Acculturation Status Research Articles

Acculturation-Related Stress and Mental Health Outcomes Among Three Generations of Hispanic Adolescents

Stress associated with acculturation and minority status among Hispanic youth is understudied. Using survey data from the Hispanic Stress Inventory–Adolescent Version (HSI-A), we examined psychosocial stress across eight domains including family economic stress and acculturation-gap stress in a national sample of three generations (first, second, and third or higher) of Hispanic adolescents ( N = 1,263). Research questions addressed generation differences in frequency of stressor events (i.e., discrimination), appraisal of these events, and mental health symptoms. Results indicated that experiences of different categories of stress were significantly related to generation status. The first generation reported more stressors and greater stress appraisal than the third-generation adolescents. Similar levels of discrimination stress were reported by participants regardless of generation. The second-generation participants reported a greater number of Acculturation Gap Stressors than the third generation, and more delinquent and aggressor behaviors than first-generation participants. An acculturation paradox was found with greater stress exposure and stress appraisals in the first-generation youth, but with lower mental health symptoms than later generations. Family integrity and more traditional family values may buffer the negative impact of greater stressor exposure among immigrants and second-generation youth when compared with third-generation adolescents.

Diabetes Risk in Older Mexican Americans: Effects of Language Acculturation, Generation and Socioeconomic Status

The effect of language acculturation, socioeconomic status (SES), and immigrant generation on development of diabetes among Mexican Americans was evaluated in the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE). HEPESE is a longitudinal cohort study of 3,050 non-institutionalized Mexican Americans aged 65 years at baseline (1993-1994) from 5 Southwestern states. Diabetes incidence was ascertained in 4 follow-up surveys to 2004-05 by respondent self-reported physician-diagnosis of diabetes, high blood glucose, or sugar in the urine. Language of interview, immigrant generation, gender, age, education, family history of diabetes, smoking status, alcohol use, health insurance type and self-reported height and weight were assessed. High socioeconomic status (SES) was defined by high school graduation and non-Medicaid insurance. Cox's proportional hazards models were fit to evaluate the effects of language acculturation, generation and SES on incident diabetes. 845 of 3,050 (27.7%) Mexican Americans had diabetes at baseline and were younger, more educated, and more likely to have health insurance than those without diabetes. Risk of developing diabetes increased for Spanish-speaking respondents with low SES from 1st to 3rd generation (HR = 1.76, 95% CI = 1.02-3.03) and from 2nd to 3rd generation (HR = 2.15, 95% CI = 1.20-3.84). Among English-speaking, high SES participants, generation had a protective effect on developing diabetes: HR = 0.45 (95% CI = 0.22-0.91) when comparing 3rd versus 1st generation. The effect of language acculturation and immigrant generation on incident diabetes is moderated by SES status in HEPESE participants.

A cluster analytic examination of acculturation and health status among Asian Americans in the Washington DC metropolitan area, United States

Previous studies reported mixed findings on the relationship between acculturation and health status among Asian Americans due to different types of acculturation measures used or different Asian subgroups involved in various studies. We aim to fill the gap by applying multiple measures of acculturation in a diverse sample of Asian subgroups.A cross sectional study was conducted among Chinese, Korean and Vietnamese Americans in Washington D.C. Metropolitan Area to examine the association between health status and acculturation using multiple measures including the Suinn-Lew Asian Self-Identity Acculturation (SL-ASIA) scale, clusters based on responses to SL-ASIA, language preference, length of stay, age at arrival in the United Sates and self-identity. Three clusters (Asian (31%); Bicultural (47%); and American (22%)) were created by using a two-step hierarchical method and Bayesian Information Criterion values. Across all the measures, more acculturated individuals were significantly more likely to report good health than those who were less acculturated after adjusting for covariates. Specifically, those in the American cluster were 3.8 times (95% Confidence Interval (CI): 2.2, 6.6) more likely and those in the Bicultural cluster were 1.7 times more likely (95% CI: 1.1, 2.4) to report good health as compared to those in the Asian cluster. When the conventional standardized SL-ASIA summary score (range:−1.4 to 1.4) was used, a one point increase was associated with 2.2 times greater odds of reporting good health (95% CI: 1.5, 3.2). However, the interpretation may be challenging due to uncertainty surrounding the meaning of a one point increase in SL-ASIA summary score.Among all the measures used, acculturation clusters better approximated the acculturation process and provided us with a more accurate test of the association in the population. Variables included in this measure were more relevant for our study sample and may have worked together to capture the multifaceted acculturation process.

