Generational status, neighborhood context, and mother-child resemblance in dietary quality in Mexican-origin families.

Children of immigrants in the United States often grow up in very different nutrition environments than their parents. As a result, parent-child concordance in diet may be particularly weak in immigrant families. Yet, little is known about parent-child dietary resemblance in immigrant families and how local contexts shape it. This study uses data from the 1999/2000-2009/2010 Continuous National Health and Nutrition Examination Survey to examine mother-child resemblance in dietary quality in Mexican-origin families in the United States. We investigate how immigrant generational status and neighborhood context shape the association between mothers' and children's dietary quality. We find that mother-child resemblance in dietary quality is weaker for first-generation children relative to third-generation children. However, residence in an immigrant enclave strengthens the mother-child association in dietary quality for first-generation children. Findings offer a unique within-family perspective of immigrant health. Results suggest that the healthy eating advantage of Mexican immigrant mothers may not be sustained across family generations and that Mexican immigrant mothers may face unique challenges in promoting healthy eating among their children.

Diabetes and fracture risk in older U.S. adults.

OBJECTIVE: We examined the diabetes-fracture relationship by race/ethnicity, including the link between pre-diabetes and fracture. RESEARCH DESIGN AND METHODS: We used Medicare- and mortality-linked data for respondents aged 65years and older from the third National Health and Nutrition Examination Survey (NHANES III) and NHANES 1999-2004 for three race/ethnic groups: non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Mexican Americans (MA). Diabetes was defined as diagnosed diabetes (self-reported) and diabetes status: diagnosed and undiagnosed diabetes (positive diagnosis or hemoglobin A1c (A1C)≥6.5%); pre-diabetes (no diagnosis and A1C between 5.7% and 6.4%); and no diabetes (no diagnosis and A1C<5.7%). Non-skull fractures (n=750) were defined using published algorithms. Hazards ratios (HRs) were calculated using Cox proportional hazards models. RESULTS: The diabetes-fracture relationship differed significantly by race/ethnicity (pinteraction<0.05). Compared to those without diagnosed diabetes, the HRs for those with diagnosed diabetes were 2.37 (95% CI 1.49-3.75), 1.87 (95% CI 1.02-3.40), and 1.22 (95% CI 0.93-1.61) for MA, NHB, and NHW, respectively, after adjusting for significant confounders. HRs for diagnosed and undiagnosed diabetes were similar to those for diagnosed diabetes alone. Pre-diabetes was not significantly related to fracture risk, however. Compared to those without diabetes, adjusted HRs for those with pre-diabetes were 1.42 (95% CI 0.72-2.81), and 1.20 (95% CI 0.96-1.51) for MA and NHW, respectively. There were insufficient fracture cases to examine detailed diabetes status in NHB. CONCLUSIONS: The diabetes-fracture relationship was stronger in MA and NHB. Pre-diabetes was not significantly associated with higher fracture risk, however.

Evaluating motivational interviewing to promote breastfeeding by rural Mexican-American mothers: the challenge of attrition.

Although most Hispanic/Latino-American mothers initiate breastfeeding, duration and exclusivity of breastfeeding remain low. We explored whether a motivational interviewing (MI) intervention could help rural Mexican-American mothers continue breastfeeding. We used a two-group (MI intervention n = 26, attention control [AC] n = 27) repeated measures experimental design. Assessments and interventions occurred at 3 days, 2 weeks, and 6 weeks postpartum (time points when mothers are particularly vulnerable to discontinuing breastfeeding), with a final phone assessment at 6 months postpartum. We collected demographic data and measured intent to breastfeed for 6 months (intent question), self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form), and collected breastfeeding information (breastfeeding assessment questionnaire). Independent t-tests and Mann Whitney U non-parametric tests were used to evaluate group differences (α = 0.05). High levels of attrition by week 6 impaired our ability to evaluate the potential of our MI intervention. No significant differences were found between groups for any of the outcome variables (intent to breastfeed for 6 months, breastfeeding self-efficacy, and duration of breastfeeding). Though the mothers intended to breastfeed for 6 months and were confident in their ability to do so, most did not breastfeed for 6 months. At 6 months, mothers receiving the MI intervention had breastfed an average of 90 days compared to 82 days for those receiving the AC sessions and 22% of the mothers in each group were still breastfeeding at some level. Because of the impact of attrition during this study, we discuss factors that contributed to attrition and approaches to lessen this problem in future studies. Such efforts may require a greater investment of time and resources and should be budgeted accordingly. Culturally appropriate interventions are needed to help rural Mexican-American mothers meet their breastfeeding goals, thus providing an opportunity to reduce their children's risk of multiple diseases and obesity. Only when we address these considerations will we have an opportunity to decrease health disparities, promote healthy behaviors, and be trusted health care partners.

