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School of Nursing receives major NIH funding to unravel The Hispanic Paradox

August 2002

by Amanda Gallagher

America: the land of opportunity; a place where children are guaranteed a free education, adults are guaranteed equal opportunities at work and health care is accessible to all. The American ideal builds the foundation for a thriving society. But among the hopes for perfection lies a paradox: The Hispanic Paradox, a troubling trend for Mexican-American mothers.

"Hispanic women who immigrate to the United States tend to have almost the same rate of healthy babies that Caucasian women do, despite poorer socioeconomic conditions," said Jeanne Ruiz, Ph.D., R.N., an assistant professor in the department of family nursing care. "But the higher the integration into the American culture, the poorer the birth outcomes. You would think the Mexican-American women who were educated here, and probably had better access to health care, would have better birth outcomes, but they don’t and that is part of the Hispanic Paradox."

Typically, 8 percent to 9 percent of Hispanic women deliver early, compared to 6 percent to 7 percent of Caucasians. But clinics like Christus Santa Rosa Medical Center in downtown San Antonio see an alarming 19 percent pre-term birth rate among Mexican-American women. The National Institutes of Health awarded Dr. Ruiz a $1.5 million grant to find out why.

"We think there are protective behaviors within the Hispanic culture that are lost the longer a family lives in America," Dr. Ruiz said. "The children who are born in the United States from immigrant families must adapt to American ways, which may be different than their own families’ values and culture. Assimilating into the American culture is stressful, and this stress may be what is leading to such a high rate of pre-term births in these moms."

Dr. Ruiz will study more than 500 Mexican-American women to prove her point.

"I am going to look at the birth outcomes in Hispanic women who just came to the United States versus the second and third generation," Dr. Ruiz said.

She is recruiting 500 pregnant Mexican-American women for the study. The expectant mothers will receive a free ultrasound to ensure there are no complications with the pregnancy. Then they’ll answer a number of questions reflecting their lifestyle and psychological state.

  Monica and Jonathon Sauceda
"We’ll ask them about anxiety, depression, social support and acculturation. We want to see how their minds are affecting their physiological response," Dr. Ruiz said. She also will take blood samples from each patient, measuring four different hormones and five different cytokines. "The cytokines are a measure of immune inflammatory response. We’re trying to see the relationship between the hormones, the immune response, and what is going on in the minds of Mexican-American women."

It will take four years to get the results, but Monica Sauceda can already predict what they will be. Sauceda is a graduate student and a full-time mom. Her son Jonathon, now 8, was born more than a month early. "I thought everything was fine during my pregnancy. At first, doctors didn’t know why he came early," Sauceda said. "But now they think it was because of stress. I was young, only 20, and when I look back, I can’t believe how much stress I had in my personal life."

When Sauceda became pregnant with her second son, she decided to cut back on her workload. Her doctor also referred her to Dr. Ruiz. "I was happy to go," Saucedo said. "Dr. Ruiz asked me about my family life, my financial situation, if I could pay my bills. I knew if I had a problem with anything, she could refer me to someone who could help. It made a huge difference during my pregnancy."

And that is ultimately what Dr. Ruiz hopes to accomplish. "Once we establish links between lifestyle factors, cytokines and hormones, we can develop objective markers and clinical assessments to determine if we need to intervene," Dr. Ruiz said. "My goal is to create interventional and prevention programs for Mexican-American women so we can help prevent early deliveries."

Sauceda applauds the concept. "Women need more support groups. Almost anyone can get pregnant, but not everyone can handle pregnancy," she said. Apparently, Sauceda can. She gave birth to her second son, Jeremiah, a 7 pound, 11 ounce, full-term baby on July 19.


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