Associations of changes in fat free mass with risk for type 2 diabetes: Hispanic Community Health Study/Study of Latinos.

AIMS: To determine whether loss of muscle mass (approximated using fat free mass [FFM]) is associated with risk for type 2 diabetes mellitus (T2DM) in Hispanic/Latino adults in the United States. METHODS: Participants were Hispanic/Latino adults (18-74-year-olds) who completed Visit 2 of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; multi-site, prospective cohort study; 6.1-year follow-up) and did not have T2DM at baseline (n = 6264). At baseline and Visit 2, FFM was measured using bioelectrical impedance analysis and fasting glucose, HbA1c, and fasting insulin were measured by examiners. Diabetes was defined according to American Diabetes Association criteria. Survey-weighted Poisson regression models examined the association of percent change in relative FFM (%ΔFFM) with incident prediabetes and T2DM. Survey-weighted multivariable regression models examined associations of %ΔFFM with changes in glucose and insulin measures. RESULTS: Relative FFM declined by 2.1% between visits. %ΔFFM was inversely associated with incident prediabetes (p-for-trend = 0.001) and with changes in glucose and insulin measures (p-for-trend <0.0001). Findings were null, except for HOMA-IR, after adjustment for changes in adiposity measures. Associations were generally stronger for individuals with baseline overweight/obesity. CONCLUSIONS: Reducing loss of FFM during adulthood may reduce prediabetes risk (primarily insulin resistance), particularly among individuals with overweight/obesity.

A randomized controlled trial to prevent obesity among Latino paediatric patients.

BACKGROUND: Obesity disproportionately affects Latino youth. Community clinics are an important resource, yet there is little evidence for the efficacy of clinic-based approaches in this population. OBJECTIVE: The purpose of this study was to test the efficacy of a clinic-based intervention to lower body mass index (BMI) and improve body composition among overweight Latino children. METHODS: A randomized trial (2 group × 3 repeated measures) was conducted among 297 randomly sampled, overweight paediatric patients (5-10 years old) and their parents. The 12-month family-based culturally tailored behavioural intervention (Luces de Cambio) was based on the 'traffic light' concepts to address behaviour change and was delivered by clinic health educators and mid-level providers. The primary study outcome was child BMI (kg m-2 ) assessed at baseline, 6-month (n = 191) and 12-month (n = 201) post-baseline. A subsample of the children was examined for overall and site-specific adiposity using dual-energy X-ray absorptiometry (n = 79). RESULTS: There were no significant intervention effects on child BMI (p > 0.05); however, intervention children showed significantly (p < 0.05) lower total and trunk per cent fat compared with the usual care condition. CONCLUSIONS: The Luces intervention did not reduce child BMI, yet small but significant reductions were observed for child per cent body fat. Further research is needed to identify and reduce barriers to recruitment and participation among Latino families.

The associations between anthropometric measurements and left ventricular structure and function: the Echo-SOL Study.

OBJECTIVE: The objective of this study is to determine associations between anthropometry and echocardiographic measures of cardiac structure and function in Hispanic/Latinos. METHODS: A total of 1,824 participants from ECHO-SOL were included. We evaluated associations between echocardiographic measures of left ventricular structure and function and anthropometric measures using multivariable-adjusted linear and logistic regression models adjusting for traditional cardiovascular risk factors. RESULTS: The mean age was 56 ± 0.17 years, 57% were women. The mean body mass index (BMI) was 30 ± 9.4 kg m-2, waist circumference (WC) was 100 ± 18 cm, and waist-to-hip ratio (WHR) was 0.93 ± 0.15. Adjusted analysis showed that 5-unit increment in BMI and 5-cm increase in WC was associated with 3.4 ± 0.6 and 1.05 ± 0.05 g m-2.7 (p < 0.05 for both) higher left ventricular (LV) mass index, respectively. Similarly, 0.1-unit increment in WHR was associated with 2.0 ± 0.16 g m-2.7 higher LV mass index (p < 0.01). WHR was associated with 0.22 ± 0.08% decrease in ejection fraction (p < 0.05). Concomitantly, 5-unit increment in BMI and WC was associated with increased odds of abnormal LV geometry (odds ratio 1.40 and 1.16, p = 0.03 and <0.01, respectively); 0.1-unit increment in WHR was associated with increased odds of abnormal LV geometry (odds ratio 1.51, p < 0.01). CONCLUSIONS: Among Hispanic/Latinos, higher anthropometric measures were associated with adverse cardiac structure and function.

