A comparison of the fertility of Dominican, Puerto Rican and mainland Puerto Rican adolescents.

Data from three fertility surveys are used to examined the probabilities and determinants of adolescent births among Dominican and Puerto Rican women. Young women in the Dominican Republic are the most likely to have had a child by each year of age from 14 through 24, followed by young women on the Island of Puerto Rico; the probability of an early birth is lowest for Puerto Rican women on the U.S. mainland. Eighteen percent of Dominican women have had a child before their 18th birthday, compared with 13% of women living in Puerto Rico, and 10% of Puerto Rican women in metropolitan New York. The cumulative probabilities that Puerto Rican women will have borne a child before their 20th birthday are almost identical, whether the women live on the island or the U.S. mainland, but the difference between Puerto Rican and Dominican women widens. The order is reversed, however, in the analysis of premarital births: The probability of a premarital birth during adolescence is highest for Puerto Rican women in New York, and lowest for Dominican women. In a separate logistic regression analysis, education and age at first sexual intercourse are shown to be important determinants of adolescent fertility in all three populations.     

Diet Quality,Social Determinants,and Weight Status in Puerto Rican Children Aged 12 Years

Diet quality may be influenced by social determinants and weight status. This has not been studied in Puerto Rico; therefore, our cross-sectional study examined whether diet quality, assessed by the Healthy Eating Index-2005 (HEI-2005), differs by social determinants (sex, school type, and region) and weight status in children in Puerto Rico. As part of an island-wide study to evaluate oral health in 1,550 children aged 12 years, dietary intake was assessed in a representative subset (n=796) using a 24-hour diet recall. Diet quality was evaluated from the diet recall results using the HEI-2005. Overall mean HEI-2005 score was 40.9, out of a total maximum score of 100. Girls had significantly higher scores for whole fruit, total vegetables, whole grains, and sodium but lower scores for total grains and milk compared with boys (P<0.05). Children from public schools had higher scores for total fruit, whole fruit, and dark green and orange vegetables and legumes, but lower scores for whole grains and milk compared with those from private schools (P<0.05). Children from the central mountains had higher scores for the dark green and orange vegetables and legumes and for whole fruit compared with the other regions (P<0.05). Overweight children had significantly higher scores for total vegetables and milk, but lower scores for total fruit and sodium compared with non-overweight children (P<0.01). Some components of diet quality were associated with the social determinants studied and with weight status in our sample. Overall diet quality needs improvement in Puerto Rican children so that it is better aligned with dietary recommendations.     

National Trends in Smoking Behaviors Among Mexican,Puerto Rican,and Cuban Men and Women in the United States

