Perspective on racial/ethnic birth weight.

OBJECTIVE: Comprehensive birth weight analyses of single primiparous infants of Samoan, Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, Japanese racial ethnic groups. Sampling of intrauterine growth designed to reflect antecedent intra- and extra-environmental factors and insure uniform racial-ethnic data for any later genetic and phenotypic birth weight modeling. STUDY DESIGN: Based upon predetermined relevant gestational age criteria, 121, 197 single primiparous infants birth weight records analyzed. The racial-ethnic basic research paradigms also specified parental diallelic crosses representing intra-and inter-ethnic racial ancestry. Hypotheses tested: 1) the mean birth weight of single primiparous infants of Samoan parentage will be significantly larger than the mean birth weight of similar single primiparous infants of Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, and Japanese parentage; 2) mean birth weight of single primiparous infants of only Samoan intra-parentage will be significantly larger t han the mean birth weights of single primiparous infants of only Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, and Japanese parentage and 3) mean birth weight of single primiparous infants Samoan mothers and non-Samoan fathers will be significantly larger than single primiparous infants of Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, and Japanese mothers and non-Caucasian, non-Chinese, non-Filipino, non-Hawaii/Part Hawaiian and non-Japanese father. CONCLUSION: Two of three proposed associated hypotheses adopted: namely, that the mean birth weight of single primiparous infants of one, primary Samoan maternal parentage, and two, of only Samoan maternal and paternal parentage, will be significantly larger than their comparative counterparts. Hypotheses 3 based on Samoan mothers and non-Samoan fathers is tenable, but questionable relative to Caucasian parental background. Research highlights importance of control for potentially confounding variables and assets inherent in independent racial-ethnic cohort investigations.

Childbirth overseas: the experience of Japanese women in Hawaii.

The purpose of this study is to investigate which kinds of stress women experience during childbirth in a foreign country and to explore whether childbirth in a foreign country influences women's mental health. The study was a quantitative and qualitative mixed study. Forty-five Japanese women, born and raised in Japan and who gave birth in Hawaii, USA, were telephone-interviewed within 1 year after childbirth. The stress factors that emerged were: language barrier, distance from family and friends, different culture, and health-care attitude about childbirth. Half of the participants experienced emotional dysfunction during their pregnancy. All primiparas experienced postpartum depression. The participants who had the maternity blues tended to have postpartum depression. Help from the participants' mothers after childbirth decreased postpartum depression. The importance of mental health for foreign-born primiparas emerges during the perinatal period.

Samoan parental ethnicity and infant birth-weight in Hawai'i.

OBJECTIVE: Comparative study of racial-ethnic (RE) gestational age (GA) mean birth-weight (MBW) differences for 1968-1994. STUDY DESIGN: Descriptive statistical analyses of 314,633 State of Hawai'i live birth certificates: birthweights of 500-5000 grams, gestational ages 24-42 weeks, and recorded Caucasian, Chinese, Filipino, Hawaiian, Japanese, Samoan, and Other RE parentage. Multiple regression analyses of single infant birth records were performed to adjust birth-weight for selected covariates and assess the independent effects of maternal and paternal RE on MBW. RESULTS: Samoans consistently displayed significantly the largest MBW whether based on single or mixed RE parentage. After covariate adjustment MBW significantly related to Samoan maternal RE followed by Samoan paternal RE. CONCLUSION: A consistent trajectory of larger MBWs across GA span of 24-42 weeks is associated with the Samoan group. Results support the importance of maternal role in determining birth-weight. Additional data for analysis of birth size and cord blood levels of insulin growth factor and research on genetic and epigenetic questions are warranted.

Factors associated with ease of using community-based systems of care for CSHCN in Hawai'i.

