The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as a predictor of insulin resistance, β-cell function,and diabetes in Hispanics and African Americans

Objective

The TG/HDL-C ratio is used as a marker of insulin resistance (IR) in Caucasians; however, there is limited data in other ethnic groups. We hypothesized that the TG/HDL-C ratio is associated with IR in Hispanics and African Americans (AA).

What do we mean by extended family? A closer look at hispanic multigenerational families

This study examined an entire residential block of a predominantly Hispanic neighborhood in Southern California. The investigation focused on a comparison of the frequency of exiended and nonextended families using structural (household residents) and functional criteria (interaction and exchange) and the reasons nuclear families did not have their grandparents in those household units. Of 48 households, 8 units contained other elements besides the nuclear family. Of these eight, only five units contained the grandparents. Using functinal criteria, however, all were extended family households. A low number of multigenerational families based on the structural criterion may not reflect preference, but merely the physical limitation imposed by the number of children. The larger the size of the family, the higher the incidence of nuclear families because it is impossible for the grandparents to be in all their children's households. Unless variables that affect the availability of kin for an extended family, such as rate of fertility or housing availability, are controlled, the assumption that frequency of multigenerational family households reflects cultural or economic choices may be inaccurate.An earlier version of this paper was presented at the Annual Scientific Meeting of the Gerontological Society of America, San Francisco, CA, December, 1991. Although partial support for a portion of the data collection was provided by the U.S. Census Bureau, the content of this article is my sole responsibility. Also, this research was supported, in part, by training grant AG00030 from the National Institute on Aging. I also want to acknowledge the intellectual contributions and cogent comments of Kaveh Ehsani M.A. and the valuable support of Nicole Sault Ph.D.     

Receipt of preventive services among privately insured minorities in managed care versus fee-for-service insurance plans

OBJECTIVE: We compare preventive services utilization among privately insured African Americans and Hispanics in managed care organizations (MCOs) versus fee-for-service (FFS) plans. We also examine racial/ethnic disparities in the receipt of preventive services among enrollees in FFS or MCO plans. DESIGN: Analysis of the nationally representative 1996 Medical Expenditure Panel Survey. PARTICIPANTS: Participants included 1,120 Hispanic, 929 African-American, and 6,383 non-Hispanic white (NHW) adults age 18 to 64 years with private health insurance. MEASUREMENTS AND MAIN RESULTS: We examined self-reported receipt of physical examination, blood pressure measurement, cholesterol assessment, Papanicolau testing, screening mammography, and breast and prostate examinations. Multivariate modeling was used to adjust for age, gender, education, household income, and health status. Hispanics in MCOs were more likely than their FFS counterparts to report having preventive services, with adjusted differences ranging from 5 to 19 percentage points (P <.05 for physical examination, blood pressure measurement, breast examination and Pap smear). Among African Americans, such patterns were of a smaller magnitude. In both MCOs and FFS plans the proportion of African Americans reporting preventive services was equal to or greater than NHWs. In contrast, among Hispanic women in FFS, a non-statistically significant trend of fewer cancer screening tests than NHW's was observed (Pap smears 75% vs 80%; mammograms 66% vs 74%, respectively). In both MCO and FFS plans, Hispanics were less likely than NHWs to report having blood pressure and cholesterol measurement (P <.05). CONCLUSIONS: With the demise of traditional MCOs, reform efforts should incorporate those aspects of MCOs that were associated with greater preventive service utilization, particularly among Hispanics. Existing ethnic disparities warrant further attention.     

Estimates of the Population Prevalence of Injection Drug Users among Hispanic Residents of Large US Metropolitan Areas

Little information exists on the population prevalence or geographic distribution of injection drug users (IDUs) who are Hispanic in the USA. Here, we present yearly estimates of IDU population prevalence among Hispanic residents of the 96 most populated US metropolitan statistical areas (MSAs) for 1992–2002. First, yearly estimates of the proportion of IDUs who were Hispanic in each MSA were created by combining data on (1) IDUs receiving drug treatment services in Substance Abuse and Mental Health Services Administration (SAMHSA)’s Treatment Entry Data System, (2) IDUs being tested in the Centers for Disease Control and Prevention (CDC) HIV-Counseling and Testing System, and (3) incident AIDS diagnoses among IDUs, supplemented by (4) data on IDUs who were living with AIDS. Then, the resulting proportions were multiplied by published yearly estimates of the number of IDUs of all racial/ethnic groups in each MSA to produce Hispanic IDU population estimates. These were divided by Hispanic population data to produce population prevalence rates. Time trends were tested using mixed-effects regression models. Hispanic IDU prevalence declined significantly on average (1992 mean = 192, median = 133; 2002 mean = 144, median = 93; units are per 10,000 Hispanics aged 15–64). The highest prevalence rates across time tended to be in smaller northeastern MSAs. Comparing the last three study years to the first three, prevalence decreased in 82% of MSAs and increased in 18%. Comparisons with data on drug-related mortality and hepatitis C mortality supported the validity of the estimates. Generally, estimates of Hispanic IDU population prevalence were higher than published estimates for non-Hispanic White residents and lower than published estimates for non-Hispanic Black residents. Further analysis indicated that the proportion of IDUs that was Hispanic decreased in 52% and increased in 48% of MSAs between 2002 and 2007. The estimates resulting from this study can be used to investigate MSA-level social and economic factors that may have contributed to variations across MSAs and to help guide prevention program planning for Hispanic IDUs within MSAs. Future research should attempt to determine to what extent these trends are applicable to Hispanic national origin subgroups.     

Enhancing adherence to long-term medical therapy: A new approach to assessing and treating patients

Poor adherence to medical therapy may cause as much as $100 billion in unnecessary healthcare expenses each year. Nonadherence is a complicated and dynamic problem that involves patient, medication, and prescriber factors. The Case Management Adherence Guidelines (CMAG-1) are an evidence-based algorithm that introduces concepts and strategies for assessing medical knowledge and readiness to change (motivational interviewing). Once the assessment has been made, the guidelines can be used regularly to help patients become and remain adherent to their medication regimens. CMAG-1 and its tools, based on up-to-date information about adherence and ways to promote behavioral change, are designed to identify motivational and knowledge deficiencies that may block adherence. As information accumulates from centers that use it, CMAG-1 will be modified accordingly, with the goal of creating structured interaction with patients that will increase their knowledge and motivation to take medication appropriately.