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Dietary Quality among Latinos: Is Acculturation Making Us Sick?
Abstract
Latinos, defined herein as individuals coming from Spanish or Portuguese speaking countries in Latin America and the Caribbean, have made and continue to make major economic, social, cultural, and political contributions to the USA (1). Yet, they are disproportionately affected by poor educational attainment, higher poverty and food insecurity rates, lack of access to health-care, and suboptimal health outcomes (2). These disparities occur in the context of neighborhoods or living environments with low social capital and major structural barriers preventing the practice of healthier recommended behaviors, including proper nutrition (3).
It is estimated that 78% of Latinos speak mostly Spanish at home (4). This strong language preference has led some to believe that Latinos can be understood as a monolithic group. However, Latinos can not be understood as a homogenous group as they come from very diverse socio-cultural contexts. In addition, their move to the USA has been driven by different social, economic, and/or political reasons (2). The objective of this commentary is to: a) present and discuss recent evidence on the association between acculturation, household food insecurity and dietary quality among Latino subgroups; b) make recommendations for improving the measurement of the construct of acculturation; and c) make specific research recommendations for advancing the knowledge in this field.
... While it is known that NL and acculturation as single factors have opposite effects on diet quality, the direction of their combined effect is unknown. The process of assimilating or adapting to a highly processed diet, aka, the Western diet, is a phenomenon observed among the Latino population in the US [8], but also in populations across Latin America [9,10]. However, the underrepresentation of Latina immigrant women in clinical and population studies leaves a problematic gap in the understanding of the factors contributing to the diet changes of pregnant Latina immigrants living in the US. ...
... Acculturation is a complex phenomenon that can have both positive and negative impacts on the lifestyle of immigrants and their families. For example, high acculturation is associated with higher physical activity levels but a lower intake of fruits and vegetables among Latino populations [10]. How immigrants assimilate to the new country is impacted by multiple individual, interpersonal and systemic factors, such as their immigration history, previous interactions in their home country, and their interaction and integration in the new environment [10]. ...
... For example, high acculturation is associated with higher physical activity levels but a lower intake of fruits and vegetables among Latino populations [10]. How immigrants assimilate to the new country is impacted by multiple individual, interpersonal and systemic factors, such as their immigration history, previous interactions in their home country, and their interaction and integration in the new environment [10]. ...
Acculturation contributes to low diet quality and can foster health inequities for Latina women during pregnancy. Conversely, nutrition literacy (NL) increases diet quality and could promote health equity. This study assessed the associations between the diet quality, acculturation, and NL of Latina women (n = 99) participating in the Assessment of Docosahexaenoic Acid On Reducing Early Preterm Birth (ADORE) study. Acculturation and nutrition literacy factored together tended to modify diet quality, but this was not statistically significant. Diet quality was associated with acculturation, age, and nativity. Most (76.8%) demonstrated low nutrition literacy. Women who were bicultural and were born in Latin American countries other than Mexico had lower diet quality scores than women who had lower acculturation and were born in Mexico. Women who were 35 years or older had better diet quality than those who were younger. Future studies are needed to explore diet quality differences for pregnant Latina women with high nutrition literacy and high acculturation, as well as for women from the Caribbean, Central and South American countries living in the US, to promote nutrition and maternal health for Latina women.
... While there has been a lot of research on the impact of acculturation on the eating habits of adults (G. X. Ayala, Baquero, & Klinger, 2008;Duffey, Gordon-larsen, Ayala, & Popkin, 2008;Montez & Eschbach, 2008;Pérez-Escamilla, 2009), there has been little research focusing on how a mother's level of acculturation effects what she feeds to her children. ...
... Discrepant findings are partly due to the variety of diets found within Mexico. When coming to the U.S., someone originating from a more urban area will change their diet less drastically than someone coming from a more rural area in Mexico, mainly because populations in the more urban parts of Mexico have already begun to consume more of a western diet whereas people in the more rural areas are more likely to consume the traditional Mexican diet (Pérez-Escamilla, 2009). Many cities in Mexico are showing trends in an increased consumption of meat and fast foods (Curiel, Levy, & Vlliasana, 1995) Traditional Mexican diets differ greatly from the American diet. ...
... They consume: less fruits, vegetables and legumes (G. X. Ayala et al., 2008;Duffey et al., 2008;Montez & Eschbach, 2008;Pérez-Escamilla, 2009), more fast food (Duffey et al., 2008), more soda (G. X. Ayala et al., 2008;Duffey et al., 2008;Pérez-Escamilla, 2009), more sugar (G. ...
In the U.S., obesity has hit alarming rates and affects Hispanic children disproportionately. Acculturation, the shift from one culture’s values, beliefs and practices to those of a new culture, may have both negative and positive health effects on immigrants. The objectives of this study were to determine the association between the level of acculturation (low acculturation or high acculturation) of low-income Latina mothers and the foods consumed by their children (0 to 36 months old). The association between acculturation and maternal perceptions of infant and toddler body size, maternal perceptions of her own body size and maternal parenting stress were also investigated. This was accomplished in 3 stages. First, data was collected cross-sectionally from 68 participants of WIC. Mothers answered many questionnaires including Food Frequency Questionnaires for their children, body size perception scale questionnaires and a parenting stress test. General linear regression models were performed to investigate an association between acculturation and food frequency, maternal perceptions of body size and parenting stress. Each model controlled for child’s age, maternal age, BMI (m/kg2) and education level. Second, key informant interviews were conducted with nine public health professionals to help gain a better understanding of some of our findings and to develop questions for the third stage: focus groups. Third, a total of 32 mothers participated in focus groups to discuss their perceptions on acculturation and child-feeding habits, and children’s body size. In addition, three mothers completed one-on-one interviews. From the cross-sectional analysis of the first study stage, the level of acculturation did not have a significant effect on any of the factors measured. For all mothers, however an increase in child’s age was associated with an increase in both the amount of healthy foods and less healthy foods consumed; an increase in mother’s BMI was associated with an increase in the children’s consumption of less healthy foods (beta coefficient of -0.042; p = 0.035). An increase in child’s age was associated with an increased likelihood of a mother to correctly estimate her own body size (beta coefficient of 0.041; p = 0.043). An increase in maternal BMI was associated with an increased likelihood to underestimate her own weight as well as that of her child. During the second stage, a theme emerged from the focus groups that the mothers try to feed the children the way they were fed growing up but they encounter difficulties when they can’t find the same ingredients and when their children start to prefer American foods. For all groups health was the number one factor they considered when choosing what to feed their children. The low acculturated mothers stated they wanted more education on how to assess if their child is at a healthy weight and admitted to not thinking about weight very much. In both groups, the mothers reported getting information about their child’s weight from health care professionals but many mothers from the bi acculturated group mentioned not believing the doctor when they told them their child was overweight. Overall, the findings suggest that children’s diets are not different by mother’s acculturation level and that the children start to prefer American foods from a young age. Parental education for several areas were identified: 1) for mothers to learn how to continue with the healthful aspects of a traditional diet 2) teach parents about appropriate stages of growth for their children; 3) when trying to teach about food focus on other areas of health rather than weight since weight does not seem to resonate as a concern.
... Investigators advocate the use of bi-or multidimensional acculturation measures that capture different domains of both origin and new cultures (6), including language use, attitudes, values, and ethnic interactions (5), because they provide clearer, more nuanced information about the complex process of acculturation and its association with health (6,7). Yet, most studies have only assessed language proficiency, or other proxy unidimensional measures, which does not fully capture the process of cultural adaptation (5). ...
... Other differences in income, educational attainment, and English proficiency at time of migration by Latin American country of origin have been reported (14), which may launch disparate acculturation paths. Differentiating by heritage may provide further insights into the inconsistent associations between acculturation and diet (7). ...
Background:
The role of acculturation in dietary behaviors among Hispanics/Latinos in the United States remains unclear. Discrepancies may be explained by variations in acculturation constructs or ethnicity-specific dynamics.
Objective:
We aimed to compare relations between 3 different acculturation constructs with dietary quality and patterns among Puerto Ricans in the mainland United States.
Methods:
We analyzed cross-sectional data with 1194-1380 Puerto Ricans, aged 45-75 y. Acculturation was measured with the use of a language-based scale (0-100; higher score denotes more English use), a psychological-based scale (0-50; higher score denotes stronger US orientation), and years living in the mainland United States. Diet quality scores (higher scores denote healthier diet) were defined with the use of the Alternate Healthy Eating Index-2010 (AHEI) and the Mediterranean Diet Score (MeDS). Three dietary patterns were previously derived with the use of principal components analysis. Adjusted multivariable regression models tested the association of each acculturation construct with diet quality score or pattern. Interaction terms were included for income or education status.
Results:
Psychological-based acculturation, but not the other constructs, was positively associated with AHEI (β ± SE: 0.013 ± 0.004; P = 0.002) and MeDS (0.009 ± 0.005; P = 0.041). Income, but not education, moderated this association (P = 0.03), with higher diet quality observed with higher income (>$25,000) and stronger US orientation. All constructs were inversely associated with a traditional dietary pattern, with the language-based scale being stronger (z score β ± SE: -0.160 ± 0.032; P < 0.0001) than the psychological-based scale (-0.097 ± 0.028; P = 0.001) or years living in the mainland United States (-0.058 ± 0.028; P = 0.041). No associations were observed for the Western or sweets/desserts patterns.
Conclusions:
In Puerto Rican adults, stronger psychological US orientation was associated with higher diet quality, particularly with higher income. More Spanish use, stronger psychological Puerto Rican orientation, and shorter length of mainland-US residency were associated with traditional dietary patterns. Appropriate diet-related acculturation constructs should be carefully considered among Hispanics/Latinos. This trial was registered at clinicaltrials.gov as NCT01231958.
... The Latino's, which are people coming from Spanish or Portuguese speaking countries in Latin America and the Caribbean, are disproportionately affected by poor educational achievement, higher poverty and food insecurity amounts, lack of access to health-care, and less than desirable health outcomes in the U.S. [33]. These barriers prevent the practice of recommended healthy behaviors which includes proper nutrition [33]. ...
... The Latino's, which are people coming from Spanish or Portuguese speaking countries in Latin America and the Caribbean, are disproportionately affected by poor educational achievement, higher poverty and food insecurity amounts, lack of access to health-care, and less than desirable health outcomes in the U.S. [33]. These barriers prevent the practice of recommended healthy behaviors which includes proper nutrition [33]. ...
... Ratios of dietary n-6 to n-3 have been reported to be~10:1 in most western populations; this is significantly higher than the 1:1 to 4:1 ratios reported to have health benefits [9,10]. This dietary shift has been observed in MO Hispanics, largely as a result of immigration and increasing acculturation to westernized diets of the U.S. [11,12]. Specifically, moving away from a traditional Mexican dietary pattern, shown to improve metabolic health [13][14][15][16], to a western dietary pattern associated with increased NAFLD risk and other obesity-related diseases, has been proposed to have devastating health effects and contribute to health disparities observed among MO Hispanics [17,18]. ...
Rates of non-alcoholic fatty liver disease (NAFLD) vary dramatically among Hispanic subpopulations, with Mexican-origin (MO) Hispanics experiencing a disproportionate burden. This study examined dietary fatty acid (FA) intake among overweight and obese MO Hispanic adults in the United States (US) and evaluated its association with liver steatosis and fibrosis. Participants (N = 285, MO Hispanic adults) completed 24-h dietary recalls to assess dietary FA exposure. Liver steatosis and fibrosis were estimated using transient elastography (FibroScan ®). Multiple regression analysis tested relationships between FA intakes and liver steatosis or fibrosis, adjusting for age, sex, body mass index (BMI) and total energy. A total of 51% (n = 145) of participants were suspected to have NAFLD and 20% self-reported a type 2 diabetes diagnosis. No significant association was observed between Linoleic Acid and α-Linolenic Acid (LA:ALA) ratio, or omega-6 to omega-3 (n-6:n-3) ratio and liver steatosis. However, a one-point increase in the LA:ALA ratio resulted in a 1.01% increase in the liver fibrosis scores (95% CI: [1.00, 1.03]; p = 0.03), and a one-point increase in the n-6:n-3 ratio resulted in a 1.02% increase in liver fibrosis score (95% CI: [1.01, 1.03]; p = 0.01). Further research is needed to determine if modulation of FA intake could reduce NAFLD risk in this high-risk population.