Objectives. We examined trends in smoking behaviors across 2 periods among Mexicans, Puerto Ricans, and Cubans in the United States.Methods. We analyzed data from the 1992–2007 Tobacco Use Supplements to the Current Population Survey. We constructed 2 data sets (1990s vs 2000s) to compare smoking behaviors between the 2 periods.Results. Significant decreases in ever, current, and heavy smoking were accompanied by increases in light and intermittent smoking across periods for all Latino groups, although current smoking rates among Puerto Rican women did not decline. Adjusted logistic regression models revealed that in the 2000s, younger Mexicans and those interviewed in English were more likely to be light and intermittent smokers. Mexican and Cuban light and intermittent smokers were less likely to be advised by healthcare professionals to quit smoking. Mexicans and Puerto Ricans who were unemployed and Mexicans who worked outdoors were more likely to be heavy smokers.Conclusions. Increases in light and intermittent smoking among Mexican, Puerto Rican, and Cuban Americans suggest that targeted efforts to further reduce smoking among Latinos may benefit by focusing on such smokers.Since 2000, Latinos have experienced the largest population growth of all US racial/ethnic groups, making Latinos the largest ethnic minority group in the country at 16.3% of the population.1 Mexicans, Puerto Ricans, and Cubans are the 3 largest Latino national and family background groups in the United States.1 The leading causes of death among Latinos are coronary heart disease and cancer, both of which are strongly associated with tobacco use.2,3 Although differences in smoking rates by Latino national origin groups have been found,4–6 very little research has examined trends in smoking behaviors for various Latino national origin groups by gender in the United States.The aggregation of smoking rates for various Latino national origin groups masks important variations within the population group.4 For example, smoking prevalence rates as determined by national data from 2008 are highest among Cubans (21.5%), followed by Mexicans (20.1%), and Puerto Ricans (18.6%).3 Puerto Ricans and Cubans are also more likely to be current smokers than are Mexicans.7 Furthermore, although research grounded on a nationally representative sample found that Latinos were approximately 4.5 times more likely to be light smokers than were non-Hispanic Whites,8 that study provided only aggregated rates for all Latinos and did not differentiate between national origin groups. Gender differences have also been reported among disaggregated Latino groups. A higher prevalence of smoking has been reported among Mexican (25.0%), Puerto Rican (27.6%), and Cuban (24.7%) men than among Mexican (10.4%), Puerto Rican (24.2%), and Cuban (12.4%) women.7 The lower rates of smoking among women have been consistent in surveys of Latinos.5,7,9 Results from these studies, although informative, have generally been determined by aggregated Latino data or data from a single survey time point. Although such data are valuable and can demonstrate existing gender differences, national-level trends from Latino nationality groups in the United States add valuable information that have not been previously reported.Previous research has also identified social and environmental factors associated with Latinos’ smoking behaviors. Acculturation to mainstream US culture plays a significant role in one’s health behaviors,10 and as Latinos acculturate, their smoking behaviors become similar to those of non-Hispanic Whites.7 Existing research has also revealed that Latinos are less likely to quit smoking,11 receive tobacco screening, and be advised to quit by a physician than are non-Hispanic Whites.12–15 A health professionals’ advice to quit smoking has been found to increase the likelihood that a smoker will successfully quit.16,17 Lastly, workplace smoking policies have also influenced smoking prevalence and intensity.18–20 Work environments adopting a smoke-free policy saw a 14% decrease in individuals’ smoking.21 When examining national-level smoking behaviors among Latinos, it is important to account for social and environmental factors such as acculturation, physician advice to quit smoking, and work environment smoking policies, as they may influence smoking behaviors.Existing research on smoking behaviors among Latino national origin groups has been predicated on data from specific regions of the United States.4,22–25 Although regional data are important for the development of community-level interventions,4 national-level data provide an overview of the country’s progress in tobacco control as well as remaining and emerging challenges for Latinos nationwide. We compared smoking behaviors across 2 periods, about a decade apart, among Mexicans, Puerto Ricans, and Cubans. Our goals in these analyses were (1) to compare Latino national origin groups across 2 periods to examine factors affecting changes in smoking behavior within and between groups, and (2) to evaluate demographic factors that influence current smoking behaviors within Latino national origin groups in the most recent period available. Examining long-term national trends in Latino smoking behaviors may prove vital to policymakers, public health officials, community workers, and interventionists as they address tobacco-related issues.     

Herbal medicine in the Puerto Rican community.

This article focuses on one aspect of health in the Puerto Rican community in the United States--the continuing utilization of herbal medicine and folk healers in the prevention and cure of illness. In addition to providing a fundamental explanation of this system of healing, the author makes recommendations for increasing the satisfaction of Puerto Rican patients with health care services.     

The Boston Puerto Rican Health Study,a longitudinal cohort study on health disparities in Puerto Rican adults: challenges and opportunities

Background  

The Boston Puerto Rican Health Study is an ongoing longitudinal cohort study designed to examine the role of psychosocial stress on presence and development of allostatic load and health outcomes in Puerto Ricans, and potential modification by nutritional status, genetic variation, and social support.     

