MEXICAN MOTHERS NARRATIVES REGARDING THE HISPANIC HEALTH
PARADOX: WHY ARE CHILDREN OF MEXICAN DESCENT SO HEALTHY?
B.S., The Florida State University, 1996
A thesis submitted to the
University of Colorado at Denver
in partial fulfillment
of the requirements for the degree of
Master of Arts
This thesis for the Master of Arts
has been approved
Marquez, Lorena (M.A., Anthropology)
Mexican Mothers Narratives Regarding the Hispanic Health Paradox: Why are
children of Mexican Descent so Healthy?
Thesis directed by Associate Professor Kitty K. Corbett
This research addresses the Hispanic Health Paradox. The paradox is that the
Latino population has lower rates of low birthweight babies, infant mortality, lower
mortality rates in general, and lower rates of many chronic illnesses (Hayes-Bautista
During the course of a five year project called The Mexican Child Health
Study, twenty-eight women were interviewed at six and eight months prepartum,
and every three months from one month to nineteen months of the babys life. The
mothers responded to the question Why do you think Mexican babies are so
healthy? Content analysis revealed that the majority of the responses fell under
three areas: nutrition, which includes breastfeeding; care, such as love and attention
the baby receives; and third, the cohesiveness of the family. Analysis of mothers
responses to the question were supplemented by other qualitative data collected
throughout the project.
This analysis attempted to determine what specifically about each of the three
themes the mothers considered to be important to child health. Interesting findings
that fell under the topic of the family was that it was mentioned at all in this context,
but also the difference in the definition of family given by the mothers in the low and
high acculturation groups. Details about nutrition included the type and quantity of
food and the timing of introduction of solids. Childcare was found to be related to
motherly duties, such as expressing love and giving children attention, but also
making sure that babies physical needs are met.. Sociocultural, economic, and
institutional factors are also considered.
This abstract accurately represents the content of the candidates thesis. I recommend
I dedicate this thesis to all mothers. May the commitment and love for your children
bring you happiness and the respect you deserve. Also, to my parents for their
continued support throughout my life.
Thanks to all of my committee members, especially Kitty Corbett, my thesis advisor,
and Lauren Clark, the Principle Investigator of the research I worked on, who have
worked with me so closely during the past few years. I have learned from all of you,
and will carry this knowledge with me forever.
I would also like to acknowledge my family and friends who have encouraged me,
distracted me, both of which I need to keep me balanced.
The research reported in this thesis was supported in part by the National Institute of
Child Health and Human Development and the National Institute of Nursing
Research (R29 HD32366)
2. BACKGROUND AND RELEVANCE OF THE HISPANIC HEALTH
History of the Hispanic Health Paradox...............7
Anthropological and Political Economic Perspective..12
Impact of Continued Emigration to the U.S. by Mexicans on
Nutrition, Care and Attention of the Children, and Family in the
Context of Mexican Culture..........................16
3. SECONDARY DATA ANALYSIS OF A LARGER STUDY..............21
Sample and Recruitment..............................25
Maternal Narrative Component........................30
Some Notes on Validity and Reliability..............34
A Family Centered Culture...........................36
The Child is Number One.............................42
Nutrition: Frijoles, Traditions, and the Family.....46
Early Introduction of Solids........................54
5. INDEPENDENT PIECES OF A DYNAMIC CULTURE.................56
Are These the Answers that will Solve the Hispanic Health?
3.1 Acculturation Categories........................................27
3.2 Demographic Table...............................................28
1.1 All In One Sentence.
Figure 1.1 All in One Sentence
Figure 1.1 is a quote from Isabel, an informant for this study. What Isabel is
saying in english is The culture there in Mexico is that the mother stays at home and
because of this, takes more care of her children and can give breastmilk, and be more
aware of the (childrens) meals. Her statement highlights in concise fashion the
Hispanic Health Paradox that is explored in this thesis.
The Hispanic Health Paradox is based on epidemiological studies that state
that the U.S. Latino population has lower rates of low birthweight babies, infant
mortality, lower mortality rates in general, and lower rates of many chronic illnesses
(Hayes-Bautista 1980). These lower rates of morbidity and mortality are not expected
based on demographics that point towards poor health outcomes in groups that
resemble Latinos on socio-economic measures. Using these findings as an impetus
this study focuses on maternal and infant health of persons of Mexican descent from
the perspective of this population.
This research is of increasing importance due to statistics that show that
currently Hispanics are the fastest growing minority in the United States and they are
projected to number over 31 million during the year 2000 or 11.4% of the population
(Spencer and Hollman 1997:8-10). It is important to realize that Hispanics as a group
are quite heterogeneous. This study recognizes this diversity. For the purposes of
this study people described as being of Mexican descent include any person that self-
identifies as having ancestors from Mexico. This includes the gamut of recent
immigrants to those who still consider themselves of Mexican descent, but whose
families have been in the United States for many generations. Current Census data
has divided Hispanics into four main groups, Cuban, Puerto Rican, Mexican and
other Latin American. Of these groups, Mexican Americans are currently the largest,
comprising 63.7% of all Hispanics, and they are also the fastest growing subgroup.
Census data also shows that Hispanics have a median age of 26.0 years compared to
the median age of 35.5 years for Non-Hispanic Whites (NHW) (COSSMHO 1995).
Therefore, Hispanics have more childbearing years ahead, making them an
increasingly larger portion of the U.S. reproductive population.
The growth of the Hispanic population has alerted policy makers to the
increasing impact that this population has. One area of interest is that of health. In a
1986 review article, Markides and Coriel identified the epidemiological phenomenon
known as the Hispanic Health Paradox (HHP). This paradox had been identified
approximately 20 years earlier by research that consistently found low rates of use of
psychiatric services (Kamo and Edgerton 1969). Since then Hispanic health
statistics have also shown fewer low birthweight babies, lower overall infant
mortality, fewer chronic illnesses, less cancer prevalence, and in general, low rates of
mortality and lower prevalence of chronic medical conditions (Mendoza et al 1991).
The reason that this is paradoxical is that on these health measures Hispanics
resembled non-Hispanic-whites (NHW) despite having much lower income and
education levels. These socioeconomic measures have been suggested to correlate
with health status (Goodwin 1991), but after more than forty years the reason for the
HHP continues to be a "public health enigma" (Williams, Binkin, and Clingman
As a member of a research team working on a five year longitudinal study
entitled Mexican-origin Children's Health in Cultural Context, I became aware of
some recurring themes in the mothers' responses when they were asked to describe
reasons for the overall good health of their children or other children of Mexican
descent. Based on the responses given by the informants, I realized that that the
traditional literature has failed to incorporate the lay conception of the Hispanic
Health Paradox. Apart from the study informants, when I tell people what the
research I worked on was about, many people, particularly those familiar with
Mexican culture would immediately express their opinions on the discrepancy
presented by the Hispanic Health paradox. Some of their statements resembled, You
know what it is? Its all the beans they feed the children. Or Its all the attention
the moms give the kids. It was this combination of recurring themes and at times
emphatic opinions that inspired me to pursue this perspective of the HHP.
This thesis contains a description of insiders perspectives from maternal
narratives about the HHP. The research is guided by a set of three questions.
1. What are the cultural characteristics that mothers of Mexican descent
attribute to the positive health outcomes of their children?
2. Since the mothers in the research study exhibited varying degrees of
acculturation, it was important to ask whether the women in this
heterogeneous group differed in their responses, and if they did, how?
3. Finally, what do these themes reveal about the meaning of Mexican
culture in the lives of these women and the health of their children?
The responses from the mothers to the question Why do you think your
children are so healthy? varied. Since the coding of the passages was done
inductively, upon first examination there appeared to be many different attributions to
the positive health of their children. Upon analysis the mothers responses could be
grouped into one of three themes: Family, care of and attention to the baby, and
nutrition. Figure 1.1 is a good example of a response from a mother, that captures all
three of the themes. The responses were evaluated by grouping the mothers into
acculturation, educational, and income levels. The only one of these that appeared to
show any relevance was acculturation. Specifically, the difference in acculturation
was how the definition of the family varied by acculturation.
The search for an explanation of the HHP has continued. Since the article by
Markides and Coriel, many studies have looked at quantifiable variables such as
socioeconomic status (SES), education, and income, that could affect health
outcomes, but most have uncovered no correlation so the enigma continues. From an
anthropological perspective, these variables come from the etic perspective. As
recently as October 1999, researchers say that a study into behavioral characteristics
is needed (Abraido-Lanza, Dohrenwend, Ng-Mak, et al 1999). The cultural attributes
that might be affecting health are identified as being of significant importance by
researchers but the cultural processes that might be involved in the HHP are difficult
to decipher using quantitative methods. Many researchers have come to recognize
the importance of cultural differences and cultural effects in relation to health issues
(Pelto and Pelto 1996). An ethnographic inquiry is well suited to study the cultural
processes that might affect infant health (Balcazar, Cole, and Hartner 1992:5).
Unlike quantitative studies, such qualitative based projects would be able to elicit
maternal behaviors, beliefs and attitudes toward the health of their children. This
thesis also attempts to combine what might be superficially construed as static
concepts, into a dynamic interpretation and incorporation of cultural attributes
possessed by the mothers in this study.
The subject matter developed by the mothers and covered in each of the three
themes can each, on their own, be topics for a thesis or dissertation. Some of the
concepts presented have been covered voluminously by expert researchers. The intent
of this thesis is not to present these topics in their full theoretical background and
implications, but to present them as the reasons the knowledgeable informants, the
mothers, give as possible explanations for the Hispanic Health Paradox. By
identifying and reinforcing the cultural attributes that contribute to the positive health
status of this population, the maternal narratives provides valuable information that
can be used to provide more culturally appropriate health and social services to this
under-served population, since some health indicators such as the high rates of
diabetes, are not positive and need to be addressed in an appropriate manner.
