Intersection of the Latino Paradox and Weathering in Afro-Latinas

Exploring the Intersection of the Latino Paradox and Weathering in Afro-Latinas What is your project? What are the goals of the project?We would like to conduct a research study which looks at the birth outcomes in native and foreign-born Afro-Latinas to determine if the Latina Birth Outcomes Paradox exists in this group and if birth outcomes are being affected due to Weathering in this population.  Afro-Latinas are Latin American or Caribbean women of African ancestry who are brown or dark skinned.1 We propose a mixed methods longitudinal cohort study following Afro-Latinas, White Latinas, White women and Black women from childhood to middle age in states where a large proportion of Latinos exists: California, Texas, Florida, New York, Illinois, New Mexico, Arizona and Nevada. Numerous biomarkers would be collected via clinical examinations including psychometrics and markers that will allow us to obtain allostatic load and observe telomere length over the life course to determine if Weathering is occurring.  Birth outcomes of interest are low birth weight to infants born to study participants, pre-term birth status, small for gestational age and infant mortality proportions.  Participants will complete demographics and economic characteristic questions to assess race, ethnicity, poverty level, perceived stress and perceived discrimination. We will also conduct In Depth Interviews (IDIs) with a subset of the sample with the goal of documenting community experiences and perspectives of stress and perceived racism, the impact of stress on women of reproductive age, their families, and/or their community, and stressors that affect maternal health. We will study the racial and ethnic differences in birth outcomes as well as examine predictors of birth outcomes and compare these among racial and ethnic groups.Stress, measured in the form of allostatic load, or over exposure to stress hormones can cause wear and tear on important body systems. Exposure to chronic stress and repeated activation of the stress response systems lead to these becoming inefficient and resulting in an increased allostatic load on the body’s systems.2,3  This high amount of allostatic load on the body can take a toll resulting in the development of progression of a broad range of clinical and preclinical pathological processes including cardiovascular disease, obesity, diabetes, susceptibility to infection, carcinogenesis and accelerated aging which is known as Weathering.2  Telomere length is an indicator of aging. Studies looking at the Weathering Hypothesis have found that non-Latino Black women, have shorter telomere lengths and age biologically faster than White women due to the cumulative stress and perceived racism their bodies undergo and work to cope with living in the United States as a Black person.2,4 The Latino Birth Outcomes Paradox indicates that babies born to  Latinas experience lower rates of low birth weight and mortality compared to White women and national averages despite socioeconomic disadvantages and less access to health care services.5,6 In addition, Latinas have favorable birth outcomes on par with White women who have higher socioeconomic status’ and better access to health services in the United States.5,6Latino immigrants are forced to reconceptualize their racial identities when moving to the United states, a country which focuses on a Black-White racial dichotomy.1,7,8  This dichotomy intersects with all life aspects and can have a great effect on health outcomes. Thus, the goal of this study is to understand the role race plays in Latina health and examine the effect cumulative exposure to stress and other health risks has on birth outcomes in Afro-Latinas. Afro-Latinas are not only exposed to repeated stress from discrimination and perceived racism, but they also share the socioeconomic profiles of Black and Latino communities in the United States which tend to be socially disadvantaged. The Afro-Latina experience in the United States is understudied since Latinos are presented as a homogenous group and the health outcomes of White-Latino’s are attributed to Afro-Latinos as well. Little is known about whether Latinos who are socially assigned as Black have different health outcomes from those who are socially assigned as White.Why is this important? What gap in the knowledge does it fill? And how would it contribute to the current understanding of this issue?Latinos are the largest and fastest growing minority group in the Unites States.  In 2017, Latinos comprised 18.1 percent9 of the population (58 million) and this percentage is expected to increase to 28 percent of the population (111 million) by 2060.10 The Latino population in the United States is heterogeneous and comprised of native born and foreign born individuals migrating from at least 25 countries in Latin America, the Caribbean and Spain.7,9 The number of Latinos who identify as Black has been increasing in the United states.  In 2010, there were nearly 1.2 million Afro Latinos in the United States.11,12 Thus, determining the health status and needs of Afro-Latinos is essential since this group contributes immensely to the economy, cultural diversity and health of the nation. Latinos are disproportionately affected by poor conditions of daily life shaped by structural and social position factors known as social determinants of health.Social determinants of health and health disparities shape the leading causes of morbidity and mortality in the United States.  