Irritable Bowel Syndrome on the US Mexico Border: A Survey in an Indigent Population Using Rome III Criteria.

GOALS: To investigate the prevalence of irritable bowel syndrome (IBS), and its association with health perception and health care-seeking behavior in this Mexican American population. BACKGROUND: The prevalence of IBS ranges from 3% to 20.4% in the United States and 4.4% to 16% in Mexico, based on Rome III and II criteria. However, its epidemiological profile in the US Mexico border is unknown. STUDY: We conducted a survey in a randomly selected indigent population (N=521) recruited into a colon cancer screening program (ACCION). The prevalence of IBS was estimated and a multivariable logistic regression was carried out to determine the associated risk factors. Results are summarized using odds ratio and 95% confidence interval (CI). RESULTS: A total of 464 (89%) completed the survey (mean age, 56.7 y; female, 74.8%). Country of birth was Mexico in 90.5% and the United States in 8.2% and acculturation was more Spanish (94.8%) than English (5.2%). Overall, 5.6% (95% CI, 3.7-8.1) fulfilled criteria for IBS with a predominance among women (6.9%) versus men (1.7%) (P=0.03). On the basis of multivariable analysis, lower number of bowel movements/week (odds ratio, 0.89; 95% CI, 0.80-1.00), having a primary care physician: 4.09 (1.51-11.12), using herbal treatments: 2.76 (1.08-7.06) and a previous IBS diagnosis: 23.11 (3.44-155.45), were significantly associated with the presence of IBS. CONCLUSIONS: The prevalence of IBS on the US Mexico border is comparable with data obtained from studies in both countries. Consulting a primary care physician as an associated factor may reveal the high rate of health-care seeking in IBS patients, while herbal treatments may reflect a cultural influence.

Against Colorectal Cancer in Our Neighborhoods, a Community-Based Colorectal Cancer Screening Program Targeting Low-Income Hispanics: Program Development and Costs.

BACKGROUND: Colorectal cancer is the second leading cause of cancer-related death in the United States. Despite universal screening recommendations, screening rates in the United States remain suboptimal, especially among the poor, the uninsured, recent immigrants, and Hispanics. This article describes the development of a large community-based colorectal cancer screening program designed to address these disparities. METHOD: The Against Colorectal Cancer in our Neighborhoods program is a bilingual, evidence-based, theory-guided, multicomponent community screening intervention, targeting the uninsured and developed using a systematic planning process. It combines community health worker-led outreach, bilingual and culturally tailored community education, and no-cost screening with provision of the fecal immunochemical test or colonoscopy and navigation services. A detailed process and outcome evaluation is planned. Program development cost calculated prospectively (in 2011 dollars) using a societal perspective and micro-costing methods was $243,278, of which $180,344 was direct cost. DISCUSSION: The detailed description of the development processes and costs of this health promotion program targeting low-income Hispanics will inform health program decision makers about the resource requirements for planning and developing new programs to reduce disease burden in communities.

AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women.

BACKGROUND: Considerable efforts have been undertaken in the United States to reduce cervical cancer incidence and mortality by increasing screening; however, disparities in screening rates continue to exist among certain racial and ethnic minority groups. The objective of the current study was to determine the effectiveness of a lay health worker-delivered intervention-AMIGAS (Ayudando a las Mujeres con Informacion, Guia, y Amor para su Salud [helping women with information, guidance, and love for their health])-to increase Papanicolaou (Pap) test screening among 3 populations of women of Mexican origin. METHODS: Six hundred thirteen women of Mexican origin in 3 treatment sites were randomized among 4 study arms: the full AMIGAS program with a video and a flip chart (n = 151), the AMIGAS program without the video (n = 154), the AMIGAS program without the flip chart (n = 155), and a usual care control group (n = 153). Six months after enrollment, women were surveyed and reported whether or not they had been screened. RESULTS: Women in any of the intervention arms were statistically significantly more likely to report being screened than those in the usual care group in both an intent-to-treat analysis and a per-protocol analysis. In the intent-to-treat analysis, 25% of women in the control group and 52% in the full AMIGAS program group reported having had Pap tests (P < .001); in the per-protocol analysis, the percentages were 29% and 62%, respectively (P < .001). CONCLUSIONS: AMIGAS was effective in increasing Pap test screening among women of Mexican descent when used in a 1-to-1 setting. Future research should compare the 1-on-1 intervention with the group-based intervention.

