This project, which began on October 1, 1994, was a prospective, longitudinal study of healthy development of Puerto Rican children living on the mainland of the United States. It was carried out by a multidisciplinary team of researchers, headed by a Hispanic physician. The study followed 257 boys and girls (in grades 1 through 3 at the starting point of the study) and their primary caregivers from three socioeconomic strata (SES) for three consecutive years, 1996-1998. The data were gathered through face-to-face interviews with the children and their primary caregivers in the language of their choice (English or Spanish). The sample was recruited mainly through the Boston elementary school system, both public and parochial.

The purpose of the investigation was (1) to study health and development of Puerto Rican children growing up in the mainland of the United States from a normative rather than a deficit-model approach, utilizing culturally appropriate theoretical models of development and health; (2) to study the "social context" of health as the relationship among family variables (SES, family composition, proficiency in English) and especially characteristics of the primary caregiver (depression, anxiety, fear of discrimination) and the child's health outcomes; (3) to study the effects of racism, discrimination and prejudice on the children's health; (4) to examine the validity of existing instruments in this population and to develop new ones when needed; and (5) to carry out this study with Hispanic professionals and personnel at all levels of involvement in the research.

We created three new instruments: The Color of My Skin, an index to study children's internal perception of their skin color and satisfaction with it; a scale to measure self-esteem; and an index to study ethnic identity and experience with discrimination in which options for choosing one or multiple identities are given. These new instruments were created using the dual-focus approach. In this method an item is simultaneously developed in both English and Spanish to preserve the concept and the purity of both languages. In addition, existing instruments were translated and adapted to be culturally synthionic, again using the dual focus technique.

What follows are the main findings of the study. We found that in our sample there was no "revolving door" migration. Although as a whole the families were recent migrants, once they came to the mainland they settled here.The majority of the children were born after a normal pregnancy and were delivered by a physician in a hospital. The mothers had been followed in a clinic from the first trimester of pregnancy, they consumed less drugs and alcohol than the national averages but smoked more. Fifty-eight percent were in their twenties and 19.5% in their thirties at the time of the birth of the index child. The low-birthweight rate was 8.4% which is lower than the national Puerto Rican rate, but higher than other Latino subgroups.

The mothers reported that their children were in good general health (90%). Their only concern was small size and low weight (45%). This perception contrasts greatly with their reporting a high incidence of chronic medical conditions on a number of questions, following the National Health Interview Survey of 1996. In this assessment our sample compared unfavorably to the sample of White, Hispanic and Black children of the same age in the National Survey. On the other hand, our sample had only 5.5% uninsured children during the first year of data collection and 2.9% and 2.7% during the second and third years, while the Census of 1995 reports 26.8% Hispanic children under the age of 18 to be uninsured.

The majority of the children identified themselves as Puerto Ricans, either as only Puerto Rican or as a combination of Hispanic, American and Puerto Rican. Their identification was not related to the parents' place of birth but it was related to the child's place of birth and the caregiver's ethnic identification. As the children matured there was a trend towards multiple rather than single ethnic identification. Eleven percent in the first and second year and 9% in the third year had experienced discrimination due to their ethnicity. It is interesting to note that mothers reported a higher experience with discrimination, but more important is their worry about being discriminated against (discrimination anxiety) and its small but significant negative effect on the children's academic self-image.

The majority of the children chose light brown as the color of their skin and 96% liked their color and were satisfied with it. All children reported high self-esteem; there was no association between self-esteem and the chosen skin color. Only the children who wanted to change skin color had a significantly lower self-esteem. There was a 68% agreement between the interviewer's external rating of the child's color and the child's internal rating.

The children's self-rated self-esteem was consistently high during the three years (4.4, 4.5 and 4.5 on a Likert-type scale of 1 to 5). The depression scores were consistently low (1.73, 1.59 and 1.48 over the three years). The children reported that they felt higher academic stress than any other type of stress during the three years. The caregivers' assessment of their children's behavioral problems using Conners' Parent Rating Scale was very low. Impulsive hyperactivity was the only significant problem in Waves I and II.

In summary, our sample consisted of a group of emotionally healthy children with poor physical health as compared with other samples.

This research was funded by a grant from the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services.