OBJECTIVES: To study factors contributing to difficulty using community-based services by families of children with special health care needs (CSHCN) in Hawai'i. METHODS: Data source was the 2001 National Survey of Children With Special Health Care Needs. The study population included the 449 respondents who were surveyed after additional items were added to the original questionnaire. Outcome of interest was "% of CSHCN whose families report community-based service systems are organized so they can use them easily." Explanatory variables included child health conditions (functional limitation, degree of severity, types of service needs), child and family characteristics (child age, maternal education, poverty level), and health services characteristics (partnership of family in decision making, family-centered coordinated care, adequate health insurance). RESULTS: Children with special health care needs comprised 11.0% of < 18 years old children. Overall, 69% of respondents reported that community-based services could be used easily. Logistic regression analysis showed that the odds of reporting difficulties in using community-based services were almost 5 times higher for families who did not partner in decision making, 2.9 times higher for families who did not receive family-centered coordinated care, and 2.7 times higher for families who did not have adequate health insurance compared with families who were satisfied with the care received. Need for services contributed independently to reporting difficulties in community-based service use. Contrary to the hypothesized associations, severe health conditions or limited functionality did not contribute significantly to reporting difficulties in service use. CONCLUSIONS: Families who reported difficulties in using community-based services were those who have children who need extensive and varied services. Lack of involvement in decision making, lack of coordinated care in a medical home, and insufficient health insurance were the main obstacles to their ability to use community-based services easily.

Ethnic differences in the prevalence of overweight among young children in Hawaii.

OBJECTIVES: To compare the prevalence of overweight among young children of different ethnic backgrounds and describe the age pattern of overweight in early childhood. METHODS: Cross-sectional study of 21,911 children, 12 to 59 months old, participating in the Hawaii Special Supplemental Nutrition Program for Women, Infants, and Children in 1997-1998. They were grouped in eight ethnic categories. For 1-year-olds we defined overweight as weight-for-age at the 95th percentile or more and underweight as weight-for-age at less than the 10th percentile. For 2- to 4-year-olds overweight was defined as body mass index (BMI) at the 95th percentile or more, underweight as BMI less than 10th percentile, tall stature as height-for-age at the 95th percentile or more, and short stature as height-for-age at less than the 10th percentile. The National Center for Health Statistics 2000 growth charts were the reference values. The analysis included bivariate and multivariate methods. RESULTS: Large differences were found among ethnic groups. Among 1-year-olds, Samoans were the heaviest (17.5% overweight) and Filipinos the lightest (30.2% underweight). Among 2- to 4-year-olds, Samoans were the heaviest (27.0% overweight) and the tallest (16.9% tall), whereas Asians were the lightest (12.2% underweight), and Filipinos the shortest (19.0% short). Hawaiians and Asians also had a high percentage of short children (13.6% and 12.2%, respectively). Prevalence of overweight in all 2- to 4-year-olds was more than the expected 5%, especially for Samoans, Filipinos, Hawaiians, and Asians. At age 2 to 4 years, overweight was almost twice as prevalent as at age 1. Multivariate analysis showed that ethnicity (Samoan) had the strongest independent association with weight-for-age percentile, BMI, and overweight in the two age groups, followed by birth weight. CONCLUSIONS: This is the first study of overweight among children of Asian and Pacific Island backgrounds in Hawaii. It identified important characteristics of growth and will be helpful in the design of appropriate activities to prevent overweight.

Pregnancy outcomes among Whites and Filipinos: A paradoxical birth weight-neonatal mortality relationship.

Evidence from the Philippines suggests that, compared to Whites, infants born to Filipino women are more likely to be low birth weight. A paucity of information is available regarding birth outcomes of U.S.-born Filipinos. Using 1979-1987 Hawaii vital record data on single live births to resident mothers, this study compares the maternal characteristics and pregnancy outcomes of White and Filipino mothers, Filipino mothers were significantly more likely to be <18 years of age and single, and have lower educational attainment and less adequate utilization of prenatal care. Significantly higher percentages of very preterm, preterm, very low birth weight, low birth weight, and small for gestational age infants were found for Filipinos. The birth weight-specific neonatal mortality rates for Filipinos compared favorably to Whites except at the high end of the birth weight distribution. After taking into account maternal sociodemographic risk and prenatal care factors in a logistic regression, a significant ethnic difference in low birth weight persisted but was not found for neonatal mortality. These data may suggest that similar neonatal mortality rates among ethnic groups may be possible in the face of persistent birth weight distribution differences and add to the growing evidence that a single standard of low birth weight may be inappropriate as an universal indicator of health status risk in a multi-ethnic population. © 1993 Wiley-Liss, Inc.