Helicobacter pylori eradication and change in markers of iron stores among non-iron-deficient children in El Paso, Texas: an etiologic intervention study.

OBJECTIVES: We assessed whether Helicobacter pylori eradication was followed by changes in iron stores among non-iron-deficient children. MATERIALS AND METHODS: Double-blind randomized intervention trial on 110 asymptomatic 3- to 10-year-olds with H pylori infection assigned to any of the following 4 arms: both quadruple eradication and iron supplementation, either quadruple sequential eradication or iron supplementation, or placebo only. Hemoglobin, transferrin saturation, and serum ferritin were measured at baseline and 8 months later to assess changes according to study arm, H pylori infection status at ≥45 days, and cytotoxin-associated gene product A status. RESULTS: Intent-to-treat (n = 110) and per-protocol (n = 90) analyses revealed no differences across study arms in changes of iron stores. However, we found that those who had their infection eradicated had a 3-fold increased average change from baseline serum ferritin compared with that of children who remained infected (P < 0.05). Eradication of infection by cytotoxin-associated gene product A negative strains was associated with a larger ferritin increase. CONCLUSIONS: In this double-blind randomized trial, the first among non-iron-deficient, asymptomatic H pylori-infected children living in the contiguous United States, we found no effect of H pylori eradication regarding changes in iron stores. However, those who had their infection eradicated at follow-up had a significantly larger increase in serum ferritin from baseline.

Double-blind randomized trial of quadruple sequential Helicobacter pylori eradication therapy in asymptomatic infected children in El Paso, Texas.

OBJECTIVES: We assessed the efficacy of a novel quadruple sequential 10-day eradication therapy, its compliance, and reported adverse events in a sample of asymptomatically Helicobacter pylori-infected children in El Paso, Texas, as part of a study aiming to assess the influence of this infection on the levels of markers of iron stores. PATIENTS AND METHODS: Using a double-blind randomized trial design, 110 asymptomatic children ages 3 to 11 with H pylori infection were randomly assigned to receive either a 10-day course of sequential eradication therapy plus 6 weeks of iron supplementation, eradication therapy plus placebo, iron supplementation plus placebo, or placebo only. H pylori infection status was assessed ≥45 days after treatment using the urea breath test. Analyses compared the proportion of subjects cured according to assignment to and completion of the sequential eradication therapy. RESULTS: Intent-to-treat and per-protocol analyses indicated that 44.3% and 52.9%, respectively, of the children receiving the novel quadruple sequential therapy had their infection eradicated compared with 12.2% and 15.4% in the arms receiving iron or placebo only, respectively (P < 0.001 in both analyses). Study medications were taken with no or only mild adverse events in most children. CONCLUSIONS: A quadruple sequential regimen eradicated H pylori in only half the asymptomatic children receiving this treatment. There was no difference in the cure rates of those receiving iron supplementation and those receiving placebo.

Hyperendemic H. pylori and tapeworm infections in a U.S.-Mexico border population.

