Differential mortality by ethnicity: foreign-born Irish, Italians and Jews in New York City, 1979-81

This paper compares the mortality experience of foreign-born Irish, Italians and Jews in New York City in 1979-81. For the Irish and Italian groups, 1980 census data were used to calculate age-specific and age-standardized death rates. For the Jewish group, denominator data were not available, so proportional mortality analysis was used. An estimate was made to show the degree to which standardized proportional mortality ratios approximated relative standard mortality measures. Major causes of death and other selected causes were examined. The results of this analysis support previous studies showing mortality is significantly greater among Irish-born immigrants than among the Italian born. The proportional mortality data suggest that the Jewish and Italian groups have cause of death distributions relatively similar to each other and dissimilar to the Irish group. Alcohol-related causes of death appear to be a major source of the uniqueness of the Irish mortality experience.     

Factor structure of the Beck Depression Inventory-Second Edition (BDI-II) with Puerto Rican elderly

The Beck Depression Inventory-Second Edition (BDI-II; (1) is one of the most useful measures for depressive symptomatology in many countries (2). The psychometric properties of this inventory, however, have not been reported with Puerto Rican elderly. This paper reports, exploratory psychometric results with a sample of 410 elderly Puerto Rican (65 years and older; men=94, women=316). The assessment of the construct validity of the BDI-II yielded four factors accounting for 52% of total variance and an internal reliability coefficient (alpha Cronbach) of .89. A factor analysis with the 21 items of the BDI-II was performed using principal component analysis as the extraction method and Varimax rotation. This analysis revealed that the BDI-II was a good measure of the dimensions of depressive symptomatology in the present sample, which resembled prior findings reported with the general Puerto Rican Population (3). This study also reports further data supporting the reliability, validity, and practical utility of the BDI-II for the Puerto Rican population including elders. Implications for potential research with minorities and clinical uses of the BDI-II are also discussed.     

Migration and HIV risk behaviors: Puerto Rican drug injectors in New York City and Puerto Rico

OBJECTIVES: We compared injection-related HIV risk behaviors of Puerto Rican current injection drug users (IDUs) living in New York City and in Puerto Rico who also had injected in the other location with those who had not. METHODS: We recruited Puerto Rican IDUs in New York City (n = 561) and in Puerto Rico (n = 312). Of the former, 39% were "newcomers," having previously injected in Puerto Rico; of the latter, 14% were "returnees," having previously injected in New York. We compared risk behaviors within each sample between those with and without experience injecting in the other location. RESULTS: Newcomers reported higher levels of risk behaviors than other New York IDUs. Newcomer status (adjusted odds ratio [OR] = 1.62) and homelessness (adjusted OR = 2.52) were significant predictors of "shooting gallery" use; newcomer status also predicted paraphernalia sharing (adjusted OR = 1.67). Returnee status was not related to these variables. CONCLUSIONS: Intervention services are needed that target mobile populations who are coming from an environment of high-risk behavior to one of low-risk behavior.     

Sexual risk factors for HIV and violence among Puerto Rican women in New York City

The authors examined sexual factors for HIV risk in 1,003 women of Puerto Rican heritage who attended a community-based NewYork City hospital clinic. Participants' ages ranged from 18 to 73 years. Half were born in the continental United States, and half were born in the Commonwealth of Puerto Rico. All were sexually active within the past 90 days with a male partner.The authors compared sociodemographic characteristics, experience of intimate partner violence (IPV), and HIV sexual risk factors (number of partners, history of sexually transmitted infections [STIs],condom use, and so on).Multiple regression analyses considering sociodemographic characteristics were a predictor for IPV and sexual risk behaviors. The authors found differences in sexual risk behaviors by place of birth (continental United States versus Commonwealth of Puerto Rico) and language chosen for the interview (Spanish or English).Puerto Rican women reported fewer sexual partners and STIs. Mainland-born and English-preference women reported more IPV, risky partners, and condom use. Birth in the continental United States and preference for English appear to be indicators of greater risk for IPV, risky sexual practices, and risky partners. HIV prevention intervention strategies for Puerto Rican women must address differences in heterosexual risk according to language and place of birth.     

