Journal of Immigrant and Minority Health

, Volume 17, Issue 3, pp 826–833 | Cite as

Revisiting the Hispanic Health Paradox: The Relative Contributions of Nativity, Country of Origin, and Race/Ethnicity to Childhood Asthma

  • Marlene Camacho-Rivera
  • Ichiro Kawachi
  • Gary G. Bennett
  • S. V. Subramanian
Original Paper


This study examined the relationship between race and Hispanic ethnicity, maternal and child nativity, country of origin and asthma among 2,558 non-Hispanic white and Hispanic children across 65 Los Angeles neighborhoods. A series of two-level multilevel models were estimated to examine the independent effects of race, ethnicity, and country of origin on childhood asthma. Lifetime asthma prevalence was reported among 9 % of children, with no significant differences between Hispanics and non-Hispanic whites overall. However, in fully adjusted models, Hispanic children of non-Mexican origin reported higher odds of asthma compared to non-Hispanic white children. A protective nativity effect was also observed among children of foreign born mothers compared to US born mothers. Our study provides evidence in support of the heterogeneity of childhood asthma by Hispanic ethnicity and maternal nativity. These findings suggest moving beyond solely considering racial/ethnic classifications which could mask subgroups at increased risk of childhood asthma.


Asthma Nativity Hispanic Latino paradox 



This study was supported by a National Institutes of Health Career Development Award NHLBI K25 HL081275 and a US Department of Health and Human Services (HRSA) Public Health Traineeship Grant. We thank RAND Corporation for the use of data from the Los Angeles Family and Neighborhood Survey.