BACKGROUND AND RELEVANCE OF THE
HISPANIC HEALTH PARADOX
History of the Hispanic Health Paradox
Hispanics have lower than expected rates of many illnesses and diseases in
comparison to Africans Americans who resemble Hispanics on several demographic
characteristics. The original reason to expect poorer health outcomes is based on an
antiquated minority model of health, where researchers apply research done with
black communities to all other racial and ethnic minority communities. This model
looked at measures of prenatal care, poverty, and educational status as identifiers of
risk. Poverty specifically, is said to "negatively impact diet, stress, self-esteem, and
social isolation, which leads to behaviors such as smoking" (Goodwin 1991). The
point here is that this is not the case among Mexican Americans. Based on the
demographic indicators of poverty, education status, and prenatal care, which tend to
lead to poor birth outcomes in other groups, public health researchers cannot explain
the positive birth outcomes of Hispanic populations (COSSMHO 1995). As discussed
by Frisbie, Biegler and de Turk (1997), these risk factors are considered exogenous
risks, and the effects function through more direct factors such as weight gain,
prenatal care and smoking, among others.
One of the main indicators of the Hispanic Health Paradox has been the
relatively low rate of low birth weight (LBW) of babies bom to Hispanic mothers.
LBW is taken as a measure of risk due to its association with increases in perinatal
death and other causes of morbidity and mortality during infancy and into later years
(Goodwin 1991). What epidemiological studies have found is that Latino women
who resemble blacks in almost all socioeconomic measures had percentages of LBW
babies similar to non-Hispanic Whites (Williams, Binkin, and Clingman 1986,
Fuentes-Afflick and Lurie 1998). This advantage has been called into question by
demographic data collected by Frisbie, Biegler and de Turk (1997) that concluded
that there is a relatively higher likelihood of compromised birth outcomes among
African Americans relative to Mexican Americans and Anglos. They point out that it
is African Americans that exhibit the health incongruity by having poor health
outcomes, not Mexican Americans who have positive health outcomes. This is true
among most Hispanic groups, specifically those people of Mexican and Cuban
descent. In contrast to the other two Hispanic groups mentioned, Puerto Ricans have
the highest number of LBW babies and also exhibit the highest level of risk factors
(Cohen 1993). This emphasizes the heterogeneity of Hispanics and how there might
be protective variables derived from Mexican American culture specifically or about
the situation of Mexican Americans in the U.S.
In the U.S. the major Hispanic groups are Cubans, who are mainly in Florida,
Puerto Ricans, who are most populous in New York, New Jersey, and Connecticut,
and Mexicans, who are concentrated in the Southwestern United States. Although
these groups may all fall under one categorical listing, they vary in many socio-
economic markers such as education, income, and marital status. Just as the people
grouped as Hispanic are diverse, so are the people that are of Mexican descent. For
example, a person of Mexican descent can fall under the categories of Chicano,
Mexican American, Latino, Latin American or Raza. For the purposes of this study,
the choices for ethnicity related to being of Mexican descent and are specified in the
methods section. Mexican descent is defined to be persons who can trace their
lineage back to Mexico, whether it be a recent immigrant who was bom in Mexico,
or a person whose family came from Mexico five generations ago. Due to this inter-
group diversity, it is important to realize that these groups are very different and
research results cannot be compared to each other (Hayes-Bautista 1980).
Key differences among Mexican Americans, such as variances in behaviors,
choice of language most used, music, food preferences, et cetera (Clark and Hofsess,
1999) are usually labeled acculturative. For the purposes of this research,
acculturation has been operationalized to resemble the definition by Kaplan and
Marks. They state that acculturation is the process of change towards the dominant
culture along the dimensions of beliefs, values, and behavioral practices that result
from contact between the cultural groups (Kaplan and Marks, 1990). Acculturation
happens for several reasons. One reason is the change in surroundings associated
with the move from Mexico to the U.S. The majority of people that come to the U.S.
from Mexico are usually from rural areas, and although at one time Mexicans were
associated with migrant field workers they are now most numerous in large urban
areas (Arevalo 1994). A difference in socialization to the U.S. mainstream between
rural and urban Mexican families has been reported and could be important in
relation to health outcomes (Buchwald et al 1994). Buchwald also reports
emigration from a rural area is a predictor of behavioral ethnicity. Environmental
differences force people to adapt to changes in working patterns, nutrition,
communication with family, and health care services. So, in order to adapt
immigrants must change certain behaviors. The cultural values, behaviors, and ethnic
identification associated with acculturation also vary intergenerationally (Vega
1990). These acculturative differences are reported to affect health behaviors and
outcomes as observed by health professionals (Clark and Hofsess 1999)
Because of the awareness of these differences between cultures,
epidemiological investigations began to examine if these differences might be
apparent in health statistics. One of the first investigations into this showed a marked
difference in morbidity and mortality. As acculturation increases, the health status of
people of Mexican descent decreases (Markides and Coriel 1996; Cramer 1995).
This also holds true for all immigrants. U.S. data shows that individuals who are
foreign bom tend to be in better health than respondents bom in the U.S. (Abraido-
Lanza, Dohrenwend, Ng-Mak, et al 1999).
Explanations and hypotheses for this paradox vary. Earlier explanations
examined both the possible methodological errors in analysis of vital statistics as well
as the possible cultural attributes of Hispanics. Two models explain favorable health
experience of Latinos and especially mothers bom in Mexico. One theory, known as
the Healthy Migrant Theory, states that Latino mothers who migrate are healthier
than those who do not migrate (Williams, Binkin, and Clingman 1986). A second
possibility brought forth is that birth in Mexico is merely a marker for a lifestyle that
is protective against negative social influences on pregnancy outcomes (Scribner and
Dwyer 1989). Some say there is an underreporting of infant deaths (Williams,
Binkin, and Clingman 1986), which has been discounted (Abraido-Lanza,
Dohrenwend, Ng-Mak, et al 1999). Abraido-Lanza et al, also examined what is
known as the Salmon Hypothesis, whereby immigrants are thought to return to
their country of origin and are thereby rendered statistically immortal. At one
point it was thought that the level of prenatal care might be related to health
outcomes but this has been ruled out (Balcazar, Cole, and Hartner 1992). Mexican
mothers who had late or no prenatal care were at the lowest relative risk for LBW
(Mendoza et al 1991). This implies that protective lifestyles and behaviors might
predate pregnancy and have a strong mediating effect in the Mexican population
(Balcazar, Aoyama, and Cai 1991, Guendelman, Gould, Hudes et al 1990), which
supports the second theory that mentions the protective lifestyles that might be
associated with Mexican birth.
Specifically these positive protective influences include a cohesive family,
church, and community systems (Winkleby, Fortmann, and Rockhill 1993), which
could work to stabilize the effects of immigration, poverty, and minority status
(Zambrana 1995). One reason given is that holding on to Mexican culture gives
women an important psychological benefit because it might increase their sense of
self-esteem and sense of coherence, that might be threatened by an otherwise
overwhelming majority (James 1993). Strong family support, presence of extended
family, and preservation of traditional beliefs and values are possible cultural factors
that favor positive pregnancy (Williams, Binkin, and Clingman 1986). Some
behaviors that also favor positive health outcomes include low use of tobacco, and
alcohol, better nutrition and a higher regard for parental roles when compared with
whites (Balcazar, Aoyama, and Cai 1991). Whatever these positive lifestyle factors
(Hayes-Bautista 1990, Scribner and Dwyer 1989) cultural attributes, or protective
factors (Balcazar, Peterson, and Krull 1996) are, they somehow counter the poverty
and low education of this population (Winkleby, Fortmann, and Rockhill 1993).
Anthropological and Political Economic Perspective
Looking back historically, Engles discussed the idea of social origins of
disease in "Conditions of the Working Class in England". His variables included
poverty, unhealthy working conditions, crowded housing, poor nutrition, and lack of
political power, resulting in social alienation, depression and self-destructive
behaviors such as alcoholism (Chavez 1986). Others working in what has become
known as the political economy point of view such as Virchow echoed the belief that
origins of illness were to be found in social and economic origins (Drotman 1999).
Concerning minority and maternal child health the anthropological
perspective centers around both the political economic issues such as allocation of
health resources and social origins of illness (Chavez 1986), but it can not forget the
biocultural issues, especially in dealing with minority groups and their transition into
the globalized culture, that are reflected in increased diseases rates such as diabetes.
A Medical Ecological perspective must include class, ownership of productive forces,
and the extraction of profit. Because the restructuring of social relationships can
have a radical impact on health status, researchers must understand the nature and
determinants of social transformation as important to medical anthropology.
From a different perspective Durkheim (1988) blames the disappearance or
erosion of traditional values and norms on the expansion of industrialization. This is
also supported by field studies which claim that the deterioration of the protective
factors of Mexican culture begins before the people leave Mexico (Selby, Murphy,
and Lorenzen 1990). It is the "promotion of coke, Doritos, Kool-Aid that the U.S.
food industry has drastically altered the eating habits, nutrition, culture, and economy
of the Mexican people.. .transnational corporations affect the health of Mexicans by
committing the people to produce export crops making staple crops less available
while corporate produced junk more accessible" (Miller 1993: 91). This
internationalization combined with urbanization and a downward economic trend that
led to a financial crisis has reduced the number of urban jobs since the mid 1980s
(Selby, Murphy, and Lorenzen 1990).
