Health Care Access and Breast Cancer Screening Among Latinas Along the California–Mexican Border

Latinas are more likely to exhibit late stage breast cancers at the time of diagnosis and have lower survival rates compared to white women. A contributing factor may be that Latinas have lower rates of mammography screening. This study was guided by the Behavioral Model of Health Services Use to examine factors associated with mammography screening utilization among middle-aged Latinas. An academic–community health center partnership collected data from community-based sample of 208 Latinas 40 years and older in the San Diego County who completed measures assessing psychosocial factors, health care access, and recent mammography screening. Results showed that 84.6 % had ever had a mammogram and 76.2 % of women had received a mammogram in the past 2 years. Characteristics associated with mammography screening adherence included a lower acculturation (OR 3.663) a recent physician visit in the past year (OR 6.304), and a greater confidence in filling out medical forms (OR 1.743), adjusting for covariates. Results demonstrate that an annual physical examination was the strongest predictor of recent breast cancer screening. Findings suggest that in this community, improving access to care among English-speaking Latinas and addressing health literacy issues are essential for promoting breast cancer screening utilization.     

Examining Breast Cancer Screening Barriers Among Central American and Mexican Immigrant Women: Fatalistic Beliefs or Structural Factors?

Researchers have examined “cancer fatalism” (the belief that cancer is predetermined, beyond individual control, and necessarily fatal) as a major barrier to breast cancer screening among Latinas. The authors examine perceptions of breast cancer, its causes, and experiences with screening among Salvadoran, Guatemalan, Mexican, and Bolivian immigrant women in Washington, DC. Two salient themes emerged: (a) perceptions of breast cancer causes and breast cancer screening; and (b) structural factors are the real barriers to breast cancer screening. Findings demonstrate participants’ awareness and motivation to get screened and elucidate structural barriers that are obscured by the discourse of fatalism and hinder breast cancer screening.     

Association Between Parity and Obesity in Mexican and Mexican–American Women: Findings from the Ella Binational Breast Cancer Study

Obesity at diagnosis of breast cancer is associated with higher all-cause mortality and treatment-associated toxicities. We evaluated the association between parity and obesity in the Ella study, a population of Mexican and Mexican–American breast cancer patients with high parity. Obesity outcomes included body mass index (BMI) ≥30 kg/m², waist circumference (WC) ≥35 in (88 cm), and waist-to-hip-ratio (WHR) ≥0.85. Prevalence of obesity ([BMI] ≥ 30 kg/m²) was 38.9 %. For WC, the multivariate odds ratio (OR) (95 % confidence interval [CI]) for having WC ≥ 35 inches in women with ≥4 pregnancies relative to those with 1–2 pregnancies was 1.59 (1.01–2.47). Higher parity (≥4 pregnancies) was non-significantly associated with high BMI (OR = 1.10; 95 % CI 0.73–1.67). No positive association was observed for WHR. Our results suggest WC is independently associated with high parity in Hispanic women and may be an optimal target for post-partum weight loss interventions.     

Health Disparities Among Mexican American Women Aged 15�C44 Years: National Health and Nutrition Examination Survey, 1999�C2004

