Costa Rican Adolescents Research Articles

Nicaraguan Migration and the Prevalence of Adolescent Childbearing in Costa Rica

This study describes the dynamics of adolescent childbearing of Nicaraguan-born and Costa Rican-born adolescents in Costa Rica and examines the association between socio-demographic factors and adolescent childbearing in the country. We studied Nicaraguan-born and Costa Rican adolescents using the data of the 2000 Census. Multivariate logistic regression was used to analyze the association between country of origin and adolescent childbearing, while controlling for socio-demographic factors (age, education, union, urbanization and poverty). 26% of Nicaraguan-born migrants and 9.5% of Costa Ricans had given birth during adolescence. The migrants' increased odds of pregnancy decreased from 3.34 (CI 3.21, 3.48) to 1.88 (CI 1.79, 1.97) when controlling for socio-demographic factors. Age, low educational attainment, urban residence, poverty and union were all significant predictors of adolescent pregnancy. Nicaraguan-born status is associated with adolescent childbearing in Costa Rica. Further research is needed to understand what factors, other than socio-demographic indicators, contribute to the differing prevalence of adolescent childbearing in Costa Rica.

La Escala de Identidad Etnica Multigrupo (EIEM) en el contexto costarricense 1

El presente artículo describe las propiedades psicométricas de un instrumento para la medición de la identidad étnica y sus componentes en jóvenes costarricenses: la “Escala de Identidad Etnica Multigrupo” (EIEM) desarrollada por Phinney (1992). En el estudio participaron 287 jóvenes afrocostarricenses, 768 jóvenes “blancos” o mestizos y 120 jóvenes de procedencia étnica mixta. Análisis factoriales confirmatorios demuestran que la escala mide dos componentes de la identidad étnica altamente relacionados en todos los grupos estudiados: afirmación e identificación étnica y exploración étnica. Análisis de confiabilidad revelan índices de consistencia interna (Alfas de Cronbach) satisfactorios para todos los grupos. La escala muestra relaciones moderadas con mediciones de orientaciones hacia los colectivos de referencia y conductas intergrupales como las actitudes hacia la aculturación y está positivamente relacionada con índices de autoestima e identidad del yo.

Parental feeding styles and adolescents’ healthy eating habits. Structure and correlates of a Costa Rican questionnaire

This study designed and validated a questionnaire aimed at examining parental feeding styles to encourage healthy eating habits among Costa Rican adolescents. Adolescents (n=133; mean age 15.4 years), and their parents, participated in the study. The parents completed a parental feeding style questionnaire, and the adolescents completed 3-day food records. Confirmatory factor analyses suggest four distinct parental feeding styles, (a) verbal encouragement of healthy eating behaviors; (b) use of verbal sanctions to indirectly control the intake of healthy food; (c) direct control of access to and intake of food; and (d) use of food to regulate emotions and behavior. There were no correlations between dietary intake and the verbal encouragement of healthy eating behaviors, but there were significant negative correlations between (1) “the use of verbal sanctions to indirectly control the intake of healthy food”, and the consumption of fruit and vegetable, of calcium, iron, vitamin B6 and folic acid intake, and (2) between the “direct control of access to and intake of food” and fast food consumption and total carbohydrates intake. The use of food to regulate emotions and behavior was positively correlated with high energy-dense food consumption. Stratification of the data shows significant differences by gender in the correlations between parental feeding style and dietary intake. Understanding parental feeding styles in a Latin American context is a first step in helping researchers develops culturally-appropriate parenting intervention/prevention strategies to encourage healthy eating behaviors during adolescence.

Barriers to and Suggestions for a Healthful, Active Lifestyle as Perceived by Rural and Urban Costa Rican Adolescents

Objective To assess the perceptions of rural and urban Costa Rican adolescents regarding which barriers and motivators affect their adoption of an active lifestyle. Design Data were collected in focus group discussions. Participants 108 male and female adolescents aged 12 to 18 from the 7th to 11th grades. Setting Two urban and 1 rural high school in San José, Costa Rica. Phenomena of Interest Active lifestyle; barriers and motivators for active life. Analysis Data were reviewed for emerging themes, and themes were coded using content analysis procedures. Results Major barriers: (a) physical education curriculum was focused on competitive sports; (b) lack of facilities in the school and community environments; (c) family did not provide good role models and reinforced the socially expected gender roles. Key motivators: (a) changed the physical education curriculum to focus on leisure and recreational activities; (b) increased the availability of facilities both in the school and in the community; and (c) provided a strong social support network. Conclusions and Implications The school, community, and family environments are potential targets for physical activity interventions for adolescents. Future studies should explore in depth the influence of adolescent socialization patterns (particularly for females) in the establishment of an active lifestyle.