... This is relevant given several studies within this review found that low acculturation plays an important role in accessing healthy foods [40,41,45,54]. Previous research suggests low acculturation in adults has been associated with lower language proficiency, socioeconomic status, and level of education, creating additional knowledge and communication barriers for individuals to access governmental and charitable assistance [67,100,101]. ...
Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States (US), specifically those with young children. While the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n=27). The strength of each article’s evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as “medium” or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.
Statement of Significance
Understanding factors contributing to food insecurity is an essential first step in addressing the negative impacts on US households with young children. Using the SEM framework, this narrative review provides an overview of the current state of knowledge about the factors associated with food insecurity, particularly in Hispanic/Latinx households with children under the age of three years. Recognizing how multiple factors intersect and impact the food security status of the most vulnerable households is pivotal for developing and/or adapting interventions and promoting policies that improve access and availability of adequate and nutritious foods to these families, contributing to health outcomes.
... Research has shown that as South Asian immigrants adjusted to a Western diet, they have faced increased risks of developing obesity, diabetes, and cardiovascular disease. 11 Furthermore, the dietary quality of most Hispanic immigrants is very poor in the United States. 12 In both immigrant groups, confounding factors may be contributing because the food choices available in ethnic grocery stores were not noted in these studies as a potential cause of poor dietary intake. ...
This study examined Denver, Colorado area grocery stores to identify if significant differences in food price, availability, or quality existed for different population groups. Thirty stores were randomly selected and analyzed using Nutritional Environmental Measure Survey for Supermarkets (NEMS-S). Results showed there was no significant relationship between availability or quality and socioeconomic status or minority status. Higher prices were seen in stores of higher total income. Large supermarkets offered higher quality produce. Further research should assess how consumers make a store and consequent purchasing decisions as there are mixed results in the connection between access to healthful food choices and health.
... For example, research suggests that the dietary patterns of Latinos in the U.S. change as immigrants acculturate, though the specific mechanisms through which this occurs are not well understood. 40,41 Complex systems models can help test hypotheses regarding the dynamic mechanisms through which immigrants both adapt to and influence the food behaviors of their communities. ...
Context:
Complex systems approaches can help to elucidate mechanisms that shape population-level patterns in diet and inform policy approaches. This study reports results of a structured review of key design elements and methods used by existing complex systems models of diet.
Evidence acquisition:
The authors conducted systematic searches of the PubMed, Web of Science, and LILACS databases between May and September 2018 to identify peer-reviewed manuscripts that used agent-based models or system dynamics models to explore diet. Searches occurred between November 2017 and May 2018. The authors extracted relevant data regarding each study's diet and nutrition outcomes; use of data for parameterization, calibration, and validation; results; and generated insights. The literature search adhered to PRISMA guidelines.
Evidence synthesis:
Twenty-two agent-based model studies and five system dynamics model studies met the inclusion criteria. Mechanistic studies explored neighborhood- (e.g., residential segregation), interpersonal- (e.g., social influence) and individual-level (e.g., heuristics that guide food purchasing decisions) mechanisms that influence diet. Policy-oriented studies examined policies related to food pricing, the food environment, advertising, nutrition labels, and social norms. Most studies used empirical data to inform values of key parameters; studies varied in their approaches to calibration and validation.
Conclusions:
Opportunities remain to advance the state of the science of complex systems approaches to diet and nutrition. These include using models to better understand mechanisms driving population-level diet, increasing use of models for policy decision support, and leveraging the wide availability of epidemiologic and policy evaluation data to improve model validation.
... More recent studies have also argued that food acculturation is a complex, dynamic, and multidimensional process and not a simple unidirectional shift from 'traditional' to 'acculturated' and that, moreover, acculturation alone is insufficient in explaining the changes in diets of immigrants Pérez-Escamilla 2009;Creighton et al. 2012;Wojcicki et al. 2012;Martínez 2013). Past research provided evidence that immigrants may prepare foods of their culture in both traditional and new ways, exclude other foods of their culture that may be unavailable in the host country's environment, and consume new foods that they have become familiar with after arrival in their new country (Kim et al. 2007;Satia 2010). ...
Changes in diet that have occurred in the last several decades in many developed countries have contributed to high obesity rates and an increasing prevalence of chronic diseases among immigrant populations. This study, conducted in the Midwestern U.S., examined changes in food practices and dietary patterns among Mexican immigrants and investigated how leisure was related to their food practices and dietary patterns. The study was based on in-depth interviews with 23 Mexican immigrants. The findings showed that immigrants prepared foods of their culture using both traditional and new techniques, excluded other foods of their culture unavailable in their local environment, and consumed foods that were new to them and which they became familiar with in the new country. Following immigration, most interviewees stopped growing food as part of their leisure, and cooking became less fun and was no longer a leisurely activity as a result of time constraints and conflicting family and work schedules.
... Simultaneously, life course experiences, including past food insecurity and migration, can also shape food behaviors (Dubowitz et al., 2007;Handley et al., 2013;Smith et al., 2016;Younginer, Blake, Draper, & Jones, 2015) and are particularly salient for immigrant women, as they may be more sensitive to early life food insecurity (Kaiser et al., 2003;Kaiser, Townsend, Melgar-Quiñonez, Fujii, & Crawford, 2004) and to the migratory process (Dean et al., 2010;Thurston & Vissandjée, 2005). Researchers have emphasized the need for considering Hispanics/Latinos' prior experiences and practices in their home country to better understand the degree to which they modify their dietary habits once in the U.S. (Dean et al., 2010;Pérez-Escamilla, 2009), including how they manage household food supplies (Kaiser et al., 2002). However, to date, there is limited evidence framing food provisioning behaviors of recently-immigrated Hispanics/ Latinos at risk of food insecurity in the context of ecological and life course factors (Dubowitz et al., 2007;C.;Quandt ...
Background:
World migration shifts emphasize the necessity of framing health behavior in the context of life course. Mexican-born households in the U.S. disproportionally experience food insecurity, a condition associated with poor health. Food assistance programs may not be accessible to immigrants, suggesting food provisioning strategies may play a critical protective role.
Objective:
To explore life course and ecological system influences on food provisioning among low-income, Mexican-born mothers in the U.S. to identify target influences and behaviors for interventions.
Methods:
Life Course Perspective and Ecological Systems Theory guided this qualitative study.
Inclusion criteria:
1) woman born in Mexico, 2) ≤10 years in U.S., 3) residing in one of two New York State counties, 4) at least one child ≤5 years old, and 5) <200% of the federal poverty line. Participants completed two semi-structured interviews, including a participant-driven photo elicitation interview, in English or Spanish, and a food insecurity assessment. Thematic content analysis identified emergent themes.
Results:
Five themes emerged that were related to three key life course concepts: social context in Mexico (food insecurity experiences, agrarian experiences, and traditional foods and flavors), transitions (motherhood), and turning points (health events). All themes related to mothers' overall priority of providing home-cooked meals, and demonstrated life course influences shaping food provisioning values and strategies.
Conclusion:
Considering life course experiences is important to creating effective, multi-level approaches to reduce food insecurity among Mexican-born families in the northeastern U.S. Programs should have a particular emphasis on new or soon-to-be mothers and should include improved access to affordable in-season produce or gardening opportunities, peer-led food provisioning programs, and food and nutrition assistance programs.
... This suggests developing nutrition intervention strategies that encourage Hispanics to diversify where they shop for food, including, but not limited to, supermarkets/grocery stores, to ensure they have access to health promoting resources such as fruits and vegetables. To encourage this behavior, it is important to consider their level of acculturation and how acculturation influences decisions on where to purchase foods [36,63,64]. Intervention strategies should be developed that support US-born Hispanics' ability to maintain some of the healthier food behaviors practiced in their Hispanic culture such as purchasing foods from more traditional food store types such as supermarket/grocery stores [43]. ...
This study examined fruit and vegetable intake by food store type shopped among US Hispanics. Using National Health and Nutrition Examination Survey 2011-2012 data, T test and chi-square tests examined differences between Hispanic consumers by food store type. Negative binomial regression analyses estimated associations between fruit and vegetable intake and food store type. Hispanics who only purchased fruits and vegetables from convenience stores were younger and more likely US born. They reported lower intakes of fruit and vegetables than individuals who purchased these foods from supermarket/grocery stores. Those who primarily purchased fruits and vegetables from supermarkets/grocery stores consumed 0.92 (p < .001) greater fruit cup equivalents and 0.26 (p = .001) greater vegetable cup equivalents than those who only purchased from convenience stores. Research on the influence of shopping in multiple food store types is needed to develop targeted in-store intervention strategies to encourage healthier food purchases. Results provide support for policy-level research such as minimum stocking requirements for healthy foods in convenience stores.
... Migrant obesity rates may also be attributable to nutritional transition ( Delavari et al., 2013) which happens in the host countries whereby migrants from low income countries locate from agrarian societies (who consume fresh foods and undertake regular physical activity) to an environment where they have easier access to processed goods and fewer opportunities to undertake daily physical activity. For example, within the USA, Latino migrant populations reported a higher consumption of fast foods and consumed inexpensive convenient foods that had high calories ( Pérez-Escamilla, 2010). It is proposed that the rate of transition is quicker in a migrant population than an already settled population, which accounts for the greater changes in body weight. ...
Objective
There is extensive evidence for weight gain among people migrating from low/middle-income to high-income countries, which may be due, in part, to acculturation factors. This review aimed to identify associations between acculturation and body weight among immigrants to high-income countries and identify if studies accounted for the role played by health behaviours.
Methods
A systematic literature search using keywords was performed with three databases (Medline, PsychINFO and EMBASE). The 35 studies were included that utilised quantitative methodology and presented empirical findings focused on acculturation and body weight among adult immigrants.
Findings
There was evidence presented across multiple studies for an association between acculturation (measured with standard measures or as duration of stay) and obesity. Most studies were cross sectional, which did not allow the exploration of drivers of change in health behaviours and weight gain.
Conclusion
This is the first review to examine associations between acculturation and body weight among migrants utilising both acculturation scales and proxy measures of acculturation and to examine the role of health behaviours. Evidence from this review suggests that health interventions should target first generation migrants to promote retention of their original healthy behaviours. Recent migrant groups report healthier behaviours than comparative host country populations, and therefore interventions should be promoted at the initial stages following migration to avoid uptake of unhealthy behaviours.
... In this study, commercially prepared items, including dietary staples, were purchased and used on a regular basis. Many of these items—such as bouillon cubes, freeze-dried or ramen noodle soups as well as breads, sausages and hot dogs, pizzas, sports drinks—tend to have a high sodium content [83][84][85][86]. In a 2013 report on obesity, The Hispanic Institute argued that the processed food industry should be held accountable for " its complicity in flooding stores with drinks that are too sugary and foods that are too salty and fat " [87]. ...
Compared to other population groups in the United States, caries (tooth decay) is a disproportionately prevalent disease among Latino populations, especially among low-income and rural sub-groups and children under five years of age. Fluoride is a primary preventive for caries. While water fluoridation is a major and effective public health means for delivering fluoride on a mass scale, it does not reach many rural areas or population groups such as Latinos who eschew drinking water from municipal sources. This study examines the acceptability to such groups of salt fluoridation, an alternate means of delivering fluoride long used on a global scale. An ethnographic study in California's rural Central Valley was performed. Thirty individual interviews and 5 focus groups (N = 61) were conducted in Spanish to investigate low-income Latino migrant caregivers' experiences, views and understandings of domestic salt, oral health, caries prevention and fluoride. Audio data were transcribed, translated, coded and thematically analyzed. Table salt was readily available and frequently consumed. Both adult and child daily sodium consumption was high. Despite a general feeling that it was good, and present in dentifrices or dietary supplements, most participants had little knowledge about fluoride. Concerns were raised about cardio-vascular and other possibly deleterious effects if an increase in salt consumption occurred because fluoridated salt was viewed as having 'extra' benefits. Once informed about fluoride's safety and role in caries prevention, most participants expressed willingness to use fluoridated salt, especially if it benefitted children. Reassurance about its safety and benefits, and demonstration of its taste, were important aspects of acceptance. Taste was paramount. Participants would not consume more fluoridated salt than their current salt as that would result in unpleasant changes in food flavor and taste. While salt fluoridation is acceptable, the feasibility of producing and distributing fluoridated salt in the United States is, however, complex and challenging.
... Obesity rates are expected to continue to increase in the United States and exceed 50% in 39 states thus driving obesity related healthcare costs to increase to $66 billion by 2030 (Voelker, 2012 ). Obesity among Latinos in particular is a major focus of both public health research and practice given that they are the largest minority group in the United States (U.S.) and experience a disproportionate burden of obesity-related chronic conditions, including cardiovascular disease and type II diabetes (Pérez-Escamilla, 2010; Roger et al., 2012). In 2010, nationally representative data revealed higher rates of obesity among Latino adults than their non-Hispanic White counterparts, 39.1% vs. 34.3% ...
