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    • The deterioration in birth outcomes is primarily

    2018-11-05

    The deterioration in birth outcomes is primarily evident in the incidence of low birth weight; even when analyzing differences in birth weight, the coefficients are always negative and larger in magnitude compared with those of second-generation immigrants. The average incidence of low birth weight is relatively stable among second- and third-generation white natives, but the coefficient (−0.001) for the third-generation children of Hispanic origin (column 4) declines significantly compared with that observed among second-generation children in column 4 of Panel A (-0.014). Panel B of Table 4 shows that the third-generation children of Mexican origin do retain some of the initial health advantage with respect to the incidence of low birth weight.The deterioration with respect to native birth outcomes is stronger among children of Cuban and Puerto Rican origin.
    Discussion and conclusion The main advantage of this study with respect to the extant literature is the possibility to provide new evidence on the Hispanic paradox in birth outcomes using intergenerational individually linked data drawn from administrative birth records. This allows overcoming some of the methodological limitations of previous studies working with cross-sectional data only. Another important strength of this paper is that it allows identifying second and third-generation immigrants, distinguishing them from higher-order generations of Hispanics. In addition, the data allow a separate analysis of the health trajectories of Hispanics descendants coming from the three major source countries, while most previous studies are limited in their ability to break down the health trajectories by country of origin because of the relatively small sample size or the lack of information on maternal country of birth (Jasso et al., 2004). Yet, this research presents important limitations. First, birth weight is the only outcome observed throughout the PA452 and this limits the ability to consider more comprehensive metrics of fitness at birth. Furthermore, as mentioned above, data drawn from a linked sample of administrative records do not allow to extensively analyzing the possible role of individual economic characteristics (e.g., occupation, income) and behaviors (e.g. dietary habits etc.) that may importantly affect birth outcomes (Guendelman & Abrams, 1995). In addition, before 1989 there is a high frequency of missing information on key control variables such as parental education and age. Compared to previous studies (Fryer & Levitt, 2004; Currie & Moretti, 2007), the quality of matching for children born in California and Florida between 1989 and 2009 whose parents were born in the same states between 1970 and 1985 is relatively high: 96.6% in Florida and 87.5% in California.
    Introduction The Institute of Medicine (IOM) defines a Learning Health System as “one in which progress in science, informatics, and care culture align to generate new knowledge as an ongoing, natural by-product of the care experience, and seamlessly refine and deliver best practices for continuous improvement in health and health care.” (IOM, 2012). Pragmatic randomized clinical trials have been proposed as one mechanism to support a Learning Health System and improve the evidence base of clinical practice. Pragmatic clinical trials are research studies that are conducted during the process of care under situations of clinical equipoise (in which the evidence regarding the risk/benefits of competing treatments is approximately equal) (Elwyn, Edwards, Kinnersley, & Grol, 2000; Little et al., 2001) The goal of pragmatic trials is to ameliorate limitations to the generalizability of research findings by using: (1) typical clinical settings, (2) clinical populations that are representative of the targeted population (as opposed to the highly selected populations commonly enrolled in clinical trials), and (3) clinicians who practice in the situations where the intervention would be implemented (Chalkidou, Tunis, Whicher, Fowler, & Zwarenstein, 2012; Thorpe et al., 2009; Zwarenstein et al., 2008).