Statements such as Mexican culture is protective (Balcazar, Peterson, and
Krull 1996), are quite encompassing but at the same time elusive. To be able to
understand how culture affects health one must first begin with a clear definition of
culture. According to noted anthropologist E. Tylor (1988: 64) "culture is that
complex whole which includes knowledge, belief, art, morals, law, custom, and any
other capabilities and habits that can only be acquired by man as a member of
society." Although the definition of culture has evolved over the succeeding 100
years it is a definition that is none the less all encompassing. These variables can
account for or explain actual behaviors (Pelto and Pelto, 1996: 301), from what we
wear to what we eat and how people behave towards others.
The ability to conceptualize culture is necessary due to the association of
culture with many health characteristics of populations. Health is a multidimensional
phenomenon that includes dimensions of the individual, family system, community,
environment and societal resources (Zambrana 1995). For example, some
researchers make an association with low rates of smoking and drinking as benefits
of association with Mexican culture (Balcazar, Peterson, and Krull 1996). This lower
incidence of smoking has been said to be a marker of a larger group of behaviors
(Scribner and Dwyer 1989).
Impact of Continued Emigration to the U.S.
by Mexicans on Health Care
The importance of this research lies in the growing number of immigrants
coming to the U.S., particularly from Mexico. Maintaining the health of immigrants
through culturally appropriate means offers the best solution to increasing health care
costs to all. As people from Mexico and other countries continue to emigrate to the
U.S. it is necessary to realize that these people bring with them traditions that differ
from the mainstream U.S. population, and which have been used by these people for
generations. These traditions inevitably affect health. Although some traditions have
changed or might have been lost all together some traditional ways persist in some
forms. This proves the existence of selective utilization of resources that prove
adaptive. Some immigrants tend to retain or discard behaviors based on the influence
of American medical culture and its views on birthing. Study of maternal behaviors,
beliefs and attitudes surrounding the pregnancy experience might provide answers for
the difference in number of babies bom at term weighing 2500 grams or less which is
considered low birthweight (Gaviria, Stem, and Schensul 1982). Researchers also
state that further research is required to identify those variables (cultural, social,
familial, economic and medical) responsible for the ethnic differences observed
(Balcazar, Cole and Hartner 1992). Possible components of Mexican orientation that
have been identified to need further investigation include nutrition, familial
integration, smoking, alcohol use, and out of wedlock births (Scribner and Dwyer
1989). Also, a high carbohydrate diet and a lower incidence of tobacco and alcohol
use are characteristics that favor positive pregnancy outcomes in Mexican women
(Poma 1987). These are all issues in line with the themes of the importance of the
family, childcare, and nutrition, brought forth by the maternal narrative explanation
of the Hispanic Health Paradox.
The strength of some traditions that allow them to persist despite other
traditions being lost to acculturation and adaptation to U.S. mainstream culture is
important to identify. This thesis attempts to extract some of these behaviors as they
affect health outcomes in people of Mexican descent. The positive deviance from
expected health outcomes should be acknowledged by the general public, due to the
fact that it shows that Mexican immigrants are not a drain to the U.S. economic and
health care system. These traditions that persist in the Mexican American
community have implications to health care providers and how to provide the best
type of care to patients of Mexican descent.
Nutrition, Care and Attention of the children, and Family
in the Context of Mexican Culture
Many of the suggestions from the literature to explain the HHP are in
accordance with what the mothers in this study stated: family, care, and nutrition.
Family, which is associated with many forms of social support, has positive effects.
Higher levels of family cohesiveness promoted the most positive health and
psychosocial outcomes. These strong family bonds are said to discourage deviant and
risky behaviors (Balcazar, Peterson, and Krull 1996). La familia emphasizes the
resiliency of ties between relatives dispersed demographically and cross-
generationally and their integration into a mutually supportive network (Wagner and
Schaffer 1980), by providing advice, assisting with childcare, and general social
Part of family cohesiveness that is characteristic of Mexican culture is the
importance of the maternal role. For some cultures being a mother and rearing
healthy children are the most important achievements of a woman (Higgins 1983).
One example is the lower incidence of nonmarital births among Latinos as compared
with African Americans is suggestive of possible differential attitudes in parental
attitudes (Williams, Binkin, Clingman 1986). Also, Mexican American mothers are
more likely to be married. This likeliness of marriage is associated with the emphasis
of the family in traditional Mexican culture, and is usually limited to family defined
within the household (Golding and Baezconde-Garbanati 1990).
Mexican American women define themselves almost exclusively in the
maternal role (Andrade 1980) which could explain pregnancy in young Mexican
women. In this population the mother usually does not work because there is a more
positive view of housewives (Zambrana 1995; Golding and Baezconde-Garbanati
1990). The mothers stay home because they have been socialized to. This, however,
is beginning to change. Some women of Mexican descent are feeling tom between
the established patriarchal norm where the females are supposed to stay at home, and
personal desires of defining themselves as productive members of society, outside of
the household (Gil and Vazquez 1996). Women of Mexican descent have a difficult
with the changes in expectations of a woman when they come to the U.S., but female
power can never be the rejection of motherhood and the capacity to nurture but rather
it is the fulfillment of all aspects of social life (Melville 1980).
This importance of the maternal role could explain the issue of child care that
is brought forth by the mothers in this study. The mothers state that certain
characteristics of childcare are relevant to the positive health status of children of
Mexican origin. Need for affection is not simply a sentimental value among humans
but a fact established by research findings, from neurophysiology to primate studies;
its lack, or its opposite, rejection or aggression has been examined crossculturally by
The third theme emphasized by the mothers was the nutritional aspect.
Nutrition can positively affect health status beginning with what mothers eat during
the prenatal period to what they feed their infants and family. This implies looking at
the dietary intake of the population as a whole, infant feeding decisions, and the
importance of the cultural aspects of nutrtition.
As might be expected, mother's food knowledge is significantly related to the
their children's intakes of key nutrients (Contento, Basch, Shea et al 1993). When
mothers mentioned the use of beans for example, they would also talk about the
important vitamins and minerals in this food and especially the iron. In the literature,
results concerning the healthfulness of foods are contradictory. Surveys have found
that Mexican Americans are less likely to practice positive dietary behaviors which is
even exhibited in their food purchases (Olvera-Ezzel, Power, and Cousins, 1990).
Specifically Mexican Americans have been found to have a higher intakes of fat
(Delapa, et al 1990).
Some say that this deterioration of diet begins before people leave Mexico.
The deterioration of diet is attributed to the promotion of items such as Coke,
Doritos, etc. by the U.S. food industry in Mexico as well as changes associated with
acculturation (Guendelman and Abrams, 1995). First generation Mexican Americans
were found to consume more protein, carbohydrates, cholesterol, folic acid, calcium,
vitamins A and C, beta carotene, and fiber (Guendelman and Abrams, 1995), but
after immigration foods such as mayonnaise, Kool-Aid, Tang, ham, sour cream
became important foods (Romero-Gwynn, 1993) Although the cholesterol would be
the only one to be negative indicator, it is important to note that Mexican Americans
do not suffer from high cardiovascular mortality (Guendelman and Abrams, 1995).
In a San Antonio heart study it was found that Hispanics in general had higher intake
of fats, but the most acculturated demonstrated the greatest avoidance of fats
(Haffher, Knapp, and Hazuda 1985).
Others report positive nutritional behaviors such as one study showing that
Mexican Mothers tend to use more fresh fruits and vegetables (COSSMHO, 1995)
and a study in Denver, CO found that despite low mean household incomes, the
toddlers had adequate or better intakes of required recommendations (Sanjur, Garcia,
Aguilar, et al 1990). Previous studies have found that dietary practices of Mexican
American women may protect against lung and breast cancer. Dietary intakes of
Mexican American adults that were higher than those of Cubans and Puerto Ricans
can possibly be attributed to greater use of legumes (Kuczmarski, Kuczmarski, and
SECONDARY DATA ANALYSIS OF A
The data collected for this research is a subset of data from the project,
Mexican-origin Childrens Health in Cultural Context. The mothers were
participants in this 5-year longitudinal conducted in a large metropolitan area. The
ultimate goal of the larger project was to describe the processes of health production
in the context of the Mexican family where the mothers are the primary care givers.
Perceptions and expectations of professional health care were also explored.
This ultimate goal is broken down into five aims.
1. Describe the processes involved in child health.
2. Describe the mothers expectation of both professional child health care.
3. Describe the mothers expectation of household based child health care.
4. Combine the previous two aims and explore any intracultural diversity in
this arena of health production and perceptions of professional health.
5. Take the cultural context and describe both the narrative and graphic
models of household health production of children.
The data for this larger study came from several sources. The primary
method of data collection was from interviews conducted with the 28 participants of
the study. Occasionally other family members also took part in the interviews. The
mothers were first interviewed, usually at their homes, while they were 6 months
pregnant, the second visit was at the eighth month of pregnancy, at birth, and regular
visits every three months at 1,4, 7,10,13,16, and 19 months of the childs age. This
interview schedule was set up according to the framework outlined by Sander (1965)
for mother-infant interactions.
All the interviews were tape recorded, transcribed verbatim, and coded. The
home visits and interviews were conducted in Spanish or English depending on the
mothers preference. All team members who conducted interviews had competency
in both Spanish and English. The mothers were given $25 at each visit. Monetary
compensation has long been used by anthropologists conducting field research and is
considered the most appropriate way of compensating (and thus increasing
participation among) Hispanics" (Marin and Marin 1991).
