identified 26 Aedes-borne diseases clusters (11 high-risk) and 5 microcephaly clusters (3 high-risk) in Pernambuco. According to the proposed Zika burden gradient, our results indicate that the northeast of Pernambuco and the Sertão region were hit hardest by the Zika epidemic. The first is the most populous area of Pernambuco, while the second has one of the highest rates of social and economic inequality in Brazil.We successfully identified possible hidden Zika hotspots using a simple methodology combining Aedes-borne diseases and microcephaly information.This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (https://www.nichd.nih.gov/): grant R01HD091257 awarded to LJM (PI: LJM, co-investigator: MD), and grants P2CH042849 and T32HD007081 awarded to the Population Research Center at the University of Texas at Austin. RL was supported by a Royal Society Dorothy Hodgkin Fellowship(https://royalsociety.org/grants-schemes-awards/grants/dorothy-hodgkin-fellowship/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer ReviewedPostprint (author's final draft