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Intergenerational Transmission of the Effects of Acculturation on Health in Hispanic Americans: a Fetal Programming Perspective

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Intergenerational Transmission of the Effects of Acculturation on Health in Hispanic Americans: a Fetal Programming Perspective FRAMING HEALTH MATTERS Intergenerational Transmission of the Effects of Acculturation on Health in Hispanic Americans: A Fetal Programming Perspective Molly Fox, PhD, Sonja Entringer, PhD, Claudia Buss, PhD, Jessica DeHaene, PhD, and Pathik D. Wadhwa, MD, PhD conditions on the developing fetus. The plau- We propose a transdisciplinary, life span framework for examining the sibility of our formulation was supported by underlying cause of the observed intergenerational decline in health among Hispanic Americans. We focus on acculturation, and we posit that acculturation- empirical evidence in the general population related processes in first-generation Hispanic immigrant mothers may affect the that the same psychological and behavioral intrauterine development of an unborn child, via the process of fetal pro- processes associated with acculturation (e.g., gramming, to produce phenotypic effectsthatmayalterthesusceptibilityfor stress, diet) are also known to affect biological noncommunicable chronic diseases. In this manner, an intergenerational processes implicated in fetal programming.37 cascade of perpetuation may become established. Our framework may shed Moreover, studies in pregnant Hispanic women light on the biological, behavioral, and social causes of intergenerational demonstrate that maternal acculturation is cycles of vulnerability among immigrantminoritygroups,with public health associated with the same psychological, be- and policy implications for primarypreventionandintervention.(Am J Public havioral, and biological processes during ges- Health. 2015;105:S409–S423. doi:10.2105/AJPH.2015.302571) tation that are implicated in the process of fetal programming.30,33,38---41 In this way, we suggest The public health significance of addressing the intergenerational aspect of the observed health that the fetal programming perspective poten- issue of health and health disparities in His- decline. We sought to address this important tially offers a parsimonious explanation for the panics, the largest ethnic minority in the United limitation. observed intergenerational decline in Hispanic States1 and an especially disenfranchised seg- In this article, we articulate a novel frame- American health, and also reconciles the ap- ment of American society,2 is well established. work that is grounded in principles from parent contradiction between the observations The fact that the majority of Hispanic Ameri- evolutionary and developmental biology, and in this population that disease risk increases cans are immigrants or the children of immi- we integrate the concepts of biological embed- across generations despite improvements in life grants,3 coupled with the robust epidemiologic ding of life experiences and fetal origins of conditions. observation that Hispanic immigrants in the health and disease risk. We propose that the United States exhibit a progressive decline origins of the observed intergenerational SIGNIFICANCE OF HISPANIC in health over time4---11 and across genera- health decline among Hispanic Americans AMERICAN HEALTH tions,5,12---20 has justified a particular focus on might be traced back to as early as the in- how postimmigration conditions affect health trauterine period of life, at which time the The importance of addressing the issue in this population. The negative consequences effects of acculturation could be transmitted of health and health disparities in minority of acculturation have commonly been invoked from a mother to her as-yet-unborn child via and underserved populations is well recog- to explain this phenomenon, and several stud- the process of fetal programming. This process nized42,43 (Healthy People 202044;NIHHealth ies in Hispanic Americans have established might produce phenotypic alterations in the Disparities Strategic Plan 2009---201345), and the associations between measures of acculturation structure and function of cells, tissues, and need for investigating the social determinants of and adverse health outcomes.21---24 The pre- organ systems that increase the offspring’s health disparities is well established.46---50 In this vailing paradigm posits the deleterious effect susceptibility for developing many of the health context, a particular focus on the Hispanic pop- of acculturation on health is a consequence disorders that are disproportionately prevalent ulation in the United States is warranted. Hispanic of the biological embedding of its psycho- among Hispanic Americans. In this manner, an Americans exhibit disproportionately high rates logical and behavioral sequelae, such as excess intergenerational cascade of perpetuation