Objectives. We analyzed the health of Mexican American women aged 15 to 44 years, by generation and language preference, to guide planning for reproductive health services in this growing population.Methods. We used personal interview and medical examination data from the 1999 to 2004 National Health and Nutrition Examination Surveys. We used SUDAAN for calculating age-adjusted prevalence estimates of demographic and health characteristics. The Satterthwaite adjusted F test and Student t test were used for subgroup comparisons.Results. The women had different health profiles (P < .05) by generation and language preference. Second- and later-generation women and women who used more English were more likely to be sexually active, to have been younger at first intercourse, and to have had more male sexual partners than were first-generation women and women who used more Spanish. Compared with their first-generation counterparts, second- and later-generation women drank more alcohol, were better educated, had higher incomes, and were more likely to have health insurance. Third-generation women were more likely to have delivered a low-birthweight baby than were first-generation women.Conclusions. Differences by generation and language preference suggest that acculturation should be considered when planning interventions to promote healthy reproductive behaviors among Mexican American women.The Hispanic population in the United States increased from 35.7 million in 2000 to 44.3 million in 2006.^1–3 In 2005, there were an estimated 10.2 million Hispanic women aged 15 to 44 years, representing an increase of about 19% from 8.6 million in 2000.² The rapid increase in the Hispanic population has been attributed to immigration and high fertility.⁴About two thirds of Hispanics in the United States are Mexican American,³ and Mexican American women of reproductive age have higher birth rates than do women of other races and Hispanic origins.⁴ This top ranking has not changed appreciably over time even though fertility and birth rates declined for Mexican and other Hispanic populations between 1990 and 2005.⁵ Young Mexican American women aged 15 to 19 years also have higher fertility and birth rates than do young women of other races and Hispanic origins.⁴ Preliminary US birth data for 2006 show that birth rates for Hispanic women aged 15–44 years are on the rise again and that more than 1 million Hispanic women gave birth in 2006, a record high.⁶ Furthermore, Hispanic women of reproductive age are less likely to be using contraception (59%) than are non-Hispanic White women (65%).⁷Recognizing the growing need for reproductive health services among the rapidly increasing Hispanic population, we studied demographics, measures of access to health care, sexual activity, pregnancy history, contraceptive use, and other health behaviors among Mexican American women aged 15–44 years from the 1999–2004 National Health and Nutrition Examination Surveys (NHANES), which collected nationally representative data through in-person interviews and physical and laboratory examinations. Many previous reports have focused more generally on Hispanic, Latina, or foreign-born women or on a single health behavior or outcome.^8–28To provide relevant and culturally appropriate information for program assessment, appropriate intervention planning, and resource allocation, we restricted our analysis to Mexican American women and stratified the sample by generational status and English or Spanish language preference. These factors are surrogate measures of acculturation, the process through which immigrant groups exchange cultural traits from their country of origin for those of their host country, and have been tied to reproductive health behaviors in previous research.^{9,10,18–20,22–25,27,28} We hypothesized that their reproductive health would vary by level of acculturation.     

“Does this Look Infected to You?” Social Network Predictors of Dental Help-Seeking Among Mexican Immigrants

Compared to U.S. born Latinos, Mexican immigrants (MAs) have diminished health care access and face substantial barriers to accessing needed dental health services. However, little research has examined how MAs social networks shape their use of dental health services. Using data from 332 Mexican immigrants to the Midwest, this research examines the significance of individual and egocentric network characteristics on two measures of dental health service utilization. Findings reveal that network size, network dental service utilization, and the frequency with which MAs discuss acute problems with network ties, positively correspond to use of oral health services. Conversely, embeddedness in networks where ties hassle egos about dental issues and have low levels of dental health knowledge correspond to lower odds of using these services. This research is among the first to use ego network data and methods to examine the ways network characteristics shape oral health behaviors among this underserved population.     

The Association Between Muscle Weakness and Incident Diabetes in Older Mexican Americans

Objectives

A natural decline of muscle strength occurs during the aging process; however, preserving muscle strength may lower the rate of many preventable diseases such as diabetes, especially in higher risk populations. The purpose of this study was to examine the sex-specific association between muscle weakness and incident diabetes in older Mexican Americans.

Butch–Femme Identity and Visuospatial Performance Among Lesbian and Bisexual Women in China

Lesbian and bisexual women who self-identify as “butch” show a masculine profile with regard to gender roles, gender nonconformity, and systemizing cognitive style, whereas lesbian and bisexual women who self-identify as “femme” show a corresponding feminine profile and those who self-identify as “androgynes” show an intermediate profile. This study examined the association between butch or femme lesbian or bisexual identity and visuospatial ability among 323 lesbian and bisexual women, compared to heterosexual women (n = 207) and men (n = 125), from multiple cities in China. Visuospatial ability was assessed using a Shepard and Metzler-type mental rotation task and Judgment of Line Angle and Position (JLAP) test on the Internet. Heterosexual men outperformed heterosexual women on both mental rotation and JLAP tasks. Lesbian and bisexual women outperformed heterosexual women on mental rotation, but not on JLAP. There were significant differences in mental rotation performance among women, with butch- and androgyne-identified lesbian/bisexual women outperforming femme-identified and heterosexual women. There were also significant differences in JLAP performance among women, with butch- and androgyne-identified lesbian/bisexual women and heterosexual women outperforming femme-identified lesbian/bisexual women. The butch–femme differences in visuospatial ability indicated an association between cognitive ability and butch–femme identity and suggest that neurobiological underpinnings may contribute to butch–femme identity although alternative explanations exist.     