Since this project was a focused ethnography, the type of interviews
conducted can best be described as semi-structured (Bernard 1995). The questions
were open-ended but a guide was particularly important due to the fact that three
researchers were conducting the interviews. During the prenatal period the mothers
were asked open ended, but focused questions concerning experiences during the
present and previous pregnancies. When the baby was bom, the questions shifted
more towards the childs health and what steps the mother took to maintain health in
the household, as well as health care seeking activities, and nutritional practices.
Structured interview data was also collected. This data was to assess
socioeconomic status (SES), acculturation, and income. At the beginning and at the
end of the study the mothers were asked to fill out an acculturation rating scale
known as the LAECA acculturation scale (Bumam, Hough, Kamo, Escobar, and
Telles 1987). Most acculturation scales use language as the main determinant of
acculturation. In contrast, the LAECA scales also takes into account place of birth of
the respondent, their parents and grandparents, what type of radio music they listen
to, the primary language on television, association of friends that are also of Mexican
descent, etc. In short the LAECA acculturation scale is more comprehensive and
useful in determining relative acculturaiton. Information on SES was based on the
Nam-Powers- Terri (Terri and Nam 1994) scale. Information on family income was
also taken at each visit. Many researchers have called for the use of this type of data
to describe and categorize this population (Balcazar, Castro, and Krull 1995,
Goodwin 1991). The participants also did an acculturation pilesort for future
development of a more appropriate acculturation measurement tool.
Other data included fieldnotes, participant observation, and focus groups.
Any fieldnotes were added to the particpants' file and coded, and any general
observations were kept in a separate memo file. Four focus groups were conducted
during the study, each with different topics of discussion. The first one was
concerned with the advice that grandmothers may give. Fathers from the study were
invited to the second focus group for their opinions on child rearing practices. The
third group was a peer group who discussed nutrition and feeding practices. Peers
were considered to be mothers from the community that were of Mexican decent and
of similar age. The final focus group was with health care professionals who worked
in community clinics. The information collected from these groups added to the
research data to overcome some of the limitations of interview settings and served as
a form of triangulation.
A hermeneutic photography component was also built into the study which
also gave great insight into the lives of the families observed and again served to
overcome the limitations of a formal interview.. This type of data served to
supplement the interview data. This interpretive photographic component of the study
involved three typesh of photographs. One form of photographs collected was from
disposable cameras given to a random set of twelve study participants at each home
visit. The mothers were to take photographs that pertained to the childs health
during the three months in between interviews. At the following visit the mothers
were then asked how the event pictured related to health. The second type of
photographs was by researchers when they visited the families. The third type of
photographic data that was collected was a project where three families, each
representing one of the three acculturation levels operationalized for this study.
These families were visited for an entire day from the time the child woke up until
the child went to sleep. The mothers were given duplicates of all the pictures that
pertained to their family.
In order to have a triangulative measurement on actual child health to
compare to the interview data, anthropometric measurements were taken. The
anthropometric data of weight and length which tracks the growth of the children in
the study was compared to the NCHS percentiles. Other data on triceps and
subscapular fat percentile and arm circumference were also taken at each visit.
Medical record data were examined for infant health outcomes. The mothers
were asked to sign consent forms for all health care centers the child attended. These
allowed the investigators to view all medical records for both the child and the
mother. This data served several purposes. It added to the interview data on child
illness episodes since data on such things as immunization, number of visits could be
obtained from these records, and are pertinent to child health (Clark 1995), and the
health care professionals diagnoses which can be compared to the information
provided by the mother. As suggested by Hammersley and Atkinson, ethnographers
need to take account of documents as part of the social setting under investigation
(Hammersley and Atkinson 1995:158). An in-depth comparison of the maternal birth
narrative from both the interview data and the medical record were completed.
Sample and Recruitment
At the time of recruitment all the women in the study had to be multiparous
and pregnant. When recruitment was extended, a total of three primaparous women
entered the study. The women of the study all came from the city and county of
Denver. As of 1990 Denver had a total population of 467,610 of which 23% are
categorized Hispanic. Since this research focussed on people of Mexican origin, it
should also be noted that 6% of the Denver population in 1990 wered grouped as
Mexican. The women who were recruited had to live within a circumscribed area of
the city. Citing 1990 U.S. census data, Clark (1996) reports this as a 5 square mile
area in the metropolitan area having a Hispanic concentration of 67.6%. Participant
mobility lead to many of the participants moving out of the study area. Since the
setting was not primary in the investigation this was seen as being acceptable and the
mothers who moved, remained in the study. A total of 28 expectant mothers began
the study with a total of 24 mothers completing the study.
The participants were recruited from local HMOs, private doctors offices,
and several county clinics. The Principal Investigator or the Research Assistants
approached the mothers at the clinic. If the expectant mothers were interested they
were asked to fill out a short questionnaire and consent form that asked their address,
their due date for the pregnancy, their language preference, and to self-identify their
ethnicity. The choices for ethnicity were Mexican, Mexican American, American of
Mexican descent, Latina, or Chicana of Mexican descent. These categories are both
member identified and observer identified categories. This was done because this
process is inextricably linked with the development of analytical ideas and the
collection of data (Hammersley and Atkinson 1995).
An informed consent form approved by the Colorado Multi-Institutional
Review Board, was presented to the participants in either Spanish or English,
depending on their preference. This document emphasized that participation was
voluntary and informants were free to withdraw at any time. The names of the
informants have been changed in this text to psuedonyms in order to provide them
with the privacy that is stated in the consent form.
It was intended that the participants were of different acculturation levels, in
order to see intracultural variation. How the participants were assigned to
acculturation groups is displayed in Table 3.1.
Table 3.1 Acculturation Categories
Characteristics Most Traditional Mexican N=13 Bicultural N=7 Mexican American N=8
Generation 1st Generation 1st Generation 2nd Generation or greater
Language Spanish only Bilingual Spanish and English Primarily English only
LAECA Score LAECA score<2.0 LAECA score 2.0-3.0 LAECA score >3.0
Although this was a convenience sample, the variety in the types of
recruitment sites allowed for different income levels and consequent levels of
acculturation in the participants as demonstrated in Table 3.2.
Table 3.2 Demographic Table
Number of Children
LAECA Acculturation Score
Single or Separated 5
Not Employed 19
These quantitative tables are presented in order to provide a reference point
on the demographics of these mothers, but by no means should these mothers be
thought of in statistical terms. Very few of the mothers in this study completed a
high school equivalent education, but despite this, they have years of teaching by
other mothers in how to raise children. One must remember that good mothering
does not necessarily come from knowing all the multiplication tables or the capitals
of African countries.
The interview data collected was coded using Atlas.ti qualitative data analysis
software (Muhr 1998). With the help of Atlas.ti software the total of 245 (check this
number) interviews were coded. Codes for the larger study were developed
inductively, all falling into the categories of acts, activities, meanings, participation,
relationships, and settings as suggested by Lofland and Lofland (1971) Based on this
framework, most codes were descriptive in nature, with a few considered interpretive
(Miles and Huberman 1994).
As new codes emerged during data collection they were added to the coding
dictionary. Interviews not coded with new codes were noted and were recoded
during the second coding phase. The codes were developed between the team of
researchers until they agreed (MacQueen, MacLellan, Kay et al 1998). Definitions
for the codes were included in a coding dictionary to ensure that the codes were
consistently applied by the researchers over time and so that multiple researchers
will be thinking about the same phenomena as they code (Miles and Huberman
1994). To check reliability several interviews were double coded by another one of
the researchers. As Miles and Huberman (1994) state, this type of coding brings
researchers to an unequivocal and common vision of what the codes signify and
which blocks of data best fit which code.
Maternal Narrative Component
The focus of this thesis research is to seek the emic perspective of the
Hispanic Health Paradox as explained by mothers of Mexican descent. By examining
the maternal narrative explanation of the Hispanic Health Paradox, it is possible to
gain a new perspective to this elusive question of "What are the Mexican cultural
attributes that promote positive health outcomes in this population?" This furthers
the aims of the larger study by exploring the cultural aspects of household based
health care production of this population.
The data to support this perspective of the Hispanic Health Paradox came
from the larger project previously described. On a personal level, I had a caseload of
five out of the twenty-eight women interviewed. Although this is a small percentage
of the total I was also in charge of transcribing all of the interviews that were done in
Spanish and some of those in English, and at team meetings we discussed all our
cases. All this gave me a deeper understanding of the lives of the study participants.
A search was conducted in the Atlas.ti database of 245 interviews for any
instance in which the mothers talked about why they thought their children were so
healthy, which was coded as Why Healthier. Most of these instances came in
response to a question resembling Why do you think your children are so healthy?
The analysis contained elements of content (Krippendorff 1980) and narrative
analysis (Reissman 1994). First, the retrieved text was coded again with new codes
that captured cultural aspects described by the mothers to explain why their children
are healthy. As suggested by Crabtree and Miller (1992), after the text was coded,
the frequency of different code occurrences was counted to identify important areas
for further investigation.
Each maternal narrative was inspected to see what was being said first, what
took the bulk of the narrative, and what was carried through the whole segment of
text by each mother. This was done to determine whether there was consistency in
the explanation by each mother interviewed and if one theme was thought to be more
important than another by each mother. This also indicates if each theme is present
in the cultural framework of each mother.
Three salient themes emerged inductively through this process. These themes
were nutrition, family cohesiveness, and attention and are discussed here as defined
by the interview data. Carefully chosen segments of interviews were chosen as
definitions and examples of each theme in order to operationalize each concept.
