ABSTRACT
Rapid Hispanic growth has been a major source of increasing ethnoracial diversity in the United States. However, diversity within the Hispanic population is frequently obscured by the tendency to lump all Latinos together. Our study examines Hispanic diversity at the local level, drawing insights from the Mexican dominance, Caribbean-centric settlement, spatial assimilation, and economic opportunity perspectives. Measures of the magnitude and structure of Hispanic origin-group diversity during the 1990-2010 period are constructed for 363 metropolitan areas based on each area's shares of Mexicans, Puerto Ricans, Cubans, Dominicans, Salvadorans, Guatemalans, Colombians, and 'others'. We find that diversity magnitude varies markedly across metropolitan Hispanic populations. Although the most diverse metro areas lack a majority origin group, Mexicans often constitute a majority or plurality of local Latinos. Diversity levels and structures have remained relatively stable over time. In both 1990 and 2010, metro areas with more diverse, multigroup Hispanic communities are distinguished by their larger size, smaller proportion of Hispanics, location farther from Mexico and closer to the Caribbean, and greater odds of being a military hub. They also exhibit higher rates of housing construction and lower rates of agricultural and manufacturing employment. We use weighted data to show that Dominican metro dwellers experience the highest Hispanic diversity while the average Mexican lives in an area where four-fifths of all Latinos are Mexican. Overall, our results provide primary support for the Mexican dominance perspective but some support for the other three perspectives as well.
ABSTRACT
This article reports the rationale for the Brazilian Cardioprotective Nutritional Program (BALANCE Program) Trial. This pragmatic, multicenter, nationwide, randomized, concealed, controlled trial was designed to investigate the effects of the BALANCE Program in reducing cardiovascular events. The BALANCE Program consists of a prescribed diet guided by nutritional content recommendations from Brazilian national guidelines using a unique nutritional education strategy, which includes suggestions of affordable foods. In addition, the Program focuses on intensive follow-up through one-on-one visits, group sessions, and phone calls. In this trial, participants 45 years or older with any evidence of established cardiovascular disease will be randomized to the BALANCE or control groups. Those in the BALANCE group will receive the afore mentioned program interventions, while controls will be given generic advice on how to follow a low-fat, low-energy, low-sodium, and low-cholesterol diet, with a view to achieving Brazilian nutritional guideline recommendations. The primary outcome is a composite of death (any cause), cardiac arrest, acute myocardial infarction, stroke, myocardial revascularization, amputation for peripheral arterial disease, or hospitalization for unstable angina. A total of 2468 patients will be enrolled in 34 sites and followed up for up to 48 months. If the BALANCE Program is found to decrease cardiovascular events and reduce risk factors, this may represent an advance in the care of patients with cardiovascular disease.