Saturated and Cis- and Trans-Unsaturated Fatty Acids Intake in Rural and Urban Costa Rican Adolescents

Objective: The purpose of this study is to determine whether intake of saturated fatty acids and cis- and trans-unsaturated fatty acids is associated with an urban compared to a rural lifestyle, and whether these associations are responsible for differences in plasma lipid concentrations.Methods: Two hundred seventy-five adolescents, aged 12 to 19 years, living in rural and urban areas of San José, Costa Rica, were included in the study. All participants completed three-day food records, provided a fasting blood sample, and carried out a modified Harvard Step Test.Results: Compared to rural, urban adolescents reported higher intakes of energy-adjusted individual and total saturated fatty acids, total n-3, total n-6 (p < 0.05). Compared to rural, urban adolescents had higher intake of 18:1 (3.65 vs. 3.25, p = 0.0001) and 18:2 (0.62 vs. 0.80, p = 0.001) trans fatty acids, as well as lower intake of carbohydrate (p < 0.05). Palm shortening was the main source of saturated fat (32%), and partially hydrogenated soybean oil used for cooking was the main source of n-3 fatty acids (33%), n-6 fatty acids (33%) and trans fatty acids (34%). Compared to rural, urban adolescents had lower systolic and diastolic blood pressure and higher plasma HDL cholesterol concentration (44 vs. 40 mg/dL, p < 0.0001), but were more likely to be sedentary (68% vs. 57%, p < 0.0001). Among environmental factors, higher carbohydrate intake was a significant determinant of a lower HDL cholesterol (β coeff = −1.45, p = 0.04), while lauric and myristic fatty acids correlated with increased LDL cholesterol (β coeff = 3.6, 1.7, p < 0.05).Conclusions:A diet containing less carbohydrate and less saturated fatty acids contributes to a more beneficial lipid profile in Costa Rican adolescents, but a trend towards high trans fatty acids intake, particularly in the urban area is worrisome given the well-known adverse effects of trans fatty acids.

Costa Rican Adolescents have a Deleterious Nutritional Profile as Compared to Adults in Terms of Lower Dietary and Plasma Concentrations of Antioxidant Micronutrients

Objective: Most prospective studies in adult populations show an inverse association between consumption of fruits and vegetables and the risk of cardiovascular disease and all-cause mortality. Fruits and vegetables are rich in antioxidants. The objective was to determine whether nutrient intakes and plasma concentrations of antioxidants of adolescents are similar to those of their parents or grandparents as a way of assessing whether dietary habits of parents are passed on to their adolescent children.Methods Parents or grandparents (n = 159) aged 29–77 y were selected from the participants of the myocardial case-control study in Costa Rica. One adolescent child or grandchild (12–20 y) was identified for each parent or grandparent. Nutrient intakes and plasma antioxidant concentrations were assessed using a validated food-frequency questionnaire and by high performance liquid chromatography, respectively.Results As compared to adults, adolescents consumed greater quantities of fruit, dairy products, red meat, carbonated drinks and polyunsaturated fat, but lower quantities of fiber and micronutrients (carotenoids, vitamins A and B6, folate, potassium, magnesium and zinc). Plasma concentrations of all carotenoids, except for lycopene, were lower in adolescents than in adults (p < 0.05). Intakes of lycopene (r = 0.16, p = 0.05), α-tocopherol (r = 0.19, p = 0.03) and γ-tocopherol (r = 0.21, p = 0.01) in adolescents were correlated with those of adults. Plasma concentrations of lycopene (r = 0.20, p = 0.02), α-tocopherol (r = 0.18, p = 0.03) and γ-tocopherol (r = 0.28, p = 0.001) in adolescents were also correlated with those of adults. These data may suggest that adolescents may acquire habitual consumption of foods rich in micronutrients from adults.Conclusion: As a proportion of energy, diets of Costa Rican adolescents contain less micronutrients than those of their adult relatives. Parents should be aware of this trend and its association with poor health status.

