Fuentes-Afflick Elena, Odouli Roxana, Escobar Gabriel J, Stewart Anita L, Hessol Nancy A
1 Department of Pediatrics and Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California.
J Womens Health (Larchmt). 2014 Aug;23(8):688-706. doi: 10.1089/jwh.2013.4585. Epub 2014 Jun 30.
Acculturation may influence women's perceptions of health care experiences and may explain the epidemiologic paradox, whereby foreign-born women have lower rates of adverse birth outcomes than United States (US)-born women. We evaluated the relationship between maternal acculturation and specific dimensions of prenatal interpersonal processes of care (IPC) in ethnically diverse women.
Cross-sectional analysis of 1243 multiethnic, postpartum women who delivered at Kaiser Permanente Medical Center in Walnut Creek or San Francisco General Hospital. Women retrospectively reported on their experiences in seven domains of IPC during their pregnancy pertaining to communication, decision making, and interpersonal style. The primary independent variables were four measures of maternal acculturation: birthplace, English language proficiency, the number of years residing in the US, and age at immigration to the US. Generalized linear models, stratified by infant outcome, measured the association between each maternal acculturation measure and specific IPC domains while adjusting for type of health insurance, demographic, and reproductive factors.
Approximately 60% of the sample was foreign-born, 36% reported low English proficiency, 43% had resided in the US <10 years, and 35% were age 20 years or older when they immigrated to the US. Over 64% of the women reported having public insurance during pregnancy. In adjusted analyses among women who delivered term and normal birth weight infants, less acculturated women and women with non-private health insurance were more likely to have higher mean IPC scores when compared to more acculturated or US-born women and women with private health insurance, respectively.
In a large and ethnically diverse sample of childbearing women in Northern California, less acculturated pregnant women reported better prenatal care experiences than more acculturated and US-born women, another dimension of the "epidemiologic paradox." However, the relationship between acculturation and IPC, as reported during the postpartum period, differed according to infant outcomes.
文化适应可能会影响女性对医疗保健经历的认知，并可能解释流行病学悖论，即外国出生的女性不良分娩结局的发生率低于美国本土出生的女性。我们评估了不同种族女性的母体文化适应与产前人际护理过程（IPC）特定维度之间的关系。
对在核桃溪市凯撒永久医疗中心或旧金山总医院分娩的1243名多民族产后女性进行横断面分析。女性回顾性报告了她们孕期在IPC七个领域的经历，这些领域涉及沟通、决策和人际风格。主要自变量是母体文化适应的四项指标：出生地、英语熟练程度、在美国居住的年数以及移民到美国时的年龄。根据婴儿结局分层的广义线性模型，在调整医疗保险类型、人口统计学和生殖因素的同时，测量了每项母体文化适应指标与特定IPC领域之间的关联。
样本中约60%为外国出生，36%报告英语熟练程度低，43%在美国居住时间不足10年，35%移民到美国时年龄为20岁或以上。超过64%的女性报告孕期有公共保险。在对足月和出生体重正常的婴儿的母亲进行的调整分析中，与文化适应程度更高或美国本土出生的女性以及有私人保险的女性相比，文化适应程度较低的女性和有非私人保险的女性分别更有可能具有更高的平均IPC得分。
在北加利福尼亚州一个规模大且种族多样的育龄女性样本中，文化适应程度较低的孕妇报告的产前护理经历比文化适应程度更高和美国本土出生的女性更好，这是“流行病学悖论”的另一个维度。然而，产后报告的文化适应与IPC之间的关系因婴儿结局而异。