Objective:
Latinos are the largest racial and ethnic minority group in the United States and bear a disproportionate burden of obesity related chronic disease. Despite national efforts to improve dietary habits and prevent obesity among Latinos, obesity rates remain high. The objective of this study is to explore the relationship between self-rated dietary quality and dietary behavior among Latinos and how this may vary by socio-demographics to help inform future public health efforts aiming to improve eating habits and obesity rates.
Design:
Cross-sectional study using a series of chi-square tests, the non-parametric Wilcoxon-Mann-Whitney test and logistic regression to explore self-rated eating habits.
Setting:
Two urban, low-income, predominantly Latino neighborhoods in Los Angeles County.
Subjects:
1000 adults who self-identified as their household's primary food purchaser and preparer were interviewed from 2012 to 2013. Households were randomly selected based on their proximity to corner stores participating in a project to improve the food environment.
Results:
Most respondents (59%) report "good" eating habits. Significant associations between "good" eating habits and overall health, fruit and vegetable consumption were observed (p < 0.001). Despite these promising findings, we also find high levels of regular soda and energy-dense food consumption.
Conclusion:
This study revealed a general understanding that healthy dietary habits are associated with fruit and vegetable consumption among Latinos in two urban neighborhoods. However, there is a need for more targeted health promotion and nutrition education efforts on the risks associated with soda and energy-dense food consumption to help improve dietary habits and obesity levels in low-income Latino communities.
... The LMD's Latino population increased by 114.7% between 1990 and 2000, and many LMD counties have a population that is over 70% Black (UMREDC, 2002;U.S. Census Bureau, 2013). Health disparities among these two minority populations across the country has been well documented (Everson et al., 2002;Perez-Escamilla, 2009;Zoellner et al., 2009). The obesity rates among Blacks and Latinos nationwide are significantly above the national average (Wang & Beydoun, 2007). ...
The Lower Mississippi Delta (LMD) region has a large minority population with concentrations of poverty and health disparities much higher than other parts of the country. The purpose of this project was to assess the health perceptions of minority women living in the LMD using a combination of PhotoVoice and journal reflections. After an initial interview, 10 women were provided digital cameras and asked to take photographs that reflected the health of their communities. A final interview was conducted to glean more information from the women about their photographs. Seven Black women and two Latinas completed the study. The photographs, journal reflections, and transcripts collected during the study were analyzed using grounded theory principles. The core category identified by the researchers was Hope for a Healthy Future. The participants were optimistic about the future of the LMD and were striving to attain the Ideal Healthy Community, which consisted of five pillars: nutrition education, physical activity, access to healthy food, safety and cleanliness, and positive role models. Participants identified barriers and facilitators to each of these pillars in their communities. The primary facilitator to health was a deep connection to family, church, and community. The primary barrier to health was resistance to change among community members. Overall, striving towards the ideal healthy community was a source of participants' hope for a healthy future. Findings from this study can be used to further understand the health-related needs of minorities in the LMD and to advocate for positive change in LMD communities.
... The LMD's Latino population increased by 114.7% between 1990 and 2000, and many LMD counties have a population that is over 70% Black (UMREDC, 2002;U.S. Census Bureau, 2013). Health disparities among these two minority populations across the country has been well documented (Everson et al., 2002;Perez-Escamilla, 2009;Zoellner et al., 2009). The obesity rates among Blacks and Latinos nationwide are significantly above the national average (Wang & Beydoun, 2007). ...
... Nevertheless, our family-meal definition, derived from a broad recall of time use, may be less susceptible to social desirability bias than variables created using more narrowly focused instruments. The challenges and limitations of conceptualizing and measuring acculturation have been extensively noted (Abraído-Lanza, Armbrister, Flórez, & Aguirre, 2006;Berry, 2003;Hunt, Schneider, & Comer, 2004;Lopez-Class, Castro, & Ramirez, 2011;Pérez-Escamilla, 2009;Zambrana & Carter-Pokras, 2010). Although nativity and generational status are limited in their ability to reflect the nuances of the acculturative experience, they have been previously associated with dietary change (Bates et al., 2008;Duffey, Gordon-Larsen, Ayala, & Popkin, 2008;Gordon-Larsen et al., 2003) and were therefore relevant to the outcomes of interest. ...
Introduction
The growing prevalence of obesity in the USA disproportionately affects Latinos compared to non-Latino Whites. Immigration and acculturation have been associated with unhealthy dietary shifts among Latino immigrants, a phenomenon known as dietary acculturation. Emerging evidence points to a more nuanced relationship between dietary habits, immigration, and acculturation, highlighting the need for a more current comprehension of dietary acculturation.
Objective
We explored how Latino immigrants’ experiences in migrating to the USA have affected their perceived dietary habits and their experiences of how supportive the USA is in establishing healthy practices compared to their native country.
Methods
Employing a descriptive qualitative study design, we conducted semi-structured interviews with 19 Latinos who had participated in a lifestyle change program between 2016 and 2019. We used thematic analysis to analyze the data and report emerging themes.
Results
Participants expressed divergent perceptions of their dietary habits post-immigration. Some affirmed prevailing assumptions of dietary acculturation, citing deteriorating diet quality in the USA in the context of a faster pace of life, healthier options in the native country, and shifts in the food environment that prevented access to healthy foods. Conversely, others held opposing views, attributing their perceived improved diet to unhealthy dietary habits in Latin America, coupled with increased access to and affordability of healthy foods in the USA.
Conclusion
Our study contributes to the evolving understanding of dietary acculturation among Latino immigrants and provides a more nuanced and updated understanding of this process that reflects their current experiences in acculturating to the USA.
Objective:
To examine the association between language use - predominantly English, English and Spanish equally, and predominantly Spanish - and food insecurity among Hispanic adults residing in the United States, 1999-2018.
Design:
Pooled cross-sectional study design.
Setting:
United States.
Participants:
15,073 Hispanic adults.
Results:
Compared to Hispanic adults who predominantly spoke English and after adjusting for age, sex, family income-to-poverty ratio, education level, and employment status, Hispanic adults who spoke English and Spanish equally (OR=1.28, 95%CI=1.05-1.56) or predominantly Spanish (OR=1.25, 95%CI=1.04-1.49) had higher odds of food insecurity. After stratifying by country of birth, language use was associated with higher odds of food insecurity only for Hispanic adults born outside of the United States, but not for Hispanic adults born in the United States. Hispanic adults born outside of the United States who spoke English and Spanish equally (OR=1.27, 95%CI=1.04-1.55) or spoke predominantly Spanish (OR=1.24, 95%CI=1.04-1.48) had higher odds of food insecurity when compared to those who predominantly spoke English.
Conclusion:
Foreign-born Hispanic adults who speak predominantly Spanish, or English and Spanish equally, have higher odds of food insecurity. Food and nutrition assistance programs that serve Hispanic immigrants should make sure to provide linguistically- and culturally appropriate services to this population.
Farmworkers are an essential workforce to maintain California's extensive agricultural production. However, this mostly Latino, immigrant population is affected by high poverty rates and food insecurity, which increases their risk of chronic diseases. We analyzed clinical and interview data from three studies of Latino farmworkers in California: (1) the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) study, (2) the PASOS SALUDABLES pilot intervention (PASOS Pilot), and (3) the PASOS Study, a cluster-randomized, controlled trial (PASOS RCT). We aimed to determine the prevalence of diet-related chronic health outcomes (obesity, elevated waist circumference, high blood pressure, and high total cholesterol) and identify sociodemographic and socioeconomic factors associated with these conditions in this population. A total of 1,300 participants were included in this study (452 from MICASA, 248 from PASOS Pilot, and 600 from PASOS RCT). Obesity prevalence ranged from 29.2 to 54.5% across samples; elevated waist circumference was observed in 29.4–54.0% of participants; high blood pressure was detected in 42.0–45.5% of participants; 23.7–25.8% of participants had high total cholesterol. Age was positively associated with each health outcome, although not for each sample; each additional year in age increased odds by 3–9%, depending on the outcome and sample. Females were at higher risk of obesity (one sample) and elevated waist circumference, but at lower risk of high blood pressure and high total cholesterol. Single, divorced or widowed participants (vs. married/living together) had 35 and 47% reduced odds of obesity and elevated waist circumference, respectively. Each additional year living in the US was associated with 3–6% increased odds of obesity, depending on the sample. Higher household income was associated with a reduction in odds of high total cholesterol up to 76% (one sample). These findings highlight the increased risk of chronic health conditions in Latino farmworkers, in particular for obesity, and among farmworkers who may lack access to health care, which represents a large proportion of this population. Differences in chronic health risks by sex suggest that clinical and public health responses might need to be sex-specific. Expansion of eligibility for supplemental nutrition programs for this low-income population could reduce their disease burden.
Background
Cardiovascular disease and obesity affect racial and ethnic minorities disproportionally. Public health research suggests that suboptimal diet is an important contributor to health disparities. Limited evidence points at an increased dietary acid load (DAL) in certain ethnic groups. DAL is determined by the balance of acidifying foods and alkaline foods, and elevated DAL scores have been associated with numerous chronic lifestyle-related conditions. The present analysis investigated DAL scores among ethnic groups in the USA.
Methods
Using cross-sectional data from the National Health and Nutrition Examination surveys (NHANES, 2007–2016), we contrasted several markers of DAL (potential renal acid load (PRAL) and net endogenous acid production (NEAP)) between Non-Hispanic Whites, Non-Hispanic Blacks, Mexican Americans, Other Hispanics, and Other Race. The comparison included crude scores and adjusted scores following multivariate linear regression.
Results
The sample for this analysis comprised 19,565 participants, which may be extrapolated to represent 156,116,471 United States Americans. When compared to Non-Hispanic Whites, Non-Hispanic Blacks and Mexican Americans had significantly higher crude DAL scores. PRAL R was highest in Mexican Americans (20.42 (0.61) mEq/day), followed by Non-Hispanic Blacks (17.47 (0.42) mEq/day). Crude NEAP F was highest in Non-Hispanic Blacks (64.66 (0.43) mEq/day), and almost 9 mEq/day higher compared to Non-Hispanic Whites (55.78 (0.39) mEq/day). Multivariate linear regression adjusting for confounders revealed comparable interracial DAL differences.
Conclusions
We found significant DAL differences across the investigated ethnic groups. Whether these differences potentially play a role in population health inequity in the USA will be subject to additional research.
Graphical Abstract
Introduction
Research examining the influence of neighborhood healthy food environment on diet has been mostly cross-sectional and lacked robust characterization of the food environment. We examined longitudinal associations between features of the local food environment and healthy diet, and whether associations were modified by race/ethnicity.
Methods
Data on 3634 adults aged 45–84 at Exam 1 and followed for 10 years were obtained from the Multi-Ethnic Study of Atherosclerosis. Diet quality was assessed using the Alternative Healthy Eating Index at Exam 1 (2000–2002) and Exam 5 (2010–2012). We assessed four measures of local food environment using survey-based measures (e.g. perceptions of healthier food availability) and geographic information system (GIS)-based measures (e.g. distance to and density of healthier food stores) at Exam 1 and Exam 5. Random effects models adjusted for age, sex, education, moving status, per capita adjusted income, and neighborhood socioeconomic status and interactions terms to assess effect modification by race/ethnicity.
Results
Net of confounders, one standard z-score higher average composite local food environment was associated with higher average AHEI diet score (1.39, 95% CI: 1.05, 1.73) over the follow-up period from Exam 1 to 5. This pattern of association was consistent across both GIS-based and survey-based measures of local food environment and was more pronounced among minoritized racial/ethnic groups. There was no association between changes in neighborhood environment and change in AHEI score, or effect modification by race/ethnicity.
Conclusion
Our findings suggest that neighborhood-level food environment is associated with better diet quality, especially among racially/ethnically minoritized populations.
