Diabetes-related mortality among Mexican Americans, Puerto Ricans, and Cuban Americans in the United States.

OBJECTIVES: Hispanics are the most rapidly growing minority group in the United States, and Mexican Americans, Puerto Ricans and Cuban Americans are the three largest Hispanic subgroups. Among Hispanics, type 2 diabetes is the fifth leading cause of death. This paper examines diabetes-related mortality in Mexican Americans, Puerto Ricans, and Cuban Americans over 35 years of age in the United States during 1996 and 1997. METHODS: Using data from the National Vital Statistics System and the 1990 and 2000 censuses, we calculated age-adjusted and age-specific diabetes-related death rates for Mexican Americans, Puerto Ricans, and Cuban Americans over 35 years of age. Diabetes-related deaths were determined to be any death for which diabetes was coded as either the underlying or contributing cause of death. RESULTS: The diabetes-related mortality rate for Mexican Americans (251 per 100,000) and Puerto Ricans (204 deaths per 100,000) was twice as high as the diabetes-related mortality rate for Cuban Americans (101 deaths per 100,000). Cuban American decedents had the highest proportion of deaths with diabetes coded as the underlying cause of death (44%). After diabetes, heart disease (31%) followed by cancer (8%) and stroke (6%) were the most frequent primary underlying causes of diabetes-related deaths in all three ethnic groups. CONCLUSION: Our analyses of these data demonstrate that diabetes-related mortality differed among Mexican Americans, Puerto Ricans and Cuban Americans more than 35 years of age in the United States in 1996 and 1997. Socioeconomic factors such as low educational attainment and low income may be factors that contributed to the disparities in these mortality rates for different subgroups. Further research is needed to update these findings and to investigate explanatory risk factors. Diversity among Hispanic subgroups has persisted in recent years and should be considered when health policies and services targeted at these populations are developed.     

Prevalence of doctor-diagnosed arthritis and arthritis-attributable effects among Hispanic adults, by Hispanic subgroup--United States, 2002, 2003, 2006, and 2009

Arthritis affects approximately 50 million adults in the United States, making it one of the most prevalent health conditions among U.S. adults and the most common cause of disability. Arthritis is associated with substantial activity limitation, work disability, increased prevalence of obesity, reduced quality of life, and high health-care costs. Among U.S. adults, the prevalence of arthritis and arthritis-attributable effects (e.g., arthritis-attributable activity limitations [AAAL]) varies among racial/ethnic groups; non-Hispanic whites and non-Hispanic blacks have a higher prevalence of doctor- diagnosed arthritis compared with Hispanics, but Hispanics and non-Hispanic blacks have a higher prevalence of arthritis-attributable effects compared with non-Hispanic whites. The prevalence of arthritis and its effects among specific Hispanic subgroups has not been studied in a nationally representative sample of U.S. adults. To determine the annualized prevalence of arthritis and arthritis-attributable effects among Hispanic subgroups, CDC analyzed National Health Interview Survey (NHIS) data for 2002, 2003, 2006, and 2009 combined. This report describes the results of that analysis, which indicated that the age-adjusted prevalence of arthritis ranged from 11.7% among Cubans/Cuban Americans to 21.8% among Puerto Ricans; an estimated 3.1 million Hispanics had arthritis during these years. Among all subgroups of Hispanics with arthritis, at least 20% of persons with arthritis reported an arthritis-attributable effect: AAAL (range: 21.1% among Cubans/Cuban Americans to 48.5% among Puerto Ricans); arthritis-attributable work limitations (AAWL) (range: 32.9% among Central/South Americans to 41.6% among Mexican Americans); and severe joint pain (SJP) (range: 23.7% among Cubans/Cuban Americans to 44.1% among Puerto Ricans). These findings identify Hispanic subgroups with high burdens of arthritis who likely are in need of interventions designed to improve their quality of life.     

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.     

Prevalence of chronic bronchitis among US Hispanics from the Hispanic Health and Nutrition Examination Survey, 1982-84.

In the Hispanic Health and Nutrition Examination Survey (HHANES), Puerto Ricans had a higher age-adjusted prevalence of self-reported chronic bronchitis (2.9 percent, 95% CI = 2.2, 3.6) than Mexican Americans (1.7 percent, 95% CI = 1.3, 2.1) or Cubans (1.7 percent, 95% CI = 0.9, 2.5). The prevalence of chronic bronchitis was at least 2 times higher in smokers as compared to nonsmokers among Puerto Ricans and Cubans, but not for Mexican Americans.     