Prevalence of intimate partner violence and associated risk factors among Latinos/as: an exploratory study with three Latino subpopulations.

This study seeks to contribute to the limited literature on intimate partner violence (IPV) with Latino populations by analyzing national estimates of prevalence of and risk factors for IPV across the three largest Latino subgroups: Cuban-Origin, Mexican-Origin, and Puerto Ricans. Results showed that foreign-born Mexicans reported the highest rates of IPV compared with foreign-born Cubans and Puerto Ricans; Latinas with higher levels of education and employment reported higher levels of IPV; and foreign-born Mexicans reported a higher rate of less injurious IPV than their U.S.-born counterparts. These findings highlight the need to inform programs of varying nature of Latinas experiencing IPV.

A decade of racial and ethnic stroke disparities in the United States.

Stroke is the fourth leading cause of death and the leading cause of long-term disability in the United States. Stroke incidence and prevalence is not uniform. It occurs more frequently in some geographical areas of the United States and the rates are higher in minority groups.(1,2) Some proposed causes for these disparities include increased rate of vascular risk factors that disproportionally affect some minority groups, differential effect of hypertension on stroke risk across racial groups, lack of access to health care and other social determinants of health, suboptimal control of risk factors, and although lacking substantive data to date, an inherited predisposition to stroke associated with genetic differences. The Reasons for Geographic and Racial Differences in Stroke (REGARDS) investigators found that the rate of suboptimal control of vascular risk factors and unhealthy lifestyles were significantly greater in African Americans compared to non-Hispanic whites (NHW).(2) Moreover, regarding high blood pressure (BP), a triple threat has been described: blacks are not only more likely to have high BP, they are less likely, once diagnosed, to have their high BP controlled, and this suboptimal control has been shown to confer a stroke risk that is 3 times higher among blacks compared to whites for every 10-mm Hg increase in systolic BP (SBP).(3.)

Economic pressure, cultural adaptation stress, and marital quality among Mexican-origin couples.

Based on data from a sample of 120 first-generation Mexican immigrant couples collected at the start of the Great Recession in the United States, this study tested an actor-partner interdependence mediation model (APIMeM) in which spouses' perceptions of stress related to economic pressure and cultural adaptation were linked to their own and their partners' reports of marital satisfaction through spouses' depressive symptoms and marital negativity. As hypothesized, results supported indirect links between economic and cultural adaptation stressors and spouses' marital negativity and satisfaction: (1) contextual stress was associated with depressive symptoms, (2) depressive symptoms were positively associated with marital negativity for both husbands and wives and negatively associated with marital satisfaction for wives only, and (3) marital negativity was inversely associated with marital satisfaction for both spouses. Two partner effects emerged: (a) husbands' depressive symptoms were positively associated with wives' reports of marital negativity and (b) husbands' marital negativity was inversely related to wives' marital satisfaction. From these findings, we can infer that the psychological distress that arises for Mexican-origin spouses as they respond to the challenges of making ends meet during difficult economic times while they simultaneously navigate adapting to life in a new country is evidenced in their marital quality. Specifically, this study found that contextual stress external to the marital relationship was transmitted via spouses' psychological distress and negative marital exchanges to spouses' marital satisfaction. Wives' marital satisfaction was shown to be uniquely vulnerable to their own and their husbands' depressive symptoms and marital negativity.

Maternal attitudes and behaviors regarding feeding practices in elementary school-aged Latino children: a pilot qualitative study on the impact of the cultural role of mothers in the US-Mexican border region of San Diego, California.

This study aimed to explore the attitudes and behaviors of Latino mothers around feeding their children. Using qualitative methods, we conducted four focus groups in Spanish with 41 Latino mothers of elementary school-age children in San Diego County, CA. Latino mothers' mean age was 41 years; 90% were foreign-born; and 74% had a high school education or less. We explored cultural viewpoints around feeding and cooking and feeding strategies used. Focus groups were analyzed based on a priori and emergent themes. The following themes around feeding emerged: feeding attitudes central to the maternal responsibility of having well-fed children and feeding behaviors that centered on cooking methods, supportive behaviors, and reinforcement strategies for "eating well." These findings increase our understanding of the Latino maternal role to feed children and can help to inform more culturally appropriate research to effectively address nutritional issues and obesity prevention in Latino children.

