The newest issue of the medical journal Obstetrics and Gynecology contains a compelling study by R. Jeanne Ruiz of the University of Texas and colleagues. The team looked at 468 low-income pregnant Hispanic women to see how much levels of acculturation (measured by proficiency in English) affected premature birth. What they found is not what you might expect: those mothers who are better assimilated are more than four times as likely to give birth to a premature baby.

That’s right: Women who were born outside the U.S., had not completed high school, were not proficient in English, and had lived in the U.S. for fewer than 10 years were more likely to have higher levels of progesterone. (Researchers have found that a form of the hormone progesterone can reduce the rate of premature births).

This is pretty counter-intuitive—poor and poorly assimilated women with low levels of education are in one important respect healthier than their more Americanized peers. What gives?

While the article is primarily concerned with pointing the distinction rather than trying to explain it, the general message is clear: there’s something different about the way unassimilated low-income Hispanic women live their lives. The obvious distinction is diet and nutrition. I think it’s fair to say that the more someone is tied to his or her culture of origin, the more likely he or she is to consume that culture’s traditional diet.

Hispanics are a broad group, so it’s tough to pinpoint exactly what “less American” Hispanics eat that “more American” Latinos don’t. On the whole, however, the Hispanic diet is much heavier in grains, beans, and fresh fruits and vegetables than the typical American meal. And studies have actually shown that Spanish-speaking Hispanics stick closer to this diet than their English-speaking peers who are more like pick up American eating habits.

Guess who eats healthier?

In 2000, the Department of Agriculture studied diet and nutrition among Hispanics in the U.S. Rating diet quality on a “healthy diet index” drawn from government nutrition recommendations and the food pyramid, the authors found that less assimilated Spanish-speaking adults and children scored higher than their English-speaking counterparts (see table below). In other words, less acculturated Latinos eat better—mostly because they consume less fat and more fiber in their diets.

As everyone knows, nutrition is essential to healthy gestation and
childbirth—and fat is a particularly important factor to consider. Many
studies have linked obesity to premature childbirth. “Weight before
pregnancy matters much more than people realize, even health
professionals,” Richard J. Deckelbaum, M.D., Professor of Nutrition at
Columbia University, told ScienceDaily in 2002.
Indeed, premature birth rates go hand-in-hand with obesity. The March of Dimes reports that
obesity among women ages 20 to 29 increased from 7 percent in 1960-62
to 17 percent in 1988-94.. At the same time, since 1990, the preterm
birth rate in the U.S. has increased more than 20 percent. Today more
than 500,000 infants are born too soon each year.

Diets that lead to obesity are particularly harmful to low-income
Hispanic women, who are two to four times more likely than white women
to be diabetic. Hispanic women also have higher rates
of both pregestational and gestational diabetes than either
African-American or non-Hispanic white women. Diabetes can lead to
premature birth. So for an at-risk population like Hispanic women, it
pays to stick to traditional cuisine—not least because high-fiber diets
actually reduce the risk
of gestational diabetes. So not only does old-school Hispanic food
combat obesity, but also other health problems that can lead to
premature births. Not bad, for a burrito.

This newest study is an interesting one, in part because it forces us
to reflect on the health risks inherent in some of our most basic,
taken-for-granted lifestyle choices. There’s something pretty stunning
about the fact that the more Americanized Latinos become, the less
healthy they are. In the context of premature births, thinking about
the hows and whys of this phenomenon immediately suggests that
attention should be paid both to nutrition and also to preterm labor
itself—and not just for Hispanic women, but for everyone. After all, if
American diets are part of the problem, than we’re all at risk.

But how do we get this point across? Often the most compelling numbers
you can show to prove a case are the economic ones. For better or
worse, the bottom line is really what raises peoples’ eyebrows—and for
premature birth, it’s a doozy. A 2006 analysis concluded the following costs were associated with premature labor:

• In 2005, preterm birth cost the United States at least $26.2
  billion, or $51,600 for every infant born preterm. The costs broke down
  as follows:
  • $16.9 billion (65 percent) for medical care
  • $1.9 billion (7 percent) for maternal delivery
  • $611 million (2 percent) for early intervention services
  • $1.1 billion (4 percent) for special education services
  • $5.7 billion (22 percent) for lost household and labor market productivity
• The average first-year medical costs, including both inpatient
  and outpatient care, were about 10 times greater for preterm infants
  ($32,325) than for term infants ($3,325).
• Average length of a hospital stay for a term infant: 1.5 days
• Average length of a hospital stay for a preterm infant: 13 days (nine times as long)
• The direct health care costs to employers for premature babies
  during the first year of their lives average $41,610, compared to
  $2,830 for babies born healthy and full term.

Some of these costs are exacerbated by poor care. A just-released study
from Boston University found that most very low birth-weight babies
born to low-income women failed to get critical follow-up care within
their first two years of life. Only 20 percent of the babies with
hearing problems returned for specialized care within their first six
months of life, while fewer than one in four underwent recommended
vision tests between 1 and 2 years of age.

This is not only morally lamentable but economically stupid. According
to study author Dr. C Jason Wang, the average cost of treating an
extremely premature baby in the hospital is $250,000—but without
follow-up care to keep the baby healthy, those are sunk costs that do
not translate into a saved life.

And in the end, it’s the wasted life, not the wasted dollars, that matters.