Macronutrient intakes among adult Hispanics: a comparison of Mexican Americans, Cuban Americans, and mainland Puerto Ricans.

OBJECTIVES. The purpose of this study was to compare energy and macronutrient intakes between adult Mexican Americans, Cuban Americans, mainland Puerto Ricans, and non-Hispanics. METHODS. Age-specific mean intakes were estimated based on 24-hour recalls from the Hispanic Health and Nutrition Examination Survey (HHANES) (1982 to 1984) and the Second National Health and Nutrition Examination Survey (NHANES II) (1976 to 1980) and were compared with the use of t tests. RESULTS. Mexican Americans had higher total fat, saturated fat, and monounsaturated fat intakes than did Puerto Ricans and older Cuban Americans. Cuban Americans and Puerto Ricans had similar intakes, except for younger Cuban Americans, who had higher total and saturated fat and lower carbohydrate intakes. Cholesterol intakes among Mexican American men and 60- to 74-year-old women were higher than those among other Hispanic groups. Carbohydrate and protein intakes were higher among Hispanic groups compared with those among non-Hispanics while total fat intakes were generally lower. CONCLUSIONS. Since macronutrient intakes differ between Hispanic groups, dietary research, recommendations, and interventions should be targeted to each group individually. Older Puerto Rican and Cuban American adults met population guidelines for reducing chronic disease risk for more macronutrients than any other group.     

Reported asthma among Puerto Rican, Mexican-American, and Cuban children, 1982 through 1984.

Data from the Hispanic Health and Nutrition Examination Survey (HHANES) (1982 through 1984) and the National Health and Nutrition Examination Survey (NHANES) II (1976 through 1980) were used to examine reported physician-diagnosed asthma among 6-month-old through 11-year-old children. The highest prevalence of active asthma was reported for Puerto Ricans: 11.2% compared with 3.3% for non-Hispanic Whites, 5.9% for non-Hispanic Blacks, 2.7% for Mexican Americans, and 5.2% for Cubans. Health services utilization and severity do not appear to explain the differences between Puerto Ricans and Mexican Americans. Educational programs on asthma should consider focusing on Puerto Ricans.     

Low intakes of energy,folate, iron,and calcium of child-bearing Korean women

The focus is on dietary diversity among United States (US) Hispanics, with attention given to differences by socioeconomic status (SES) and level of acculturation. The subjects of study were 18 to 74 years of age Mexican Americans (n = 3201), Cuban Americans (n = 831), and Puerto Ricans (n = 1224) included in the 1982–84 Hispanic Health and Nutrition Examination Survey (HHANES). Dietary diversity was assessed as ‘food group’ and ‘portion’ scores derived from single 24 hour recalls. Less than 10% of Hispanic men and 5% of women satisfy diversity recommendations (17 or more portions out of a possible 20) and patterns are as found in the general US population. Multivariate analysis suggest that among Mexican Americans and Puerto Ricans diversity is related to education and level of acculturation. Income is not related to diversity in any group. Generation of residency in the US is associated with less variety among Mexican Americans and Puerto Rican men. Socioeconomic status and acculturation are not significantly related to diversity among Cuban Americans. In conclusion, the diets of US Hispanics lack variety and this places these populations at long‐term health risk. While interventions need to consider the educational level and cultural differences among Hispanics, income levels are unrelated to diversity in all groups, and therefore, not an apparent limitation to change.     

Hypertension prevalence and the status of awareness, treatment, and control in the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-84.

The prevalence rates of hypertension among adult (ages 18-74) Mexican Americans, Cuban Americans, and Puerto Ricans were estimated using data from the 1982-84 Hispanic Health and Nutrition Examination Survey (HHANES). Hypertension is defined as diastolic greater than or equal to 90 mm Hg, or systolic greater than or equal to 140 mm Hg, or currently taking antihypertensive medication. Among Mexican Americans in the Southwestern United States, 16.8 percent of the males and 14.1 percent of the females were found to be hypertensive. Among Cuban Americans in Dade County, Florida 22.8 percent of the males and 15.5 percent of the females were hypertensive. Among Puerto Ricans in the New York City area 15.6 percent of the males and 11.5 percent of the females were hypertensive. The age-adjusted rates are significantly lower than comparable rates for Whites and Blacks as measured in the second National Health and Nutrition Examination Survey (NHANES II), 1976-80. Control of hypertension in the HHANES populations fall short of the 1990 Objectives for the Nation established by the US Public Health Service 60 percent (34 percent controlled Mexican American hypertensives, 27.8 percent controlled Cuban American hypertensives, and 29 percent controlled Puerto Rican hypertensives.     