Low Utilization of SNAP and TANF by EFNEP and WIC Participants

To find if the full benefit of nutrition assistance programs are being utilized by eligible women already participating in EFNEP or WIC. Prior research with this population suggested that EFNEP and WIC participants are not pursuing other nutrition assistance programs that they could qualify for. Program outreach is imperative to reduce health disparities among limited-income populations. In 2011, 444 women aged 18 to 65 at EFNEP (41%), WIC (43%), and an unemployment center (16%) completed a self-administered survey on nutrition assistance program participation, demographics, USDA food security module, and the Bidimensional Acculturation Scale (BAS). Data was analyzed using descriptive statists and comparisons were made using Chi Square as appropriate. Seventy-two percent self-identified as Hispanic, 53% were non-US born, but only 38% were Hispanic dominant, with 23% bicultural by the BAS. Nearly half of all participants were food secure (51%). Significant differences in degree of food insecurity were seen by acculturation status with 8% of Hispanic dominant women having “very low food security” in contrast to 19% of English dominant women (p=0.003). Forty-seven percent received SNAP benefits, but more US born (54%) than non-US born (41%; p=0.004) used the program. Only 12% of all women used TANF with significantly more English dominant and US born women receiving funds (p=0.004). These findings suggest underutilization of SNAP and TANF by EFNEP and WIC participants. Greater efforts are needed to increase awareness of these resources across programs in addition to further analysis identifying barriers and motivators to participation.

Preliminary Analysis of Baseline Data for Niños Sanos, Familia Sana

ObjectiveAnalysis of the baseline data collected from 440 families with a total of 580 eligible children, 3 to 8 years old during the first year of study implementation.DescriptionData presented includes demographic data, anthropometric measures (i.e. BMI, waist circumference and skinfold thickness), medical history and acculturation status of the families and eligible children.EvaluationPreliminary descriptive data presented such as frequency distributions, percentages and correlationsConclusions and ImplicationsResults of baseline data collection may help in understanding underlying conditions of childhood obesity.FundingUSDA Grant #20116800130167. ObjectiveAnalysis of the baseline data collected from 440 families with a total of 580 eligible children, 3 to 8 years old during the first year of study implementation. Analysis of the baseline data collected from 440 families with a total of 580 eligible children, 3 to 8 years old during the first year of study implementation. DescriptionData presented includes demographic data, anthropometric measures (i.e. BMI, waist circumference and skinfold thickness), medical history and acculturation status of the families and eligible children. Data presented includes demographic data, anthropometric measures (i.e. BMI, waist circumference and skinfold thickness), medical history and acculturation status of the families and eligible children. EvaluationPreliminary descriptive data presented such as frequency distributions, percentages and correlations Preliminary descriptive data presented such as frequency distributions, percentages and correlations Conclusions and ImplicationsResults of baseline data collection may help in understanding underlying conditions of childhood obesity. Results of baseline data collection may help in understanding underlying conditions of childhood obesity.

Dietary Approaches to Stop Hypertension Patterns in Older Latinos With or at Risk for Hypertension

Older Latinos represent a growing segment of our population, yet little is known about whether older Latinos are following the recommended Dietary Approaches to Stop Hypertension (DASH) eating plan, which promotes certain food groups to reduce blood pressure (BP) over and above established strategies. Among Latinos, greater acculturation to the American society has been associated with suboptimal dietary choices and risk for chronic diseases. Therefore, the purpose of this study was to assess differences in DASH accordance/adherence by BP status taking into account level of acculturation. This was a descriptive, cross-sectional study involving older Latinos wherein DASH accordance and adherence were calculated on the basis of nutrient analyses of food frequency questionnaires. A DASH score of 4.5 or higher indicated accordance, and a DASH Adherence Index greater than 0 indicated adherence. Blood pressure was measured in triplicate using Omron HEM-907XL and was categorized according to BP level and/or antihypertensive medication. The Acculturation Rating Scale for Mexican Americans-II was used to rate level of acculturation. Participants were 169 Latinos, primarily women (73%) and older (66 ± 9.0 years); the majority were hypertensive (66%), preferred speaking in Spanish (85%), and were more Latino oriented (63%) with respect to acculturation status. Overall, participants were moderately DASH accordant (4.2 ± 1.6) and DASH adherent (-0.8 ± 0.8). Acculturation scores (odds ratio, 1.4-1.7, P < 0.02) were predictive of hypertensive status (defined as BP ≥ 140/90 mm Hg) regardless of which dietary score was modeled. Based on these findings, greater attention should be paid to identification of traditional Latino foods and food preparation that are consistent and acceptable to this older community in effort to foster greater DASH accordance and improve BP status.