Drug use among Puerto Rican youth: an exploration of generational status differences

An analysis of the relationship between generational status, or a migrational experience, and adolescent drug use takes advantage of a natural experiment--the migration of Puerto Ricans to the continental United States and their immigration back to the island. Although researchers have studied different sources of variation in adolescent drug use behavior, few have examined the drug use experience of the same ethnic group in varying sociocultural settings. The present study focused on the drug use involvement of four generational status groups of Puerto Rican adolescents in two different settings--New York City and San Juan, Puerto Rico. The groups surveyed in New York City were: New York Ricans (New York City-born Puerto Ricans) and New York migrants (island-born Puerto Rican adolescents). The two groups identified in Puerto Rico were: Puerto Rican islanders (adolescents who had never lived outside of Puerto Rico) and Puerto Rican immigrants (New York City-born youngsters of Puerto Rican parentage whose families had returned to live on the island). In this study, it was hypothesized that the more the perceived environment dimensions of the different generational status groups have characteristics conducive to drug use, the greater the drug use involvement of the groups will be. The analysis confirmed that the drug use involvement of the four groups of Puerto Rican adolescents paralleled the exposure of the groups to a host society, New York City, which has a higher prevalence of adolescent drug use than the culture of origin, Puerto Rico. In addition, it was found that the longer New York migrants lived in New York City, the greater was their drug use involvement. The roles of various other sociodemographic factors (i.e. gender, grade level, family structure and socioeconomic status) in relation to adolescent drug use were also investigated. Two important conditional relationships were documented. First, the impact of length of time living in New York City varied with the adolescent's gender, with higher risk of drug involvement observed for female migrants. Second, socioeconomic status was associated with Puerto Rican adolescents' drug use involvement in the New York City subgroups, but not among the students in Puerto Rico.     

Ethnicity modifies seasonal variations in birth weight and weight gain of infants

Early growth is considered critical for the development of obesity and adulthood cardiovascular diseases. Because season and environmental temperature at birth have also been associated with obesity, it is important to examine whether birth weight and postnatal weight gain vary by season. Data from the National Collaborative Perinatal Project were used to assess the influence of season on birth weight and weight gain during the first 4 mo of life. The sample included 11,091 whites, 11,477 blacks, 1536 Puerto Ricans and 221 subjects of other ethnic groups born at full-term gestation. Black infants born in the fall had a significantly lower birth weight (3.12 +/- 0.42 kg) than those born in the winter (3.16 +/- 0.43 kg, P = 0.002). This difference was not found in the other ethnic groups. Additionally, weight gain (g/mo) for black and Puerto Rican infants during the first 4 mo of life was significantly lower for those born during the fall (black: 816 +/- 186; Puerto Rican: 820 +/- 181) compared to those born in the spring (black: 844 +/- 194, P < 0.001) and summer (Puerto Rican: 861 +/- 185, P < 0.04). Birth weight and early infancy weight gain varied by season and were modified by ethnicity. The potential importance of seasonal variations in pre- and postnatal growth was evaluated in this study.     

Childbearing among young Latino women in the United States.

We analyzed 1979 and 1982 data from the Youth Cohort of the National Longitudinal Surveys (NLS) of Labor Market Experience to compare rates of early childbearing among White, Black, Mexican-origin and Puerto Rican women up to age 21. Latino young women fall in between the extremely low rate of the Whites and the extremely high rate of the Blacks. Mexican and Puerto Rican young women have similar proportions of premarital first births, but the marital first birth rate for young Mexicans is twice that of the Puerto Ricans. The bulk of Mexican first births, like births to Whites, occur within marriage, while Puerto Rican first births are similar to those of Blacks, the majority being out-of-wedlock. These racial/ethnic differences in premarital first birth rates do not change greatly when socioeconomic status, and birthplace of respondents and respondents' parents are controlled.     

Infant feeding practices in East Harlem

Infant feeding practices among low-income infants in East Harlem were surveyed prior to undertaking a nutrition education program. Data were obtained from 24-hr. recalls on 153 infants seen in a well-baby clinic. Intakes of energy, protein, fat, ascorbic acid, iron, and sodium showed wide variations among infants of similar ages. Nutrient intakes were similar for black and Puerto Rican infants, although some ethnic differences were observed in the types of milk and solid foods consumed. Black infants received formula for a longer period, while Puerto Rican infants were transferred to whole cow's milk at a younger age. In contrast black infants were introduced to table foods earlier.     