Economic hardship and Mexican-origin adolescents' adjustment: examining adolescents' perceptions of hardship and parent-adolescent relationship quality.

Studies examining economic hardship consistently have linked family economic hardship to adolescent adjustment via parent and family functioning, but limited attention has been given to adolescents' perceptions of these processes. To address this, the authors investigated the intervening effects of adolescents' perceptions of economic hardship and of parent-adolescent warmth and conflict on the associations between parental economic hardship and adolescent adjustment (i.e., depressive symptoms, risky behaviors, and school performance) in a sample of 246 Mexican-origin families. Findings revealed that both mothers' and fathers' reports of economic hardship were positively related to adolescents' reports of economic hardship, which in turn, were negatively related to parent-adolescent warmth and positively related to parent-adolescent conflict with both mothers and fathers. Adolescents' perceptions of economic hardship were indirectly related to (a) depressive symptoms through warmth with mothers and conflict with mothers and fathers, (b) involvement in risky behaviors through conflict with mothers and fathers, and (c) GPA through conflict with fathers. Our findings highlight the importance of adolescents' perceptions of family economic hardship and relationships with mothers and fathers in predicting adolescent adjustment.

Socioeconomic status and stress in Mexican-American women: a multi-method perspective.

Stress is a hypothesized pathway in socioeconomic status (SES)-physical health associations, but the available empirical data are inconsistent. In part, this may reflect discrepancies in the approach to measuring stress across studies, and differences in the nature of SES-stress associations across demographic groups. We examined associations of SES (education, income) with general and domain-specific chronic stressors, stressful life events, perceived stress, and stressful daily experiences in 318 Mexican-American women (40-65 years old). Women with higher SES reported lower perceived stress and fewer low-control experiences in everyday life (ps < .05), but greater chronic stress (education only, p < .05). Domain-specific analyses showed negative associations of income with chronic housing and financial stress (ps < .05), but positive associations of SES with chronic work and caregiving stress (all ps < .05 except for income and caregiving stress, p < .10). Sensitivity analyses showed that most SES-stress associations were consistent across acculturation levels. Future research should adopt a multi-dimensional assessment approach to better understand links among SES, stress, and physical health, and should consider the sociodemographic context in conceptualizing the role of stress in SES-related health inequalities.

Religion and selected health behaviors among Latinos in Texas.

Though research has shown that religion provides a protective influence with respect to a number of health-related outcomes, little work has examined its influence on patterns of alcohol (especially binge drinking) and tobacco consumption among Latinos in Texas. Thus, we used a probability sample of Texas adults to test this relationship via logistic regression. Our results revealed that clear distinctions emerge on the basis of both denomination and frequency of attendance. Specifically, Protestants who regularly attend religious services are significantly more likely to be abstainers and to have never smoked, while those with no religious affiliation exhibit relatively unfavorable risk profiles. These findings persist despite a range of socio-demographic controls. Our study supports the assertion that religion may serve as an important protective influence on risky health behaviors.

Discrimination, ethnic identity, and academic outcomes of Mexican immigrant children: the importance of school context.

This study examined ethnic identity, perceptions of discrimination, and academic attitudes and performance of primarily first- and second-generation Mexican immigrant children living in a predominantly White community (N=204, 19 schools, mean age=9years). The study also examined schools' promotion of multiculturalism and teachers' attitudes about the value of diversity in predicting immigrant youth's attitudes and experiences. Results indicated that Latino immigrant children in this White community held positive and important ethnic identities and perceived low overall rates of discrimination. As expected, however, school and teacher characteristics were important in predicting children's perceptions of discrimination and ethnic identity, and moderated whether perceptions of discrimination and ethnic identity were related to attitudes about school and academic performance.

Associations between socioeconomic status and catecholamine levels vary by acculturation status in Mexican-American women.