OBJECTIVE: A higher incidence of infectious disease has been documented in U.S. regions bordering Mexico compared with non-border areas. We assessed the prevalence of important gastrointestinal infections in Ciudad Juarez, Mexico, and El Paso, Texas, the largest binational community along the U.S.-Mexico border. METHODS: Fecal specimens from a sample of the asymptomatic population representing all ages were tested for Helicobacter pylori (H. pylori), Cryptosporidium spp., Giardia spp., and other intestinal parasitic pathogens using flotation, immunoassays, and/or polymerase chain reaction. We also measured indicators of microbiological contamination of drinking water, hands of food preparers, and kitchen surfaces. RESULTS: Overall, of the 386 participants, H. pylori was present in 38.2%, Taenia spp. in 3.3%, Giardia spp. in 2.7%, Cryptosporidium spp. in 1.9%, Entamoeba dispar in 1.3%, and Ascaris lumbricoides and Necator americanus in 0.3% of the study subjects; Cyclospora spp. and Entamoeba histolytica were not found. H. pylori infection was associated with handwashing (prevalence ratio [PR] = 1.3, 95% confidence interval [CI] 1.0, 1.8). Taenia spp. was found more often on the U.S. side (PR=8.6, 95% CI 2.3, 30.8). We did not find an association between these infections and the occurrence of total coliforms or fecal coliforms on kitchen surfaces. In addition, Escherichia coli was not found in any drinking water sample. CONCLUSION: The study results indicated that H. pylori and Taenia spp. infections may be highly prevalent along the U.S.-Mexico border. Additional research is necessary to adequately characterize the prevalence, as well as determine whether interventions that reduce these infections are warranted.

A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population, 2005-2008.

INTRODUCTION: The high prevalence of cardiovascular disease (CVD) in the Hispanic population of the United States, together with low rates of health insurance coverage, suggest a potential cardiovascular health crisis. The objective of Project HEART (Health Education Awareness Research Team) was to promote behavior changes to decrease CVD risk factors in a high-risk Hispanic border population. METHODS: Project HEART took place from 2005 through 2008 as a randomized community trial with a community-based participatory research framework using promotores de salud (community health workers). A total of 328 participants with at least 1 CVD risk factor were selected by randomizing 10 US Census tracts in El Paso, Texas, to either the experimental or the control group. The experimental group (n = 192) was assigned to a series of 8 health classes using the Su Corazón, Su Vida curriculum. After 2 months of educational sessions, the group was followed for 2 months. The control group (n = 136) was given basic educational materials at baseline, and no other intervention was used. Main outcomes of interest included changes in health behaviors and clinical measures. RESULTS: Participants in the experimental group showed more awareness of CVD risk factors, more confidence in the control of these factors, and improved dietary habits (ie, lower salt and cholesterol intake, better weight-control practices) compared with the control group. Total cholesterol was 3% lower in the experimental than in the control participants, and nonhigh-density lipoprotein cholesterol and low-density lipoprotein cholesterol were both 5% lower. CONCLUSION: The HEART trial suggests that community health education using promotores de salud is a viable strategy for CVD risk reduction in a Hispanic border community.

Cross-border purchase of medications and health care in a sample of residents of El Paso, Texas, and Ciudad Juarez, Mexico.

BACKGROUND: We examined data from a US-Mexico bi-national survey conducted among adult residents of El Paso, Texas, and Ciudad Juarez, Mexico, to assess frequency of purchase of medications and use of health care services across the border. METHODS: We analyzed questionnaire data from face-to-face interviews of 1000 randomly selected adults on both sides of the border to assess prevalence and prevalence ratios using log binomial logistic regression analysis. RESULTS: One-third of adult residents of El Paso and 5% of those in Ciudad Juarez reported crossing the border to purchase medications (P < .001). Lack of health insurance in the United States was associated with crossing the border to purchase medications. Nine percent and 7% of US residents traveled to Mexico seeking dental and medical care, respectively. Mexican nationals traveling to the United States to purchase medications or health care services were more likely to be uninsured and more-educated men. CONCLUSION: US residents of areas along the border in close proximity to Mexico often travel south to purchase medications. Other health care services are also utilized, although at lower rates. These patterns may be attributed to a number of barriers to health care in the United States.

Hearing threshold comparisons between 2001-02 NHANES and 2003-05 Fort Bliss U.S. Army Service components.