Resumen
La migración internacional tiene consecuencias económicas y en la salud. El proceso de aculturación en el país de acogida puede estar relacionado con la obesidad infantil. Utilizamos el marco conceptual del balance energético comunitario (CEB, por sus siglas en inglés) para analizar la relación entre migración y obesidad infantil en los hogares mexicanos con migrantes internacionales. Utilizando datos longitudinales de la Encuesta Nacional de Niveles de Vida de los Hogares de México (ENNViH), examinamos cómo influyen las redes de migrantes sobre la obesidad infantil en las comunidades de origen. También revisamos programas de salud binacionales que podrían ser eficaces para abordar la obesidad infantil en los hogares de migrantes procedentes de México. Los niños que forman parte de las redes de migrantes presentan un mayor riesgo de -desarrollar sobrepeso y obesidad, lo cual sugiere una relación significativa entre la obesidad infantil y la migración internacional en los hogares mexicanos. Basándonos en los criterios de búsqueda que habíamos definido, realizamos un análisis de programas de extensión comunitaria en salud cuyos resultados indican que las Ventanillas de Salud (VDS) son una opción prometedora para prevenir la obesidad infantil en un entorno de confianza y culturalmente sensible. El marco conceptual CEB es útil para comprender cómo contribuye la migración al riesgo de sobrepeso y obesidad infantil en los hogares de los migrantes. Las VDS son una estrategia viable y replicable con un gran potencial para abordar la obesidad infantil entre las familias migrantes y que toma en cuenta los determinantes dinámicos y binacionales de la obesidad infantil.
International migration has economic and health implications. The acculturation process to the host country may be linked to childhood obesity. We use the Community Energy Balance (CEB) framework to analyze the relationship between migration and childhood obesity in Mexican households with international migrants. Using longitudinal data from the Mexican Family Life Survey (MxFLS), we examine how migrant networks affect childhood obesity in origin communities. We also review binational health programs that could be effective at tackling childhood obesity in migrant households from Mexico. Children embedded in migrant networks are at greater risk of developing overweight or obesity, suggesting a significant relationship between childhood obesity and international migration in Mexican households. Based on our search criteria, our analysis of health outreach programs shows that Ventanillas de Salud (VDS)/Health Windows has great promise to prevent childhood obesity in a culturally sensitive and trustful environment. The CEB framework is useful to understand how migration contributes to the risk of childhood overweight and obesity in migrant households. VDS is a feasible and replicable strategy with great potential to address childhood obesity among migrant families accounting for the dynamic and binational determinants of childhood obesity.
Young children's lifestyle behaviors are largely shaped by their parents. There are socioeconomic risk factors particular to Hispanic populations that influence the way parents feed their children. As obesity continues to be a public health issue with substantial inequities across race and ethnicity, it is critical to understand Hispanic parents' food choices and feeding practices. The objective of this qualitative study is to identify the behavioral, environmental, and cognitive factors that influence the parental food choices and feeding behaviors of Hispanic mothers of children ages 0-5 years. Snowball sampling was used to recruit participants from the community (n=30) who were 1) female; 2) Hispanic; 3) over the age of 18; and 4) a mother to child(ren) between the ages zero and five. Each interview consisted of a brief demographic survey and a set of open-ended questions based on Social Cognitive Theory constructs. A thematic analysis using a combined deductive and inductive approach was used to analyze transcriptions. Results indicated that mothers' attitudes around breastfeeding were connected with their challenges, while their attitudes around solid foods were expressed in their feeding strategies. Mothers used strategies of modeling, repeated exposure, and practices of "sneaking" in healthy foods and bribing to promote healthy eating. Mothers were most likely to seek out information from (1) pediatricians, (2) female family members, and (3) the internet. Hispanic mothers actively seek out information from many different sources that impact how they feed their young children. Understanding their trusted sources and how it influences the SCT constructs is an important step in preventing early childhood obesity.
The purpose of this study was to understand recommendations of key stakeholders regarding cultural adaptation of an evidence-based nutrition and physical activity education curriculum for Spanish-speaking adults. Findings from focus groups with Spanish-speaking adults (n=43) and telephone interviews with experts in Spanish nutrition and health education (n=9) revealed: 1) emphasis of the heterogeneity of Spanish-speaking communities; 2) importance of including family in nutrition education; 3) importance of addressing cultural differences between Spanish-speaking and general United States culture; and 4) tips for engaging Spanish-speaking adults in health education. These findings were used to inform cultural adaptation of a nutrition education curriculum.
Purpose
The purpose this paper is to offer an understanding of the role of food in the adjustment journey of Nigerian students in the UK.
Design/methodology/approach
A qualitative approach was used, involving interviews with ten Nigerians studying in the UK.
Findings
Thematic analysis revealed that participants found the food they ate locally to be bland and fattening, and that they quickly adopted a home country diet, using ingredients bought locally or sent and brought from home to recreate Nigerian dishes. Eating Nigerian food had a positive emotional impact, and it was also a vehicle for social interaction.
Research limitations/implications
It is acknowledged that this is a small-scale preliminary study that could be extended across the UK with a more quantitative approach to get a broader picture of the eating habits of Nigerian students at British Universities. There is also an opportunity to widen it to include other African states which are neglected within the present literature. A more longitudinal study picking up migrants could also explore how adjustments have been made in their eating habits. Participants in this research equated fast food with local, English food due to their limited access to authentic local cuisine.
Practical implications
There are practical implications of this study whereby actions can be taken to help avoid the negative impacts experienced causing concerns in around mental well-being and poor health.
Originality/value
This study fills a gap in knowledge on how this important segment of the international student population adapts to a new food culture.
In this chapter, I delineate the historical and theoretical foundations of acculturation in anthropology, sociology, and psychology; identify popular measures of acculturation; and outline their critiques. After this multidisciplinary refresher, I explore how the process of acculturation can be conceptualized and investigated in relation to one health outcome commonly examined in Latinx health: obesity. My approach departs from stereotypes, acknowledges pre-immigration conditions, and captures the host context. My goal is to provide an example of how to conceptualize the process of acculturation specific to distinct health outcomes. I end by arguing that addressing the problems of acculturation in health research and creating new conceptualizations may help us resolve our divergent dilemma and produce research that provides meaningful information about Latinx health inequalities, both in the United States and abroad.
The current family mealtime literature shows that assessments of the mealtime environment are typically self-report, yet few studies discuss validation techniques or report using validated scales. As such, the current analysis was conducted to validate one of the only published measures to assess the mealtime environment from the adolescent perspective. Specifically, the Childhood Family Mealtime Questionnaire (CFMQ)was evaluated in a sample of 280 overweight and obese Hispanic adolescents to address the need for a validated measure of the family mealtime environment in a demographic that is disproportionately affected by the current obesity epidemic. Results of exploratory and confirmatory factor analyses to evaluate the optimal factor structure, reliability, and validity for a revised, abbreviated CFMQ are presented here. The concurrent validity of the CFMQ was evaluated using correlations between the factor structures and the previously used, culturally appropriate comparable measure of family functioning. Correlations were also computed between factor scores and obesogenic outcomes (fruit and vegetable intake, added sugar intake, and physical activity). Analyses produced a revised, abbreviated version that includes 22 items (reduced from a total of 69 items)and consists of the following 4 factors: family mealtime communication (5 items), family mealtime stress (7 items), appearance weight control (5 items), and mealtime structure (6 items). Cronbach's alphas are reported for reliability. When examining CFMQ concurrent validity with the family functioning latent variable, results showed the family mealtime communication subscale ranked highest. Additionally, the family mealtime communication subscale was associated with all three obesogenic outcomes. This abbreviated CFMQ may be a useful tool for those studying family mealtime environments and their influence on obesity and its associated lifestyle behaviors.
Objective
To discern the impact of food donations provided by a food pantry and soup kitchen on food security.
Design
In this cross-sectional study, participants completed a demographic questionnaire, core food security module, FFQ and list of food donations. The FFQ was utilized to assess diet quality as estimated via the 2010 Healthy Eating Index.
Setting
Clients were selected randomly from a food pantry and soup kitchen in Central Texas, USA.
Participants
A total of 222 adults.
Results
Approximately 73 % of participants lacked food security. Compared with the food secure, the food insecure consisted of 61 % men, 42 % Caucasians, 56 % single and 67 % homeless. Also, of the food insecure, 60 % were soup kitchen clients and 64 % had an annual income <$US 1000 ( P <0·01). The probability of food insecurity was reduced by ≥1·17-fold when the total dietary intake included the food donations, as these were rich in fruits, total vegetables and grains, dairy and protein foods ( P <0·05).
Conclusions
Food insecurity was quite prevalent in this sample of individuals who visited food pantries and soup kitchens. The addition of food donations improved the quality of the participants’ total diet and had a positive influence on food security. Thus, community organizations should financially support these food assistance agencies and strive to offer a variety of healthy and tasty foods in adequate quantities to provide optimum diet quality.
Latinos in the United States have poor outcomes for periodontal and dental health. However, a detailed description of the mechanisms driving these patterns has only recently started to be addressed in the literature. In the current study, we explore relationships between individual-level characteristics of Mexican immigrants, properties of their networks, and experiences of dental problems. Specifically, using data from an urban community of Mexican immigrants to the American Midwest (n = 332), this study examines how characteristics of oral health matters (OHM) discussion networks and individual-level sociodemographic characteristics are associated with four adverse oral health outcomes. The results provide strong support for relationships between immigrants’ network characteristics and dental problems. We find that people with more dental problems talk about these issues more frequently with network ties. Conversely, stronger relationships with OHM discussion networks, as measured by mean closeness, are predictive of fewer dental problems. In addition, we identify a link between perceptions of alters’ knowledge about teeth, mouth, and gums and egos reporting better oral health outcomes. The observed patterns are suggestive of mechanisms of social influence that are well replicated in the social, medical, and public health literatures, but that have seldom been empirically tested in the domain of oral health. Though preliminary, our findings suggest a potential explanatory role for social networks in some of the most important questions and problems in oral health disparities research. In all, our findings suggest that social network members are active participants in the management and response to oral health problems in this immigrant group and should be considered an important factor in the development and course of diseases.
Colorectal cancer is the fourth most frequently diagnosed cancer. However, due to variations in diet, it was hypothesized that risk of adenomatous or hyperplastic polyps or malignancies would be lower among Hispanics. Participants (n = 1671) underwent a colonoscopy. Results were grouped into one of four groups: normal, hyperplastic polyps only, adenomatous polyps, and malignancies. As expected, Hispanics had a lower risk of hyperplastic (p = .031, OR = 0.47) and adenomatous polyps (p = .031, OR = 0.66) than non-Hispanic Whites. Comparison between malignancies was not possible as no Hispanics had a malignancy. Contrary to expectations, risk of hyperplastic and adenomatous polyps and malignancies were no different between non-Hispanic Blacks and Whites. Among rural and mostly rural populations, Hispanics had a lower risk of hyperplastic and adenomatous polyps.
Hispanics/Latinos are burdened by chronic kidney disease (CKD). The role of acculturation in this population has not been explored. We studied the association of acculturation with CKD and cardiovascular risk factor control. We performed cross-sectional analyses of 13,164 U.S. Hispanics/Latinos enrolled in the HCHS/SOL Study between 2008 and 2011. Acculturation was measured using the language and ethnic social relations subscales of the Short Acculturation Scale for Hispanics, and proxies of acculturation (language preference, place of birth and duration of residence in U.S.). CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² or urine albumin-to-creatinine ratio ≥ 30 mg/g. On multivariable analyses stratified by age, lower language subscale score was associated with higher odds of CKD among those older than 65 (OR 1.29, 95% CI, 1.03, 1.63). No significant association was found between proxies of acculturation and CKD in this age strata. Among individuals aged 18–44, a lower language subscale score was associated with lower eGFR (β = −0.77 ml/min/1.73 m², 95% CI −1.43, −0.10 per 1 SD increase) and a similar pattern was observed for ethnic social relations. Among those older than 65, lower language subscale score was associated with higher log-albuminuria (β = 0.12, 95% CI 0.03, 0.22). Among individuals with CKD, acculturation measures were not associated with control of cardiovascular risk factors. In conclusion, lower language acculturation was associated with a higher prevalence of CKD in individuals older than 65. These findings suggest that older individuals with lower language acculturation represent a high risk group for CKD.
