Immigrant mothers and access to prenatal care: evidence from a regional population study in Italy.

OBJECTIVES: We addressed the question of whether use of adequate prenatal care differs between foreign-born and Italian mothers and estimated the extent to which unobservable characteristics bias results. SETTING: This study is on primary care and especially on adequate access to prenatal healthcare services by immigrant mothers. PARTICIPANTS: Approximately 37,000 mothers of both Italian and foreign nationality were studied. Data were obtained from the Standard Certificate of Live Birth between 2005 and 2010 in Umbria. RESULTS: Estimates from the bivariate probit model indicate that immigrant mothers are three times more likely to make fewer than four prenatal visits (OR=3.35) and 1.66 times more likely to make a late first visit (OR=1.66). The effect is found to be strongest for Asian women. CONCLUSIONS: Standard probit models lead to underestimation of the probability of inadequate use of prenatal care services by immigrant women, whereas bivariate probit models, which allow us to consider immigrant status as an endogenous variable, estimated ORs to be three times larger than those obtained with univariate models.

Estimating the Smoking Ban Effects on Smoking Prevalence, Quitting and Cigarette Consumption in a Population Study of Apprentices in Italy.

OBJECTIVES: We evaluated the effects of the Italian 2005 smoking ban in public places on the prevalence of smoking, quitting and cigarette consumption of young workers. DATA AND METHODS: The dataset was obtained from non-computerized registers of medical examinations for a population of workers with apprenticeship contracts residing in the province of Viterbo, Italy, in the period 1996-2007. To estimate the effects of the ban, a segmented regression approach was used, exploiting the discontinuity introduced by the application of the law on apprentices' smoking behavior. RESULTS: It is estimated that the Italian smoking ban generally had no effect on smoking prevalence, quitting ratio, or cigarette consumption of apprentices. However, when the estimates were applied to subpopulations, significant effects were found: -1% in smoking prevalence, +2% in quitting, and -3% in smoking intensity of apprentices with at least a diploma.

Height convergence and internal migration in mid-twentieth-century Italy.

Height convergence across Italian regions during the second half of the twentieth century is a widely recognized fact. However, it has been suggested that this process was partly affected by the massive migratory flow of people from southern to northern Italy in the 1950s and 1960s, which greatly slowed the height growth rate in the receiving regions, since immigrants were on average shorter than the receiving northern population. The main aims of this study were to estimate the speed of height convergence of Italian military conscripts in the second half of the twentieth century, and to estimate the contribution of internal migration from the south to the north of Italy to height convergence. We hypothesized that migrants from southern Italy reduced height levels among northerners relative to what they would have been without considering migration. We used cohort data on Italian conscripts born in 1951 and 1980. Results indicate that internal migration may explain from 24 to 32.7 percent of height convergence, meaning that ignoring migration flows yields an overestimation of the height changes for conscripts living in the south of Italy.

Socio-demographic determinants and access to prenatal care in Italy.

BACKGROUND: Many governments have made commitments to examine inequalities in healthcare access based on studies assessing the association between several socio-demographic factors and late initiation or fewer prenatal examinations. This study addressed the question of whether socio-demographic determinants were significant in explaining differences in prenatal care in one administrative region of Italy, Umbria. METHODS: Data were obtained from the administrative source of the regional Standard Certificate of Live Births between 2005 and 2010, and were merged with Census data to include a socio-economic deprivation index. Standard and multilevel logistic regression models were used to analyze the magnitude of various individual-level maternal characteristics and socio-demographic indicators, such as nationality, employment status, education with respect to late access to the first examination, and low number of medical visits. RESULTS: The study involved approximately 37,000 women. The heterogeneous effects of socio-demographic variables were documented on the prenatal care indicators analyzed. A multivariate model showed that women born outside Italy had a higher probability of making their first visit later than the 12th week of pregnancy and low numbers of prenatal medical visits; the estimated odds ratio for the analyzed indicators range from 2.25 to 3.05. Inadequate prenatal healthcare use was also observed in younger and pluriparous women and those with low education; in addition, having a job improved the use of services, possibly through transmission of information of negative consequences due to delayed or few prenatal visits. Interestingly, this study found a substantial reduction in the number of pregnant women who do not use prenatal healthcare services properly. CONCLUSIONS: The aim of this research is to provide more accurate knowledge about the inadequate use of prenatal healthcare in Italy. Results highlight the existence of differences in healthcare use during pregnancy, especially for women from less advantaged social classes (i.e., unemployed or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for their use.

Health and body mass index changes among Italian conscripts born in 1951 and 1980.

This paper investigates changes in BMI in the second half of the twentieth century, focusing on two cohorts of Italian conscripts born in 1951 and 1980, and examines how the correlates of high and low BMI have changed over time. Data from conscript cohorts taken from the archives of Italian military districts show that younger conscripts exposed to the rising prevalence of immune-allergological and psychological diseases and metabolic dysfunctions underwent substantial increases in weight. These results are evidenced by quantile regression models, the largest BMI gains being found in diabetic conscripts at the 75th and 90th percentiles.