(1) The theme of nutrition is based on discussion in the narrative about the types and
quantity of food that the child eats and overall emphasis by the mothers of the
importance of eating "natural" foods. This definition arose from quotes such as this
one from one informant ^Sera porque la comida que come uno, no? O sea que uno
come mas comida natural. Translation It could be the food that one eats, no? In
other words, one eats more natural foods.
(2) The family cohesiveness theme relates the emphasis on having family nearby to
assist in some childcare and basic importance of interaction with family.
(3) The theme of attention and care of the child details the importance of the child in
the family structure.
Based on these themes further data analysis ensued. The codes were further
developed and placed into categories (Miles and Huberman 1994) based on nutrition,
family cohesiveness, and care and attention. Based on these themes, the Why
Healthier data is supplemented from the full text of interviews and by focus group
data. Once the themes were identified, the original full set of interviews were
searched for codes pertaining to these three themes. For nutrition, the codes for
breastfeeding, feeding practices, food given to the child, formula, prenatal vitamins,
and prenatal nutrition were pulled. Pertaining to care and attention of the child,
attention, cleanliness, discipline, description of what a good mother should be,
emphasis on wanting to be with the baby, and reasons for working or not working
were looked at in greater detail. For family cohesiveness, adopted by grandmother,
babysitting, family living arrangements, female solidarity, friends, social networks,
and visit at birth were also examined. This detail examination of the 245 coded
interviews, focus groups, photos, and time spent in observation were a part of a larger
body of text that informed the ultimate interpretation of the maternal Why healthier
narratives. This both reinforced the findings of the maternal narrative, elucidated
and expanded the details on the themes described. It was done as a triangulation, to
confirm what the mothers said, since the data on the maternal narrative of the
Hispanic Health Paradox came from 40 of the total 245 interviews conducted. This
greater body of data added to the ultimate goal of defining each of the three themes
according to the overall narratives of the mothers.
In order to verily if the mothers of different acculturation, education, or SES
groups emphasized different themes their response were examined in each of these
contexts.Taking into consideration the literature stating that the health advantage for
Hispanics appears to be lost with acculturation, the mothers were separated into three
acculturation groups. The women were also separated by high and low education and
income levels. Low education was operationally defined as equal to or less than 6
years of maternal education (n=7). High was defined as greater than or equal to 11
years of school (n=12) for the mother. This is based on suggestion by Balcazar that
education in Mexico is structured so that sixth grade is approximately equivalent to a
twelfth grade education in the United States, where most people consider the end of
education in the respective countries (Balcazar, Castro, and Krull 1995). High SES
was defined as the income of the family being greater than 1 of the poverty threshold,
and low SES was less than 1 on the Nam-Powers-Terri scale.
Some Notes on Validity and Reliability
Due to the great variation in people in the U.S. considered to be of Mexican
descent, the external validity of this study should be addressed. The ethnographic
nature of this study limited the number of informants to a total of 28 all of which
came from the same metropolitan area. On account of this, extrapolation of the
findings presented should be done conscientious of the regional differences exhibited
by people of Mexican descent in the U.S. Whether these differences can be attributed
to migration patterns or differences in infrastructure in different U.S. cities or towns.
To insure validity in the coding process, only those portions of narrative from the
main body of data that was in response to the question "Why do you think your child
is healthy?" was selected. All answers to this question were coded as "why healthier"
in the main database. There were portions of text in the main body of data that were
coded as "why healthier" that did not follow the question. These instances were
assumed to be interpretive and subjective and were not analyized for the Maternal
Triangulation of other forms of data such as measuring growth or examining
medical records to determine number of illness episodes to determine if the themes
brought forth by the mothers actually contribute to health is not in the scope of this
study, although it would be interesting for future research. Some pragmatic validity
is established by the fact that the responses analysed came from multiple informants
who were all asked the same basic question.
From the set of 22 inductively derived codes three themes arose from the
maternal narrative: Importance of the Family, Child care, and Nutrition. They share a
common driving force which is best described as the family being the single most
important impetus for action, and within this, the place of children as number one.
Most women of Mexican descent face unique challenges that compromise an
individuals ability to optimize health, such as crowded living conditions and
substandard economic conditions. This is a particular stress to women, since they are
in charge of all elements pertaining to their familys health.
This section will describe the differences in attitudes within a group of
mothers, which at the same time, are just variations of the family theme that is found
throughout Mexican culture and are well covered in the literature. It has been
observed that family is important to Mexican culture, and is, from this study, an
attribute that can be considered consequential in the study of health outcomes in this
group. This importance of the family is then also taken to the level of childcare in
people of Mexican descent. The last theme, nutrition, may be able to stand alone, but
as is explained in the narrative, it is inextricably linked to the main theme of family.
A Family Centered Culture
The importance of the family is not something that should come as a surprise
when speaking of Mexican culture. As mentioned, familism, is one of the cultural
attributes that appears frequently in the Hispanic health literature, and researchers
have said it is a possible explanation for the HHP (Markides and Coriel 1986, Kamo
and Edgerton 1969). Actually familism is sometimes used interchangeably with
family cohesion, and for the Hispanic population, with la familia which is described
as the resiliency of ties between relatives dispersed demographically (Wagner and
Schaffer 1980). Familism is best understood in terms of the face to face interaction
or supporting behaviors (Vega 1990). Family cohesion is more of the emotional
bonding that family members have toward one another (Vega, Patterson, Sallis, et al
1986). These are all used to describe the importance of the family that threads
through Hispanic culture.
The maternal narratives give a slightly different perspective. Although family
is very important across all levels of acculturation there is an operational difference
in how each acculturation group defines the family. Again research has shown that
there is a difference in attitudes towards familism based on acculturation, but for this
(familism) cultural attribute it is not a direct or linear relationship. Size of social
networks and attitudes towards familism have been found to differ based on
acculturation (Zambrana 1995).
It is also suggested that the importance of family cohesiveness in acculturated
persons can be attributed to the time immigrants have had to reassemble ties lost with
migration (Balcazar, Peterson, and Krull 1996). Even among the most acculturated
individuals, Latinos exhibit attitudes and behaviors that are very familistic (Zambrana
1995). This counters regular assimilation theory because some studies indicate that
familism and social support increases with each generation living in the U.S. (Keefe
and Padilla 1987, Vega, Patterson, Sallis, et al 1986), discrediting notions that
familism is directly associated with "Mexicanness."
First, for the most acculturated group, the meaning of family is defined by the
presence of the extended family. Mothers, grandmothers, aunts, uncles, and cousins
are all important in the maintenance of health of the children. As Nina said, I think
that he says that it comes down to the family being so close, close- knitted, you
know, that grandparents still watch the grandkids and if possible in your own home.
And you know, stuff like that. And that's the way it is with ours. As shown in this
quote, the relationship with the extended family in this group is usually identified
with their availability to help with childcare and other forms of social support. These
mothers associate extended family with positive health outcomes because, by leaving
the children with family members, it is not necessary to go to a professional daycare
center. These daycare centers are seen as not being able to provide the children the
emotional attention that is exhibited by family members, and as centers of contagion
for illness, because of the presence of many other children to spread disease.
NAZARIO: You know, the other thing is Day Care. That's true.
NINA: You know, that's why it's probably going to come down to
that you mention it.
NAZARIO: Gettin' sick. Colds.
NAZARIO: In Mexico your kids don't go to Day Care. And we're
fortunate that we have our grandma downstairs. So he doesn't get sick
On the other end of the acculturation spectrum family is also very important
and is seen as a mediator in protecting children's health. Demographically, research
in California shows that Latinos have high rates of intact nuclear families (Hayes-
Bautista, Baezconde-Garbanati, Schink, et al 1994). In this study the mothers who
were considered recent immigrants and categorized under the Mexican type did not
mention any sort of help from the extended family. To the least acculturated mothers
the family consists of what is commonly known as the nuclear family unit, comprised
of the mother, dad, and kids.
The way the Mexican mothers explain it, it is the devotion of the mother to
the family that has the positive effect on health. This is somewhat in line with the
concept of Marianismo, where the mother, and females in general, are expected to
put her wants and needs behind those of her duties as mother (Gil 1995). Many
authors refer to this with negative connotations such as sacrificial (Poma 1987), but
Isabel is quite eloquent in her explanation of this concept and illustrates how this
devotion is something considered natural and positive.
ISABEL: La tradition, por ejemplo una madre modema, una madre
antigua, ahora se usa mucha, se le puede dar pecho, pero por
comodidad se da leche de formula porque ya las madres modemas
tienen que trabajax o tienen que salir fuera de casa. La cultura alia en
Mexico es que la estarse, este, en la casa y por lo mismo tiene mas
cuidado con sus hijos, se le puede dar leche matema, esta mas
pendiente de sus comidas.
ISABEL: The tradition, for example a modem mother, a
traditional mother, now it is used quite a bit, one can breastfeed,
but for practical reasons, one gives formula milk because now the
modem mothers have to work or have to go outside the house.
The culture, there in Mexico is that the mother stays at home and
because of this, takes more care of her children, they can give
breastmilk, and be more aware of the (childrens) meals.
These expectations of the nuclear family are also reported by Zambrana et al
(1997), where Mexican immigrant women experienced more support from the babys
father during during the prenatal period than Mexican American women during this
same time period.