Association Between Perceived Discrimination and Racial/Ethnic Disparities in Problem Behaviors Among Preadolescent Youths

Objectives. We examined the contribution of perceived racial/ethnic discrimination to disparities in problem behaviors among preadolescent Black, Latino, and White youths.Methods. We used cross-sectional data from Healthy Passages, a 3-community study of 5119 fifth graders and their parents from August 2004 through September 2006 in Birmingham, Alabama; Los Angeles County, California; and Houston, Texas. We used multivariate regressions to examine the relationships of perceived racial/ethnic discrimination and race/ethnicity to problem behaviors. We used values from these regressions to calculate the percentage of disparities in problem behaviors associated with the discrimination effect.Results. In multivariate models, perceived discrimination was associated with greater problem behaviors among Black and Latino youths. Compared with Whites, Blacks were significantly more likely to report problem behaviors, whereas Latinos were significantly less likely (a “reverse disparity”). When we set Blacks’ and Latinos’ discrimination experiences to zero, the adjusted disparity between Blacks and Whites was reduced by an estimated one third to two thirds; the reverse adjusted disparity favoring Latinos widened by about one fifth to one half.Conclusions. Eliminating discrimination could considerably reduce mental health issues, including problem behaviors, among Black and Latino youths.Racial/ethnic disparities in mental health, including problem behaviors (e.g., disruptive or aggressive behaviors), are substantial among US youths. Black adolescents report higher rates of problem behaviors than do their White counterparts.1,2 Latino adolescents generally report lower rates of these behaviors than do Blacks but greater rates than do Whites. In a nationally representative survey of high school students, 41% of Blacks, 36% of Latinos, and 28% of Whites reported involvement in a physical fight in the preceding year.2 However, little research has gone beyond mere documentation of disparities to examine reasons for disparities or why youths of different races/ethnicities show distinct outcomes.One factor that may contribute to disparities in mental health is discrimination.3–7 Biopsychosocial models of discrimination3–7 posit that discrimination can lead to stress responses that are detrimental to physical and mental health, including physiological changes and poor health behaviors. Chronic discrimination can wear away at protective psychological mechanisms and lead to a lower capacity for coping with new stressors, precipitating maladaptive coping responses. Such responses include poor self-control, including substance use and externalizing behaviors (e.g., aggression). A substantial body of work, mostly among adults, indicates that discrimination is significantly related to poor mental and physical health and health behaviors, including problem behaviors among children.8Discrimination experienced at young ages may have implications for mental health disparities across the life course. Nevertheless, a relatively small amount of research has examined health effects of discrimination among children and adolescents.9–24 This work, which has primarily focused on Black youths, has shown relationships between discrimination and greater externalizing symptoms (i.e., problem behaviors),9,10,16,19,20 internalizing symptoms (anxiety, depression),9,11,14,15,21–24 and substance use.12,13 Little is known regarding whether Latino youths similarly experience mental health deficits following discrimination.A major gap in the discrimination literature is examination of the extent to which discrimination explains health disparities, especially among youths.6 Some research indicates that discrimination has a mediating or explanatory effect on the relationship between race/ethnicity and mental and physical health in adults, although no research has examined health behaviors.25–29 These studies have demonstrated that significant associations between race/ethnicity and health outcomes decrease or become nonsignificant when discrimination is controlled, suggesting that discrimination influences inequities. For example, a study found that, after controlling for everyday perceived discrimination, Black (vs White) differences in self-reported health decreased even after adjusting for socioeconomic status.25Although work examining potential roles of discrimination in disparities has advanced the field, it has limitations. No research in this vein has examined the effects of discrimination on disparities among Latino youths. Furthermore, previous analyses have conflated the effects of racial discrimination against Whites and disadvantaged racial/ethnic groups (e.g., Blacks) by measuring perceptions of discrimination among all groups, including Whites. For example, in a study of New Zealand Maori and Europeans, the disparity favoring Europeans on health outcomes was nonsignificant after adjusting for age, gender, socioeconomic status, and discrimination experiences among both Maori (the disadvantaged group) and Europeans (the dominant group).28 Such models do not provide a clear demonstration of the distinct effects of discrimination against a disadvantaged group only, separate from the effects of discrimination against Whites. Rather, these analyses test effects of discrimination against both the dominant and the disadvantaged groups as potential reasons for health inequalities.Conceptually, however, discrimination is posited to be a reason for poor health in disadvantaged groups only,6 because the dominant group tends both to fare better on health outcomes and to perpetrate discrimination and because the nature of discrimination experienced by dominant and minority groups may differ qualitatively. An analysis that considers the effects of discrimination against the disadvantaged group in particular would be more consistent with conceptual models discussing discrimination as a reason for health disparities.We extended previous work on the discrimination–health relationship by testing the magnitude of the statistical contribution of perceived discrimination to disparities in problem behaviors among preadolescent Black and Latino children. Our analytic approach differs from previous approaches, which have documented the extent of disparities and effects of discrimination but have not examined the magnitude of disparities explained by discrimination specifically from the Black and Latino perspectives. We used data from Healthy Passages, a Centers for Disease Control and Prevention–funded study of 5119 fifth graders on risk factors, protective factors, health behaviors, and health outcomes.30 Previous multivariate analyses of these data demonstrated that Black youths were more likely to have perpetrated both physical aggression (e.g., hit another child) and nonphysical aggression (e.g., put down other children to their faces) than were White youths; although Latino youths were more likely to have perpetrated aggression than were White youths in bivariate analyses, this disparity was reversed in multivariate analyses.31 Perceived discrimination was associated with mental health problems for both Black and Latino youths.32     