This study compares population mean hearing threshold levels in decibels (dB) at 4 kHz among the 2001-02 National Health and Nutrition Examination Survey (NHANES) (n=1872) and the 2003-05 Fort Bliss Army Active Duty (AD) (n=9096), National Guard (NG) (n=3842), and Reserve Components (RC) (n=2025) and by gender. Comparisons between male populations show that mean hearing thresholds are not significantly different (p<0.05) between U.S. Army Active Duty males and NHANES males, which differ from a 1984 U.S. Army Active Duty/1971-74 NHANES study showing significantly higher hearing thresholds for the Army Active Duty population. In addition, this study shows that Active Duty males have significantly lower hearing thresholds than National Guard males at ages <40 years old. Female groups generally have significantly lower hearing thresholds than male groups at all ages, but there are not significant differences between female military and civilian populations.

Evaluation of smoking cessation behaviors and interventions among Latino smokers at low-income clinics in a US-Mexico border county.

A descriptive study of 94 Latino smokers receiving nicotine replacement therapy (NRT) in US-Mexico border clinics in El Paso County, Texas was conducted. A baseline questionnaire and two follow-up telephone surveys (8-12 weeks and 6 months) were administered to evaluate smoking habits, behaviors, and cessation interventions. Participants reported an average daily cigarette consumption of 15 cigarettes and smoked within 30 min of waking (44%). Primary motivations for quitting were personal health (95%), family's health (74%), and doctor's advice (71%). Female smokers were more likely to smoke due to being anxious (p=0.012), not being able to sleep (p=0.02), or to feel thin (p=0.002). Male smokers were more likely to smoke when drinking alcohol (p=0.005). Nearly 40% of smokers reported they had never tried to quit before. Medication use at baseline was 82% patch, 53% lozenge, 29% gum, and 24% bupropion (combination therapy permitted). At 8-12 weeks, nearly two-thirds of patients were quit and 44% remained quit at six months. Smoking habits, behaviors, and successful cessation interventions among Latinos in a US-Mexico border community were identified.

Seasonal fine and coarse culturable fungal constituents and concentrations from indoor and outdoor air samples taken from an arid environment.

This study was undertaken to determine the normal indoor and outdoor airborne culturable fungal constituents and concentrations of an arid environment. Air samples were taken with two-stage, ambient, culturable sampler systems and analyzed for nine specific fungal genera from 50 homes as a repeated measure during each season of the year. These homes had no previous histories of indoor air quality issues. This study detected seasonal differences for the arid environment between different culturable fungal concentrations across the two size ranges. The highest concentrations were during fall, in the outdoor fine-size range. The lowest concentrations were the indoor coarse concentrations in the spring. From this study it can be concluded that Cladosporium spp. had the highest concentrations during fall in an arid environment. The overall findings suggest that Cladosporium had concentrations greater than the other genera evaluated, specifically, the fall outdoor fine concentrations. Seasonality was found to be a key factor in determining the variability of fungal constituents and concentrations within the arid indoor and outdoor environments. The fine-size range was 12 times and 6 times greater than the coarse-size range for indoor and outdoor samples, respectively, which accounted for the majority of fungal organisms. In addition, the results from this study in an arid climate differ from those conducted in a moister climate.

Diabetes prevalence and treatment adherence in residents living in a colonia located on the West Texas, USA/Mexico border.

Little is known about how diabetes affects the health status of Hispanic people living in colonias located along the USA/Mexico border. The purpose of this report is to describe the demographic factors, prevalence of diabetes, and the health status of the residents living in a colonia on the border between El Paso, Texas, USA, and Juarez, Mexico, and to report the residents' adherence to the Behavioral Risk Factor Surveillance System (BRFSS) protocols for the management of type 2 diabetes. This study included 188 participants. The instruments used included a demographic questionnaire, the Short Acculturation Scale for Hispanics, "Cutting Down, Annoyance by Criticism, Guilty Feelings, and Eye-openers", BRFSS, and the Short Form-36 (v2). The prevalence of diabetes was 15.4% and 41.3% of the residents had a Body Mass Index score > 30. The rate of hypertension, elevated cholesterol, and depression for those reporting diabetes was significant. The SF-36 v2 physical score for the diabetic residents was 42.9 and it was 52.4 for the non-diabetic residents. The average resident of the colonia who reports diabetes has many health disadvantages when compared to those in other parts of Texas and the USA generally.