Level of acculturation, food intake, dietary changes, and health status of first-generation Filipino Americans in Southern California

This exploratory descriptive study investigates the acculturation level, food intake, dietary changes and practices, health status perceptions, and diet-related health indicators-body mass index (BMI), waist and hip circumferences, and waist-to-hip ratio-of first-generation Filipino Americans (FAs) in Southern California. Healthy FA adults-20 women and 10 men-were interviewed. Acculturation level was obtained using A Short Acculturation Scale for Filipino Americans. A 24-h dietary recall elicited their food intake. Survey questions revealed dietary changes and practices, health status perceptions, and sociodemographic characteristics. Height, weight, waist and hip circumferences were measured. FAs consider themselves more Filipino than American, but their acculturation level reflects transitioning into biculturalism. FAs relinquish, maintain, and adapt elements of both Philippine and U.S. cultures in food intake, dietary changes, and practices. Although FAs perceive their health status as very good to excellent, many exceed the cut-off points for BMI, waist circumference, and waist-to-hip ratio. This study underscores the importance of nurse practitioners and other healthcare givers conducting cultural dietary assessment as a basis for culturally appropriate dietary counseling. The inclusion of waist measurement to regularly monitor abdominal obesity-a predictor of cardiovascular disease and diabetes-is highly recommended.

Latino Racial Reporting in the US: To Be or Not To Be

AbstractThis review focuses on how Latinos report their race. This is an area that has recently experienced a major surge of interest in both government and academic circles. This review of the literature examines how and why Latinos report their race on the census, in surveys and in more qualitative studies. It reviews the vibrant and growing scholarly literature relevant to the questions of the placement – by self or others – of Latinos along the US color line, what determines it and how the Census has coped and is coping with it. We begin with a brief review of the history of Latino classification in the census and then discuss the factors influencing racial reporting. These include national origin and skin color, acculturation and generational status, socioeconomic status, perceived discrimination and identification with others who have experienced actual discrimination, location, and question format. We end with a discussion of the implications of the recent 2010 Alternative Questionnaire Experiment conducted by the census, and conclude with suggestions for future research.

Converging identities: dimensions of acculturation and personal identity status among immigrant college students.

The present study was designed to ascertain the extent to which dimensions of acculturation would differ across personal identity statuses in a sample of 2,411 first- and second-generation, immigrant, college-attending emerging adults. Participants from 30 colleges and universities around the United States completed measures of personal identity processes, as well as of heritage and American cultural practices, values, and identifications. Cluster-analytic procedures were used to classify participants into personal identity statuses based on the personal identity processes. Results indicated that, across ethnic groups, individuals in the achieved and searching moratorium statuses reported the greatest endorsement of heritage and American cultural practices, values, and identifications; and individuals in the carefree diffusion status reported the lowest endorsement of all the cultural variables under study. These results are discussed in terms of the convergence between personal identity and cultural identity processes.

Sociodemographic, behavioral, and biological variables related to weight loss in native hawaiians and other pacific islanders