BACKGROUND: Lower socioeconomic status (SES) is associated with poorer health, possibly through activation of the sympathetic nervous system. PURPOSE: This study aimed to examine the association between SES and catecholamine levels, and variations by acculturation. METHODS: Three hundred one Mexican-American women underwent examination with a 12-h urine collection. Analyses tested associations of SES, acculturation (language and nativity), and their interaction with norepinephrine (NOREPI) and epinephrine (EPI). RESULTS: No main effects for SES or the acculturation indicators emerged. Fully adjusted models revealed a significant SES by language interaction for NOREPI (p< .01) and EPI (p< .05), and a SES by nativity interaction approached significance for NOREPI (p= .05). Simple slope analyses revealed that higher SES related to lower catecholamine levels in Spanish-speaking women, and higher NOREPI in English-speaking women. Although nonsignificant, similar patterns were observed for nativity. CONCLUSIONS: Associations between SES and catecholamines may vary by acculturation, and cultural factors should be considered when examining SES health effects in Hispanics.

Mobile and home-based vendors' contributions to the retail food environment in rural South Texas Mexican-origin settlements.

A growing concern with high rates of obesity and overweight among immigrant minority populations in the US has focused attention on the availability and accessibility to healthy foods in such communities. Small-scale vending in rural, impoverished and underserved areas, however, is generally overlooked; yet, this type of informal activity and source for food is particularly important in such environs, or "food desserts," where traditional forms of work and mainstream food outlets are limited or even absent. This exploratory study investigates two types of small-scale food vending that take place in rural colonias, or Mexican-origin settlements along the South Texas border with Mexico: mobile and home-based. Using a convenience sample of 23 vendors who live and work in Texas colonias, this study identifies the characteristics associated with mobile and home-based food vendors and their businesses and its contributions to the rural food environment. Findings reveal that mobile and home-based vending provides a variety of food and beverage options to colonia residents, and suggests that home-based vendors contribute a greater assortment of food options, including some healthier food items, than mobile food vendors, which offer and sell a limited range of products. Findings may contribute to the development of innovative policy solutions and interventions aimed at increasing healthy food options or reducing health disparities in immigrant communities.

Diet and acculturation among Hispanic/Latino older adults in the United States: a review of literature and recommendations.

Among U.S. and foreign-born Hispanic/Latino older adults living in the United States, associations of dietary acculturation and health outcomes have yielded no consistent findings. The purpose of this review was to present current knowledge and research disparities on acculturation, dietary intake, and health outcomes among the fastest growing minority group in the United States. Fifteen peer-reviewed studies that measured dietary acculturation among Mexican, Puerto Rican, and Dominican older adults living in the United States were identified and examined. This literature review divulged contradictory associations between dietary acculturation and dietary intake, along with nutritional and general health outcomes. Conclusive evidence has yet to be attained due to use of cross-sectional study designs and numerous acculturation measures as well as unique cultural and dietary patterns across diverse Hispanic/Latino populations. Further research is needed to ascertain dietary acculturation among U.S. and foreign-born Hispanic/Latino older adults in the United States and should strive to develop instruments that consider the social, economic, and political environments that influence the dietary acculturation process. Furthermore, longitudinal study designs and qualitative methodologies are warranted.

Nutrient and food intakes differ among Latina subgroups during pregnancy.

OBJECTIVE: To document nutrient and food group serving intakes from food sources among Latina subgroups living in the same geographical area. DESIGN: A cross-sectional study. Nutrient and food group serving intakes were assessed by means of a 24 h recall administered immediately after a prenatal survey. SETTING: Hartford, CT, USA. SUBJECTS: A total of 233 low-income pregnant Latinas. For analyses, Latinas were classified into two groups on the basis of self-reported ethnic identity: Puerto Ricans and non-Puerto Rican Latinas. RESULTS: Puerto Rican Latinas were more likely than non-Puerto Rican Latinas to be more acculturated and to consume foods (i.e. processed meat, cheese, soft drinks) and higher levels of nutrients (i.e. fat, SFA, MUFA, trans fatty acids) that have been implicated in the development of chronic diseases. By contrast, non-Puerto Rican Latinas were more likely to consume foods (i.e. fruits, dark green/yellow vegetables, tomatoes, non-starchy vegetables) and higher levels of nutrients (i.e. fibre, vegetable protein, folate, ß-carotene) that promote health when compared with Puerto Rican Latinas. CONCLUSIONS: Findings suggest that acculturation may play a role in dietary intake. Clinicians and dietitians need to be aware of these differences to encourage healthy eating patterns among more acculturated pregnant Latina clients.

Medical returns: seeking health care in Mexico.