Background Childhood obesity is a major public health concern and families play an important role. Improving strategies to reach parents and directing tailored nutrition education to them is needed. Purpose To investigate the challenges and facilitators to promoting a healthy environment at home and to identify communication preferences to inform intervention strategies for effectively reaching low-income urban minority families. Procedure Semi-structured focus group interviews were conducted with four groups involving 16 low-income urban parents (94% female; 88% Hispanic/Latino, 12% African American) of elementary school children. Interviews were transcribed and analyzed applying Social Cognitive Theory and using in-vivo coding. Main Findings The most common barriers to parents providing healthy foods to their children were accommodating child preferences and familial opposition. Parents showed intentionality to engage in healthy behaviors, and often shared procedural knowledge for reaching health goals. The analyses of desired communication channels yielded major preferences: tailored information, information provided through multiple mediums, appropriate duration/frequency of messages, and presented from a voice of authority. Conclusion and Implication While parents expressed desires to be healthy, the home food environment presented substantial challenges. Multi-media supports such as workshops, flyers, and text messaging may be useful to facilitate the sharing of information to minimize the tensions between intentionality and reaching desired goals to be healthy. Some parents thought that information received through text messaging could be easily shared and would act as a voice of authority to support child behavior change.
Nutrition is important for preventing and treating chronic diseases highly prevalent among Latinos, yet no tool exists for measuring nutrition literacy among Spanish speakers. This study aimed to adapt the validated Nutrition Literacy Assessment Instrument for Spanish-speaking Latinos. This study was developed in two phases: adaptation and validity testing. Adaptation included translation, expert item content review, and interviews with Spanish speakers. For validity testing, 51 participants completed the Short Assessment of Health Literacy-Spanish (SAHL-S), the Nutrition Literacy Assessment Instrument in Spanish (NLit-S), and socio-demographic questionnaire. Validity and reliability statistics were analyzed. Content validity was confirmed with a Scale Content Validity Index of 0.96. Validity testing demonstrated NLit-S scores were strongly correlated with SAHL-S scores (r = 0.52, p < 0.001). Entire reliability was substantial at 0.994 (CI 0.992–0.996) and internal consistency was excellent (Cronbach’s α = 0.92). The NLit-S demonstrates validity and reliability for measuring nutrition literacy among Spanish-speakers.
Purpose
This paper presents a case study of the research steps taken to identify message directions for a community-wide health communication campaign aimed at supporting healthier eating behaviors among Latino farmworker families in the Immokalee, Florida, community. Latino mothers were targeted of to understand their beliefs about children’s healthy eating needs, as well as to identify communication campaign opportunities that would reinforce choices made in the home surrounding meal planning, food selection and preparation, and portion sizes.
Design/methodology/approach
A sequential mixed-methods approach using focus group, group interview, and qualitative message concept testing was administered in three distinct stages of research exploration. An independent sample was recruited at each stage through convenience sampling and snowball sampling methods. The stages of change theory provided a framework for research inquiry in the context of healthy-eating-at-home practices.
Findings
In general, mothers were aware and participatory in the effort to serve healthy meals for their children at home. The time and money associated with buying nutritious foods and cooking healthy meals daily was stressful, but they were receptive to communication efforts to help them maintain their commitment to give their children healthy foods. These findings provided directional opportunities for the discovery and implementation of health communication strategies. Test results found that the target was most receptive to message strategies that acknowledged the responsibility of both parents to model healthy eating practices to children.
Research limitations/implications
Recruiting resulted in small sample sizes at each stage of the investigation. The reliability of quantitative measurement was a limitation to the research conclusions.
Practical implications
Partnership with the audience from discovery to conceptualization resulted in messages that uniquely resonated with the audience for which they were aimed. The understanding about the target stage of readiness improves message effectiveness to the target group.
Originality/value
The study provides a unique exploration of the steps health communication agents should pursue to establish a thorough profile of their target audience and the issues that resonate when considering healthy eating behavior at home. The application of the stages of change model encouraged the discovery of issues surrounding the challenge and highlighted potential obstacles that would mitigated behavior change efforts.
To understand the process by which immigrants adopt dietary practices, this study offers a binational comparison of factors that predispose, enable, and reinforce healthful eating in the sending and receiving countries. Data are from two qualitative studies that examined barriers and facilitators to healthful eating in El Salvador (four focus groups, n = 28 adults) and in the US (30 in-depth interviews n = 15 mothers recently migrated from Central America). There was a strong emphasis on hygiene and vitamin-content of foods among participants in El Salvador. In both settings, participants perceived that their respective community food environments (schools, food stores) exposed their families to highly processed, unhealthful foods. In both settings, they described similar struggles to encourage their families to eat foods healthfully (traditional, home-made foods). These results underscore the importance of acknowledging the changing food environment in sending countries where people may already be exposed to processed foods.
Hispanics are the largest and the fastest-growing minority group. Almost half of Hispanics currently residing in the USA are foreign-born and come from different racial, religious, and cultural backgrounds. Hispanics in the USA face such health disparities as high rates of obesity and diabetes, low health literacy, and low access to health care. Several health outcomes and disparities are diet-related. Dietary behaviors are important to address, but because these behaviors vary within and between sub-populations health promotion and disease prevention and control are complex matters. Factors influencing dietary behavior within the different Hispanic groups include but are not limited to nativity, pre-migration diet and environment, post-migration environment, acculturation, gender, values, knowledge, and beliefs. Thus, a range of factors need to be considered when addressing dietary behaviors in this population to ensure interventions are culturally appropriate and effective. This chapter provides an overview of the Hispanic population in the USA, followed by a detailed description of dietary behaviors and influencing factors observed in the population, and finally, a discussion of dietary considerations and interventions.
In 2015, there were 916,000 Poles living in the UK, making them the largest group of non-UK nationals at 16.5 percent of the population. Though increasingly research has focused on the consequences of this migration for both migrants themselves and the receiving country, little research has looked at food habits. This paper will explore the role of food in the Polish migrant adjustment journey. A qualitative approach was adopted, involving semi-structured interviews with nine Polish migrants.
In this study, Polish migrants described the move to a new culture as a time of stress and loneliness. Due to a lack of money, they were forced to eat local food, which exacerbated their unease, as they found it to be tasteless and unhealthy. As soon as their financial situation improved, they reverted to a Polish diet, relying on ingredients brought from home, from London, or more recently, purchased from local Polish shops. This gave them comfort, and all participants acknowledged the vital role of food in their adjustment to life in a new culture.
Hispanic children of Mexican origin have a high incidence of NAFLD. Susceptibility has been linked to a combination of factors including an increasing epidemic of obesity in children and adolescents, an allele substitution in the PNPLA3 gene that reduces hepatic lipid catabolism, and an altered microbiome that may increase hepatic endotoxins. The combination of NAFLD and portal vein toxins secondary to an indigenous gut microbiome appear to lead to the early occurrence of NASH, which progresses to cirrhosis and early hepatocellular carcinoma. Early detection and treatment of hepatic changes are needed. Given the success of gastric bypass in reducing body weight, modifying the gut microbiome, and improving NAFLD/NASH in adults, a trial of gastric bypass in predisposed pediatric candidates should be undertaken.
This article uses original survey data to explore the barriers to health care access among Latinos who are low-wage warehouse workers, providing a window on health care vulnerabilities of workers of low wages that are especially acute among undocumented immigrants and contingent workers. About one third of respondents had visited a doctor in the past year, whereas about two thirds lacked health insurance. Results from our logistic regression analysis show that, controlling for other factors, unemployed workers, direct hires, and those with health insurance had significantly greater odds than those without these characteristics to have visited a doctor in the past year. Along with changes in immigration and health care policies, reducing employers’ reliance on temporary staffing agencies is imperative for improving these and other low-wage workers’ health care access.
The United States population is growing, and its racial and ethnic composition is changing. According to the U.S. Census Bureau, the Latino population is projected to increase rapidly from 1995 to 2025, accounting for 44 percent of the growth in the nation's population (Campbell, 1996). Latinos already accounted for almost half (1.4 million) of the national population growth (2.9 million) between July 1, 2005 and July 1, 2006. While much of this growth can be attributed to high birth rates among Latinos in the U.S., immigration constitutes a significant proportion (Bernstein, 2007). For Latinos, introduction to U.S. culture occurs with varying degrees of acculturation, defined as -the bidirectional process in which individuals adopt new values, beliefs, and norms as an adaption into a new, mainstream culture while still retaining some aspects of their traditional culture.? (Ayala, Baquero, and Klinger, 2008). The influence of acculturation on specific behaviors has been a subject of investigation for decades.
The purpose of this cross-sectional exploratory study was to describe Hispanic women's level of obesity, eating patterns, and access to food. Forty-eight Hispanic women ages 23-73 years participated in the study during a community health fair in the Northeastern United States. Data were analyzed using descriptive statistics, nonparametric Mann-Whitney tests, and Fisher's exact tests. Findings revealed that women had an average body mass index of 30, with 76% being classified as overweight or obese. Sixty-one percent of the women reported not having enough money to buy food at least once a week, and 50% received Supplemental Nutrition Assistance Program benefits. More than half of the women regularly ate fast food, and those women with the lowest income ate fast food more often. More than 90% of the women reported not knowing how to choose healthy foods. Half had been informed to change their diet for health reasons. Gaining a better understanding of access barriers to healthy foods in marginalized populations may assist in developing future weight loss interventions.
For years now, the United States has faced an "obesity epidemic" that, according to the dominant narrative, is harming the nation by worsening the health burden, raising health costs, and undermining productivity. Much of the responsibility is laid at the foot of Blacks and Latinos, who have higher levels of obesity. Latinos have provoked particular concern because of their rising numbers. Michelle Obama's Let's Move! Campaign is now targeting Latinos. Like the national anti-obesity campaign, it locates the problem in ignorance and calls on the Latino community to "own" the issue and take personal responsibility by embracing healthier beliefs and behaviors. In this article, we argue that this dominant approach to obesity is misguided and damaging because it ignores the political-economic sources of Latino obesity and the political-moral dynamics of biocitizenship in which the issue is playing out. Drawing on two sets of ethnographic data on Latino immigrants and United States-born Latinos in southern California, we show that Latinos already "own" the obesity issue; far from being "ignorant," they are fully aware of the importance of a healthy diet, exercise, and normal weight. What prevents them from becoming properly thin, fit biocitizens are structural barriers associated with migration and assimilation into the low-wage sector of the US economy. Failure to attain the normative body has led them to internalize the identity of bad citizens, assume personal responsibility for their failure, naturalize the conditions for this failure, and feel that they deserve this fate. We argue that the blaming of minorities for the obesity epidemic constitutes a form of symbolic violence that furthers what Berlant calls the "slow death" of structurally vulnerable populations, even as it deepens their health risks by failing to address the fundamental sources of their higher weights.
Current versions of Canada's Food Guide (CFG) aim to inform a culturally diverse population, but it is not known how intended audiences from different cultural and linguistic groups within Canada's diverse population understand and apply its messages.
We analyzed data from qualitative interviews conducted with 32 newcomer mothers of children aged 1-5 years to explore how conceptions of food and health change with migration to Canada among Spanish-speaking Latin American and Tamil Speaking Sri Lankan newcomers and may influence the appropriateness and applicability of Canada's Food Guide (CFG) as a nutrition education tool. We applied Jordan's model of authoritative knowledge to identify different forms of newcomer maternal nutrition knowledge, how they influence child feeding practices, and shifts causing some forms of knowledge to be devalued in favor of others.
Awareness of CFG differed between groups, with all Latin American and only half of Tamil participants familiar with it. Three distinct, overlapping ways of knowing about the relationship between food and health are identified within both groups of mothers: "natural" foods as healthy; influence of foods on illness susceptibility, and the nutritional components of food. CFG was found to be limited in its representations of recommended foods and its exclusive utilization of biomedical concepts of nutrition.
Development of new, culturally competent versions of CFG that depict a variety of ethno-culturally meaningful diets and encompass both non-biomedical conceptualizations of food and health has the potential to enhance effective knowledge translation of CFG's key messages to an increasingly cosmopolitan Canadian population.
Copyright © 2015. Published by Elsevier Ltd.
To compare and evaluate the dietary quality of young and older sedentary Mexican-American women. Understanding key dietary concerns, while considering developmental transition periods and cultural relevance, can provide insight for developing appropriate nutrition interventions.
Cross-sectional dietary data were collected using unannounced 24 h diet recalls to assess nutrient intake adequacy (Estimated Average Requirement cut-point method) and dietary quality (Healthy Eating Index (HEI) 2010).
Mujeres en Acción and Madres para la Salud, two community-based physical activity interventions.
Participants were 139 young (28 (sd 6) years) and 124 older (55 (sd 7) years) overweight/obese sedentary Mexican-American women (BMI=25·0-35·0 kg/m2) of low socio-economic status.
Older women consumed less Ca, Fe, folate, empty calories and energy from carbohydrate, but more fruit, vegetables, greens and beans, and fibre than younger women (all P<0·05). Over 60 % of all participants had an intake below recommendations for fibre, Ca, vitamin E, vitamin C and folate. Both groups had low total HEI-2010 scores (62 for older and 63 for younger women; NS), with 57 % of older and 48 % of younger women classified as having a poor diet.
