Physical activity patterns and obesity in Hispanic and non-Hispanic white women.
Slattery ML, Sweeney C, Edwards S, Herrick J, Murtaugh M,
Baumgartner K, Guiliano A, Byers T.
University of Utah, Salt Lake City, UT 84108, USA.
Med Sci Sports Exerc. 2006 Jan;38(1):33-41.
PURPOSE: Cultural differences in diet and lifestyle patterns probably contribute to cancer rates among ethnic groups in the United States. In this paper, we describe physical activity patterns of Hispanic and non-Hispanic white women living in the southwestern United States and the effects of these patterns on obesity.
METHODS: We use data from population-based controls (N = 2039) participating in the 4-Corner's Breast Cancer Study to evaluate associations between physical activity and language acculturation and the associated effects on obesity.
RESULTS: The majority of both Hispanic and non-Hispanic white women did not perform 30 min of activity > or = 5 d x wk(-1), although a greater percentage of Hispanic women meet the goal if they reported higher levels of language acculturation. However, the type and intensity of activities performed by Hispanic and non-Hispanic women differed; Hispanic women reported more housework, dependent care giving, dancing, and work activity. Differences in activity patterns existed by level of language acculturation among Hispanic women. Hispanic women who had higher levels of language acculturation reported continued activity throughout their lives. Prevalence of obesity was greater among Hispanic than non-Hispanic white women for all levels of language acculturation. Women with intermediate levels of language acculturation had the greatest relative risk of obesity compared with non-Hispanic white women (odds ratio (OR) = 2.79, 95% confidence interval (CI) = 1.85-4.02); Hispanic women with higher levels of language acculturation also were at increased relative risk of obesity (OR = 1.78, 95% CI = 1.28-2.47).
CONCLUSIONS: Interventions to increase physical activity among Hispanic women are needed to address the problems of physical inactivity and obesity in that population. Facilitating culturally relevant activities might be reasonable approaches to increasing physical activity.
Correspondence: mslatter@hrc.utah.edu
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November 2006
Maternal birthplace and breastfeeding initiation among term and preterm infants: a statewide assessment for Massachusetts.
Merewood A, Brooks D, Bauchner H, MacAuley L, Mehta SD.
Pediatrics. 2006 Oct;118(4):e1048-54.
OBJECTIVES: Among premature infants, formula feeding increases the risk for necrotizing enterocolitis, delayed brainstem maturation, decreased scoring on cognitive and developmental tests, and delayed visual development. With this in mind, many interventions are designed to increase breast milk consumption in preterm infants. Breastfeeding initiation rates among US premature infants are not collected nationally, however, and published data on breastfeeding rates in this population are limited. In addition, national surveys calculate breastfeeding rates among term infants according to maternal race/ethnicity, but maternal birthplace is not recorded. This is likely to be important, because breastfeeding is the cultural norm in the countries of origin for many non-US-born US residents. Massachusetts has a diverse racial/ethnic population, including many non-US-born women. The goals of this study were to compare breastfeeding initiation rates among preterm and term infants in Massachusetts in 2002 and to determine the effect of maternal race/ethnicity and birthplace on breastfeeding initiation rates among term and preterm infants.
METHODS: Massachusetts Community Health Information Profile, an online public health database that was created by the Massachusetts Department of Public Health, includes breastfeeding initiation data that are obtained from the electronic birth certificate, which we used to compare breastfeeding rates among preterm and term infants. Birth-linked demographics and data that also were accessed were maternal age, race/ethnicity, birthplace, and health insurance (public or private) as an indicator of socioeconomic status and infant's gestational age. We assessed the association between breastfeeding initiation and maternal birthplace, as well as race/ethnicity and the other potential confounders, using logistic regression.