Factor and subscale structure of a parental health locus of control instrument (parental health beliefs scales) for use in a mainland United States Puerto Rican community

This study was undertaken to determine whether the subscale structure of an instrument used to measure parental health locus of control is a valid representation of the concept of locus of control in the Puerto Rican community. Ethnocultural differences in values and attitudes may create different conceptualizations of questionnaire items, which may impact on the subscale factor loadings for these items. Four hundred and twenty parents of Puerto Rican ethnicity living in a mainland inner city community in the United States completed the Parental Health Beliefs Scales (PHBS) instrument, which was developed to measure parental locus of control regarding their children's health. Results were subject to exploratory factor analysis. The resultant factor structure was then compared to other published factor structures by confirmatory factor analysis. Exploratory factor analysis results show a new five factor solution. Compared to two previously published factor structures for this instrument, the new five factor structure has a better goodness of fit for this Puerto Rican study sample. Through item analysis, we were able to refine the final structure into a four factor, 15 item instrument. We conclude that the new factor structure for the PHBS creates an instrument with subscales that reflect Puerto Rican cultural beliefs and values, especially as it pertains to locus of control issues (e.g. respect of professionals, collectivism, and the importance of fate). When working with ethnocultural minority groups, the health services researcher needs to be certain that the research instruments used are culturally appropriate and sensitive.     

Degree of trait anxiety in a sample of athletes of the Puerto Rican delegation to the XII Pan American Games held in Winnipeg '99

This study was conducted in an attempt to determine the degree of anxiety generated by athletes of the Puerto Rican delegation to the XII Pan American Games held in Winnipeng'99 to develop support programs that contribute to the enhancement of the athletes' mental skills and the development of sports, psychology, in particular. The sample consisted of 55 athletes that participated in the abovementioned Pan American Games. The athletes represented 16 sorts and made up 40% of the Puerto Rican athletes officially registered to participate. The Sport Competition Anxiety Test-Form A was used to detect trait anxiety during competition. An analysis of the variables was conducted utilizing t-tests to determine whether there were significant (p < or = 0.05) between the quantitative variables under study. The results indicated that the athletes of the Puerto Rican delegation that participated in the XII Pan American Games have a degree of trait anxiety that needs professional attention.     

Migrant Drug Users: Predictors of HIV-Related Sexual and Injection Risk Behaviors

Background Puerto Rican drug users recruited in NY who previously used drugs in Puerto Rico (PR) have been found to have higher HIV injection and sex-related risk behaviors than those who had not used in PR. This study examined predictors of risk among migrant Puerto Rican drug users. (For the purpose of this paper, the term “migrant” was used to designate Puerto Rican drug users who had used drugs in Puerto Rico and were recruited in New York or New Jersey). Methods A total of 290 drug users who had previously used drugs in PR were recruited in NY and New Jersey and interviewed regarding drug use history and HIV risk behaviors. Results Participants engaged in high risk behaviors, e.g., 39% shared injection paraphernalia and 62% reported unprotected sex. Multivariate analyses found that predictors of injection-related risk included being born in PR and purchasing drugs jointly with other drug users; predictors of sex-related risk included younger age and homelessness. Discussion Addressing risk reduction among those drug users who were born in Puerto Rico and are younger or homeless was indicated, and efforts to reach those at highest risk through NEPs was recommended.     

HIV knowledge among a sample of Puerto Rican and Mexican men and women

This study assessed levels of HIV knowledge and identified factors associated with HIV knowledge among a sample of heterosexual Puerto Rican and Mexican men and women, ages 18 to 45. The sample consisted of 144 men and women living in San Diego County, California, who self-identified as being of Mexican ethnicity and 209 men and women living in Cuyahoga County, Ohio, who self-identified as Puerto Rican. Interviews were conducted by trained, bilingual interviewers. Data were collected on demographic variables, attitudes towards decision-making in relationships, and HIV knowledge and risk behaviors. Puerto Rican individuals were significantly more likely than Mexican individuals to respond correctly to almost one-half of the 12 HIV knowledge items. Multiple logistic regression analysis indicated that higher levels of education, greater U.S. acculturation, legal status and birth in the United States, a self-focused locus of control in relationships, and being male were predictors of higher knowledge.     