  1. 1.
    Abraido-Lanza AF, Armbrister AN, Florez KR, et al. Toward a theory-driven model of acculturation in public health research. Am J Public Health. 2006;96(8):1342–6.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Acevedo-Garcia D, Soobader MJ, Berkman LF. Low birthweight among US Hispanic/Latino subgroups: the effect of maternal foreign-born status and education. Soc Sci Med. 2007;65(12):2503–16.CrossRefPubMedGoogle Scholar
  3. 3.
    Ceballos M, Palloni A. Maternal and infant health of Mexican immigrants in the USA: the effects of acculturation, duration, and selective return migration. Ethn Health. 2010;15(4):377–96.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Creighton MJ, Goldman N, Pebley AR, et al. Durational and generational differences in Mexican immigrant obesity: is acculturation the explanation? Soc Sci Med. 2012;75(2):300–10.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Lara M, Gamboa C, Kahramanian MI, et al. Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context. Annu Rev Public Health. 2005;26:367–97.CrossRefPubMedGoogle Scholar
  6. 6.
    Van Wieren AJ, Roberts MB, Arellano N, et al. Acculturation and cardiovascular behaviors among Latinos in California by country/region of origin. J Immigr Minor Health. 2011;13(6):975–81.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Cagney KA, Browning CR, Wallace DM. The Latino paradox in neighborhood context: the case of asthma and other respiratory conditions. Am J Public Health. 2007;97(5):919–25.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Eldeirawi K, McConnell R, Freels S, et al. Associations of place of birth with asthma and wheezing in Mexican American children. J Allergy Clin Immunol. 2005;116(1):42–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Gold DR, Acevedo-Garcia D. Immigration to the United States and acculturation as risk factors for asthma and allergy. J Allergy Clin Immunol. 2005;116(1):38–41.CrossRefPubMedGoogle Scholar
  10. 10.
    Eldeirawi K, McConnell R, Furner S, et al. Associations of doctor-diagnosed asthma with immigration status, age at immigration, and length of residence in the United States in a sample of Mexican American School Children in Chicago. J Asthma. 2009;46(8):796–802.CrossRefPubMedGoogle Scholar
  11. 11.
    Eldeirawi KM, Persky VW. Associations of physician-diagnosed asthma with country of residence in the first year of life and other immigration-related factors: chicago Asthma School Study. Ann Allergy Asthma Immunol. 2007;99(3):236–43.CrossRefPubMedGoogle Scholar
  12. 12.
    Subramanian SV, Jun HJ, Kawachi I, et al. Contribution of race/ethnicity and country of origin to variations in lifetime reported asthma: evidence for a nativity advantage. Am J Public Health. 2009;99(4):690–7.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Davis AM, Kreutzer R, Lipsett M, et al. Asthma prevalence in Hispanic and Asian American ethnic subgroups: results from the California Healthy Kids Survey. Pediatrics. 2006;118(2):e363–70.CrossRefPubMedGoogle Scholar
  14. 14.
    Lara M, Akinbami L, Flores G, et al. Heterogeneity of childhood asthma among Hispanic children: puerto Rican children bear a disproportionate burden. Pediatrics. 2006;117(1):43–53.CrossRefPubMedGoogle Scholar
  15. 15.
    Canino G, Koinis-Mitchell D, Ortega AN, et al. Asthma disparities in the prevalence, morbidity, and treatment of Latino children. Soc Sci Med. 2006;63(11):2926–37.CrossRefPubMedGoogle Scholar
  16. 16.
    Hunninghake GM, Weiss ST, Celedon JC. Asthma in Hispanics. Am J Respir Crit Care Med. 2006;173(2):143–63.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Cohen RT, Canino GJ, Bird HR, et al. Area of residence, birthplace, and asthma in Puerto Rican children. Chest. 2007;131(5):1331–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Sastry N, Ghosh-Dastidar B, Adams J, et al. The design of a multilevel survey of children, families, and communities: the Los Angeles Family and Neighborhood Survey. Soc Sci Res. 2006;35(4):1000–24.CrossRefGoogle Scholar
  19. 19.
    Peterson CE, Sastry N, Pebley AR, Ghosh-Dastidar B, Williamson S, Lara-Cinisomo S. The Los Angeles Family and Neighborhood Survey Codebook. RAND Labor and Population Working Paper. March 2004.
  20. 20.
    Asher MI, Keil U, Anderson HR, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8(3):483–91.CrossRefPubMedGoogle Scholar
  21. 21.
    Koinis-Mitchell D, Sato AF, Kopel SJ, et al. Immigration and acculturation-related factors and asthma morbidity in Latino children. J Pediatr Psychol. 2011;36(10):1130–43.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Dumanovsky T, Matte TD. Variation in adult asthma prevalence in Hispanic subpopulations in New York City. J Asthma. 2007;44(4):297–303.CrossRefPubMedGoogle Scholar
  23. 23.
