title: Acculturation and maternal health behaviors: findings from the Massachusetts birth certificate.
abstract: BACKGROUND
  Although prior studies have shown disparities in maternal health behaviors according to race/ethnicity and acculturation, whether these patterns are evident among new immigrant populations remains unclear.
  
  
  OBJECTIVE
  To examine the associations among proxies of acculturation and maternal smoking during pregnancy and breastfeeding initiation within each major ethnic group in Massachusetts.
  
  
  METHODS
  Data were from the Standard Certificate of Live Births on 1,067,375 babies by mothers from 31 ethnic groups for 1996-2009. Mothers reported whether they smoked during pregnancy and the birth facility recorded whether mothers started breastfeeding. The acculturation proxy combined mothers' country of birth and language preference: U.S.-born, foreign-born English-speaking, and foreign-born non-English speaking. For each ethnic group, adjusted logistic regression models were used to examine associations between the acculturation proxy and whether mothers smoked or initiated breastfeeding. Data were analyzed from 2012 to 2013.
  
  
  RESULTS
  A lower proportion of foreign-born mothers had a high school degree or private insurance than U.S.-born mothers. However, foreign-born mothers who were English (range of AORs=0.07-0.93) or non-English speakers (AORs=0.01-0.36) were less likely to smoke during pregnancy than their U.S.-born counterparts. Foreign-born mothers who were English (AORs=1.22-6.52) or non-English speakers (AORs=1.35-10.12) were also more likely to initiate breastfeeding compared to U.S.-born mothers, except for some mothers with Asian ethnicities.
  
  
  CONCLUSIONS
  The consistency of the associations of being foreign-born with less smoking and more breastfeeding suggests that for the majority of ethnic groups studied, acculturation in the U.S. results in poorer maternal health behaviors.
authors.affiliation: Graduate School of Social Work, Boston College, Chestnut Hill, Boston, Massachusetts. Electronic address: summer.hawkins@bc.edu.
authors.forename: Summer Sherburne
authors.initials: SS
authors.lastname: Hawkins
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.affiliation: Department of Sociology, Portland State University, Portland, Oregon.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Shafer
authors.affiliation: Bureau of Health Information,, Statistics, Research, and Evaluation, Massachusetts Department of Public Health, Boston, Massachusetts.
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Cohen
mesh_terms: D000069:Acculturation; D000328:Adult; D001719:Birth Certificates; D001942:Breast Feeding / Q000208:ethnology / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006801:Humans; D016015:Logistic Models; D008404:Massachusetts / Q000453:epidemiology; D008425:Maternal Behavior / Q000208:ethnology; D008429:Maternal Welfare / Q000208:ethnology / Q000706:statistics & numerical data; D011247:Pregnancy; D012907:Smoking / Q000453:epidemiology / Q000208:ethnology