Serum alpha-tocopherol levels of Mexican Americans, Cubans, and Puerto Ricans aged 4-74 y

Data from the Hispanic Health and Nutrition Examination Survey were used to examine serum alpha-tocopherol levels (in subjects aged 4-74 y) and ratios of alpha-tocopherol to cholesterol plus triglyceride and to cholesterol (in subjects aged 20-74 y) of Mexican Americans (MA), Cubans, and Puerto Ricans (PR). Neither alpha-tocopherol nor the alpha-tocopherol-lipid ratios differed between sexes. PR had lower mean alpha-tocopherol and alpha-tocopherol-lipid ratios and higher prevalences of alpha-tocopherol less than 11.6 mumol/L than did MA or Cubans in several age groups. MA and Cuban adolescents had lower alpha-tocopherol levels than children had. Mean alpha-tocopherol levels and alpha-tocopherol-lipid ratios increased and prevalences of alpha-tocopherol less than 11.6 mumol/L decreased during adulthood in all three ethnic groups.     

Pap smear and mammogram screening in Mexican-American women: the effects of acculturation.

OBJECTIVES. For Mexican Americans, acculturation is a multidimensional process of adopting attitudes, values, and behavior from the non-Hispanic White culture. This study examines the effects of different dimensions of acculturation on the cancer screening behavior of Mexican-American women. METHODS. Subjects were 450 randomly selected Mexican-American women age 40 years and older living in El Paso, Texas. Personal interviews solicited information on age, income, education, health insurance, Pap smear and mammogram use, and acculturation. Acculturation was measured with five scales that assessed English proficiency, English use, value placed on culture, traditional family attitudes, and social interaction. RESULTS. The 2-year prevalence of Pap smear and mammogram screening increased with each gain in acculturation on English proficiency and use. These associations disappeared when adjusted for age, income, insurance, and education. After adjusting for sociodemographic factors and other acculturation dimensions, a strong traditional Mexican attitude toward family was positively related to mammography use. CONCLUSIONS. Taking advantage of the positive influence of Hispanic familism on cancer screening behavior may increase the effectiveness of cancer control interventions in Mexican Americans.     

Psychosocial risk factors for eating disorders in Hispanic females of diverse ethnic background and non-Hispanic females

This study investigated differences in psychosocial risk factors for eating disorders among university females (n=406) of diverse Hispanic background (Puerto Rican, Cuban, Central American/Mexican, Dominican, Venezuelan) and among White non-Hispanic (n=102) female students. Risk factors were assessed using the Psychosocial Risk Factor Questionnaire (PRFQ) which includes four subscales: Social Pressure for Thinness, Media Pressure for Thinness, Concern for Physical Appearance, and Perception of Physical Appearance. There were significant differences among the groups in total PRFQ score, F(7,499)=2.76, P<.008, and the subscale score for Concern, F(7,499)=2.99, P<.004, with Dominicans, Venezuelans and Columbians having higher scores than White non-Hispanics and Central Americans/Mexicans. In addition, there was a significant difference in BMI, F(7,499)=2.70, P<.009. Both Puerto Ricans (24.27+0.81) and Venezuelans (24.66+1.00) had higher BMIs than White non-Hispanics (21.87+0.37), Cubans (21.99+0.24) and Brazilians (21.46+0.96). There was also a significant, F(7,498)=2.70, P<.009, difference among the groups in Ideal Body Image score. Puerto Ricans had the highest score and Brazilians the lowest. Acknowledging that differences in psychosocial risk factors exist among Hispanic females of diverse background can assist us in creating more targeted approaches for the prevention of potential eating disorders in this population.     

Calcium intakes of Mexican Americans, Cubans, Puerto Ricans, non-Hispanic whites, and non-Hispanic blacks in the United States