Research with Severely Mentally Ill Latinas: Successful Recruitment and Retention Strategies

Individuals from minority groups in the United States have been found less likely than non-Hispanic whites to participate in research studies. The recruitment and retention of individuals from minority groups has also proved challenging. We describe the challenges that we encountered in recruiting and retaining a sample of severely mentally ill Mexican and Puerto Rican ethnicity for a study of the context of HIV risk. We recruited women in San Diego County, California and northeastern Ohio who were between the ages of 18 and 50 and who had diagnoses of schizophrenia, bipolar disorder, or major depression. We identified challenges to recruitment and retention at the macro, mediator, and micro levels. We were able to retain 81.1% of the Puerto Rican cohort and 26.7% of the Mexican cohort over a 5-year period. The vast majority of barriers to recruitment and retention within the Puerto Rican cohort occurred at the micro (individual) level. Macro level barriers occurred more frequently and impacted retention to a greater extent within the cohort of Mexican women. Our experience underscores the importance of outreach to the community and the interaction between staff and individual participants. Diverse strategies are required to address the impact of migration on follow-up, which may vary across groups.     

Health outcomes among Hispanic subgroups: data from the National Health Interview Survey, 1992-95

BACKGROUND: Within the next 50 years, Hispanics will become the largest minority group in the United States. The largest Hispanic subgroups are those of Mexican, Cuban, and Puerto Rican descent. The Hispanic population is heterogeneous in terms of culture, history, socioeconomic status (SES) and health status. In this report, various health status measures are compared across Hispanic subgroups in the United States. METHODS: National Health Interview Survey (NHIS) data aggregated from 1992 through 1995 were analyzed. NHIS is one of the few national surveys that has a sufficiently large sample size to adequately compare the different subgroups. Data are presented for four Hispanic origin subgroups--Mexican, Cuban, Puerto Rican, and "other Hispanic" persons--for the Hispanic population as a whole and for the non-Hispanic white and non-Hispanic black populations. These groups are compared with respect to several health status outcomes, providing both age-adjusted and unadjusted estimates. RESULTS: The health indicators for Puerto Rican persons are significantly worse than for the other Hispanic origin subgroups. For example, about 21% of Puerto Rican persons reported having an activity limitation, compared with about 15% of Cuban and Mexican persons and 14% of "other Hispanic" persons. In contrast, the health indicators of Cuban persons are often better than those of the other subgroups. For example, Cuban persons reported an average of 3 days per year lost from school or work, compared with about 6 days for Mexican and Puerto Rican persons and 7 days for "other Hispanic" persons. Mexican persons fare better than Puerto Rican persons on measures such as restricted activity days, bed disability days and hospitalizations. CONCLUSION: These data demonstrate clear differences in health status as well as indicators of socioeconomic status across Hispanic subgroups in the United States. Data on Hispanic subgroups facilitate the planning of public health services for various underserved populations.     

The health insurance status of US Latino women: A profile from the 1982-1984 HHANES.

OBJECTIVES: This research studied the correlates of health insurance status among three major subpopulations (Mexican, Puerto Rican, and Cuban) of adult (ages of 20 to 64) Latino women. METHODS: Data from the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-1984, were examined to determine the percentages of health insurance coverage among the sample populations and to assess the relationship between access to coverage and selected sociodemographic employment/income, ancestry, and acculturation variables. RESULTS: Variations in health insurance coverage existed by Latina subpopulation. While Puerto Rican women had the highest percentage of any health insurance coverage, Mexican-origin women (particularly those 50 to 64 years old) had the lowest. For all three Latina groups, health insurance coverage was greater among those who reported a family income above the poverty level than among those whose income fell below the poverty level; employment location, acculturation variables, and ancestry were also related to coverage. CONCLUSIONS: Eligibility requirements, particularly for Mexican-and Cuban-origin women, need to be streamlined, and innovative health insurance programs need to be developed to increase access of Latinas to health insurance.     

The social and economic correlates of pregnancy resolution among adolescents in New York City, by race and ethnicity: a multivariate analysis.