Asthma, Current Wheezing, and Tobacco Use Among Adolescents and Young Adults in Costa Rica

Objectives. To examine the prevalence of asthma and the relation between tobacco use and asthma among university students in Costa Rica. Methods. Cross-sectional study of 1279 adolescents and young adults enrolled in careers in the health sciences in public and private universities in Costa Rica. Results. Of the 1279 study participants, 105 (8.2%) had current asthma, and 136 (10.6%) reported wheezing in the previous 12 months (current wheezing). Among individuals with either current wheezing or current asthma, none was using anti-inflammatory medications for asthma (e.g., inhaled corticosteroids). Approximately one third of the study participants reported any cigarette smoking. Young adults who had current wheezing were 5.8 times more likely to smoke at least 10 cigarettes per day than those who had no current wheezing [95% confidence interval (CI) for odds ratio (OR) = 3.3–10.2, p < 0.001]. Similar results were observed when an alternative definition of asthma (current asthma) was used in the analysis (OR for smoking at least 10 cigarettes per day = 4.4, 95% CI = 2.3–8.5, p < 0.001). Conclusions. Adequate public health measures are needed to prevent tobacco use in Costa Rican adolescents and to promote smoking cessation among young adults. Young adults with asthma living in Latin American countries with high asthma prevalence, such as Costa Rica, should be better educated with regard to asthma and the risks of tobacco use.

Barriers to and Motivators for Healthful Eating as Perceived by Rural and Urban Costa Rican Adolescents

Objective To assess the perceptions of rural and urban Costa Rican adolescents about their diet and the factors they consider significant to healthful eating. Design Data were collected in focus group discussions. Participants The study sample included 108 male and female adolescents aged 12 to 18 years. Adolescents were recruited among 7th to 11th grade students interested in taking part in the study. Setting Two urban and one rural high school in San José, Costa Rica. Phenomena of Interest Diet perceptions and barriers to and motivators for healthful eating. Analysis Data were reviewed for emerging themes, and themes were coded applying content analysis procedures. The conceptual model for understanding adolescent eating behavior, proposed by Story and colleagues, served as the framework for this study. Results Factors perceived as barriers to adopting healthful eating practices included unavailability of healthful food in the school environment, inadequate food choices within the family diet, and the peer-group notion among males and females that healthful eating by males is effeminate. Factors perceived as motivators included improving the nutritional quality of foods available at school, adoption of healthful eating practices by the entire family, and healthful eating becoming a peer-group social norm. Conclusions and Implications This study suggests that the family, peer group, and school environment are potential targets for nutrition interventions for Costa Rican adolescents, but further studies are needed to confirm this conclusion. Future studies should explore in depth the factors associated with the family's eating pattern and the influence of adolescent socialization patterns (particularly male) in the establishment of a healthful diet.

The comorbidity of substance abuse and depressive symptoms in Costa Rican adolescents

Patterns of comorbidity between depressive symptoms and substance use were examined simultaneously in community and clinical-based samples of 5268 Costa Rican adolescents, ages 12–20, through a series of descriptive, ANCOVA and logistic regression analyses. Groups surveyed included high school students, street youth, and youth in treatment for substance abuse problems. Results revealed significant group differences in substance use and significant correlations between depressive symptoms and problems with alcohol and drugs. The association between depressive symptoms and overall substance use involvement was significant for all youth, but strongest for female street youth. Logistic regression analyses revealed that depressive symptoms were associated with increased odds of specific substance use for all three groups, though in the case of street youth and youth in treatment, these associations only were observed in males. Analyses of covariance indicated that problems with drugs and alcohol differed across group and sex. Youth in treatment had more problems with drugs and alcohol than other groups. Among street youth, males had more problems with drugs than females. This study provides a unique cross-cultural perspective on the comorbidity of depression and substance use among youth, and allows for comparative analyses between community and clinical-based participants.

Frequent Intake of Tropical Fruits That Are Rich in β-Cryptoxanthin Is Associated with Higher Plasma β-Cryptoxanthin Concentrations in Costa Rican Adolescents