Native Hawaiians and other Pacific Islanders (NHs/PIs) have a high obesity prevalence compared to other ethnic groups. We examined socio-demographic, behavioral, and biological factors related to ≥3% weight loss in 100 overweight/obese NHs/PIs who completed a lifestyle intervention. Data were from 56 Native Hawaiians, 22 Chuukese, and 22 Other Pacific Islanders who participated in a randomized controlled trial of the Partnership for Improving Lifestyle Intervention (PILI) 'Ohana Project. All completed a 3-month weight loss program (WLP) to initiate weight loss and were then randomized into either a 6-month family/community focused WLP called the PILI Lifestyle Program (PLP; n = 49) or a standard behavior WLP (SBP; n = 51). We collected baseline, 3- and 9-month follow-up data on socio-demographics, weight (kg), a 6-min. walk test, dietary fat, exercise frequency, and blood pressure. Based on ANCOVA or logistic fit, ethnicity, sex, initial weight loss, fat in diet at baseline, change in systolic blood pressure, and intervention type were significantly associated (P ≤ .05) with ≥3% weight loss at 9-month follow-up. A logistic regression model indicated that Chuukese (OR = 6.04; CI = 1.14-32.17) and participants who had more weight loss in the first 3-months (OR = 1.47; CI = 1.22-1.86) and who were in the PLP (OR = 4.50; CI = 1.50-15.14) were more likely to achieve ≥3% weight loss [model; χ(2) (7, N = 100) = 45.50, P < .0001]. The same lifestyle intervention does not benefit all NHs/PIs equally, possibly due to differences in acculturation status and social support. The findings also point to the importance of initial weight loss to sustain motivation toward long-term weight loss maintenance.

Culturally Relevant Factors and the Young Parenthood Program

I applaud Florsheim et al.1 for bridging the research to practice gap by developing and implementing the Young Parenthood Program (YPP) for expectant adolescent parents. The influence of intimate relationship factors upon the psychological adjustment and health of parents and children is a critical linkage that warrants more attention in the field of public health. While the aims and outcomes of this study were promising, there appeared to be key issues that were either overlooked in the study or omitted from the article. Mainly, the lack of discussion of cultural factors left me with many unaddressed questions regarding the implementation, results, and implications for the YPP. The authors point out that the study participants were primarily White or Latino. Indeed, the sample descriptive statistics indicate that 65% of the male participants and 50% of the female participants were identified (or self-identified) as Latino or Other. Research literature2 has documented how factors such as historical exclusion, discrimination, and oppression have hindered ethnic minority groups from accessing culturally relevant interventions. It has also been noted that an intervention’s lack of fit with the target cultural population can result in recruitment and retention difficulties,2 and culturally adapted interventions have been linked to participant satisfaction and improved outcomes in parenting interventions for a subgroup of Latinos.3 Thus, I was left wondering how culturally relevant factors were handled in this study. For example, did potential culturally based perceptions of the therapeutic process (e.g., stigma) impact recruitment and retention? How did the match or mismatch of therapist and participant ethnicity impact the intervention outcomes? How much attention was given to cultural factors such as family values, kinship networks, religious and spiritual beliefs, acculturation, and language preferences in the intervention? Finally, it would be valuable to further specify the participants’ ethnic backgrounds given that the Latino population in the United States is very heterogeneous with regard to factors such as country of origin, acculturation, language proficiency, and socioeconomic status.4 Again, the authors’ examination of coparenting factors, and specifically the inclusion of fathers in this research, is refreshing. Nonetheless, attending to culturally relevant factors is critical and could potentially help to move this important intervention from efficacy to effectiveness.

Self-care Behaviors for Orofacial Pain Among Different Racial/Ethnic Groups: Influences of Acculturation and Socioeconomic Status

ABSTRACT AIM The aim of this study was to test the influence of acculturation and socioeconomic status on orofacial pain self-care across race/ethnicity stratified by sex among South Florida residents, using a sample of residents of Miami-Dade and Broward counties in Florida. METHODOLOGY This study reports data on respondents who self-endorsed their race and ethnicity as Hispanic, non-Hispanic White, or non-Hispanic Black and reported tooth pain (n=1,767) or jaw joint/face pain (n=1,199). Acculturation was associated with self-care use for pain among Whites and Hispanics. Socioeconomic status (SES) was associated with several self-care behaviors and was most predictive among White women. Acculturation towards other ethnic groups led to differential self-care use dependent on the type of self-care, pain condition, and ethnicity. RESULTS Black and Hispanic women were greater users of self-care for orofacial pain than other sex/ethnicities. CONCLUSION The associations between SES and self-care were stronger in White women than in Black and Hispanic women.

The effect of immigration and acculturation on victimization among a national sample of Latino women.