This study utilizes a data set combining vital records from live birth and induced abortion certificates in New York City in 1984 to examine the correlates of the two outcomes among pregnant adolescents. Four groups totaling 31,207 teenagers were examined: Black non-Latinos (51 per cent), White non-Latinos (17 per cent), Puerto Ricans (25 per cent), and non-Puerto Rican Latinos (8 per cent). Multivariate regressions were fit for each group. Simulations based on the regressions reveal that the proportion of live births plus induced abortions among unmarried 18-year-olds, on Medicaid, with a previous live birth, no previous induced abortions, and nine years of completed schooling was .55 in the case of Puerto Ricans, .34 for non-Puerto Rican Latinos, .60 for Blacks, and .51 for Whites. For nulliparous adolescents of the same age and marital status, with an additional year of schooling, but not on Medicaid, and with a previous induced abortion, the fraction of pregnancies that were terminated rose to .84 in the case of Puerto Ricans, .81 for non-Puerto Rican Latinos, .87 for Blacks, and .96 for Whites. The results suggest that attitudes toward abortion as proxied by previous induced terminations substantially increase the likelihood of aborting as well as narrow the racial and ethnic differences with respect to pregnancy resolution.     

Latinas and HIV/AIDS risk factors: implications for harm reduction strategies

OBJECTIVES: We examined risk factors for HIV infection among Puerto Rican and Mexican American women aged 15 through 44 years. METHODS: We used data from the 1995 National Survey of Family Growth. Analyses focused on the relation between sex role attitudes, sex education, anxiety, and consistent condom use. RESULTS: Nearly 60% of Puerto Rican and Mexican American women received no sex education from parents. Twenty-one percent of Puerto Rican and 38.3% of Mexican American women reported no sex education in schools. Women with some sex education in school, less than 13 years of education, or higher sex role attitude scores were more likely than other women to have partners who consistently used condoms. CONCLUSIONS: Harm reduction interventions must be designed to reach multiple Latino audiences by age, gender, and subgroup     

"Watching a person who knows how to cook, you'll learn a lot". Linked lives, cultural transmission, and the food choices of Puerto Rican girls

In-depth individual interviews were conducted with mainland- and island-dwelling Puerto Rican girls (n=23) to determine how migration, acculturation, and family contexts influenced food choices. Interview data from girls with diverse migration experiences (U.S. mainland raised, recent migrants to U.S. mainland, and Puerto Rico raised) were triangulated with extensive participant observation conducted in New York State and Puerto Rico. Data analysis using a ground theory approach revealed that participants' access to traditional foods varied in three domains: mothers' (cultural orientation, health, work, and cooking skills); household (composition, presence of Puerto Rican grandmother, and cooking skills); and girls' (migration experience, food preferences and values, and cooking skills) characteristics. Four food choice types emerged from participant narratives that differed in these domains: everybody cooks, tradition keeper, seeker, and on my own. Varied language orientations and migration experiences were represented among girls across all four food choice types, ranging from consistent to limited access to traditional food, demonstrating the limitations of one-dimensional models for understanding dietary acculturation. Findings demonstrate how a multidimensional, culture-specific model, including both cultural and structural characteristics, can influence dietary acculturation at the family and household level and food choices among immigrant adolescent girls, and guide future research and interventions.     

Infant health among Puerto Ricans--Puerto Rico and U.S. mainland, 1989-2000

Although the overall U.S. infant mortality rate (IMR) declined dramatically during the 1900s, striking racial/ethnic disparities in infant mortality remain. Infant health disparities associated with maternal place of birth also exist within some racial/ethnic populations. Eliminating disparities in infant health is crucial to achieving the 2010 national health objective of reducing the infant death rate to 4.5 per 1,000 live births (objective 16-1c). Hispanics comprise the largest racial/ethnic minority population in the United States. Among U.S. Hispanics, considerable heterogeneity exists in infant health, with the poorest outcomes reported among Puerto Rican infants. This report compares trends during the previous decade in IMRs and major determinants of these rates such as low birthweight (LBW), preterm delivery (PTD), and selected maternal characteristics among infants born to Puerto Rican women on the U.S. mainland (50 states and the District of Columbia) with corresponding trends among infants born in Puerto Rico. The findings indicate that despite having lower prevalence of selected maternal risk factors, Puerto Rico-born infants are at greater risk for LBW, PTD, and infant death than mainland-born Puerto Rican infants. This report also highlights a persistent disparity in IMRs and an emerging disparity in LBW and PTD rates between Puerto Rico-born infants and mainland-born Puerto Rican infants. Future research should focus on identifying factors responsible for these disparities to improve infant health in Puerto Rico.     

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.