Association of Acculturation Factors with Dietary Intakes of Folate Among Older Mexican Americans in the Post-Fortification Era: National Health and Nutrition Examination Survey (NHANES) 2001–2006

Previous studies have shown that acculturation factors are associated with dietary patterns of older Mexican Americans (MAs), but the association of these factors with post-fortification folate intake is unknown. We estimated usual folate intakes for U.S. MAs aged ≥60 years (N = 712) by acculturation factors using data from the National Health and Nutrition Examination Survey 2001–2006. Mean total folic acid and total folate, but not natural folate intakes, were lower for MAs with lower acculturation factors, and 16% of MAs had total folate intakes less than the estimated average requirement (EAR) of 320 µg/day. Most older U.S. MAs did not meet requirements from natural food folate intake alone, regardless of acculturation status, but their intakes were adequate when fortified foods and supplement sources were taken into account. Logistic regression models including age, sex, education, poverty, and acculturation factors indicated that low income, not acculturation, was significantly associated with intake below the EAR. Thus our findings indicate that the association of low acculturation with folate intake below the EAR is not independent of poverty.

[Supplementary materials are available for this article. Go to the publisher's online edition of the Journal of Nutrition in Gerontology and Geriatrics for the following free supplemental resource: a table of the distribution of usual folate intake among Mexican Americans aged ≥60 years by sex, age, education level, poverty income ratio, and acculturation factors, from the National Health and Nutrition Examination Survey 2001–2006.]     

Using Walk Score™ and Neighborhood Perceptions to Assess Walking Among Middle-Aged and Older Adults

We aimed to determine the relationship between neighborhood characteristics (walkability, cohesion/safety) and recommended activity levels among community-dwelling middle-aged and older adults. Subjective and objective data on 394 individuals aged ≥50 years were used to assess the likelihood of walking ≥150 min/week. Environmental factors associated with a greater likelihood of any walking ≥150 min/week included living in a neighborhood with high perception of cohesion/safety versus low, living in walkable areas versus car-dependent, and living in an area with a low-moderate median income versus the lowest. Middle-aged and older adults were more likely to walk ≥150 min/week in a walkable, perceived safe/cohesive neighborhood. Identifying neighborhood factors associated with promoting walking among this population can enable stakeholders (e.g., researchers, planners, and policy makers) to direct interventions focusing on the built environment.     

Anthropometric and Dietary Evaluations in a Sample of “Healthy” Mexican Older Adults

The purpose of this study was to describe anthropometric, metabolic, and nutritional characteristics in healthy elderly adults in a primary health care setting. It was conducted through a cross-sectional study of 80 subjects 60 years of age and older. After confirming healthy status, clinical, biochemical, dietetic, and anthropometric evaluations were performed. The findings indicated 22% had anemia, 22% had impaired glucose tolerance, 46% had hypertriglyceridemia, and 51% had hypercholesterolemia. More than 50% had obesity, and almost 80% had a high risk waist circumference measure. Mean energy intake was normal; however, more than 50% of participants did not have adequate intakes of potassium, calcium, magnesium, zinc, folic acid, and vitamins B₁₂ and A. Inadequate food intakes were common. Specific examples are that 16% of the subjects ate no meat/egg, 31% ate no dairy products, 56% ate no legumes, 22% ate no fruits, and 41% ate no vegetables. Additionally, 31% consumed soft drinks. Therefore, we can conclude that elderly people otherwise considered as “healthy” nonetheless had a high proportion of obesity and cardiovascular risk factors. Inadequate dietary patterns were also observed and corresponded with poor micronutrient intake.     

Durational and generational differences in Mexican immigrant obesity: Is acculturation the explanation?

Using the Los Angeles Family and Neighborhood Survey (L.A.FANS-2; n = 1610), we explore the link between Mexican immigrant acculturation, diet, exercise and obesity. We distinguish Mexican immigrants and 2nd generation Mexicans from 3rd+ generation whites, blacks and Mexicans. First, we examine variation in social and linguistic measures by race/ethnicity, duration of residence and immigrant generation. Second, we consider the association between acculturation, diet and exercise. Third, we evaluate the degree to which acculturation, diet, exercise, and socioeconomic status explain the association between race/ethnicity, immigrant exposure to the US (duration since immigration/generation), and adult obesity. Among immigrants, we find a clear relationship between acculturation measures, exposure to the US, and obesity-related behaviors (diet and exercise). However, the acculturation measures do not clearly account for the link between adult obesity, immigrant duration and generation, and race/ethnicity.     