Dietary tocopherols and carotenoids may play a role in preventing cancer and cardiovascular diseases. Because these may begin to develop during adolescence, dietary patterns during this period could influence long-term risk. The objective of this study was to examine the intake and plasma concentrations of the major carotenoids and tocopherols in 159 adolescents (mean +/- SD, 15.5 +/- 2.5 y old) living in Costa Rica. All participants completed a 135-item food-frequency questionnaire and provided a fasting blood sample. Carotenoid and tocopherol intakes were adjusted for total energy and plasma concentrations for total cholesterol. The relative abundance of carotenoids in the diet was similar to their distribution in plasma; lycopene was the most abundant, followed by beta-carotene and lutein + zeaxanthin. gamma-Tocopherol was more abundant than alpha-tocopherol in the diet, but alpha-tocopherol was approximately sevenfold higher in plasma. The highest diet-plasma correlations (adjusted for age, sex and body mass index) were 0.38 for beta-cryptoxanthin, 0.33 for gamma-tocopherol and 0.17 for lutein + zeaxanthin (all P < 0.05). All other correlations were r < 0.15. Papaya intake was the best food predictor of plasma beta-cryptoxanthin concentrations (r = 0.41). Subjects that frequently (> or =3/d) consumed tropical fruits with at least 50 micro g/100 g beta-cryptoxanthin (papaya, tangerine, orange and watermelon) had twofold the plasma beta-cryptoxanthin concentrations of those with intakes of <4/wk (P for trend = 0.0009). In sum, the diet-plasma carotenoid and tocopherol correlations were generally low in Costa Rican adolescents. Intakes of beta-cryptoxanthin and papaya, a tropical fruit frequently consumed in Latin America, were the best predictors of beta-cryptoxanthin concentrations in plasma.

Psychosocial aspects of Costa Rican adolescents' eating and physical activity patterns.

To determine the importance of some psychosocial aspects on the eating and physical activity patterns of Costa Rican adolescents. A total of 1200 adolescents were included in the study. Data were collected using a self-administered instrument containing the following elements: questions to elicit demographic information and five sections with several items (stated as positive or negative behaviors) to study the influence of peers, parents, social environment, body image, and self-efficacy on five target behaviors, intake of foods rich in saturated fats, calcium, and iron, along with consumption of fruits and vegetables and physical activity practices. Data were analyzed using a factor analysis with main component extraction and varimax rotation, along with multiple regression analyses. Social environment and peer influence were the major factors that predict behaviors associated with the intake of foods rich in saturated fat. Meanwhile, parental and social environment influences were the main factors in explaining the fruit and vegetable intake-related behaviors. Self-efficacy was a significant predictor of behaviors associated with physical activity. Body image influence was an important variable associated with all the behaviors analyzed. Multiple regression analyses suggest that the fathers' educational level, the adolescents' age, being female, and living in a rural area may have positive influence on the behaviors studied; however, the overall R(2) for all regression models was quite small (<.03). Most of the variability in adolescents' food intake and physical activity-related behaviors remained unexplained by the demographic variables included in the study. Nevertheless, the results suggest that promotion of health programs built on the influence of social environment, peers and family members, and self-efficacy may have a positive impact on the adolescents' food and physical activity patterns. However, the clear definition of which psychosocial aspect(s) strongly influence the behavior to be modified, is essential for designing an intervention that is properly directed at the correct target.

DRUG USE AND ASSOCIATED FACTORS AMONG RURAL ADOLESCENTS IN COSTA RICA

The objectives of this study, carried out in 1995, were to assess both licit and illicit substance use among rural male and female Costa Rican adolescents, and associated health, psychological, and psychosocial problems. A sample of 304 students from rural schools was randomly selected. The mean age for females was 14.7 years (S.D. = 1.71), and for males was 14.4 years (S.D. = 1.62). The data were collected using the Latin-American version of Drug Use Screening Inventory (DUSI). Results showed a high prevalence of past-year alcohol use for both males and females (56.6% and 47.4%, respectively), and a lower prevalence of past-year tobacco use (44.0% and 7.7%). There results also showed a low level of use of solvent inhalants and benzodiazepines. In terms of illicit drugs, males preferred cocaine and marijuana, while females only reported amphetamine use. An analysis of adolescent functioning showed differences among alcohol users and nonusers in behavior patterns and peer relationships. However, no significant differences were found regarding rebellion, depression, and social isolation. The implications of these results are discussed, along with the importance of enhancing prevention, as well as early detection and intervention. [Translations are provided in the International s Section of this issue.]

Dietary intake as a cardiovascular risk factor in Costa Rican adolescents.

To evaluate Costa Rican adolescents' dietary intake as a cardiovascular disease (CVD) risk factor. Dietary intake was determined using 3-day food records; nutrient content of fast foods prepared in school cafeteria was calculated by the weighted records. Around 30% of adolescents exceed the American Heart Association dietary recommendation for total fat and saturated fat. About 50% reported a cholesterol intake higher than 100 mg/1000 kcal. On average, 45% of adolescents do not meet the dietary fiber recommendation of 10 g/1000 kcal, the 66% of the recommended daily allowance for vitamins E and B(6), or around 25% for folic acid. A higher proportion of urban adolescents do not satisfy the established dietary recommendation to prevent CVD. To avoid further increases in the Costa Rican CVD mortality rate, it is necessary to develop primary prevention programs, oriented to modify adolescent's nutrition habits. Schools have the potential to carry out such programs, as at least 60% of all adolescents in Costa Rica are enrolled in high schools.

