Revisiting the hispanic health paradox: The relative contributions of nativity, country of origin, and race/ethnicity to childhood asthma

Background: Asthma is one of the most prevalent chronic conditions affecting children in the United States today, with significant heterogeneity documented between racial/ethnic groups and within Hispanic subgroups. This study examined the relative contributions of Hispanic ethnicity, maternal and child nativity, and country of origin to lifetime asthma diagnosis among children living in Los Angeles neighborhoods. Methods: Multilevel models were estimated among a sample of non-Hispanic white and white children (n=2,558) interviewed within wave 1 of the Los Angeles Family and Neighborhood Survey (2000 to 2002). Mothers reported information regarding children's physician diagnosed asthma, child's race/ethnicity and gender, maternal and child country of origin, socioeconomic status, and maternal history of asthma and smoking. Results: Lifetime asthma prevalence was reported among 9% of children within the sample. Odds of reporting lifetime asthma among children did not differ between Hispanics and non-Hispanic Whites overall; however substantial heterogeneity was found within Hispanic subgroups. Hispanic children of non-Mexican origin reported higher odds of asthma compared to non-Hispanic white children, which persisted after controlling for all covariates. A protective nativity effect was also observed among children of foreign born mothers compared to US born mothers. Conclusion: Our study provides evidence in support of the heterogeneity of childhood asthma across Hispanic ethnic groups and child and maternal nativity, prompting future research to reconsider the use of the term Hispanic Health paradox. Future studies should further examine the effects of nativity within diverse racial/ethnic groups, with a particular focus on multilevel strategies and multifactorial approaches.