Self-reported and accelerometer-measured physical activity by body mass index in US Hispanic/Latino adults: HCHS/SOL.

The association between obesity and physical activity has not been widely examined in an ethnically diverse sample of Hispanic/Latino adults in the US. A cross-sectional analysis of 16,094 Hispanic/Latino adults 18-74 years was conducted from the multi-site Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Body mass index (BMI) was measured and categorized into normal, overweight, and obese; underweight participants were excluded from analyses. Physical activity was measured using the 16-item Global Physical Activity Questionnaire and by an Actical accelerometer. Minutes/day of physical activity and prevalence of engaging in ≥ 150 moderate-vigorous physical activity (MVPA) minutes/week were estimated by BMI group and sex adjusting for covariates. No adjusted differences were observed in self-reported moderate (MPA), vigorous (VPA), or MVPA across BMI groups. Accelerometry-measured MPA, VPA, and MVPA were significantly higher for the normal weight (females: 18.9, 3.8, 22.6 min/day; males: 28.2, 6.1, 34.3 min/day, respectively) compared to the obese group (females: 15.3, 1.5, 16.8 min/day; males: 23.5, 3.6, 27.1 min/day, respectively). The prevalence of engaging in ≥ 150 MVPA minutes/week using accelerometers was lower compared to the self-reported measures. Efforts are needed to reach the Hispanic/Latino population to increase opportunities for an active lifestyle that could reduce obesity in this population at high risk for metabolic disorders.

Trait anger, cynical hostility and inflammation in Latinas: variations by anger type?

Anger and hostility are psychological factors that appear to play a salient role in relation to cardiovascular disease (CVD) risk; however, their association with risk within the Latino population remains relatively unexplored. The current study examined associations between overall trait anger, anger subdimensions (i.e., anger temperament and anger reaction) and cynical hostility with sICAM-1, a marker of cellular adhesion and systemic inflammation related to CVD risk, in a sample of 294 middleaged Mexican-American women. Results showed no association between trait anger or anger temperament and sICAM-1. Anger reaction was marginally associated with sICAM-1 (ß=4.77, p=.06). Cynical hostility was significantly associated with sICAM-1 (ß=5.89, p=.04) even after controlling for demographic, biological and behavioral covariates. The current study provides evidence that specific aspects of anger and hostility relate to physiological pathways that potentially influence CVD risk. Findings are discussed in light of contextual cultural factors.

Structured behavioral intervention to increase children's adherence to treatment for latent tuberculosis infection.

SETTING: San Diego, California public health department tuberculosis clinic. OBJECTIVE: To evaluate the effectiveness of a behavioral intervention (the Treasure Chest) that employed the behavior modification techniques of self-monitoring and positive reinforcement to increase adherence to therapy for latent tuberculosis infection (LTBI) in children. DESIGN: A retrospective study utilizing a historical comparison group. The treatment adherence of children who attended San Diego County TB Control Program (SDCTBCP) clinics with positive tuberculin skin tests who were started on LTBI treatment prior to Treasure Chest program implementation (n=841) was compared to that of SDCTBCP children enrolled in the Treasure Chest program (n=741). RESULTS: Logistic regression analysis demonstrated that children who participated in the Treasure Chest program were 2.4 times more likely to complete therapy than those who did not receive the intervention. CONCLUSION: The Treasure Chest intervention is effective in increasing adherence to LTBI therapy in children.

Evaluation of a culturally appropriate smoking cessation intervention for Latinos.