RESULTS: There were 80,624 births in Massachusetts in 2002, and 8.2% (6611) of newborns had a gestational age <37 weeks. The state's overall breastfeeding initiation rate was 74.6%. We excluded records of mothers who were younger than 15 years and older than 39 years, nonsingleton births, infants with a gestational age <24 weeks and >42 weeks, and records with missing data. Of the total births in Massachusetts, 67,884 (84%) met inclusion criteria for this study. Breastfeeding initiation rates were lowest among preterm infants of the youngest gestational ages. Breastfeeding initiation was 76.8% among term infants born at 37 to 42 weeks, 70.1% among infants born at 32 to 36 weeks, and 62.9% among infants born at 24 to 31 weeks. In univariate analysis, among preterm infants, a lower proportion of US-born black, Asian, and Hispanic mothers initiated breastfeeding than US-born white mothers; non-US-born black and non-US-born Hispanic mothers had the highest breastfeeding initiation rates. Among term infants, US-born black mothers had the lowest initiation rates, and non-US-born black and non-US-born Hispanic mothers had the highest. In multivariate logistic regression, however, after controlling for mother's age, race, birthplace, and insurance, US-born white mothers were least likely to breastfeed either term or preterm infants when compared with any other racial/ethnic group, including US-born black mothers. The likelihood that non-US-born Hispanic mothers would breastfeed was almost 8 times greater than that for US-born white mothers for a preterm infant and almost 10 times greater for a term infant. In multivariate logistic regression analysis stratified by gestational age for both preterm and term infants, older mothers and mothers with private health insurance were most likely to breastfeed.
CONCLUSIONS: In Massachusetts, preterm infants were less likely to receive breast milk than term infants, and the likelihood of receiving breast milk was lowest among the youngest preterm infants. In multivariate logistic regression, mothers who were born outside the United States were more likely than US-born mothers to breastfeed either term or preterm infants in all racial and ethnic groups. In an unexpected finding, US-born white mothers were less likely to breastfeed term or preterm infants than US-born black mothers or mothers of any other racial or ethnic group.
This article can be downloaded at:
http://pediatrics.aappublications.org/cgi/content/full/118/4/e1048
(subscription may be required)
Correspondence: Department of Pediatrics, Boston University School of Medicine, Boston,
Massachusetts, USA. anne.merewood@bmc.org
October 2006
Experiences of Latino immigrant families in North Carolina help explain elevated levels of food insecurity and hunger.
Sara A. Quandt2, John I. Shoaf3, Janeth Tapia4, Mercedes Hernández-Pelletier4, Heather M. Clark5 and Thomas A. Arcury5
J Nutr. 2006 Oct;136(10):2638-44.
ABSTRACT: Household food insecurity is higher among minority households in the U.S., but few data exist on households of recent minority immigrants, in part because such households are difficult to sample. Four studies of a total of 317 Latino immigrant families were conducted in different regions and during different seasons in North Carolina. A Spanish translation of the 18-item U.S. Food Security Survey Module was used to assess the prevalence of food insecurity and hunger. In 3 of the studies, a total of 76 in-depth interviews were conducted to gather information on immigrants' experiences of food insecurity. Households in the 4 studies classified as food secure ranged from 28.7 to 50.9%, compared with 82.4% in the U.S. in 2004. Food insecurity without hunger ranged from 35.6% to 41.8%, compared with 13.3% in the U.S. The highest rates of hunger reported were 18.8% (moderate hunger) and 16.8% (severe hunger) in an urban sample. Qualitative data indicate that food insecurity has both quantitative and qualitative effects on diet. Immigrants experience adverse psychological effects of food insecurity. They report experiencing a period of adjustment to food insecurity leading to empowerment to resolve the situation. Reactions to food insecurity differ from those reported by others, possibly because immigrants encounter a new and not chronic situation. Overall, these findings suggest that immigrant Latinos experience significant levels of food insecurity that are not addressed by current governmental programs.
This article can be downloaded at:
http://jn.nutrition.org/cgi/content/full/136/10/2638 (subscription may be required)
2: Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; 3: Physician Assistant Program, Wake Forest University School of Medicine, Winston-Salem, NC; 4: North Carolina Farmworkers Project, Benson, NC; and 5: Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
Correspondence: To whom correspondence should be addressed. E-mail: squandt@wfubmc.edu
September 2006
Toward a theory-driven model of acculturation in public health research.