Iron and Folate Status in Urban and Rural Costa Rican Teenagers

This study evaluated the iron and folate status of Costa Rican adolescents and their dietary intake of these micronutrients. Hematological data, serum ferritin, serum folate and iron and folate intakes were evaluated in 307 adolescents aged 13 to 17 years. The prevalence of anemia was 4%. Iron deficiency was found in 3% of adolescents and iron-deficiency anemia in 2% or less. The prevalence of deficient serum folate levels was less than 1%. Over 50% of females and around 20% of males did not consume 66.7% of the recommended daily allowance (RDA) for iron. Iron bioavailability in the diet of urban adolescents was intermediate, whereas it was low in the diet of rural adolescents. Approximately 53% of adolescents did not consume two-thirds of the RDA for folate. It is necessary to modify adolescents’ food habits in order to ensure an adequate iron and folate intake.

Marginal Vitamin and Mineral Intake of Costa Rican Adolescents

Background Although a great deal of attention is given to macronutrient and energy intake in the diet, elements essential to dietary metabolic balance include important micronutrients. Very little information exists on vitamin and mineral intake during adolescence, especially in developing countries. Methods The micronutrient intake of urban and rural adolescents aged 12–19 years from the Costa Rican capital city, San José, was evaluated. Prospective 3-day diet records including 2 weekdays and 1 weekend day were used for dietary data. We evaluated the micronutrient intake to determine the nutrient adequacy ratio. Results Approximately 30% of adolescents did not meet the 70% level of the daily recommended intake (DRI) for vitamin Bl2. Additionally, 40% of the Costa Rican youngsters presented a vitamin A, E, and iron intake of between 30 and 69% of the DRI or recommended daily dose (RDA) for these nutrients. Likewise, approximately 15% of adolescents did not meet 30% of the DRI or RDA indicators for these nutrients. The micronutrients most at risk for inadequate intake were zinc, calcium, magnesium, and folate: more than 25% of the adolescents did not meet 50% of DRI or RDA indications for these micronutrients. Contrariwise, vitamin C, vitamin B6, thiamin, riboflavin, and niacin were the nutrients less at risk for inadequate intake. Fast foods prepared in school cafeterias provided approximately 15–30% of the DRI for vitamins B1, B2, B6, Bl2, and niacin, approximately 18% of the RDA for iron, and over 40% of the RDA for vitamin E. Conclusions Nutritional interventions and educational strategies are needed to promote the adoption of healthful eating habits among adolescents.

Prevalence of coronary heart disease risk factors in Costa Rican adolescents

Purpose: To determine the prevalence of coronary heart disease (CHD) risk factors among Costa Rican adolescents. Methods: The prevalence of high blood pressure, obesity, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, sedentarism, family history of premature CHD, saturated fat intake, diabetes mellitus, and cigarette smoking was determined in 328 adolescents, ages 12–18 years (167 males, 161 females), randomly selected from San José’s urban and rural high schools. Results: Over 70% of the adolescents studied presented one risk factor for CHD. While the prevalence of family history of premature CHD, sedentarism, and cigarette smoking was significantly higher in urban adolescents, low HDL cholesterol and high blood pressure were significantly higher in rural adolescents. Girls demonstrated a significantly higher prevalence of sedentarism and LDL cholesterol >2.9 mmol/L than boys. Elevated saturated fat intake (>10% total energy) was found in 37% of the adolescents. Conclusions: The prevalence of CHD risk factors among Costa Rican adolescents is high; particularly of saturated fat intake, sedentarism and low HDL-C levels. Primary prevention programs are urgently needed, especially among female adolescents and in the urban areas, to reduce the increased prevalence of CHD mortality among Costa Rican adults.

A Spanish Psychological Screening Inventory

The purpose of this project was to develop a Spanish version of the Psychological Screening Inventory for use with Costa Rican adolescents and to assess its psychometric equivalence to the English version and its external validity. In Study 1, norms were generated on 600 male and 600 female high school students who were stratified on age and socioeconomic level and were geographically representative. Comparisons with the PSI English version were made for means, scale reliabilities, scale intercorrelations, and item endorsement frequencies. Study II compared the PSI Spanish version scores of students who did and did not request counseling. The Spanish version showed reasonable psychometric equivalence to the English version and was also shown to possess preliminary external validity. Its potential utility for use with U.S. Spanish-speaking populations is discussed.