Despite differences in nutrient requirements according to developmental transition periods (childbearing v. perimenopausal), overall, older and younger Mexican-American women generally had low-quality diets and may benefit from dietary quality improvement.
Background:
Gastroschisis is unique because of its substantial risk in pregnancies of adolescent women. Adolescents may have poor diet quality, which places them at higher risk of gastroschisis.
Objective:
We investigated whether better maternal diet quality, measured by 2 different indices, reduced the risk of gastroschisis.
Methods:
We used case-control data from the National Birth Defects Prevention Study to investigate maternal diet quality among 1125 gastroschisis cases and 9483 controls (estimated delivery dates between 1997 and 2009). Cases were ascertained from 10 U.S. birth defect surveillance systems. Control subjects were randomly selected from birth certificates or hospital records. Using a 58-item food-frequency questionnaire, interviewers queried mothers about their average food and cereal intake during the year before conception. Diet quality scores [Diet Quality Index (DQI) and Mediterranean diet score (MDS)] were calculated using specific components. Women were excluded if they consumed <500 or >5000 kcal/d, reported pregestational diabetes, or had >1 missing food item. Quartile-specific adjusted ORs (aORs) were calculated, using as reference the lowest quartile.
Results:
Overall, we observed a statistically significant decrease with increasing diet quality for both the DQI and MDS. When stratified by maternal race/ethnicity, this finding was confined to Hispanic women. Among Hispanic women, the risk of gastroschisis decreased significantly with increasing DQI quartiles: quartile 2, aOR = 0.58 (95% CI: 0.40, 0.86); quartile 3, aOR = 0.52 (95% CI: 0.36, 0.79); and quartile 4, aOR = 0.48 (95% CI: 0.32, 0.76). Increasing diet quality, as measured by the MDS, showed reduced risk of gastroschisis among women, mostly Hispanic, who were born outside the United States: quartile 2, aOR = 0.62 (95% CI: 0.33, 1.16); quartile 3, aOR = 0.51 (95% CI: 0.28, 0.94); and quartile 4, aOR = 0.50 (95% CI: 0.28, 0.90).
Conclusions:
Increasing diet quality was associated with a reduced risk of gastroschisis only among Hispanic and foreign-born women, but these findings require replication.
Exposure to US culture is negatively associated with fruits and vegetables (F&V) intake. Our goal was to investigate how parent's nativity and length of stay in the US influences preschoolers' F&V intake. We analyzed survey data from 2,352 children, aged 36-60 months, who participate in the Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County. Using multiple linear regression, we examined children's F&V intake by parent's nativity and years in the US, adjusting for possible confounders. Children of foreign born parents who had lived in the US for <10 years consumed fewer servings of vegetables than children of US born parents and of foreign born parents who had lived in the US for ≥10 years. Children of newer immigrant families may be at greater risk for consuming poor-quality diets. Research to identify determinants of poor diet quality among children of immigrant families may increase the effectiveness of WIC in addressing this population's nutritional needs.
Latina immigrant mothers face complex challenges as they try to ensure their children get adequate nourishment to grow up healthy in their new U.S. communities. Eighty‐three Latina immigrant mothers living in a rural area of a Midwestern state who had young children and low household incomes were interviewed to explore their satisfaction with the food their children were eating, as well as ecological factors that affected children's eating patterns. Three overarching themes emerged from the data: (i) Mothers as gatekeepers of healthy child eating; (ii) Barriers to healthy child eating; and (iii) Changing child eating patterns. Mothers retained their cultural identity as primary caregivers and wanted their children to consume nourishing food. Mothers varied in their ability to negotiate their new food environments to maintain cultural food practices and promote healthy child eating patterns. Family and consumer science professionals could facilitate opportunities to (i) link immigrant families to Extension Master Gardeners to learn techniques to successfully grow food in a new climate; (ii) bring immigrant families, school food service staff, growers and grocers together to strategize how to increase children's access to locally grown food at school; (iii) assist immigrant families in identifying strategies to maintain healthy cultural food traditions while consuming less fat, salt, and sugar; and (iv) increase representation of immigrant families on school and community program advisory committees to ensure policies and programs are informed by families. Such opportunities can strengthen social capital among immigrant families and their community and support healthy child eating patterns.
Introduction:
In 2002, the National Heart, Lung, and Blood Institute partnered with the Health Resources and Services Administration's (HRSA's) Bureau of Primary Health Care and Office of Rural Health Policy to address cardiovascular health in the US-Mexico border region. From 2003 through 2005, the 2 agencies agreed to conduct an intervention program using Salud para su Corazón with promotores de salud (community health workers) in high-risk Hispanic communities served by community health centers (CHCs) in the border region to reduce risk factors and improve health behaviors.
Methods:
Promotores de salud from each CHC delivered lessons from the curriculum Your Heart, Your Life. Four centers implemented a 1-group pretest-posttest study design. Educational sessions were delivered for 2 to 3 months. To test Salud para su Corazón-HRSA health objectives, the CHCs conducted the program and assessed behavioral and clinical outcomes at baseline, 3 months, 6 months, and 12 months after the intervention. A 2-sample paired t test and analyses of variance were used to evaluate differences from baseline to postintervention.
Results:
Changes in heart-healthy behaviors were observed, as they have been in previous Salud para su Corazón studies, lending credibility to the effectiveness of a promotores de salud program in a clinical setting. Positive changes were also observed in low-density lipoprotein cholesterol level, triglyceride level, waist circumference, diastolic blood pressure, weight, and glycated hemoglobin (HbA1c).
Conclusion:
Results suggest that integrating promotores de salud into clinical practices is a promising strategy for culturally competent and effective service delivery. Promotores de salud build coalitions and partnerships in the community. The Salud para su Corazón-HRSA initiative was successful in helping to develop an infrastructure to support a promotores de salud workforce in the US-Mexico border region.
This study investigated the reliability and validity of the Brief Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) using two samples of Mexican American children: 292 middle school students from a mid-sized culturally diverse southwestern city, and 116 third-through fifth graders in culturally homogeneous rural elementary schools. Results provided evidence of the reliability and validity of this measure of acculturation for both age levels. Factor analysis supported the two-scale structure reported by Cuéllar. Internal consistency (Cronbach’s alpha) was adequate for both samples. Validity was demonstrated by the significant association between the distribution of acculturation status and sample group. Language of form (English or Spanish) selected by the student was correlated with acculturation status.
Little is understood about the patterns and trends in adolescent and adult beverage intake in Mexico or most other countries. Here, we used nationally representative dietary intake, income, and food expenditure surveys, which included 416 adolescents (aged 12-18 y) and 2180 adults (aged >or=19 y) from the 1999 Mexican Nutrition Survey and 7464 adolescents and 21,113 adults from the 2006 Mexican Health and Nutrition Survey. We measured the volume and energy per day contributed by all beverages consumed by the sample subjects. In 2006, Mexican adolescents and adults obtained 20.1 and 22.3%, respectively, of their energy intake from energy-containing beverages. Whole milk, carbonated and noncarbonated sugar-sweetened beverages, fruit juice with various sugar and water combinations added, and alcohol represented the 4 major categories of beverage intake. The trends from the dietary intake surveys showed very large increases in the intake of energy-containing beverages among adolescents and adults between 1999 and 2006. Income elasticities showed a high likelihood that intakes will increase as Mexican incomes continue to rise. Whereas the own-price elasticities for whole milk and sodas were both modest, intakes of these were increasing and higher than those for all other food groups. Energy intake trends and current levels of beverage intakes in Mexico are the highest recorded in a nationally representative survey and present major challenges for public health authorities.
The purpose of this study was to estimate the prevalence of diagnosed and undiagnosed diabetes among Mexican Americans, Cubans, and Puerto Ricans in the United States and compare these estimates to data from prior surveys for U.S. non-Hispanic whites and blacks. Data for this study are from the Hispanic Health and Nutrition Examination Survey, a multipurpose cross-sectional survey of three U.S. Hispanic populations conducted in 1982-1984. The interviewed sample of people aged 20-74 yr included 3935 Mexican Americans in the southwest, 1134 Cubans in Florida, and 1519 Puerto Ricans in the New York City area. The diabetes component consisted of interview questions on diabetes diagnosis and treatment and an oral glucose tolerance test administered to a subsample. The prevalence of diabetes was two to three times greater for Mexican Americans and Puerto Ricans than for non-Hispanic whites surveyed in 1976-1980. In Cubans, the prevalence was similar to that for non-Hispanic whites. In men and women 45-74 yr of age, the prevalence of diabetes was extremely high for both Mexican Americans (23.9%) and Puerto Ricans (26.1%) compared with Cubans (15.8%) or non-Hispanic whites (12%). The total prevalence of diabetes was not significantly different for Mexican Americans and Puerto Ricans but was significantly lower for Cubans. The relatively lower prevalence of diabetes among Cubans and the high prevalence in both Mexican Americans and Puerto Ricans may be related to socioeconomic, genetic, behavioral, or environmental factors.
Low socioeconomic status is associated with poor diet, food insufficiency, and poor child health. Hispanic households have disproportionately low incomes. Acculturation-related changes may augment the effects of poverty on children's diet and health.
The goal was to determine the associations that acculturation, measured by parents' language use, and income have with dietary intakes and food insufficiency among Hispanic youths.
Data on 2985 Hispanic youths aged 4-16 y were from the third National Health and Nutrition Examination Survey (1988-1994). Nutrient intake data were from one 24-h dietary recall. The analysis was controlled for demographic, socioeconomic, and program variables.
Parents' exclusive use of Spanish was associated in bivariate analyses with differences in intakes of energy, protein, sodium, and folate and in percentages of energy from fat and saturated fat. When other factors were controlled for, less acculturation was associated with differences in intakes of energy and sodium and in percentages of energy from fat and saturated fat. Individuals in poorer households had higher intakes of energy, protein, sodium, and some micronutrients. Although not significant for all indicators of food insufficiency, consistent patterns showed that household food insufficiency decreased with less acculturation (odds ratio: 0.4; 95% CI: 0.2, 0.7 for adult meal size reduced) and increased with low income [odds ratio: 5.9 (3.0, 11.7) for not enough food and 5.4 (2.2, 13.4) for child meal size reduced].
Both acculturation and poverty have roles in children's diets and in household food insufficiency. Culturally specific public health and nutrition education should complement efforts to improve the financial security of low-income households.
Interest in studying the impact of acculturation on immigrant health has increased in tandem with the growth of the Latino population in the United States. Linear assimilation models continue to dominate public health research despite the availability of more complex acculturation theories that propose multidimensional frameworks, reciprocal interactions between the individual and the environment, and other acculturative processes among various Latino groups.
Because linear and unidimensional assessments (e.g., nativity, length of stay in the United States, and language use) provide constricted measures of acculturation, the rare use of multidimensional acculturation measures and models has inhibited a more comprehensive understanding of the association between specific components of acculturation and particular health outcomes. A public health perspective that incorporates the roles of structural and cultural forces in acculturation may help identify mechanisms underlying links between acculturation and health among Latinos.
Latinos have become the largest ethnic minority group in the U.S. and will become 25% of the population by 2050. The purpose of this critical review is to examine the influence of acculturation on type 2 diabetes and corresponding risk factors, including 1) dietary intake, 2) physical activity patterns, 3) smoking and alcohol consumption, and 4) obesity. Among Latinos, acculturation has been associated with obesity risk, suboptimal dietary choices including lack of breast-feeding, low intake of fruits and vegetables, a higher consumption of fats and artificial drinks containing high levels of refined sugar, smoking, and alcohol consumption. In contrast, acculturation has been positively associated with physical activity and a lower likelihood of type 2 diabetes among Latinos. However, findings have been inconsistent across acculturation indicators and appear to be strongly modified by Latino subethnicity and gender. It is important to improve existing acculturation measures available. Mexican Americans have been the target group in the majority of studies. Research in this group must continue but it is important to conduct additional research with other Latino subgroups that have been left out of most of the acculturation, lifestyles, and health outcomes research. Differences between acculturation and health-related outcomes may be confounded by socio-economic status, age, and movement from urban to rural areas. Longitudinal multivariate acculturation research is essential to disentangle these relations and to develop sound behavioral change theories that adequately predict behavioral change among Latinos.