There are special considerations that must be taken into account when
considering what defines family for this group. This difference in the definition of
the family between the mothers On each end of the acculturation spectrum create a
distinct line in these women, which is also discerable when speaking about maternal
employment. In the preceding quotation, Isabel explains how since the mother is
dedicated to her family and stays at home, she is able to provide special care to the
child, give the child breastmilk, and be more conscious of meals. For the less
acculturated mothers, it is this "family first" that drives the care and attention given to
the children and the importance of feeding them well. There are those in the Mexican
category who do not even see working as an option, and those that are tom because
they "have" to return to work, but don't have extended family present to assist with
Olivia, one of the Bicultural informants, brings some of the characteristics
from both sides of the definition of family together.
LISA: Why do you think that children in Mexican households are
OLIVIA: I think we're more united. We're more family united.
LISA: Um hmm.
OLIVIA: Personally that's what I've seen. A lot of us, Hispanic.. .I've
seen a lot of Anglo mothers that go to work right away and we're
LISA: When the baby is bom?
OLIVIA: Yeah. We'll sit back and we'll wait to go back. We're more
bonded as a family. We're more united. That's why I think.
LISA: So there are more people that take care of the baby?
OLIVIA: Its not there's more people...there's more family
involvement. The grandma, grandpa, dad and mom. Even the older
siblings. It's what I notice.
LISA: Anything else? Any other things?
OLIVIA: Um huh. No. It's just mostly the way the family is united.
Olivia illustrates the importance of the family, and in this case, family
cohesiveness. In the case of Olivia and several other women in the study, family is
the first thing she mentions when asked about why Mexican children are considered
healthy, and then moves on to explaining a delayed return to work after the childs
birth, which coincides with the importance of the involvement of extended family,
voicing what many of the Mexican American mothers mention as being the important
aspect of family, the presence of other family members. This is in contrast to most of
the Mexican mothers who did not work during the study.
The explanation for this difference in the definition of the family is shaped by
several observations. The most salient of these is that the recent immigrants have
little or no family at least in the metro area, but also throughout the U.S. (Anderson,
Wood, and Sherboume 1997). Many of the least acculturated mothers long for the
togetherness they had in Mexico. This group exhibits a loose social network
resembling that of families that are physically mobile (Bott 1971: 106), but still
value extended kin networks. Although distance does not allow for active support,
the ties to family in Mexico are still meaningful for those here in the U.S. More
established Mexican families have close-knit networks because they tend not to be
physically mobile. These findings support those of Balcazar, Peterson and Krull
(1996) who state that more highly acculturated individuals reported higher levels of
family social support than less highly acculturated individuals. It is the most
acculturated who have had time for other family members to establish themselves in
the same metro area, but this familism increases with each generation in the U.S.,
which discredits earlier assumptions that familism is related to "Mexicanness" (Vega,
Patterson, Sallis, et al 1986). At first it was thought that the importance of the family
should be exhibited in the least acculturated and these "family ties" would be lost
with acculturation. Instead of acculturation being the barrier to family cohesiveness,
the mothers in this study point towards physical distance from the extended family as
the main obstacle. Greater length of residence allows for the time necessary for
family members from Mexico to immigrate and join these families here in the U.S.
The details of this cultural category are not in what defines it, but in its
relationship to the other two themes emphasized by the mothers. The concept of
familism is supported by nutrition and childcare statements, and will be further
The Child is Number One
Due to the nature of this category and of the research questions in general,
this category becomes inextricably linked with familism and nutrition.The question
here is, which of these characteristics do the mothers associate with positive health
outcomes? As explained under the family theme, it could be the importance of being
a dutiful mother that counts towards having healthy children as well as the fact that
this culture is very child centered.
In the context of this study, childcare can be operationally defined by what
most might consider to be "motherly" duties, such as keeping the children warm,
clean, or well fed, but most importantly it is the physical and emotional attention that
the children are given. Some of the mothers identified some of the physical acts of
childcare from brushing the childrens teeth, to making sure they took their baths, as
well as the importance of showing the children love or (in Spanish) carihos.
Some of the physical acts of taking care of the children are specific to
Mexican culture. Here Nina gives a response that applies as an example.
NINA: I think it goes back to the old wives' tales that the
grandparents and great grandparents bring to us. Whether it
is herbs or whether it is, just you know, covering your
head or not walking barefoot, or whatever. That must have
Here we see the explanation of the interrelatedness of culture, family, and childcare.
First, old wives tales can be seen as a form of cultural symbolism. She tells about
the transmission through the grandparents, and how they tell mothers how to take
care of the children. This willingness to learn and accept comments by the new
mother, and the willingness to share by the older more experienced family members,
is a result of familistic attititudes so prevalent in Mexican culture. Nina, who is lucky
enough to have family nearby, expresses this type of teacher-student relationship
between new mothers and experienced mothers.
NINA: But they're probably the ones more to know. We're just
learning from them.
NINA: So we don't even know what the secret is, or if we're doing
right or wrong. And yet with them, you know, I mean they can throw
things at us and say...we're sitting here saying, "Oh my God. I don't
know what to do. The baby has this or that." And she will say, "Oh
just do this, this, and that."You know. And so...it's...and it's just a
cultural thing that goes back.
This learning and sharing of experiences on mothering is many times more powerful
than biomedical instruction that the mothers may receive, as evidenced by the early
introduction of solids, which will be described in detail.
From what these mothers say about the mother working, the children of
working mothers are exposed to both physical and emotional factors that could
inhibit health. First, if the mother works, she can not as easilyprovide the emotional
and physical attention that children need to develop emotionally. Second, the
mothers who work must use some type of daycare which expose children to cold air
and others kids germs. In Mexico, as well as in most Latin America countries, the
women stay at home and the men work.
GLORIA: Pues, lo mas importante es la salud. Que tengan salud y
carino de parte de los padres, y comprension para que no se hagan
malos ninos. Porque ya ve que hay mucha gente que tiene los ninos y
no los ve en todo el dia porque se va uno a trabajar y ya no tiene uno
comunicacion con los ninos y ni les da todo lo que necesita y no mas
los deja uno todo el tiempo con las senoras que los cuidan. Y es darles
mucha atencion para que tengan, para que vivan mejor...
GLORIA: Yo digo que es lo mas importante que tiene que tener un
GLORIA: Well, the most important thing is health. That they have
health and love on the part of their parents, and comprehension so they
dont turn into bad kids, because there are lots of people that have kids
and doesnt see them the whole day because they go to work and dont
communicate with the kids and dont even give them everything they
need and they leave them all the time with the ladies that take care of
them. Its about giving them lots of attention so they have, so they live
GLORIA: I say that it is the most important thing a baby has to have.
This Mexican mother values staying home with the children. She draws the
comparison to other mothers who work and leave their children with someone else
for childcare. She says that this way the parents lose the ability to communicate with
their children because they are not there. By being present for the child, the parents
can give them the attention and understanding that children need. This same mother
GLORIA: Pues, no se, yo creo que por los descuidan. Ellas se
van. Trabajan. Los dejan tiempo con gente que los cuidan.
Los sacan mas de la casa. Pues yo digo que por eso, porque
no los cuida bien la senora que los cuida.
GLORIA: Well, I dont know, I think its because they dont take
care of them. They leave. They work. They leave them (children)
with people that take care of them. They take them out of the house
more. Well, I say thats why, the lady that takes care of them doesnt
take care of them well.
She mentions that taking them physically outside the house brings on more illnesses.
Many of the less acculturated mothers mention that staying inside with a baby is very
important in preventing illness. Traditionally this is associated with the practice of
Cuarentena, where the mother is supposed to take special care of herself and the
child. This folk belief of the Cuarentena period leads many mothers to hesitate about
leaving the home, taking newborns outside, adhere to certain food restrictions, and
showering, among other limitations, for the first 40 days post-partum, and sometimes
even longer. Today this practice is seen less for reasons which are also based on
acculturation, immigration, and convenience as summarized by Clark (in prep), but
mothers of all acculturation levels in this study talked about keeping the children
warm and limiting their exposure to the out of doors which they can not do if they
work, because inevitably they must take the children to day-care.
Nutrition: Friioles, Traditions, and the Family
PALOMA: Segun como los acostumbra uno. Alla en Mexico casi
siempre los hombres trabajan y uno no, y aqui si. Aqui trabaja la
mujer y el hombre, y no tiene tiempo de darle comida a los ninos.
PALOMA: Its how one trains them. There in Mexico the men
usually work and we dont, and here you do. Here the man and the
woman work, and dont have time to give meals to the children.
This quote gives the cultural explanation of why the mothers stay home and how this
affects the feeding of the children. Mexico has always been described as a
patriarchal culture, but the importance of the mother is sometimes understated. She
is the one that has the responsibility for the children and their welfare. Again this is
an example of Marianismo. A good mother is one that is married, stays at home and
takes care of their husbands and children (Williams 1990). From an acculturated
fathers perspective the importance of the family and the nutritional aspect of health
maintenance is also captured in the following exchange where the mother, Belicia
explains her husbands feelings.
BELICIA: I think it's like what he (Balcazar) said. The food. They
have a lot more help, like a lot of them have help from...they all live
together and stuff...a lot of extended families live together. And like us
we always have someone, like family...
Both of these examples express the implication of the family aspect in nutrition. This
association of the family with nutrition is expressed when the mothers speak of types
of foods they serve their children, breastfeeding, and the introduction of solids. In
some way the family, whether it be the meaning of family or the physical presence of
family members, is involved.