The current study examined the effect of immigrant status, acculturation, and the interaction of acculturation and immigrant status on self-reported victimization in the United States among Latino women, including physical assault, sexual assault, stalking, and threatened violence. In addition, immigrant status, acculturation, gender role ideology, and religious intensity were examined as predictors of the count of victimization among the victimized subsample. The Sexual Assault Among Latinas (SALAS) Study surveyed 2,000 adult Latino women who lived in high-density Latino neighborhoods in 2008. The present study reports findings for a subsample of women who were victimized in the United States (n = 568). Immigrant women reported significantly less victimization than U.S.-born Latino women in bivariate analyses. Multivariate models showed that Anglo orientation was associated with greater odds of all forms of victimization, whereas both Latino orientation and being an immigrant were associated with lower odds of all forms of victimization. Latino orientation was more protective for immigrant women than for U.S.-born Latino women with regard to sexual victimization. Among the victimized subsample, being an immigrant, Anglo acculturation, and masculine gender role were associated with a higher victimization count, whereas Latino orientation and religious intensity were associated with a lower victimization count. The findings point to the risk associated with being a U.S. minority, the protective value of Latino cultural maintenance, and the need for services to reach out to Anglo acculturated Latino women.

Acculturative status and psychological well-being in an Asian American sample.

We sought to examine the relationship between acculturative status and positive psychological functioning (i.e., psychological well-being) in a sample of 96 Asian Americans. Using a supplemental item from the Suinn-Lew Asian Self-Identity Acculturation Scale, we classified participants into one of three acculturative statuses: Asian-Identified (n 56), Western-Identified (n 20), and Bicultural-Identified (n 20). We used Ryff’s (1989) Scales of Psychological Well-Being as a comprehensive measure of well-being, in addition to other commonly used indicators of well-being such as life satisfaction and depressed mood. We hypothesized that BiculturalIdentified individuals would show greater well-being relative to Asian-Identified and Western-Identified individuals as a result of these latter groups experiencing acculturative stress and bicultural stress, respectively. Results of a priori contrast tests largely confirmed our hypothesis, revealing the predicted pattern among four of six subscales of subjective well-being. Implications for future work examining Asian Americans’ well-being and mental health are discussed.

The More Things Change, the More They Stay the Same: Gender, Culture, and College Students’ Views about Work and Family

A culturally/ethnically diverse sample of 955 students (M = 20.2 years old) at a large U.S. university completed online surveys about their parents’ division of labor, trajectories of their mothers’ employment, gender role ideology, and beliefs about the costs and benefits of maternal employment for children. Differences in these work–care domains were examined by student gender, culture/ethnicity, acculturation status, and own employment. Generational differences in beliefs about maternal employment also were examined. Propensity score matching reduced selection bias. Asian American students, especially male students and those less acculturated, were more likely to endorse gender role segregation and maternal nonemployment when children are young. Their mothers’ employment and own employment status were associated with more positive views about maternal employment. However, students’ work–care beliefs have held fairly constant since the 1980s. The views of young adults about career and care may impinge on their success in attaining work–family goals. The more things change, the more they stay the same: Gender, culture, and college students’ views about work and family

Residential Integration on the New Frontier: Immigrant Segregation in Established and New Destinations

This article explores patterns and determinants of immigrant segregation for 10 immigrant groups in established, new, and minor destination areas. Using a group-specific typology of metropolitan destinations, this study finds that without controls for immigrant-group and metropolitan-level characteristics, immigrants in new destinations are more segregated and immigrants in minor destinations considerably more segregated than their counterparts in established destinations. Neither controls for immigrant-group acculturation or socioeconomic status nor those for demographic, housing, and economic features of metropolitan areas can fully account for the heightened levels of segregation observed in new and minor destinations. Overall, the results offer support for arguments that a diverse set of immigrant groups face challenges to residential incorporation in the new areas of settlement.

Differences in Patient-Reported Experiences of Care by Race and Acculturation Status

Patient-reported experiences of care are an important focus in health disparities research. This study explored the association of patient-reported experiences of care with race and acculturation status in a primary care setting. 881 adult patients (African-American 34%; Hispanic--classified as unacculturated or biculturated--31%; Caucasian 33%; missing race 2%), in outpatient Family Medicine clinics, completed a written survey in Spanish or English. Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group (CAG) Survey Adult Primary Care instrument was used for experiences of care and Short Form-12 survey for health status. Controlling for other variables, race and acculturation were significantly associated with several CAG subscales. Hispanic patients gave significantly higher ratings for care experiences and expressed greater interest in shared decision making. Selected patient-reported measures of care are associated with patients' race and acculturation status (for Hispanic patients). We discuss implications for both provision and measurement of quality care.