Afro-Latinos have lower median household income, higher unemployment and a higher poverty rate than White-Latinos.11,13 Perceived discrimination has been shown to be associated with increased stress, anxiety and depression in addition to poor general health including smoking and lack of physical activity.14–16  The neighborhoods Afro-Latinos inhabit have lower median incomes, a lower proportion of homeowners and more poor residents than the neighborhoods where White-Latinos live.11 In addition, one study found that Afro-Latinos living in low Latino neighborhoods are more likely to live in Black segregated areas where there are less healthy food options and access; while White Latinos living in low Latino neighborhoods are more likely to live in high White segregated areas where health enhancing resources are available.17 Afro-Latinos have reported a higher prevalence of self-reported hypertension than White-Latinos. In addition, a study found that Afro-Latinos had greater odds of reporting fair or poor self-rated health compared to White-Latinos. 18–20  Some studies have also found that Afro-Latinos  report different experiences in their mental health status than White Latinos.21,22 One study found that Black Latinas have higher levels of symptoms of depression than other Latinas.21 It is possible that in the Latino community, colorism has an impact on mental health. Other studies have found that skin color and discrimination impact self-reported health.23,24 Darker skinned Latinos who faced discrimination report worse outcomes than lighter skinned Latinos who have not faced discrimination in the past year. In regards to birth outcomes in Afro-Latinas one study found that some Puerto-Rican woman with dark skin had a higher risk of having low birth weight infants than those with light skin. 25While very little research has been done on Afro-Latino health, the literature identified indicates that Afro-Latinos report experiencing worse physical and mental health outcomes than White Latinos. In addition, the literature shows that disparities exist between Afro and White Latinos in a way which closely resembles the disparities between non-Latino Blacks and non-Latino Whites.1,17,18,18,26 Latinos who belong to subgroups that have strong African ancestry and are more likely to phenotypically appear as Black,  such as Puerto Ricans and Dominicans27,28, are documented as having worse birth outcomes than other Latino subgroups whose birth outcomes resemble non-Latino Whites.29 However, at present a larger study collecting clinical data has not been done on all subgroups which contain individuals that identify as Afro-Latinas. The Weathering hypothesis which indicates that prolonged exposure to stress in addition to perceived racism and discrimination in Black women leads to early deterioration of health compared to White women2, has not been explored assessing birth outcomes using clinical data including the measurement of telomeres and in Afro-Latinas.  Previous studies on the Latina Birth Paradox have found evidence of the Latina Birth Outcomes Paradox largely among recent foreign-born Mexican immigrants.  The birth outcomes paradox is attributed to the healthy migrant theory, acculturation related behaviors like smoking and nutrition, and social and cultural support during birth via personalism (interpersonal relationships)  and the use of parteras (lay midwives) among those who have recently immigrated.5–7 These effects do not apply to all Latino subgroups however. The heterogeneity among Latino subgroups is often lost due to data aggregration.7 Finally, all the studies found on Afro-Latinos used mainly self-reported measures of health, which are prone to bias. This study will allow us to use more objective measures via the collection of clinical data which can be placed in context and supported by self-report in the IDIs. Much of the current research has studied Latinos as a homogeneous group. There is great heterogeneity among Latinos and many health disparities currently remain hidden for the Latino population, especially Afro-Latinos. It is evident that race influences structural processes which can have downstream effects on health. This study will help us to elucidate the relationship between stress and disease as they relate to birth outcomes in Afro-Latinas.How might your proposed work address and advance health equity? Afro-Latinas are a bridge between two groups with opposing birth outcomes, understanding their birth outcomes will help us address the needs of Afro-Latinas while moving toward greater understanding of characteristics and pregnancy risk patterns separately in Latinas and Black women.This type of study will allow us to determine if the Latino Paradox holds true for Afro-Latinas and to continue to explore Weathering and the biological mechanism through which social structures like white supremacy and racism impose their impact on morbidity and mortality of minorities to produce health inequities. In addition, it will allow us to change the discourse around Latino health which has largely been focused around the Latino Paradox which does not apply to all subgroups. We will further exemplify that Latinos are a heterogenous group in health needs and sociodemographic characteristics. This study will force us to focus on the racial composition of Latinos and the advantages and disadvantages associated with race in the United States while contributing to better understanding of Latino health and disentangling the role of race in the elimination of health disparities.   REFERENCES Cuevas AG, Dawson BA, Williams DR. Race and Skin Color in Latino Health: An Analytic Review. Am J Public Health. 2016;106(12):2131-2136. doi:10.2105/AJPH.2016.303452Geronimus AT, Hicken MT, Pearson JA, Seashols SJ, Brown KL, Cruz TD. Do US Black Women Experience Stress-Related Accelerated Biological Aging?: A Novel Theory and First Population-Based Test of Black-White Differences in Telomere Length. Hum Nat Hawthorne N. 2010;21(1):19-38. doi:10.1007/s12110-010-9078-0McEwen BS. Protective and damaging effects of stress mediators. 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