Objective To compare dietarty calcium intakes from food in Mexican Americans, Cubans, Puerto Ricans, non-Hispanic whites, and non-Hispanic blacks aged 11 through 74 years.Design Population survey data from the Hispanic Health and Nutrition Examination Survey and the second National Health and Nutrition Examination Survey were used to calculate calcium intake from a single 24-hour recall. These data were compared by age and sex between the five population groups. Food sources of calcium in the three Hispanic groups were also examined using 24-hour recall data.Subjects The sample consisted of 11,773 non-Hispanic whites, 1,728 non-Hispanic blacks, 4,739 Mexican Americans, 1,076 Cubans, and 1,835 Puerto Ricans. Main outcome measures Mean calcium intake, percentage intake of Recommended Dietary Allowance, and, for Hispanics, food sources of calcium.Statistical analyses Means were compared within age and sex groups between the five population group using a t test. Results Calcium intakes from food in three Hispanic groups were similar to intakes of non-Hispanic whites and higher than intakes of non-Hispanic blacks. Although dairy foods were the main sources of calcium for Hispanics, corn tortillas were important calcium sources among Mexican Americans. Women consumed less calcium than the Recommended Dietary Allowance in all age and racial or ethnic groups.Applications When assessing calcium intakes of the three Hispanic groups, ethnic differences in food sources of calcium need to be considered. Efforts to increase calcium intake in Hispanics also need to account for ethnic differences.     

Hearing loss and hearing aid use in Hispanic adults: results from the Hispanic Health and Nutrition Examination Survey.

Data from the Hispanic Health and Nutrition Examination Survey were employed to investigate the prevalence of hearing loss and hearing aid use in Mexican-American, Cuban-American, and Puerto Rican adults. Hearing loss was 6 to 14 times more prevalent in older (ages 54 to 74) vs younger (ages 20 through 34) subjects. Cuban Americans and Mexican Americans tended to have a similar prevalence of hearing loss, whereas Puerto Ricans had markedly lower rates. Mexican-American men had higher rates of hearing loss than Mexican-American women. The prevalence of hearing aid use among hearing-impaired individuals ranged from 2% to 11%. Implications for future research are discussed.     

How Have You Been? or ¿Como estás?: Does Language of Interview Influences Self-Rated Health Among Hispanic Subgroups?

This paper reports language differences in poor/fair self-rated health (SRH) among adults from six Hispanic groups in the United States. Data are from the cross-sectional 1997–2013 National Health Interview Survey (NHIS). The total sample of Hispanic adults with valid information for the variables considered in the study (n?=?156,374) included Mexican-Americans (Mex-Am; n?=?43,628), Mexicans (n?=?55,057), Puerto Ricans (n?=?14,631), Cubans (n?=?8,041), Dominicans (from Dominican Republican, n?=?4,359) and Other Hispanics (n?=?30,658). We compared percentage of the population that reported poor/fair SRH among Hispanic individuals by language of interview and across origins using bivariate tests of association. Multivariable logistic regression analysis was used to study the odds of reporting poor/fair SRH based on language among the overall population and each group. Among the six Hispanic origins Puerto Ricans (15.92%), Cubans (16.36%) and Dominicans (15.32%) reported poor/fair SRH at higher levels than the overall sample (12.32%). In the logistic regression model adjusting potential covariates, those interviewed in Spanish were at higher odds of reporting poor/fair SRH than those interviewed in English (OR?=?1.47, p?<?0.0001). In the stratified analysis, Mexican–Americans were the only group where language of interview did not affect the odds of reporting poor/fair SRH. There are differences by Hispanic origin for reporting poor/fair SRH, and also by language of interview. Achieving accurate measurement of health status among Hispanics is a concern for all researchers, in particular those who study differences in health status by race/ethnicity in the United States. Future, research should account for Hispanic background and language of interviews.     

Cervical Cancer Screening Among Immigrant Hispanics: An Analysis by Country of Origin

As the largest and most diverse ethnic minority population in the U.S., it is important to examine differences in and correlates of Pap test adherence among Hispanics by country of origin. The data for these analyses are baseline responses from a Randomized Controlled Trial. Bivariate and multivariable logistic regression models were conducted among Hispanic immigrant women who identified as Mexican, Puerto Rican, Dominican, or Central/South American (n = 1,305). There were significant differences in Pap test adherence: Dominicans (81.6%), Mexicans (77.5%), Central/South Americans (71.2%), and Puerto Ricans (69.3%). In multivariable analyses, there were different correlates of Pap test adherence for each country of origin. For example, marriage status (P = .0001) and younger age (P = .006) were positively associated with adherence among Mexican women. This research provides insight into the variability that exists among Hispanics and can help improve understanding of important determinants that may influence Pap test screening among diverse Hispanics.     

Predictors of digital rectal examination in U.S. Latinos.