Despite the growing prevalence of transnational medical travel among immigrant groups in industrialized nations, relatively little scholarship has explored the diverse reasons immigrants return home for care. To date, most research suggests that cost, lack of insurance and convenience propel US Latinos to seek health care along the Mexican border. Yet medical returns are common even among Latinos who do have health insurance and even among those not residing close to the border. This suggests that the distinct culture of medicine as practiced in the border clinics Latinos visit may be as important a factor in influencing medical returns as convenience and cost. Drawing upon qualitative interviews, this article presents an emic account of Latinos' perceptions of the features of medical practice in Mexico that make medical returns attractive. Between November 15, 2009 and January 15, 2010, we conducted qualitative interviews with 15 Mexican immigrants and nine Mexican Americans who sought care at Border Hospital, a private clinic in Tijuana. Sixteen were uninsured and eight had insurance. Yet of the 16 uninsured, six had purposefully dropped their insurance to make this clinic their permanent "medical home." Moreover, those who substituted receiving care at Border Hospital for their US health insurance plan did so not only because of cost, but also because of what they perceived as the distinctive style of medical practice at Border Hospital. Interviewees mentioned the rapidity of services, personal attention, effective medications, and emphasis on clinical discretion as features distinguishing "Mexican medical practice," opposing these features to the frequent referrals and tests, impersonal doctor-patient relationships, uniform treatment protocols and reliance on surgeries they experienced in the US health care system. While interviewees portrayed these features as characterizing a uniform "Mexican medical culture," we suggest that they are best described as unique to the private clinics and hospitals returning migrants visit. In short, we suggest that the perceived contrast in cultures of medicine derives from the difference in organization of health care services on each side of the border.

Wide disparity in genetic admixture among Mexican Americans from San Antonio, TX.

We studied 706 participants of the San Antonio Family Diabetes Study (SAFDS) and 586 male samples from the San Antonio Center for Biomarkers of Risk of Prostate Cancer (SABOR) and used 64 ancestry informative markers to compare admixture proportions between both groups. Existence of population substructure was demonstrated by the excess association of unlinked markers. In the SAFDS sample, ancestral proportions were estimated at 50.2 ± 0.6% European, 46.4 ± 0.6% Native American, and 3.1 ± 0.2% West African. For the SABOR sample, the proportions were 58.9 ± 0.7%, 38.2 ± 0.7%, and 2.9 ± 0.2%, respectively. Additionally, in the SAFDS subjects a highly significant negative correlation was found between individual Native American ancestry and skin reflectance (R(2) = 0.07, P= 0.00006). The correlation was stronger in males than in females but clearly showed that ancestry only accounts for a small percentage of the variation in skin color and, conversely, that skin reflectance is not a robust surrogate for genetic admixture. Furthermore, a substantial difference in substructure is present in the two cohorts of Mexican American subjects from the San Antonio area in Texas, which emphasizes that genetic admixture estimates should be accounted for in association studies, even for geographically related subjects.

"Hay que ponerse en los zapatos del joven": adaptive parenting of adolescent children among Mexican-American parents residing in a dangerous neighborhood.

We examined parenting of adolescents with Consensual Qualitative Research analyses of five 90-minute focus groups with 45 Mexican immigrant parents residing in a high-crime and low-income neighborhood. Parents identified gangs as their major challenge in parenting. Relatedly, they endorsed control-oriented practices to ensure the safety of their adolescents. In addition, parents used practices that aimed to build strong, trusting relationships with their adolescents. The co-occurrence of parenting strategies that promote strong parent-adolescent bonds along with strict monitoring highlights the need to conceptualize parenting with both controlling as well as supportive dimensions. Moreover, the parents' narratives pertaining to the dangers in their neighborhood suggest that interventions for Latino families should be not only consistent with their cultural heritage, but also grounded in the families' local neighborhood contexts.

Family-based health needs along the Texas-Mexico border.

BACKGROUND: The population in the Texas-Mexico border is rapidly increasing and exacerbating a number of public health problems and healthcare services. The needs of this area have been predominantly assessed through a professional lens. To better inform public policy and serve the area, this study assessed the needs of families living along the Texas-Mexico border. METHODS: Approximately 2000 households along the Texas-Mexico border were interviewed for their basic demographic information and health needs. RESULTS: It was found that children's healthcare services were the highest reported need among families along the border. The probability of reporting healthcare needs increased by 43% among families with children under the age of 5, whereas the probability of reporting healthcare needs decreased by 40% among families with children 13 and older. CONCLUSION: The findings from this study suggest child healthcare services, particularly for families with young children, is the most pressing need of the area.