Test of a cultural framework of parenting with Latino families of young children.

This study examined the mental health and academic functioning of 442 4- and 5-year old children of Mexican (MA) and Dominican (DA) immigrant mothers using a cultural framework of Latino parenting. Data were collected on mothers' self-reported acculturative status, parenting practices and cultural socialization, and on children's behavioral functioning (mother- and teacher-report) and school readiness (child test). Results provide partial support for the validity of the framework in which mothers' acculturative status and socialization of respeto (a Latino cultural value of respect) and independence (a U.S. American cultural value) predict parenting practices. For both groups, English language competence was related to less socialization of respeto, and other domains of acculturative status (i.e., U.S. American/ethnic identity, and U.S. American/ethnic cultural competence) were related to more socialization of respeto and independence. Socialization of respeto was related to the use of authoritarian practices and socialization of independence was related to the use of authoritative practices. Socialization of respeto was also related to lower school readiness for DA children, whereas socialization of independence was related to higher school readiness for MA children. Independence was also related to higher teacher-rated externalizing problems for MA children. For both groups, authoritarian parenting was associated with more parent-reported internalizing and externalizing problems. The discussion focuses on ethnic subgroup differences and similarities to further understanding of Latino parenting from a cultural perspective.

Associations Between Socioeconomic Status and Catecholamine Levels Vary by Acculturation Status in Mexican-American Women

Lower socioeconomic status (SES) is associated with poorer health, possibly through activation of the sympathetic nervous system. This study aimed to examine the association between SES and catecholamine levels, and variations by acculturation. Three hundred one Mexican-American women underwent examination with a 12-h urine collection. Analyses tested associations of SES, acculturation (language and nativity), and their interaction with norepinephrine (NOREPI) and epinephrine (EPI). No main effects for SES or the acculturation indicators emerged. Fully adjusted models revealed a significant SES by language interaction for NOREPI (p< .01) and EPI (p< .05), and a SES by nativity interaction approached significance for NOREPI (p= .05). Simple slope analyses revealed that higher SES related to lower catecholamine levels in Spanish-speaking women, and higher NOREPI in English-speaking women. Although nonsignificant, similar patterns were observed for nativity. Associations between SES and catecholamines may vary by acculturation, and cultural factors should be considered when examining SES health effects in Hispanics.

Association between Acculturation and Breastfeeding among Hispanic Women

Breastfeeding rates are typically higher among Hispanic women; however, they vary by acculturation status in that those more acculturated are less likely to breastfeed than those who are less acculturated. This study examined the association between acculturation and breastfeeding behaviors using population-based data. Data (N = 8942) from the Pregnancy Risk Assessment Monitoring System (PRAMS) were used for analysis. Acculturation status was determined using self-reported Hispanic ethnicity and the language in which the women responded to the PRAMS survey, either English or Spanish. Hispanic women who responded to the survey in Spanish were categorized as less acculturated than those who responded in English. Breastfeeding indicators used were: initiation, duration to ≥ 10 weeks, and exclusive breastfeeding to ≥ 10 weeks. The prevalence rates of breastfeeding initiation, duration, and exclusive breastfeeding to ≥ 10 weeks were significantly higher among less acculturated than among highly acculturated. More acculturated were less likely to initiate breastfeeding (prevalence ratio [PR] = 0.88; 95% CI, 0.86-0.90), less likely to breastfeed ≥ 10 weeks (PR = 0.77; 95% CI, 0.72-0.82), and less likely to report exclusive breastfeeding to ≥ 10 weeks (PR =,0.70; 95% CI, 0.58-0.85). The relationship between breastfeeding continuation and acculturation persisted after adjusting for covariates in that more acculturated were less likely to breastfeed to ≥ 10 weeks (adjusted prevalence ratio [APR] = 0.81; 95% CI, 0.75-0.87), as did the relationship between exclusivity and acculturation; more acculturated were less likely to report exclusive breastfeeding (APR = 0.69; 95% CI, 0.55-0.87). Breastfeeding promotion efforts must include culturally/linguistically supportive services to assure that women are able to make optimal infant feeding decisions.