BACKGROUND: Many believe that smoking cessation programmes for Latinos should be tailored to the values and beliefs of the culture. However, randomised studies of culturally appropriate smoking cessation interventions with Latinos are rare. METHODS: Latino smokers (n = 313) were randomised to an intervention condition or a comparison group. The intervention was a three month programme based on social cognitive constructs and delivered in the smoker's home by trained lay health advisors, or promotores. Comparison group participants were referred to the California Smoker's Helpline in Spanish. Predictors of abstinence among all participants also were examined. RESULTS: About one week post-intervention, validated (carbon monoxide) past week abstinence rates were more than twice as high in the intervention group (20.5%) than in the comparison (8.7%) (p < or = 0.005). The pattern of results held for self reported abstinence, and after recoding dropouts to non-abstinence. The primary predictor of abstinence was number of cigarettes smoked per day at baseline, a common measure of addiction. CONCLUSIONS: The culturally appropriate intervention facilitated abstinence in Latino smokers, at least in the short term. Strengths and weaknesses of the study are discussed.

Cigarette smoking behavior among US Latino men and women from different countries of origin.

OBJECTIVES: This study sought to compare smoking behavior among Latino men and women from different countries of origin. METHODS: A telephone-administered survey was conducted in 8 cities with Latino men and women of different national origin living in census tracts with at least 70% Latino individuals. RESULTS: A total of 8882 participants completed the survey; 53% were women. The average age of respondents was 44 years; 63% were foreign-born, and 59% preferred Spanish for the interview. Current smoking was more prevalent among men (25.0%, 95% confidence interval [CI] = 23.7, 26.3) than among women (12.1%, 95% CI = 11.1, 13.0). Smoking rates were not significantly different by national origin among men, but Puerto Rican women had higher rates of smoking than other women. Central American men and women had the lowest smoking rates. Foreign-born respondents were less likely to be smokers (odds ratio [OR] = 0.77, 95% CI = 0.66, 0.90) than US-born respondents, and respondents with 12 years or less of education had an increased odds of smoking (OR = 1.17, 95% CI = 1.01, 1.35). High ac culturation was associated with more smoking in women (OR = 1.12, 95% CI = 1.00-1.25) and less smoking in men (OR = 0.86, 95% CI = 0.78-0.95). Puerto Rican and Cuban respondents were more likely to be current smokers and to smoke more than 20 cigarettes per day. CONCLUSIONS: Older, US-born, and more-educated respondents were less likely to be current smokers. Respondents of Puerto Rican and Cuban origin were more likely to smoke. Acculturation has divergent effects on smoking behavior by sex.

Social networks and cancer screening in four U.S. Hispanic groups.

BACKGROUND: Evidence shows that social relationships play an important role in health and health behavior. We examined the relationship between social networks and cancer screening among four U.S. Hispanic groups. METHODS: We used telephone surveys to collect data in eight U.S. regions that have concentrations of diverse Hispanic-origin populations. We interviewed 8903 Hispanic adults, for a response rate of 83%; analysis was restricted to the 2383 women aged > or =40. As a measure of social integration, we formed a social network index from items on the number of close relatives and friends, frequency of contact, and church membership. We used logistic regression to estimate the effects of social integration on screening, adjusting for sociodemographic factors. RESULTS: Among Mexican, Cuban, and Central-American women, the effect of social integration on mammography screening was slight. The odds ratios (OR) per unit change in social integration category ranged from 1.16 to 1.22 with confidence intervals (CI) that overlapped with the null. For Pap smear screening, the effect was strongest among Mexican-American women (OR=1.44, 95% CI=1.21 to 1.72), but also evident among Central-American women (OR=1.22, 95% CI=0.72 to 2.06) and Cuban women (OR = 1.25, 95% CI = 0.81 to 1.93). Among Puerto Rican women, social integration had no effect on either mammography (OR=1.03) or Pap smear screening (OR=1.08). CONCLUSIONS: Independent of socioeconomic factors, social integration appears to influence cancer screening participation of Hispanic women. The modest effect is not universal across Hispanic groups and was stronger for Pap smear than for mammography screening behavior. Researchers should recognize Hispanic group differences in social network characteristics and the potential of social networks to change screening behavior.

Results of language for health: cardiovascular disease nutrition education for Latino English-as-a-second-language students.