Sexual Well-Being and Quality of Life Among High-Functioning Adults with Autism

The current research addresses the effect that being in an intimate relationship has on quality of life and well-being among high-functioning young adults on the autism spectrum (HFA). The research included 31 participants: 14 involved in intimate relationships (HFA-R) and 17 not (HFA-NR). In this integrated (quantitative and qualitative) research, participants completed on-line questionnaires on demographics, quality of life and sexuality. We hypothesized that HFA-R will report higher quality of life and sexual well-being than HFA-NR. Further, a correlation was predicted between quality of life (including: satisfaction, productive capacity, social belonging/community inclusion and independence and empowerment) and sexual well-being (including: self-esteem, sexual depression and sexual preoccupation/sexual worries), especially among HFA-R. Despite the lack of significant differences in quality of life, differences were found in the indices’ content areas. There was a higher sense of social belonging/community inclusion among HFA-R, and a positive correlation between sexual well-being and productive capacity among this group. A correlation was found between high productive capacity and low sexual worries among HFA-R, but not among HFA-NR. Contrary to expectations, a positive correlation was found between sexual well-being and satisfaction among HFA-NR, while no such correlation was found among HFA-R. The findings are discussed in the context of healthy sexuality and social development and acclimation of people with HFA. The results highlight the importance of promoting social dialogue and research on the subject.     

Perinatal Outcomes Among Foreign-Born and US-Born Chinese Americans, 1995–2000

This paper examines nativity differences in adverse perinatal outcomes of Chinese-American mothers. Singleton live births to US-resident Chinese women (150,620 foreign-born, 15,040 US-born) and a random sample of 150,620 non-Hispanic White mothers were selected from 1995 to 2000 national linked birth/infant death certificate files. Associations between maternal nativity status and adverse perinatal outcomes were assessed using multivariable logistic regressions. Compared to US-born Chinese mothers, foreign-born Chinese mothers were less likely to be unmarried, teen mothers, have a non-Hispanic White or other race partner, be rural residents, and more likely to be less educated, or utilize prenatal care inadequately. Controlling for these factors, foreign-born Chinese-American mothers had significantly lower risks for low birth weight, preterm birth, and small-for-gestational age, whereas risks for infant mortality, neonatal mortality, and post-neonatal mortality did not differ significantly from those of infants of US-born Chinese mothers. Chinese Americans exhibited clear nativity differentials for adverse birth outcomes.     

“Hooking Up” Among College Students: Demographic and Psychosocial Correlates

This study investigated 832 college students’ experiences with hooking up, a term that refers to a range of physically intimate behavior (e.g., passionate kissing, oral sex, and intercourse) that occurs outside of a committed relationship. Specifically, we examined how five demographic variables (sex, ethnicity, parental income, parental divorce, and religiosity) and six psychosocial factors (e.g., attachment styles, alcohol use, psychological well-being, attitudes about hooking up, and perceptions of the family environment) related to whether individuals had hooked up in the past year. Results showed that similar proportions of men and women had hooked up but students of color were less likely to hook up than Caucasian students. More alcohol use, more favorable attitudes toward hooking up, and higher parental income were associated with a higher likelihood of having hooked up at least once in the past year. Positive, ambivalent, and negative emotional reactions to the hooking up experience(s) were also examined. Women were less likely to report that hooking up was a positive emotional experience than men. Young adults who reported negative and ambivalent emotional reactions to hooking up also reported lower psychological well-being and less favorable attitudes toward hooking up as compared to students who reported a positive hooking up experience. Based on these findings, suggestions for psychoeducational programming are offered. Additionally, directions for future research are provided.     

Clinicians’ Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients

PURPOSE

We investigated whether clinicians’ explicit and implicit ethnic/racial bias is related to black and Latino patients’ perceptions of their care in established clinical relationships.

METHODS

We administered a telephone survey to 2,908 patients, stratified by ethnicity/race, and randomly selected from the patient panels of 134 clinicians who had previously completed tests of explicit and implicit ethnic/racial bias. Patients completed the Primary Care Assessment Survey, which addressed their clinicians’ interpersonal treatment, communication, trust, and contextual knowledge. We created a composite measure of patient-centered care from the 4 subscales.

RESULTS

Levels of explicit bias were low among clinicians and unrelated to patients’ perceptions. Levels of implicit bias varied among clinicians, and those with greater implicit bias were rated lower in patient-centered care by their black patients as compared with a reference group of white patients (P = .04). Latino patients gave the clinicians lower ratings than did other groups (P <.0001), and this did not depend on the clinicians’ implicit bias (P = .98).

CONCLUSIONS

This is among the first studies to investigate clinicians’ implicit bias and communication processes in ongoing clinical relationships. Our findings suggest that clinicians’ implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, this finding supports the Institute of Medicine’s suggestion that clinician bias may contribute to health disparities. Latinos’ overall greater concerns about their clinicians appear to be based on aspects of care other than clinician bias.Key words: race, ethnicity, communication, prejudice, patient-centered care, healthcare disparities, primary care, practice-based research