To classify the foods consumed by Mexican children 1-4 years in three food categories according to the preparation process and temporality: a) Processed Modern Foods (PMF), b) Processed Traditional Foods (PTF) and c) Non-Processed Foods.
Twenty-four-hour dietary recalls were collected from the National Nutrition Survey 1999 in children 1-4 years (n =1070). The contribution of each food category to the total energy, macronutrient and fiber intakes was analyzed.
The contribution of PMF and PTF was as follows, respectively: Energy: 17%, 31%; total protein: 14%, 25%; non-animal protein: 10%, 10%; animal protein: 17%, 34%; carbohydrates: 18%, 26%; fiber: 4%, 5%; total fat 15%, 41%; saturated fat 16%, 52%; and cholesterol 7%, 7%.
The contribution of PF to the diets of Mexican children accounts for >39% of energy, total protein, animal protein, carbohydrates and fat. The authors recommend the participation of food industry to prevent malnutrition in children.
Access to food is essential to optimal development and function in children and adults. Food security, food insecurity, and hunger have been defined and a U.S. Food Security Scale was developed and is administered annually by the Census Bureau in its Current Population Survey. The eight child-referenced items now make up a Children's Food Security Scale. This review summarizes the data on household and children's food insecurity and its relationship with children's health and development and with mothers' depressive symptoms. It is demonstrable that food insecurity is a prevalent risk to the growth, health, cognitive, and behavioral potential of America's poor and near-poor children. Infants and toddlers in particular are at risk from food insecurity even at the lowest levels of severity, and the data indicate an "invisible epidemic" of a serious condition. Food insecurity is readily measured and rapidly remediable through policy changes, which a country like the United States, unlike many others, is fully capable of implementing. The food and distribution resources exist; the only constraint is political will.
Food and eating environments likely contribute to the increasing epidemic of obesity and chronic diseases, over and above individual factors such as knowledge, skills, and motivation. Environmental and policy interventions may be among the most effective strategies for creating population-wide improvements in eating. This review describes an ecological framework for conceptualizing the many food environments and conditions that influence food choices, with an emphasis on current knowledge regarding the home, child care, school, work site, retail store, and restaurant settings. Important issues of disparities in food access for low-income and minority groups and macrolevel issues are also reviewed. The status of measurement and evaluation of nutrition environments and the need for action to improve health are highlighted.
Studies of leisure-time physical activity disparities for Hispanic individuals have not adjusted for sociodemographic confounds or accounted for variation by country of origin. We used the National Health Interview Survey to compare leisure-time physical activity among Hispanic and non-Hispanic White persons. All Hispanic subgroups were less active than were non-Hispanic White people, yet significant heterogeneity existed among Hispanic persons. Sociodemographic factors partly accounted for disparities among men; disparities among women persisted despite multivariate adjustments. Interventions must attend to these under-served yet varied sub-communities.
The study's objective was to examine the relationship between cesarean section delivery and the initiation of breastfeeding in a representative sample of 1695 Puerto Rican women aged 15 to 49 years, who delivered their last healthy singleton child in Puerto Rico between 1990 and 1996. Secondary analysis of data collected in the population-based cross-sectional study Puerto Rico Reproductive Health Survey was performed. Bivariate and multivariate logistic regression analyses were used to examine the crude and covariate adjusted association between type of childbirth and initiation of breastfeeding. Overall, 36% of all births were performed by cesarean section, while initiation of breastfeeding was achieved by 61.5% of the women. Cesarean section was negatively related to breastfeeding initiation in multivariable logistic regression models (odds ratio=.64; 95% CI=0.51-0.81) after controlling for confounding variables. Intervention programs that aim to promote breastfeeding and that provide special assistance to women undergoing this procedure should be developed.
The Acculturation Rating Scale for Mexican Americans (ARSMA) was revised for the purpose of developing an instrument that assessed acculturation processes through an orthogonal, multidimensional approach by measuring cultural orientation toward the Mexican culture and the Anglo culture independently. Two subscales, Anglo Orientation Subcale (AOS) and Mexican Orientation Subscale (MOS), were developed from items from the original ARSMA scale. The two cultural orientation subscales were found to have good internal reliabilities (Cronbach's Alpha = .86 and .88 for the AOS and the MOS, respectively. The revised scale (ARSMA-JJ) yielded a high Pearson correlation coefficient (r = .89) with the original scale. Strong construct validity of ARSMA -II was demonstrated using a sample of 379 individuals representing generations I to 5. ARSMA-II is multifactorial and capable of generating multidimensional acculturative types, for example, integrated, separated, assimilated and marginalized.
Dietary intake is an important determinant of obesity and numerous chronic health conditions. A healthful diet is an essential component of chronic disease self-management. Researchers have indicated that the healthfulness of the Latino diet deteriorates during the acculturation process. However, given the many operationalizations of acculturation, conclusive evidence regarding this relationship is still lacking. This comprehensive and systematic literature review examines the relationship between acculturation and diet by examining national, quantitative, and qualitative studies involving Latinos living in the United States. Studies of diet included those that examined dietary intake using one of several validated measures (eg, food frequency questionnaire, 24-hour dietary recall, or dietary screener) and/or dietary behaviors (eg, away-from-home-eating and fat avoidance). Articles were identified through two independent searches yielding a final sample of 34 articles. Articles were abstracted by two independent reviewers and inter-rater reliability was assessed. Analyses examined the extent to which various measures of acculturation (ie, acculturation score, years in the United States, birthplace, generational status, and language use) were associated with macronutrient intake, micronutrient intake, and dietary behaviors. Several relationships were consistent irrespective of how acculturation was measured: no relationship with intake of dietary fat and percent energy from fat; the less vs more acculturated consumed more fruit, rice, beans, and less sugar and sugar-sweetened beverages. Additional observed relationships depended on the measure of acculturation used in the study. These findings suggest a differential influence of acculturation on diet, requiring greater specificity in our dietary interventions by acculturation status.
Acute effects of high-sugar/low-fiber meals vs low-sugar/high-fiber meals on hormones and behavior were studied in 10 overweight Latina females, age 11 to 12 years, using a crossover design. In this exploratory pilot study, participants arrived fasted at an observation laboratory on two occasions and randomly received either a high-sugar/low-fiber meal or a low-sugar/high-fiber meal at each visit. Glucose, insulin, and leptin were assayed from serum drawn at 0, 15, 30, 60, 90, and 120 minutes. Ad libitum snacks were provided at 120 minutes. Physical activity was measured using an observational system that provides data on time spent lying down, sitting, standing, walking, and in vigorous activity. Data were collected between March 2005 and July 2006. In the high-sugar/low-fiber condition, glucose and leptin levels decreased more slowly, glucose levels were higher at 60 minutes (111.2 mg/dL vs 95.4 mg/dL, P=0.03), and leptin levels were higher at 90 minutes (49.3 ng/mL vs 46.7 ng/mL, P=0.017) than in the low-sugar/high-fiber condition. Meals did not affect insulin or ad libitum dietary intake. Sitting, standing, lying down, and vigorous activity differed by condition, but not walking. Participants were significantly more active in the first 30 to 60 minutes after the high-sugar/low-fiber meal, but after 60 minutes there was a trend for activity to be lower after the high-sugar/low-fiber meal vs the low-sugar/high-fiber meal. High-sugar meals sustain glucose and leptin levels longer, which may play an important role in modulating levels of physical activity in this group at high risk for obesity-related disease.
The role of diet quality and nutrient adequacy in the etiology of childhood obesity is poorly understood. The specific aims of these analyses were to assess overall diet quality and nutrient adequacy, and test for association between weight status and diet in children from low socioeconomic status (SES) Hispanic families at high risk for obesity.
A cross-sectional study design was used to assess dietary intake in low-SES Hispanic children with and without overweight who were enrolled in the Viva la Familia Study. Multiple-pass 24-hour dietary recalls were recorded on two random, weekday occasions. Diet quality was evaluated according to the Dietary Guidelines for Americans. Nutrient adequacy was assessed using z scores based on estimated average requirement or adequate intake.
The study included 1,030 Hispanic children and adolescents, aged 4 to 19 years, in Houston, TX, who participated between November 2000 and August 2004.
STATA software (version 9.1, 2006, STATA Corp, College Station, TX) was used for generalized estimating equations and random effects regression.
Diet quality did not adhere to the Dietary Guidelines for Americans for fat, cholesterol, saturated fatty acids, fiber, added sugar, and sodium. Although energy intake was significantly higher in children with overweight, food sources, diet quality, macro- and micronutrient composition were similar between non-overweight and overweight children. Relative to estimated average requirements or adequate intake levels, mean nutrient intakes were adequate (70% to 98% probability) in the children without and with overweight, except for vitamins D and E, pantothenic acid, calcium, and potassium, for which z scores cannot be interpreted given the uncertainty of their adequate intake levels.
Whereas the diets of low-SES Hispanic children with and without overweight were adequate in most essential nutrients, other components of a healthful diet, which promote long-term health, were suboptimal. Knowledge of the diets of high-risk Hispanic children will inform nutritional interventions and policy.
Elevated blood pressure at a young age is a predictor of blood pressure elevation later in life and has been associated with being overweight. However, it seems that there are other factors related to hypertension in childhood.
To determine the anthropometric, physical activity, and dietary factors associated with both systolic and diastolic hypertension in a group of Mexican school-aged children.
In this cross-sectional descriptive study, blood pressure, anthropometrics, physical activity, and dietary intake (assessed with a multiple-pass 24-hour dietary recall) evaluations were performed on school-aged children from September 2005 to July 2006.
Children aged 8 to 10 years (626 boys and 613 girls) from a convenience sample of 23 public schools of low socioeconomic status in Mexico City were included. Systolic and diastolic hypertension were defined as blood pressure > or = 95th percentile for age, sex, and height, without diastolic or systolic prehypertension or hypertension, respectively. Mixed hypertension was defined as the presence of both systolic and diastolic hypertension.
Descriptive statistics, chi(2) tests, analysis of variance, post hoc analysis with Bonferroni method, and logistic regression analysis were performed. Continuous variables are presented as mean+/-standard deviation, categorical variables as percentages, and the association measures as adjusted odds ratios (ORs). A P value < 0.05 was considered statistically significant, and 95% confidence intervals were calculated for adjusted ORs.
The dietary intake analysis showed that both boys and girls had low fiber intake (< 25 g/day) as well as an excessive mean consumption of total and saturated fat (> 35% and > 10% of daily energy, respectively). From the total group of children, 3.6% had systolic hypertension, 14.2% diastolic hypertension, and 22.8% mixed hypertension. The higher values of weight, body mass index, waist circumference, and prevalence of overweight and obesity were more commonly seen among children with mixed hypertension, followed by children in the systolic group. Subjects with diastolic and mixed hypertension had an elevated intake of dietary total fat (37.7% and 38.2% of daily energy intake, respectively). Moreover, an adjusted OR of 1.06 (95% confidence interval 1.01 to 1.11) for systolic hypertension per increase of 1 cm in waist diameter was found and total fat intake > 35% of the daily energy showed an adjusted OR of 2.61 (95% confidence interval 1.27 to 5.36) for diastolic hypertension.
In a sample of Mexican children of low socioeconomic status, the prevalence of hypertension was high. Waist circumference was the main factor associated with systolic hypertension, and higher intake of total fat was related to diastolic hypertension.
The Hispanic Health and Nutritional Examination Survey (HHANES) was utilized to examine diabetes-related risk factor variables between and among 3 Hispanic subgroups.
The study design that was conducted was descriptive using the HHANES secondary data set. Sample: The sample included individuals between 20 and 74 years of age, self-identified as Mexican American, Puerto Rican, and/or Cuban American and had been told by a doctor that they had diabetes.
The 5 diabetes-related risk factor variables were obesity measured by body mass index (BMI), hypertension by systolic blood pressure (SBP) and diastolic blood pressure (DBP), hyperlipidemia by cholesterol and triglyceride levels, renal insufficiency by blood urea nitrogen (BUN), and creatinine and fasting plasma glucose.