BACKGROUND: Little is known about prostate and colorectal cancer knowledge, attitudes, and screening practices among U.S. Latino men. Even less is known about the population's subgroup variations. This study assessed predictors of having obtained digital rectal examinations (DREs) among four Latino subgroups. METHODS: Findings in this report are based on a cross-sectional telephone survey conducted between October 1993 and June 1994 as part of a multisite demonstration project for cancer prevention and control. The survey was conducted in eight U.S. cities identified via census data as having relatively high concentrations of targeted Latino subgroups. The analysis included 1499 Latino men aged > or = 40 who self-identified as Central American, Cuban American, Mexican American, or Puerto Rican. RESULTS: Overall, 53% of the sample reported ever having had a DRE and 68% reported ever having heard of the procedure. For all subgroups, the only significant predictor for obtaining a DRE was "ever heard of DRE." "Having your doctor discuss DRE" was a significant factor for Mexican Americans and Puerto Ricans. CONCLUSIONS: The lack of a universal DRE cancer-screening model among Latino groups highlights the need to address barriers in the context of the population's diversity. Ecologic approaches and clinician communication with Latinos need to be tailored to accommodate subgroup differences in knowledge, attitude, and practices related to DRE.     

Gender, acculturation and alcohol use among Latina/o adolescents: a multi-ethnic comparison

This is the first study to examine the relationship between acculturation and alcohol use by gender and ethnicity using a nationally representative sample of Hispanic and non-Hispanic white adolescents. Specifically, we use data from the National Longitudinal Study of Adolescent Health (Add Health) to explore alcohol use and binge drinking for a sample that includes 6792 non-Hispanic whites, 910 Mexican Americans, 290 Cuban Americans, and 336 Puerto Ricans. Bivariate results reveal significant gender differences in alcohol use among first generation Mexican American, first generation Puerto Rican, and second generation Cuban American adolescents. In addition, these results indicate binge drinking differs significantly by gender among first generation Mexican American, first generation Cuban American, third plus generation Puerto Rican, and third plus generation non-Hispanic white adolescents. Multivariate logistic regression reveals that gender also moderates the effect of acculturation as well as ethnicity on alcohol use and abuse. Among both males and females, first generation immigrants are significantly less likely than third plus generation immigrants to use alcohol and binge drink while selective acculturation significantly reduces the odds of both behaviors. However, the effects of immigrant generation and selective acculturation on binge drinking are larger for females. Further, the trajectories that alcohol use and binge drinking follow with acculturation differ significantly by gender and ethnicity. These results reaffirm the need to further develop theoretical models and intervention strategies that are both gender-specific and culturally-specific, targeting high risk groups in particular in these efforts.     

Breast and cervix cancer screening among multiethnic women: role of age, health, and source of care

OBJECTIVE: The aim of this study was to evaluate the relationships between age, health status, access to care, and breast and cervical cancer screening among multiethnic elderly and nonelderly women. METHODS: A structured telephone survey of a quota sample of 1,420 New York City women from four Hispanic groups (Columbian, Dominican, Puerto Rican, Ecuadorian) and three black groups (U.S., Caribbean, and Haitian) was performed. Outcome measures included "ever" and "recent" self-reported use of mammography, clinical breast examination (CBE), and Pap smears. Logistic regression models assessed the predictors of screening use. RESULTS: Having a regular source of care significantly predicted all screening use for both elderly and nonelderly, controlling for ethnicity, sociodemographics, health status, access to care, proportion of life in the United States, and cancer attitudes. Elderly women (>/=65 years) were significantly less likely to have ever had (OR = 0.79, 95% CI 0.65-0. 96) and to have recently had (OR = 0.67, 95% CI 0.57-0.79) Pap smears than younger women, controlling for the other variables; being elderly also tended to be an independent predictor of ever and recent mammography and CBE use. Interestingly, there was a trend for health status to act differently in predicting Pap smear use for the two age groups. For younger women, being in poor health increased the odds of Pap smear screening, while for elderly women, being in good health increased the odds of screening. CONCLUSIONS: Elderly women reported being screened less than younger women; interactions between health status and age need further exploration.     

Frailty and education in the Hispanic Health and Nutrition Examination Survey

This study tests for the presence of education-frailty correlations among 1,176 Mexican Americans, 522 Cuban Americans, and 560 Puerto Ricans, 50 years and older, in the Hispanic Health and Nutrition Examination Survey. Hispanics with the least schooling (less than 7 years) were found to have the highest frailty rates, and those with the most (more than 12 years of schooling) were found to have the lowest frailty rates. Similar, but somewhat weaker, correlations were discovered after a measure of self-efficacy was accounted for.