It was not the intent of this study to measure the dietary intake of the
participants, but due to the nature of the questions asked it was possible to assess the
attitudes of the mothers toward nutrition and the perceived association they make to
positive health outcomes. Although having appropriate nutrition is vital to health, it is
the attitudes towards nutrition that can be seen as cultural characteristics. Food is not
only a basic requirement to sustain life, but "food habits are among the most
emotionally based and culturally bound of all activities" (Lang 1992: 8) and is used
as an expression of sociocultural values (Coronios-Vargas. Toma, Tuveson, et al
In this study the concept of nutrition consists of the mothers' perception about
what are good and bad foods and how all these nutritional aspects contribute to the
health promotion aspect, specifically concerning breastfeeding versus formula, the
introduction of solids, and the use offrijoles (beans) in the Mexican diet. The
concern and dedication of the mother with proper nutrition found in the least
acculturated group is also explored.
The first link of Mexican culture and nutrition is demonstrated by Gloria.
Gloria was an informant who was a first generation Mexican informant.
GLORIA: ^Sera porque la comida que come uno, no? O sea que uno
come mas comida natural. Que verduras, que uno hace, o sea que no
compra uno, de bote, de lata, todo eso. ^Yo digo que por eso salen
mas sanos no? Por la alimentacion que les da uno. Y los cuidados que
tiene uno con ellos.
GLORIA: It could be the food that one eats, no? In other words, one
eats more natural foods. Like vegetables that one makes, in other
words, dont buy canned foods and all that. Thats why I say they turn
out healthier, no? Because of the food that we give them, and the
attention that we have with them.
Here, the importance of eating natural foods is described. Gloria makes the link to
attention with the baby through making food instead of buying it pre-made, or using
food out of the can. This example portrays the notion that cooking and making sure
the children eat well is part of the cultural practice of focusing on children.
Mothers believed canned foods are bad because they contain chemicals. However,
these mothers, like all mothers, demonstrated their own rating scale on the
healthfulness of foods. Some mothers know these types of powder sugar drinks are
bad because of the high sugar content, but others put it into the "juice" category. Pop
or soda is also recognized by this group as a bad food, but through home
observations, soda is very present in the diet of most families. Many in this group
recognize unhealthy foods, but they do not act on this information. Mothers that
described good foods mainly stuck with staple foods such as potatoes, rice meat
vegetables, et cetera. Besides these very general categories of foods, they also
mentioned foods that are associated with Mexican culture such as chilis, tortillas,
sopas (soups), and beans.
Based on the literature reviewed, the effects of marketing by processed food
companies are affecting nutritional behaviors in a direction that is negatively
affecting health (Miller 1993). Mexican mothers are taking advantage of the
convenience provided by processed foods. The replacement of caldos (soups) with
Ramen Noodles reduces vegetable intake and the replacing of fruit juice with Tang or
Kool-Aid also has negative consequences, but there is still something about Mexican
traditions and culture that are acting as an opposing force or at least slow in its
response to changing food habits (at least for the time being). At the same time these
conveniences and selective targetting of marketing campaigns for junk food to
Hispanics (Critser 2000) take a toll on health, as evidenced by the high levels of
obesity and increased rates of Non-Insulin Dependent Diabetes Mellitus.
Frijoles are identified by the mothers as directly associated with positive
health outcomes. In response to being asked about what makes Mexican babies
healthier than expected, one mother immediately responded, Its the beans its got to
be the beans. Mothers cite the vitamins, minerals and iron available in frijoles,
demonstrating their food knowledge, which has been found to significantly relate to
children's intakes of nutrients (Contento, Basch, Shea, et al 1993).
LAUREN: What do you thinks going on, that's going right? That
makes Mexican babies healthier than you would expect.
ADRIANA: The food, more protein and fiber in the food.
LAUREN: A hum.
ADRIANA: Cause they are eating more beans and tortillas and getting
more fatter and (laughing).
Elena, a recent immigrant, talks about the nutritive value of beans as well as their
use in multiple recipes.
LISA: A sus hijos le gusta?
ELENA: Si, al le gusta mucho los frijoles y todo que hago con quesos
y sopas y asi. No es muy buena la sopa pero si los frijoles. Tienen
mucho hierro, muchas vitaminas y hierro y todo. Todo asi, lo que
cocino, tortillas de harina, lo que hago, ellos comen. Tacos de frijoles,
de papa. Los dos se les doy y comen ya.
LISA: Do your children like it?
ELENA: Yes, he likes beans quite a bit, and everything that I make
with cheese and soups and like that. The soups are not very good, but
the beans are. They have lots of iron, lots of vitamins and iron and
everything. Everything that I make, flour tortillas, whatever I make,
they eat. Bean tacos, potato (tacos).
Elena mentions the many recipes or uses for beans and the vitamins, minerals,
and iron found in beans. Although this fact by itself may seem unimportant, the fact
that frijoles were mentioned almost equally across the three acculturation groups is.
It should be appropriate to say that frijoles are a symbolic indicator of ethnic identity.
In the American Southwest the term beaner is sometimes used to refer to Mexicans.
Although this is generally derogatory, it demonstrates the association of beans with
Some eating habits are lost with acculturation, but now we see that at least the
use offrijoles persists. Specifically, this shows three things. One, how things are
passed down through the generations. Second, how Mexicans identify with beans as
a staple in their lives, that resembles what Emiko Oknuki-Tiemey (1995) says in Rice
as Self, that there is a certain qualitative value placed on rice or in the case of
Mexicans, in beans, that speaks to more than just the nutritional value. It shows a
cultural importance that is symbolic to the people. Frijoles' nutritional value can be
seen as a folk belief among people of Mexican descent.
If beans are seen as symbolic of Mexican culture, the fact that beans were
mentioned in all three acculturation groups demonstrates the ability of some portions
of culture to withstand the pressures of acculturation and remain a vital part of
Mexican culture. In this case, it is some of the behaviors relating to nutrition.
Although mothers may have breastfed out of necessity in the past or even
because of the inaccessibility of formula in Mexico, most of the mothers in the study
associated breastfeeding with more biomedical factors such as increased immune
response and overall positive health. Even the recent immigrants know and
acknowledge this. From the literature it seemed as though breastfeeding was seeing a
decline all over the world, due to the introduction of formula products. Surprisingly,
initiation of breastfeeding among Mexican Americans is lower than that for non-
Hispanic Whites but highest among the top three Hispanic groups, Mexican, Puerto
Rican, and Cuban (Stroup-Benham and Trevino 1991). Within this group, the
women bom in Mexico showed a rate of breastfeeding that was eight times greater
than their more acculturated counterparts (Balcazar, Trier, and Cobas 1995). When
this sample was analyzed for breastfeeding as relating to the question of "why
healthier," a combination of these two statements were apparent. The least
acculturated group mentioned breastfeeding as a positive factor affecting child health.
In the Bicultural acculturation group this declined and in the Mexican American
group breastfeeding again was mentioned as protective. This corresponds to data
gathered by Rassin, Markides, Baranowski et al (1994). Besides measures of
acculturation in women, they also used education levels as variables. Their findings
indicated that the least and most educated women were the most likely to initiate
If the mothers in this study did not breastfeed they usually mentioned some
extenuating circumstance that prevented them from doing so. Any extra-household
work that separates mother and child makes carrying out intentions to breastfeed
more difficult (Quandt 1996) But some mothers simply did not force the issue if
breastfeeding was not convenient or comfortable, because the option of formula is
LISA: ^Que cosas hace para mantener la salud?
ELENA: Pues quien sabe porque nunca se me enferman. Siempre,
pues el es bien bueno para comer. Dicen este si, jugos, pero dicen
porque siempre les doy pecho y ellos resisten mucho la
enfermedad.. .Como la de mi hermana que se enferma mucho. Ella
casi no le dio. Le esta dando leche. Yo le tuve que dar a los dos, pues
dice que le hacia bien a ella. Pues lo primero lo que le debe dar es
pecho para una enfermedad o algo, pues ellos pueden resistir mas.
Esta bien, porque uno como le hace como en Mexico o algo que se
enfermen, alia esta muy lejos el doctor.
LISA: What do you do to maintain their health?
ELENA: Well, I dont know cause they never get sick. Always, well
he is a good eater. They say that juices, yes, but they say its because I
always breastfeed them and they resist illness.. .Like my sisters child
gets sick quite a bit. She hardly gave her (breastmilk). She is giving
her milk. I had to give them both, and they say it did her well. Well,
the first thing one should give a child is breastmilk for an illness, well,
they can resist more. Thats right, because how does one do it in
Mexico when they get sick, and the doctor is far away.
Elena suggests that since she breastfed her boy, he was rarely or never sick. She
backed it up with verification from the doctor that wondered about the good health of
the baby. From this narrative we also see that breastfeeding is a type of adaptation to
the rural life in Mexico, where the doctor is usually inaccessible, so breastmilk is said
to be important because of the anti-infective properties. So as explained by Elena,
now that they are here in the U.S. breastfeeding continues and so does the better
health of the children.
And then I breastfed 'em so, that's a lot healthier for 'em
LISA: You always breastfeed them?
MARIS A: Yeah.They don't get sick as much.
LISA: Mmm hmm.
MARIS A: You know, and if they do get sick it doesn't stay with them
Early Introduction of Solids
OLIVIA: It's so many things that we feed the babies when the babies
they are, you know baby-babies. Like, I don't know if you know about
yerba and manzanilla and muchas cosas que nosotros, we Mexicans
give to our babies. These kind of tea. Many in my country don't use
that kind of stuff. I got friends who work here and they don't believe
that stuff. They tell me, "You're crazy."
This quote illustrates more Mexican traditions exhibited in food practices.