This study demonstrates significant differences between specific subgroups through chi-square. SBP in Cuban Americans was significantly higher than that of Puerto Ricans (28.39 mmHg) and of Mexican Americans (25.94 mmHg). Cuban Americans also had significantly higher cholesterol values than Mexican Americans (88.49 mg/dL) and Puerto Ricans (84.49 mg/dL). The only significant difference for triglyceride was between Mexican Americans and Puerto Ricans (37.25 mg/dL). For BUN, there were significant differences when Cuban Americans (9.06 mg/dL) and Mexican Americans (2.20 mg/dL) were separately compared from Puerto Ricans, and Cuban Americans had significantly higher creatinine values than Puerto Ricans (0.38 mg/dL) and Mexican Americans (0.25 mg/dL). Through linear regression, significant differences for the association of each diabetes-related risk factor and the risk for diabetes complications were computed for each subgroup. For Mexican Americans and Puerto Ricans there were significant differences in overweight BMI (25.0-29.9 kg/m2) and obesity (> or =30.0 kg/m2); for Mexican Americans, Puerto Ricans and Cuban Americans in elevated SBP (130-139 mmHg) or elevated DBP (80-89 mmHg), for high SBP (> or =140 mmHg) or high DBP (> or =90 mmHg), and for high glucose (> or =126 mg/dL); and for Mexican Americans in elevated triglyceride (> or =150 mg/dL), elevated BUN (> or =21 mg/dL), and elevated creatinine (> or =1.5 mg/dL).
The findings of this study will add to the diabetes and Hispanic literature highlighting the need to evaluate Hispanic subgroups in future health behavior and outcomes research.
In 2002, the National Heart, Lung, and Blood Institute partnered with the Health Resources and Services Administration's (HRSA's) Bureau of Primary Health Care and Office of Rural Health Policy to address cardiovascular health in the US-Mexico border region. From 2003 through 2005, the 2 agencies agreed to conduct an intervention program using Salud para su Corazón with promotores de salud (community health workers) in high-risk Hispanic communities served by community health centers (CHCs) in the border region to reduce risk factors and improve health behaviors.
Promotores de salud from each CHC delivered lessons from the curriculum Your Heart, Your Life. Four centers implemented a 1-group pretest-posttest study design. Educational sessions were delivered for 2 to 3 months. To test Salud para su Corazón-HRSA health objectives, the CHCs conducted the program and assessed behavioral and clinical outcomes at baseline, 3 months, 6 months, and 12 months after the intervention. A 2-sample paired t test and analyses of variance were used to evaluate differences from baseline to postintervention.
Changes in heart-healthy behaviors were observed, as they have been in previous Salud para su Corazón studies, lending credibility to the effectiveness of a promotores de salud program in a clinical setting. Positive changes were also observed in low-density lipoprotein cholesterol level, triglyceride level, waist circumference, diastolic blood pressure, weight, and glycated hemoglobin (HbA1c).
Results suggest that integrating promotores de salud into clinical practices is a promising strategy for culturally competent and effective service delivery. Promotores de salud build coalitions and partnerships in the community. The Salud para su Corazón-HRSA initiative was successful in helping to develop an infrastructure to support a promotores de salud workforce in the US-Mexico border region.
The prevalence of obesity among Hispanic American populations is generally greater than among white populations in the United States. Among Mexican Americans, the prevalence of obesity was higher than among either Cuban Americans or Puerto Ricans. It is well known that the prevalence of diabetes increases with increasing levels of obesity or body mass index. However, it does not appear that the high prevalence of obesity in Mexican Americans completely accounts for the higher prevalence of diabetes seen in this ethnic group. Among Mexican Americans, the association of selected cardiovascular disease risk factors, high-density lipoprotein cholesterol subfractions and systolic blood pressure, was similar to that seen among other U.S. populations. Individuals with diabetes had higher values than seen among those without diabetes. In a comparison of nutrient intake in two Mexican-American populations, one rural and one urban, there were no major differences other than higher calorie intakes in the rural population compared with the urban population. In addition, the diet in the rural population, based on higher levels of the Keys score, was more atherogenic than that of the urban population.
To examine the relationship of food insecurity to nutrition of Mexican-American preschoolers.
Cross-sectional survey of low-income Mexican-American families with children of preschool age (3 to 6 years). Data included food security using the Radimer/ Cornell scale; acculturation; parental education; monthly income; past experience of food insecurity; and child weight, height, and frequency of consuming 57 foods. Weight-for-height z scores (WHZ), height- for-age z (HAZ) scores, and the percentage of overweight (> or = 85th percentile WHZ) were calculated.
A convenience sample of Mexican-American families (n=211) was recruited through Head Start, Healthy Start, Migrant Education, and the Special Supplemental Nutrition Program for Women, Infants, and Children in Tulare, Fresno, Monterey, and Kern counties in California. Statistical analyses Analysis of variance, t tests, Spearman's correlations, and Mantel Haenszel chi2.
Limited education, lack of English proficiency, and low income were negatively correlated with food security (r = -0.31 to -0.44, P<.0001). After controlling for acculturation, children in severely food-insecure households were less likely to meet Food Guide Pyramid guidelines than other children (median number of food groups > or = recommended levels [interquartile range]: 2.0 (2.0) vs 3.0 (2.0), P<.006). Although WHZ (mean +/- SD = 1.28 +/- 1.80) and percent overweight (48%, N=19) tended to peak among children from household level food insecure families, no significant differences were found in weight or height status of children by level of food insecurity.
Dietetics professionals working with low-income Hispanic-American families should screen for different levels of food insecurity to determine needs for nutrition education and other services.
RETRACTED: High Intake of Saturated Fat and Early Occurrence of Specific Biomarkers May Explain the Prevalence of Chronic Disease in Northern Mexico.
Martha Nydia Ballesteros,¹ Rosa Maria Cabrera,¹ Maria del Socorro Saucedo,¹ Dimple Aggarwal,² Neil S. Shachter,³ and Maria Luz Fernandez².
J Nutr. 135:70-73.
¹Centro de Investigacion de Alimentos y Desarrollo (CIAD), Hermosillo, Mexico; ²Department of Nutritional Sciences, University of Connecticut, Storrs, CT, and ³Columbia University, New York, NY
The authors of the manuscript referenced above request that this article be retracted because there is an overlap of data presented in Table 1 and part of Table 2 in this paper with the population baseline data (Table 1) previously published in American Journal of Clinical Nutrition, Citation: Ballesteros MN, Cabrera RM, Saucedo MS, Fernandez ML. Dietary cholesterol does not increase biomarkers for chronic disease in a pediatric population at risk from Northern Mexico. Am. J. Clin. Nutr. 2004;80:855-861.
During the past decade, rates of food insecurity and obesity have risen, and an association has been made between these two seemingly paradoxical states. Although this relationship has not been repeatedly seen in men, research suggests a correlation in women. Studies have not been able to consistently show a relationship in children, because findings differ based on age, race/ethnicity, household income, and sex. Several proposed hypotheses explain why a correlation between food insecurity and obesity exists in adults - especially women - but not in children. This review proposes a conceptual framework linking the Food Stamp Program and other coping strategies to the food insecurity-obesity relationship. This link has implications for Food Stamp Program policy changes, welfare reform, and poverty prevention.
This study identified differences between women from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)- and WIC/Farmers' Market Nutrition Program-participating households regarding household food security status, fruit and vegetable intake and behaviors, perceived diet quality, and education level; and assessed the relationship between household food security status and perceived diet quality and perceived health. DESIGN, SUBJECTS/SETTING: Cross-sectional survey of women from Athens County, Ohio (WIC, n=829; Farmers' Market Nutrition Program, n=246) living in WIC households.
Of 228 participants completing the food security portion of the survey, 61 (26.8%) were living in food secure households, while 47 (20.6%), 75 (32.9%), and 45 (19.7%) were living in households at risk for (marginal) food insecurity, with low food security, and with very low food security, respectively. For the entire sample, food insecurity was associated with poorer diet quality (r=-0.248, P<0.001). Food security status (chi(2)=2.117, P=0.548) did not differ between groups. Farmers' Market Nutrition Program reported higher education levels (P=0.027). Unlike fruit intake (t test, P=0.769), vegetable intake servings were greater among Farmers' Market Nutrition Program (2.2+/-1.2), compared to WIC (1.9+/-1.0) (t test, P=0.040). Both perceived benefit (chi(2)=4.574, P=0.032) and perceived diet quality (chi(2)=7.219, P=0.027) were greater for Farmers' Market Nutrition Program.
Farmers' Market Nutrition Program participants exhibit more indicators of a healthful diet, but appear not to be more food secure. Nutrition education regarding the benefits of fresh produce intake can help to improve diet quality and increase Farmers' Market Nutrition Program participation.
To determine if measures of diet quality differ between food insecure and food secure adults in a rural high-risk population.
Random digit dialing telephone survey of a cross-section of the population designed to collect data on food intake, household demographics, and food security status.
A representative sample of adults who live in 36 counties in the Lower Mississippi Delta region of Arkansas, Louisiana, and Mississippi.
One thousand six hundred seven adults, both white and African American.
Food security status and diet quality, as defined by adherence to the Healthy Eating Index and Dietary Reference Intakes by determinations from self-reported food intake (1 day intake).
Regression analysis, t tests, Wald statistic, and beta tests were employed.
Food secure adults scored higher on Healthy Eating Index than food insecure adults (P=0.0001), but the regression model showed no differences when multiple factors were included. Food secure individuals consistently achieved higher percentages of the Dietary Reference Intakes (specifically Estimated Average Requirements and Adequate Intakes) than food insecure individuals, with the greatest differences seen for vitamin A (P<0.0001), copper (P=0.0009), and zinc (P=0.0022) and very little difference for vitamins C (P=0.68) and E (P=0.32). Both populations consumed diets extremely low in fiber.
Food insecurity is associated with lower quality diets in this population. It is acknowledged that serious limitations are associated with the use of one 24-hour recall and for comparison between food intake and assessment of food security. These findings still suggest a pressing need for nutrition interventions to improve dietary intake in these at-risk impoverished individuals.
This systematic review assesses the impact of peer education/counseling on nutrition and health outcomes among Latinos and identifies future research needs.
A systematic literature search was conducted by: (1) searching Internet databases; (2) conducting backward searches from reference lists of articles of interest; (3) manually reviewing the archives of the Center for Eliminating Health Disparities among Latinos; (4) searching the Journal of Nutrition Education and Behavior; and (5) directly contacting researchers in the field. The authors reviewed 22 articles derived from experimental or quasi-experimental studies.
Type 2 diabetes behavioral and metabolic outcomes, breastfeeding, nutrition knowledge, attitudes and behaviors.
Peer nutrition education has a positive influence on diabetes self-management and breastfeeding outcomes, as well as on general nutrition knowledge and dietary intake behaviors among Latinos.
There is a need for longitudinal randomized trials testing the impact of peer nutrition education interventions grounded on goal setting and culturally appropriate behavioral change theories. Inclusion of reliable scales and the construct of acculturation are needed to further advance knowledge in this promising field. Operational research is also needed to identify the optimal peer educator characteristics, the type of training that they should receive, the client loads and dosage (ie, frequency and amount of contact needed between peer educator and client), and the best educational approaches and delivery settings.
Twenty of the most frequently asked questions about Hispanics in the U.S. Washington, DC: National Council of La Raza
- National Council
National Council of La Raza. Twenty of the most frequently asked questions about Hispanics in the U.S. Washington, DC: National Council of La Raza. http://www.nclr.org/files/1466_file_FreqAskedQuests_10_ 07_fnl.pdf. Accessed February 2, 2009.
Health issues in the Latino community
- M Aguirre-Molina
- Molina Cw
- Zambrana
Aguirre-Molina M, Molina CW, Zambrana RE. Health issues in the Latino community. New York, NY: John Wiley and Sons; 2001.
Twenty of the most frequently asked questions about Hispanics in the U
- National Council
- La Raza
National Council of La Raza. Twenty of the most frequently asked questions about Hispanics in the
U.S. Washington DC. [February 2, 2009]. available at:
www.nclr.org/files/1466_file_FreqAskedQuests_10_07_fnl.pdf
Hispanics and the future of America: The National Academies Press
- M Tienda
- F Mitchell
Tienda, M.; Mitchell, F., editors. Hispanics and the future of America. Washington, D.C.: The National
Academies Press; 2007. Panel on Hispanics in the United States, Committee on Population, National
Research Council.
Hispanics in the United States available at: http://www.census.gov/population
- Census Us
- Bureau
- D C Washington
US Census Bureau. Washington D.C. Hispanics in the United States. Washington DC: [February 2,
2009]. available at:
http://www.census.gov/population/www/socdemo/hispanic/files/
Internet_Hispanic_in_US_2006.pdf
5. US Census Bureau. Washington DC: [February 2, 2009]. Washington D.C. the American Community-
Hispanics 2004. the American Community Survey. available at:
http://www.census.gov/prod/2007pubs/acs-03.pdf
Lower Mississippi Delta Nutrition Intervention Research Initiative
- Champagne