of of many of the noncommunicable chronic disor- psychological stress,25---27 declining social the deleterious consequences of acculturation ders (NCDs) that confer the major national ties,28,29 and adoption of unhealthy diets and on health might become established. Our burden of disease, including obesity,51 diabetes,52 other behaviors.30---36 This paradigm, as cur- framework also addresses the proximate the metabolic syndrome,53 certain cancers,54 and rently formulated, may account for the observed causal pathway by highlighting the tripartite dementia.55 decline in first-generation immigrant health role of maternal---placental---fetal endocrine, Hispanics currently represent the largest associated with length of residence in the immune, and oxidative-state---related biological minority group in the United States, and it is United States. However, a major shortcoming processes, such as sensors, transducers, and projected that by 2030, Hispanics will consti- is that it does not adequately explain the effectors of acculturation-related states and tute one third of the United States population.1 Supplement 3, 2015, Vol 105, No. S3 | American Journal of Public Health Fox et al. | Peer Reviewed | Framing Health Matters | S409 FRAMING HEALTH MATTERS Moreover, Hispanics are the most rapidly mental14---20 health outcomes, and lower mor- varying rates and time points, in multiple di- growing population in the United States,56 and tality rates67 than second-generation (US-born) rections, with variation in the order and nature the only ethnic group projected to maintain Hispanics. Also, among first-generation Hispanics, of these life changes,115 which is not sufficiently population growth above replacement level.57 longer residence in the United States has been captured in many of the existing instruments. The majority (70%) of Hispanics in the United associated with diminished mental4 and physical One ideology with respect to intercultural re- States are immigrants or the children of immi- health5---11 and higher mortality rates.67 lations, often adopted in the United States, is grants.3 Hispanics exhibit the highest immi- guided by an assumption of assimilation, in gration rate to the United States of any ethnic The Construct of Acculturation which the terms acculturation and assimilation group,58 making up 36% of all immigrants in Of the myriad factors that influence health, are equated and used synonymously. However, the United States.58 Mexican Americans ac- the effects of postmigration sociocultural con- this may not represent an accurate depiction count for the majority (65%) of Hispanic ditions in the Hispanic population may warrant because acculturation can take many different Americans.56 Hispanics represent a disadvan- particular consideration because, as discussed paths.100,116 For example, certain acculturation taged segment of American society. According previously, the majority of Hispanics in the strategies are more often associated than other to the Census Bureau’s Supplemental Poverty United States are immigrants or the children of strategies with health mediators (e.g., psycho- Measure, Hispanics have the highest poverty immigrants.3 The rapid rate of Hispanic immi- logical distress). With regard to the widely used rate (28.2%) of any ethnic group in the United gration is a major contributor to the growth of 4-category model of acculturation profiles by States.59 Mexican immigrants are exceptionally this population.58,92 Migration necessitates ad- Berry,100,117 research has demonstrated that disenfranchised, with the highest poverty rate justment to life in the adoptive-host country, individuals who abandon heritage cultural (29%) of any immigrant group in the United which may be substantially different from life identity alongside acquisition of host cultural States.60,61 in the origin country. This adjustment may identity (“assimilation”), or who retain heritage involve changes in identity, values, beliefs, and cultural identity and do not acquire host EPIDEMIOLOGICAL TRENDS IN behaviors. The term “acculturation” is com- cultural identity (“separation”), may be at HISPANIC AMERICAN HEALTH monly used to describe this process of postmi- greater risk for poor mental health than those OUTCOMES gration adjustment, which involves the acqui- who exhibit a bicultural orientation (“integra- sition of the host-country cultural orientation, tion”).108,109,118---121 However, biculturalism has Two major epidemiological trends have the loss of origin-country cultural orientation, or also been associated with higher levels of stress consistently been described in terms of health both.93---95 Some of the major aspects of cultural attributed to one’s role as cultural translator in outcomes in the Hispanic American popula- change measured in acculturation instruments the family,32,122 and has been associated with tion: a health paradox, and an acculturation are related
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