Contraceptive use and sterilization among Puerto Rican women.

A comparison of contraceptive use in the early to mid-1980s among married Puerto Rican women aged 15-49 in the New York City area reveals that island-born Puerto Rican women living in New York rely on female sterilization to nearly the same extent as do women living in Puerto Rico (45% and 41%, respectively) and that mainland-born Puerto Rican women use sterilization as much as do all women in the United States (19% for both groups). Puerto Rican women in New York use reversible methods to a greater extent than do women in Puerto Rico (22% v. 16%), but to a lesser extent than do all women in the United States (37%). Although mainland-born Puerto Rican women in New York use reversible methods more than do island-born women in New York (42% v. 23%), they tend not to adopt these methods to the same extent as do all U.S. women during the early reproductive years, when education and employment are critical to socioeconomic attainment.     

Predicting Resting Energy Expenditure in Healthy Puerto Rican Adults

Equations to predict resting energy expenditure (REE) can be influenced by cultural and climatic factors. The purpose of this cross-sectional study was to evaluate the validity of the Harris-Benedict and Mifflin-St Jeor equations to predict REE in 48 healthy Puerto Rican adults (23 men, 25 women; aged 21 to 60 years, tested between January and March 2007) using indirect calorimetry as the criterion method for comparison. Weight, height, and skinfold thickness were measured. One-way analysis of variance was used to determine differences between the REE measured and predicted with the two equations, and independent t tests were used to detect differences between men and women. Linear and multiple regressions were conducted to determine relationships between the measured and predicted REE and to evaluate factors influencing REE. The REE predicted with Harris-Benedict and Mifflin-St Jeor were not statistically different from the REE measured with indirect calorimetry (mean±standard deviation: 1,555±268, 1,500±285, and 1,633±299 kcal/day, respectively; P=0.08). There was a strong correlation between the REE measured and predicted with Harris-Benedict and Mifflin-St Jeor (r=0.83, 0.87, respectively; P=0.0001). Mean REE was higher in men compared to women, and fat-free mass was the most influencing factor on REE. The Harris-Benedict and Mifflin-St Jeor are both valid equations for the prediction of REE in healthy Puerto Rican adults living in a tropical climate such as Puerto Rico. Both equations are appropriate for dietetics practitioners to use in assessing energy requirements in this population.