This report presents the final evaluation of Language for Health, part of a federally funded initiative to develop heart disease prevention interventions for low-literate populations. Language for Health specifically intervened with recent immigrants enrolled in English-as-a-second-language classes, incorporating nutritional behavior change materials into English-language curricula. Latino participants (n = 732) were exposed to either nutrition education or stress management classes (attention-placebo group) designed specifically for low-English-literate adults. Participants completed physiological measures assessing blood pressure, total and high-density lipoprotein (HDL) cholesterol, waist and hip circumference, and weight. Self-report surveys were administered to collect students' nutrition-related knowledge, attitudes, self-reported fat avoidance behaviors, and demographic information. Data were collected at baseline, 3-month posttest, and 6-month follow-up. Results indicated long-term effects of the intervention on nutrition knowledge and fat avoidance, yet only short-term effects on total cholesterol:HDL ratio and systolic blood pressure.

Breast cancer screening in regional Hispanic populations.

Although Hispanics' use of breast cancer screening services has been investigated, to date there have been no published studies of distinct Hispanic populations in different areas of the country. Using the diverse populations and sites involved in the National Hispanic Leadership Initiative on Cancer 'En Acción', this study examines ethno-regional differences in breast cancer screening rates among these groups and explores the correlates of screening participation. Data collected through telephone surveys were analyzed for women 40 years of age and older (n = 2082). After controlling for demographic variables traditionally related to breast cancer screening rates, it was found that ethno-regional differences in breast cancer screening practices clearly persisted. In addition to traditional demographic factors, other variables evidently underlie differences in Hispanics' utilization of breast cancer screening services. These variables may be cultural and should be investigated in future research. Meanwhile, researchers should not refer to the 'Hispanic' population at large without identifying, addressing and clarifying the ethno-regional characteristics of their samples.

Project Salsa: development and institutionalization of a nutritional health promotion project in a Latino community.

PURPOSE: Project Salsa was a community-based effort seeking to promote health through nutritional behavior change in a Latino community of San Diego, California. The purpose of this article is to report on program factors related to long-term institutionalization of Project Salsa interventions. DESIGN: Project Salsa was a demonstration rather than an experimental project. To ensure maximum sensitivity to the needs and values of the community, Project Salsa began with an extensive health needs assessment, including development of an advisory council, telephone survey, archival research, and key informant interviews. SETTING: Project Salsa interventions took place in San Ysidro, California, located near the U.S.-Mexico border adjacent to Tijuana from 1987 to 1992. SUBJECTS: The intervention community had 14,500 residents, of which nearly 83% were Latino. INTERVENTIONS: Interventions included coronary heart disease risk factor screenings, meal preparation classes, newspaper columns, point-of-purchase education, school health and cafeteria programs, and breast-feeding promotion. MEASURES: Institutionalization of intervention components. RESULTS: Two of the interventions, the risk factor screenings and school health programs, are still in operation 4 years after the end of project funding. CONCLUSIONS: Four factors common to institutionalized components are presented in the paper.

Initial results of 'Language for Health': cardiovascular disease nutrition education for English-as-a-second-language students.

Low literacy skills may negatively affect health through misuse of medication, inability to follow medical directions or due to limitations placed on the consumer's ability to access health information. The association between low literacy among adults and cardiovascular disease has not been thoroughly investigated in some ethnic groups. The purpose of this comprehensive study is to describe the results of a nutritional-related cardiovascular health program for limited English proficient adults enrolled in English-as-a-second-language (ESL) classes. Subjects (n = 408), nearly 87% of whom were Latino, were exposed to either nutrition education (intervention group) or stress management (attention-placebo control group) classes designed specifically for ESL classes. Subjects completed physiological measures assessing blood pressure, total and high-density lipoprotein (HDL) cholesterol, waist and hip circumference, and body mass. Self-report surveys were administered to collect students' nutrition-related knowledge, attitudes and behaviors. Data were collected at baseline, 3 month post-test and 6 month follow-up. Analyses showed that differential group change was seen for fat avoidance, nutrition knowledge, HDL and total cholesterol:HDL ratio, but, for the two latter variables, the effect was not maintained at the 6 month follow-up. Both groups showed positive changes in blood pressure, total cholesterol and nutrition-related attitudes. Results showed moderate success of the intervention, but suggest contamination between experimental groups may have occurred.