Ana F. Abraído-Lanza, PhD, Adria N. Armbrister, MA, Karen R. Flórez, MPH and Alejandra N. Aguirre, MPH
Am J Public Health. 2006 Aug;96(8):1342-6.
ABSTRACT: Interest in studying the impact of acculturation on immigrant health has increased in tandem with the growth of the Latino population in the United States. Linear assimilation models continue to dominate public health research despite the availability of more complex acculturation theories that propose multidimensional frameworks, reciprocal interactions between the individual and the environment, and other acculturative processes among various Latino groups. Because linear and unidimensional assessments (e.g., nativity, length of stay in the United States, and language use) provide constricted measures of acculturation, the rare use of multidimensional acculturation measures and models has inhibited a more comprehensive understanding of the association between specific components of acculturation and particular health outcomes. A public health perspective that incorporates the roles of structural and cultural forces in acculturation may help identify mechanisms underlying links between acculturation and health among Latinos.
The authors are with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
Correspondence: Ana Abraído-Lanza, PhD, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168 St, 5th floor, New York, NY 10032 aabraido@columbia.edu
This article can be downloaded at: http://www.ajph.org/cgi/content/full/96/8/1342 (subscription may be required)
August 2006
The Impact of Medical Interpreter Services on the Quality of Health Care: a Systematic Review.
Flores G.
Medical College of Wisconsin, USA.
Med Care Res Rev. 2005 Jun;62(3):255-99
Twenty-one million Americans are limited in English proficiency (LEP), but little is known about the effect of medical interpreter services on health care quality. A systematic literature review was conducted on the impact of interpreter services on quality of care. Five database searches yielded 2,640 citations and a final database of 36 articles, after applying exclusion criteria. Multiple studies document that quality of care is compromised when LEP patients need but do not get interpreters. LEP patients' quality of care is inferior, and more interpreter errors occur with untrained ad hoc interpreters. Inadequate interpreter services can have serious consequences for patients with mental disorders. Trained professional interpreters and bilingual health care providers positively affect LEP patients' satisfaction, quality of care, and outcomes. Evidence suggests that optimal communication, patient satisfaction, and outcomes and the fewest interpreter errors occur when LEP patients have access to trained professional interpreters or bilingual providers.
PMID: 15894705 [PubMed - indexed for MEDLINE]
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New England Journal of Medicine related commentary by Dr. Glenn Flores available for free here.
July 2006
Painting a Truer Picture of US Socioeconomic and Racial/Ethnic Health Inequalities: The Public Health Disparities Geocoding Project
Nancy Krieger, PhD, Jarvis T. Chen, ScD, Pamela D. Waterman, MPH, David H. Rehkopf, MPH and S.V. Subramanian, PhD
The authors are with the Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Mass.
Am J Public Health. 2005 Feb; 95(2): 312-23.
OBJECTIVES: We describe a method to facilitate routine monitoring of socioeconomic health disparities in the United States.
METHODS: We analyzed geocoded public health surveillance data including events from birth to death (c. 1990) linked to 1990 census tract (CT) poverty data for Massachusetts and Rhode Island.
RESULTS: For virtually all outcomes, risk increased with CT poverty, and when we adjusted for CT poverty racial/ethnic disparities were substantially reduced. For half the outcomes, more than 50% of cases would not have occurred if population rates equaled those of persons in the least impoverished CTs. In the early 1990s, persons in the least impoverished CT were the only group meeting Healthy People 2000 objectives a decade ahead.
CONCLUSIONS: Geocoding and use of the CT poverty measure permit routine monitoring of US socioeconomic inequalities in health, using a common and accessible metric.
This article can be downloaded at:
http://www.ajph.org/cgi/reprint/95/2/312
Correspondence: Requests for reprints should be sent to Nancy Krieger, PhD, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Hunting-ton Ave, Boston, MA 02115 (e-mail: nkrieger@hsph.harvard.edu).