Characterization of seasonal indoor and outdoor bioaerosols in the arid environment of El Paso, Texas.

The authors conducted a study in the El Paso, Texas, region to assess the seasonal bioaerosol concentrations in a convenience sample of one-story residences. The authors sampled the same houses for each season over the course of a year (March 2005 to February 2006) to determine bacterial and fungal concentrations. They used a two-stage ambient culturable sampler system to collect the bioaerosol samples. They took indoor and outdoor bioaerosol samples and studied meteorological conditions for each house at each season. The study found that most of the measured bioaerosol concentrations differed statistically by season (p < .05). The greatest concentrations throughout the year were found to occur in fine-sized indoor bacteria during the winter. Meteorological conditions were found not to significantly influence bioaerosol concentrations throughout the year.

Promotora diabetes intervention for Mexican Americans.

PURPOSE: The purpose of this randomized controlled trial is to determine the effectiveness of an intervention led by promotoras (community lay workers) on the glycemic control, diabetes knowledge, and diabetes health beliefs of Mexican Americans with type 2 diabetes living in a major city on the Texas-Mexico border. METHODS: One hundred fifty Mexican American participants were recruited at a Catholic faith-based clinic and randomized into 2 groups. Personal characteristics, acculturation, baseline A1C level, diabetes knowledge, and diabetes health beliefs were measured. The intervention was culturally specific and consisted of participative group education, telephone contact, and follow-up using inspirational faith-based health behavior change postcards. The A1C levels, diabetes knowledge, and diabetes health beliefs were measured 3 and 6 months postbaseline, and the mean change between the groups was analyzed. RESULTS: The 80% female sample, with a mean age of 58 years, demonstrated low acculturation, income, education, health insurance coverage, and strong Catholicism. No significant changes were noted at the 3-month assessment, but the mean change of the A1C levels, F(1, 148) = 10.28, P < .001, and the diabetes knowledge scores, F(1, 148) = 9.0, P < .002, of the intervention group improved significantly at 6 months, adjusting for health insurance coverage. The health belief scores decreased in both groups. CONCLUSIONS: The intervention resulted in decreased A1C levels and increased diabetes knowledge, suggesting that using promotoras as part of an interdisciplinary team can result in positive outcomes for Mexican Americans who have type 2 diabetes. Clinical implications and recommendations for future research are suggested.

Comparison of nondeployable hearing profiles by Army component (Active Duty, National Guard, and Reserve) and by gender.

The Hearing Conservation Service at Fort Bliss conducted baseline-hearing assessments from January 2003 to March 2005 on 14,974 soldiers in the Active Duty (AD), National Guard (NG), and Reserve Component (RC). The percentages of soldiers with >H-2 (i.e., nondeployable) hearing profiles based on Army component and gender are as follows: AD male = 2.21%; AD female = 0.65%; NG male = 5.05%; NG female = 1.64%; RC male = 5.02%; and RC female = 0.54%. Female soldiers in all three components and AD male soldiers are not significantly different (p < 0.05) from each other and have a significantly lower percentage of >H-2 hearing profiles than NG and RC male soldiers after adjusting for age. With the Army engaged in worldwide missions, these results should prove useful to commanders and medical officers for assessing deployment capabilities and for hearing conservation interventions.

Promovision: designing a capacity-building program to strengthen and expand the role of promotores in HIV prevention.

This article describes the development of Promovisión, a program based on the utilization of promotores in community-based organizations (CBOs) to improve the provision of HIV prevention services to recent immigrants and Latinos who are less acculturated. Promovisión aims to demonstrate the contribution of promotores as a cost-effective strategy in HIV prevention efforts, and how promotores facilitate the formation of community, regional, and national CBO networks working collaboratively to prevent the spread of HIV in Latino communities. In addition, this article examines the interpersonal, organizational, community, and sociocultural dimensions that facilitate or hinder community mobilization, and coalition formation and growth, and how these findings shaped the final design of the program. Finally, the Promovisión program seeks to demonstrate that a promotor-based program is a culturally appropriate model for HIV prevention and care, which can be successfully implemented in community and clinical settings among ethnic populations with limited English proficiency.

