PEDIATRICS Vol. 105 No. 4 April 2000, pp. 920-921

Multiethnic Families: An Underrecognized Influence on Health Statistics

To the Editor.

In Southern California, Agran et al¹ found that Hispanic (mainly Mexican) children had much higher rates of serious injury requiring hospitalization than did non-Hispanic white children. To investigate possible reasons for this disparity, we designed an ethnographic study involving in-depth interviews and observations in homes in geographical areas where large numbers of such injuries had occurred. Our subjects consisted of Mexican mothers (born and educated in Mexico), Mexican American mothers (of Mexican ancestry but born and educated in the United States), and non-Hispanic US-born white mothers. We assumed that the children in these families would have the same racial and ethnic identity as their mothers and that in this way we could study possible effects of cultural factors on injury rates.

We found that the children of the Mexican and Mexican American mothers did indeed share their mothers' ethnicities, but of the 30 white mothers interviewed, 10 had children who had Hispanic surnames because their biological fathers were Hispanic. These children, many of whom spoke Spanish as well as English, would have been classified as "Hispanic" in most studies. Furthermore, in 5 of the 10 cases the biological father was not living with the family and, thus, whatever attitudes and behaviors were present in the home were much more a function of the non-Hispanic white mother than of the absent Hispanic father.

We bring this to the attention of other researchers because of its implication for interpretation of "ethnic" data and subsequent design of programmatic interventions. Particularly where children are involved, ethnic classifications should not be considered in isolation from the total household situation. With increased mixing of ethnicities and races,² especially in areas such as California,³ it is becoming very difficult to say that a particular health condition or behavior is purely the result of ethnicity rather than, for example, a function of social class. Indeed, Krieger and Fee⁴ and Krieger et al⁵ have called for the reintroduction of social class variables into health statisticsvariables now used in all developed nations with the exception of the United States.

Recent articles have pointed out two major problems besetting attempts to study ethnicity in relation to health status. One is the fact that in virtually all published research, including that on Hispanics,⁶ the ethnic classifications used are not clearly defined.⁷ Another is the marked lack of reliability in ethnic identifications regardless of whether the identifications are provided by subjects themselves or by other people, especially where classifications other than "white" and "black" are in question.^8,9 Misclassification may cause erroneous conclusions to be drawn, leading to inappropriate health interventions.¹⁰

Our research reveals yet another complication in studies of ethnicity focusing on children: the adult controlling the physical and emotional environment in the household may be of a different ethnicity from the child whose health status is being investigated. As stated in a recent task force report on the health of immigrant children sponsored by the National Research Council and the Institute of Medicine,¹¹ in-depth ethnographic studies of household factors influencing health are essential if statistics from broader surveys are to be fully understood.

Dorothy S. Mull, PhD, Phyllis F. Agran, MD, MPH, Diane G. Winn, RN, MPH, and Craig L. Anderson, DHSc, PhD
Pediatric Injury Prevention Research Group
Center for Health Policy and Research
University of California, Irvine
Irvine, CA 92697-5800

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