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Why genes don't count (for racial differences in health).
Goodman AH
US Southwest and Mexico Program, School of Natural Science, Hampshire College, Amherst, MA 01002, USA. agoodman@hampshire.edu
Am J Public Health. 2000 Nov;90(11):1699-702.
There is a paradoxical relationship between "race" and genetics. Whereas genetic data were first used to prove the validity of race, since the early 1970s they have been used to illustrate the invalidity of biological races. Indeed, race does not account for human genetic variation, which is continuous, complexly structured, constantly changing, and predominantly within "races." Despite the disproof of race-as-biology, genetic variation continues to be used to explain racial differences. Such explanations require the acceptance of 2 disproved assumptions: that genetic variation explains variation in disease and that genetic variation explains racial variation in disease. While the former is a form of geneticization, the notion that genes are the primary determinants of biology and behavior, the latter represents a form of racialization, an exaggeration of the salience of race. Using race as a proxy for genetic differences limits understandings of the complex interactions among political-economic processes, lived experiences, and human biologies. By moving beyond studies of racialized genetics, we can clarify the processes by which varied and interwoven forms of racialization and racism affect individuals "under the skin."
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May 2006
A vision for the future of genomics research.
Collins FS, Green ED, Guttmacher AE, Guyer MS; US National Human Genome Research Institute.
National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
Nature. 2003 Apr 24;422(6934):835-47.
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April 2006
Should "acculturation" be a variable in health research? A critical review of research on US Hispanics.
Hunt LM, Schneider S, Comer B
Soc Sci Med. 2004 Sep;59(5):973-86.
Department of Anthropology, Michigan State University, East Lansing, MI 48824, USA. huntili@msu.edu
Acculturation has become a popular variable in research on health disparities among certain ethnic minorities, in the absence of serious reflection about its central concepts and assumptions. Key constructs such as what constitutes a culture, which traits pertain to the ethnic versus "mainstream" culture, and what cultural adaptation entails have not been carefully defined. Using examples from a systematic review of recent articles, this paper critically reviews the development and application of the concept of acculturation in US health research on Hispanics. Multiple misconceptions and errors in the central assumptions underlying the concept of acculturation are examined, and it is concluded that acculturation as a variable in health research may be based more on ethnic stereotyping than on objective representations of cultural difference.
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March 2006
ACCULTURATION AND LATINO HEALTH IN THE UNITED STATES: A Review of the Literature and its Sociopolitical Context
Annual Review of Public Health
Vol. 26: 367-397 (Volume publication date April 2005)
(doi:10.1146/annurev.publhealth.26.021304.144615)
Marielena Lara,1,2 Cristina Gamboa,3, M. Iya Kahramanian,3 Leo S. Morales,4 and David E. Hayes Bautista3
1UCLA/RAND Program on Latino Children with Asthma, RAND Health, Santa Monica, California, 90407; email: lara@rand.org
2Department of Pediatrics, 3Center for Study of Latino Health and Culture, 4Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, 90024; email: cgamboa@ucla.edu, mariamK@ucla.edu, leo_morales@rand.org, dhayesb@ucla.edu
This chapter provides an overview of the concept of acculturation and reviews existing evidence about the possible relationships between acculturation and selected health and behavioral outcomes among Latinos. The effect of acculturation on Latino health is complex and not well understood. In certain areas—substance abuse, dietary practices, and birth outcomes—there is evidence that acculturation has a negative effect and that it is associated with worse health outcomes, behaviors, or perceptions. In others—health care use and self-perceptions of health—the effect is mostly in the positive direction. Although the literature, to date, on acculturation lacks some breadth and methodological rigor, the public health significance of findings in areas in which there is enough evidence justifies public health action. We conclude with a set of general recommendations in two areas—public health practice and research—targeted to public health personnel in academia, community-based settings, and government agencies.
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