    Carter-Pokras OD, Gergen PJ. Reported asthma among Puerto Rican, Mexican-American, and Cuban children, 1982 through 1984. Am J Pub Health. 1993;83(4):580–2.CrossRefGoogle Scholar
  24. 24.
    Jacobson JS, Mellins RB, Garfinkel R, et al. Asthma, body mass, gender, and Hispanic national origin among 517 preschool children in New York City. Allergy. 2008;63(1):87–94.CrossRefPubMedGoogle Scholar
  25. 25.
    Mallol J, Sole D, Baeza-Bacab M, et al. Regional variation in asthma symptom prevalence in Latin American children. J Asthma. 2010;47(6):644–50.Google Scholar
  26. 26.
    Choudhry S, Burchard EG, Borrell LN, et al. Ancestry-environment interactions and asthma risk among Puerto Ricans. Am J Respir Crit Care Med. 2006;174(10):1088–93.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Lind DL, Choudhry S, Ung N, et al. ADAM33 is not associated with asthma in Puerto Rican or Mexican populations. Am J Respir Crit Care Med. 2003;168(11):1312–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Salari K, Choudhry S, Tang H, et al. Genetic admixture and asthma-related phenotypes in Mexican American and Puerto Rican asthmatics. Genet Epidemiol. 2005;29(1):76–86.CrossRefPubMedGoogle Scholar
  29. 29.
    Martin MA, Shalowitz MU, Mijanovich T, Clark-Kauffman E, Perez E, Berry CA. The effects of acculturation on asthma burden in a community sample of Mexican American schoolchildren. Am J Pub Health. 2007;97(7):1290–6.CrossRefGoogle Scholar
  30. 30.
    Joseph SP, Borrell LN, Shapiro A. Self-reported lifetime asthma and nativity status in U.S. children and adolescents: results from the National Health and Nutrition Examination Survey 1999-2004. J Health Care Poor Underserved. 2010;21(2 Suppl):125.PubMedGoogle Scholar
  31. 31.
    Holguin F, Mannino DM, Anto J, et al. Country of birth as a risk factor for asthma among Mexican Americans. Am J Respir Crit Care Med. 2005;171(2):103–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Bostean G. Does selective migration explain the hispanic paradox? a comparative analysis of Mexicans in the U.S. and Mexico. J Immigr Minor Health. 2013;15(3):624–35.CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Ceballos M. Simulating the effects of acculturation and return migration on the maternal and infant health of Mexican immigrants in the United States: a research note. Demography. 2011;48(2):425–36.CrossRefPubMedGoogle Scholar
  34. 34.
    Landale NS, Gorman BK, Oropesa RS. Selective migration and infant mortality among Puerto Ricans. Matern Child Health J. 2006;10(4):351–60.CrossRefPubMedGoogle Scholar
  35. 35.
    Franzini L, Ribble JC, Keddie AM. Understanding the Hispanic paradox. Ethn Dis. 2001;11(3):496–518.PubMedGoogle Scholar
  36. 36.
    Javier JR, Wise PH, Mendoza FS. The relationship of immigrant status with access, utilization, and health status for children with asthma. Ambul Pediatr. 2007;7(6):421–30.CrossRefPubMedGoogle Scholar
  37. 37.
    Akinbami LJ, Rhodes JC, Lara M. Racial and ethnic differences in asthma diagnosis among children who wheeze. Pediatrics. 2005;115(5):1254–60.CrossRefPubMedGoogle Scholar
  38. 38.
    Patel MI, Schupp CW, Gomez SL, Chang ET, Wakelee HA. How do social factors explain outcomes in non-small-cell lung cancer among Hispanics in California? Explaining the Hispanic paradox. J Clin Oncol. 2013;31(28):3572–8.CrossRefPubMedCentralPubMedGoogle Scholar
  39. 39.
    Thomson EF, Nuru-Jeter A, Richardson D, Raza F, Minkler M. The Hispanic paradox and older adults’ disabilities: is there a healthy migrant effect? Int J Environ Res Public Health. 2013;10(5):1786–814.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Dinwiddie GY, Zambrana RE, Garza MA. Exploring risk factors in Latino cardiovascular disease: the role of education, nativity, and gender. Am J Public Health. 2013;. doi: 10.2105/AJPH.2013.301280.PubMedCentralPubMedGoogle Scholar
  41. 41.
    Acevedo-Garcia D, Sanchez-Vaznaugh EV, Viruell-Fuentes EA, Almeida J. Integrating social epidemiology into immigrant health research: a cross-national framework. Soc Sci Med. 2012;75(12):2060–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Canino G, McQuaid EL, Rand CS. Addressing asthma health disparities: a multilevel challenge. J Allergy Clin Immunol. 2009;123(6):1209–17.CrossRefPubMedCentralPubMedGoogle Scholar
  43. 43.
    Wright RJ, Subramanian SV. Advancing a multilevel framework for epidemiologic research on asthma disparities. Chest. 2007;132(5 Suppl):757S–69S.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Marlene Camacho-Rivera
    • 1
  • Ichiro Kawachi
    • 2
  • Gary G. Bennett
    • 3
  • S. V. Subramanian
    • 2
  1. 1.Department of Population HealthNorth Shore-Long Island Jewish Health SystemGreat NeckUSA
  2. 2.Department of Social and Behavioral SciencesHarvard School of Public HealthBostonUSA
  3. 3.Department of Psychology and NeuroscienceDuke UniversityDurhamUSA

Personalised recommendations