Guide for herbal product use by Mexican Americans in the largest Texas-Mexico border community.

Use of herbal products is a very common practice among Mexican Americans living in the El Paso, Texas, region. Although medicinal plants are generally assumed to be a safe and natural alternative to conventional medications, some herbal products could pose a potential health risk to the consumer. Currently, only a few studies focus on herbal product use by Mexican Americans, and no studies have focused on its use by patients with human immunodeficiency virus (HN) living on the US-Mexico border. A prospective observational study was conducted in 439 non-HIV patients, as well as in 35 patients suffering from HIV Findings showed that 347 out of 439 (79%) of non-HIV patients and 25 out of 35 (71%) of HIV patients reported using herbal products.

Herbal product use in non-HIV and HIV-positive Hispanic patients.

PURPOSE: The primary endpoint of this study was to determine the prevalence of herbal product use by a sample of Mexican-American patients in the El Paso, TX region. Even though medicinal plants are popularly assumed to be a safe and natural alternative to conventional medications, some herbal products may pose a potential health risk to the consumer. Currently, there are few studies related to herbal use by Mexican Americans and none in HIV patients living on the U.S./México border. METHODS: A prospective observational study was conducted in hospitals and clinics throughout the El Paso region area. A semistructured interview was conducted by trained bilingual interviewers. A 45-item bilingual questionnaire was used to collect the information. RESULTS: A total of 439 non-HIV patients as well as 35 patients afflicted with HIV participated in the study. Seventy-nine percent (347/439) of non-HIV and 71% (25/35) of HIV patients reported using herbal products. The percentages of herbal use among the two groups did not show any statistically significant differences (p=0.29), and both groups reflected that herbal products are commonly used. CONCLUSIONS: The use of herbal products was very common among non-HIV (79%) and HIV-positive (71%) Mexican-Americans patients in the El Paso region.

Evaluation of the use of complementary and alternative medicine in the largest United States-Mexico border city.

STUDY OBJECTIVE: To evaluate the use of complementary and alternative medicine (CAM) in the El Paso, Texas, region. DESIGN: Prospective observational study conducted from April-October 2000. SETTING: Several hospitals and clinics. SUBJECTS: Five hundred forty-seven participants. INTERVENTION: Semi-structured interview with a bilingual questionnaire. MEASUREMENTS AND MAIN RESULTS: Complementary and alternative medicine was used in 77% of our population. The most common CAM providers were massage therapists (19.4%) and herbalists (12.4%). The most common herbal or home remedies were chamomile (13.1%) and aloe vera (8.5%). The most common nutritional or commercial products were multivitamins (16%), ginseng (3.6%), and ginkgo biloba (2.8%). We identified 599 CAM usages that could result in drug interactions, disease interactions, or adverse reactions. CONCLUSIONS: A wide range of CAM use was documented in this study. Our results indicate that Hispanics in this area use CAM at a higher rate than national trends. Many of these therapies can adversely affect a variety of disease states and drug therapies.

The relationship between liquor outlet density and injury and violence in New Mexico.

This study used an ecologic design based on data from 1990 to 1994 gathered from forensic, vital statistic, census, law enforcement and liquor licensing agencies to assess the relationship between liquor outlet density and alcohol-related health outcomes in New Mexico. Linear regression models show that suicide, alcohol-related crash, and alcohol-related crash fatality (adjusted for age, sex, and minority status) are significantly associated with liquor outlet density. Data also show that, compared with the first tertile, suicide and alcohol-related crash rates increase about 50% and the alcohol-related crash fatality rate two-fold with the third tertile of liquor outlet density. Greater availability of liquor outlets is associated with higher rates of suicide, alcohol-related crash, and alcohol-related crash fatality.