Teas and herbs are very important in this culture, and most of the mothers in the
study used them at least once during the two years that they were in the study. There
is a type of ethnic pride involved in what they feed their children that is demonstrated
in the mere fact that the traditions are kept. This quote also brings up the issue of the
early introduction of solids. Although mothers usually said that they follow doctor's
orders, introducing other solid foods, instead of relying solely on formula or
breastmilk, seems to be prevalent in this population. For one mother mentioned this
fact as the reason why Mexican kids are so healthy. This is not an issue of failure to
comply, but rather an emphasis on the role that food plays in Mexican culture.
Hispanics may be more likely to introduce solids at an early age (Wright et al in
OMalley 1991). For example, in another study, beans, either just the water or bits of
beans squeezed skinless into the mouth was first food for all infants, were initiated
around 4-6 weeks (Johnson in Melville 1986). This is contrary to recommendations
by American Association of Pediatrics to withhold solids until four to six months.
Most mothers are aware that they are going against doctors orders, as Olivia explains
We do against what the doctors say, like with her the doctor said don't feed her until
she's 6 months. I started feeding her at a month old. This same idea is more detailed
in the following conversation with Marisa.
MARISA: He eats all the time. I mean he's eating. So I give
'em eggs, rice, beans, since you know, since he started
getting his teeth. Smash it up. My mom always does. My mom,
you know, with the little ones. It's like, "It's okay, as
long as you smash it up real good.".. .That's what I do, and you know,
I've always fed 'em food.
INDEPENDENT PIECES OF A DYNAMIC CULTURE
The analytic focus needs to change from that of
elucidating static categories of traditions, values and
belief systems to a more dynamic view of Latinos as
cultural creators and to understanding of the processes
by which Latinos continue to create meaningful action
(Furino 1992: 148).
Although the three themes elucidated by the mothers may initially seem
separate and distinct, it becomes apparent that they are best examined and explained
as an interrelated group of cultural attributes that affect health status. They are a
package deal. One aspect cannot be examined without looking at the host of other
factors affecting the group. As mentioned, some researchers have tried to base some
findings on acculturation scales and measures to see where mothers in this category
might fit, in order to explain behavior. Again this becomes a fixed concept when
looked at in reality. With this dynamic population it will be a great task to try to
make a gradient scale based on static portions of what constitutes the dynamic
culture. Due to the nature of some research, this multidimensional approach of
looking at the proposed interrelatedness may prove challenging. Nonetheless linear
measure such as acculturation have elucidated many aspects of culture and change
but it does not suffice in the explanation of the Hispanic Health Paradox.
For example, familism explains some behaviors among Mexican Americans,
but it cannot explain them as a lone variable. So, family alone is not going to be
shown as a mediator of illness, but when it is used to bring together other variables
that can be found to be affected by the family, such as is the case with nutrition in
this study, it will make understanding of Mexican culture stronger. As Hector
B alcazar said (Personal communication, December 10, 1999) once you recognize and
peel off one layer of culture, you see that the details become even more complex. All
parts of culture may not remain active in the most acculturated, self-identified
Mexican-Americans, but they are to some degree still influenced by these main
characteristics of Mexican culture.
The narratives of these themes when looked at together point to one thing:
this population is very child-focussed, and this is what drives the actions involved
with the importance of the family, child care, and nutrition. This importance of the
family and the children can be seen as multidimensional concepts that can explain
static concepts associated with this population. This emphasis on the child also,
automatically, makes the role of the mothers more important. Whatever might be
said of Mexican women, their domestic role is not passive. They give warmth,
support, and affection to family members, all of which are essential family functions
(Mirande and Enriquez 1979) that are usually taken for granted. These
characteristics are reinforced by the iconolatry of the Virgin of Guadalupe which
represents the sanctity and suffering of motherhood (Rodriguez 1994). For most
mothers in the study the issue of working was a concern in that mothers that work
can not dedicate the necessary time to their children and was reflected in answers
within each theme.
As emphasized the themes brought forward by the maternal narrative make a
stronger impact on the understanding of the production of health in Mexican culture
when looked at as an interrelated and dynamic set of cultural attributes. There were
however, messages in each of the three themes that can be separated and can add to
the understanding of Mexican culture, from the insiders' perspective.
Pertaining to the family, the difference in the definition of what constitutes
the family between the least and most acculturated subgroups is the most notable
message. For childcare the main references were to daycare. The important thing to
take from these statements and as expressed by the mothers is that they prefer to stay
home with the kids, or take them to be watched over by family. This idea of
childcare also includes the traditions and folk beliefs of the cuarentena and "keeping
babies warm". Indirectly, one of the most important aspects of childcare in this
research is the way it links values and themes of family and nutrition. Although this
may be a consequence of the fact that the discussions during the interviews were
about child health, the importance of the care of the child cannot be understated.
The mothers speak in what can be construed as very general and non-
scientific terms, although concerning nutrition they do mention the availability of
some vitamins and minerals in some of the foods, specifically beans. Marvalene
Hughes (1996) uses the example of African Americans, but what she states is
universal: a mother's expression of love, nurturance, creativity, sharing, patience,
economic frustration, survival are all embodied in meal preparation. Meals and food
preparation reference the place of what is considered proper childcare in this
Part of the message that can be derived comes from the prevalence of beans in
the diet and the importance of the family. These attributes show that there are some
Mexican specific cultural attributes that withstand the pressures of assimilation
because nearly all the mothers identify with these two attributes to some degree
establishing a degree of cultural consensus (Bernard 1995: 171).
Are these answers that will solve
the Hispanic Health Paradox?
Charles Valentine describes poverty as a relative concept (1968: 12-13); in
other words the poor are deprived in comparison with the comfortable and opulent
lives of the affluent. This issue of poverty is what makes the Hispanic health
statistics a paradox relative to whites in the U.S. If poverty affects health in a
psychosocial manner, by looking at blacks, we see that they have lived for
generations with this relative disadvantage to the whites in the U.S. The majority of
Mexicans that live in the U.S. come from humble lives in their native Mexico. Their
point of reference is not the other people here in the U.S., but the people in Mexico,
where whole communities were poor. So relative to life in Mexico, immigrants are at
an economic advantage. This is called into question when the Paradox is examined
using acculturation as a variable, which has found that the health advantage
disappears with acculturation. A second reason for this relative health advantage is
the maintenance of some ethnic identity. Research has found that there were fewer
symptom levels when migrants held an attitude that they could maintain an ethnic or
cultural identity within the dominant (U.S.). When this is taken into consideration it
was observed that the mothers in this study were proud of their heritage and
expressed some symbolic indicators of Mexican identity.
The mothers in this study speak in very general terms, and it can be said that
what they say can be taken quite literally. However, as researchers, it is possible to
take what they say and develop theoretical models for explanation of behaviors
described that can be used to ensure that children of Mexican descent can continue to
enjoy the health benefits described. For example, the superficial simplicity of the
mothers saying that "It's got to be the beans" as an explanation for child health can be
taken literally and the nutritive value of this food "staple" can be measured, but it can
also be taken as a form of ethnic identity that characterizes this population. This
knowledge and awareness can then be taken by researchers and health educators to
use as a way of instilling and maintaining cultural pride while achieving improved
results in nutrition and compliance with health advice. In some way the validations of
these themes can be to turn them into a form of cultural capital that although they
may not produce economic wealth as is commonly associated with this concept, it
produces an unquantifiable wealth, health. According to most researchers into Latino
issues, these cultural values are likely to continue. Regardless of national origins, all
Latinos share a desire that their children learn and maintain their cultural traditions
and language (Zambrana 1995).
These themes are not intended to challenge biomedical knowledge, but what
they can do is supplement certain aspects of research and present programs, such as
WIC and prenatal care programs as well as inform individuals, such as health care
providers. Mexicans in the U.S. have a right to be proud of their heritage. Others in
the health care community should acknowledge the positive health outcomes of
people of Hispanic descent. By acknowledging these beliefs that have been
emphasized by the mothers in this research, health care messages can be
strengthened. The National Alliance for Hispanic Health formerly known as
COSSMHO also recognizes this and states that as long as the Hispanic Health
Paradox continues, the health care community must support and continue these
practices among Hispanic women during pregnancy (1995).
One must remember that whatever it is that makes children of Mexican
descent healthy may not be the best method for all groups to follow. These Mexican
American traits are part of a social, cultural, and possibly environmental and genetic
adaptation. Other groups have not been exposed to these same biocultural variables
or in the same quantities. The cultural attributes defined in this research should be
promoted in this population. However, recognizing that certain aspects of day to day
life are different in the U.S. as compared to Mexico and that with time, changes and
improvements in health care knowledge should acknowledged. Health education
must be responsive to these changes. This may even mean that some of the cultural
attributes discussed can cross cut inter/intra group variation, and could be beneficial
to all or some.
Some might say that the paradox challenges the conventional wisdom of
liberals by suggesting that the cultural values that individuals hold, rather than
government programs, are what really matters. This does not hold true when the
population of Mexican descent are compared to their counterparts that still reside in
Mexico. In Mexico they still hold traditional Hispanic values but have an inadequate
health care system. There the infant mortality rate is almost triple the rate of
American blacks so government programs and infrastructure do count (Hernandez
This thesis shows, first and foremost that, the topic of family, nutrition, and
child care should be examined in the context of how these concepts revolve around
the life of children in Mexican culture. This should then be translated into how it
might affect programs, health care services, policies, the Hispanic communities, and
Hispanic mothers. For now, the mothers speak of general and broad factors that
affect the whole family. Many of these factors are not specific to infant care, but to
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