Hispanic Subgroups Research Articles

Knowledge, perceptions, and experiences of Dominicans with diabetes.

Dominicans, one of the fastest growing Hispanic subgroups in New York City (NYC), have a high rate of diabetes. A qualitative study exploring Dominicans' knowledge, perceptions, and experiences in managing their diabetes was conducted. There were a total of 40 participants who were Spanish speaking Dominicans, 40-74 years of age, diagnosed with diabetes and NYC residents. Four focus groups were conducted in Spanish, which were recorded and then transcribed into English. Content analysis was used to analyze the text of the focus groups. Different themes emerged from the data, with apparent gaps in diabetes knowledge and of awareness of risk for diabetes complications.

Gastric cancer incidence among Hispanics in California: patterns by time, nativity, and neighborhood characteristics.

Better understanding about gastric cancer incidence patterns among Hispanics by birthplace, socioeconomic status (SES), and acculturation can improve preventive strategies and disease models. Incidence rates, rate ratios, and estimated annual percent change (EAPC) in rates of anatomic and histologic subtype-specific gastric cancer were calculated by age, sex, and nativity among Hispanics using California Cancer Registry data from 1988 through 2004. Incidence rates in 1998 to 2002 were compared by neighborhood SES and Hispanic enclave status according to 2000 US Census data. Incidence rates of diffuse gastric cancer increased from 1988 through 2004 among foreign-born Hispanic men (EAPC: 3.5%, 95% CI: 1.5%-5.5%) and U.S.-born Hispanic women (EAPC: 3.0%, 95% CI: 0.7%-5.3%). During the same time period, incidence rates of intestinal gastric cancer declined significantly and both cardia and noncardia gastric cancer were steady or declined among foreign-born and U.S.-born Hispanic men and women. Noncardia and both intestinal and diffuse gastric cancer were more common in foreign-born than U.S.-born Hispanic men and women, and in those from lower SES, higher enclave neighborhoods. By contrast, among younger and middle-aged Hispanic men, cardia tumors were more common in the U.S.-born than the foreign-born, and in higher SES, lower enclave neighborhoods. Varying gastric cancer risk factors among Hispanic subgroups and increasing rates of diffuse gastric cancer in foreign-born Hispanic men and U.S.-born Hispanic women merit further investigation to identify separate disease etiologies. Age, sex, birthplace, SES, and acculturation modify gastric cancer incidence in Hispanics and should be considered when examining disease risk and prevention.

Surveillance of Colorectal Cancer Screening in New Mexico Hispanics and Non-Hispanic Whites

The incidence of colorectal cancer (CRC) among Hispanics in the state of New Mexico has increased in the past decade while that among whites has declined significantly. Using the 2006 New Mexico Behavioral Risk Factor Surveillance System (BRFSS) survey, we compared CRC screening among Hispanics and whites by gender to examine the influence of demographic, socioeconomic, preventive health, and clinical measures on the utilization of CRC screening. Although we found no ethnic differences in the prevalence of current breast, cervical and cancer screening, Hispanics were less likely to be current with CRC screening than whites. These differences were observed across a range of socioeconomic and other explanatory measures and in both genders. Hispanics also had a higher prevalence of CRC-related risk factors than whites, including inactivity, obesity, and diabetes, and ranked lower for most socioeconomic measures. Adjusting for healthcare coverage, education, and income in logistic regression models eliminated the Hispanic-white differences in CRC screening among men, and substantially reduced but did not eliminate screening differences among women. Innovative methods are needed to reach Hispanics to raise awareness of and participation in CRC screening. Because many CRC risk factors are potentially modifiable, appropriate cultural and linguistic interventions tailored to specific Hispanic subgroups and aimed at promoting CRC screening and reducing CRC risk factors may decrease ethnic disparities in CRC incidence.

Racial and ethnic disparities in survival of US children with acute lymphoblastic leukemia: evidence from the SEER database 1988–2008

Prior studies have shown poorer survival from childhood acute lymphoblastic leukemia (ALL) among some minorities compared to non-Hispanic whites (NHW). Here, we examine whether these survival disparities have persisted and to see whether they also exist for Asian and Hispanic subgroups. Using data from the US National Cancer Institute's Surveillance, Epidemiology and End Results program from 1988 to 2008, we compared all natural-cause survival for children aged 19 years or under diagnosed with ALL using Cox proportional hazards models adjusted for age, diagnosis year, gender and disease immunophenotype. Black, Hispanic and Native American children continue to have significantly poorer survival than NHW. Unlike previous studies, we found that Asian Americans also had significantly worse survival. Among Asian subgroups, Vietnamese (relative risk [RR]=2.44, 95% CI=1.50-3.97) and Filipinos (RR=1.64, 95% CI=(1.13-2.38) had significantly poorer survival, while other East Asian groups, except Chinese, had non-significantly worse survival. Most Hispanic subgroups had RRs around 2. Previously observed poorer prognosis for childhood ALL for some minority groups appears to be shared by most Asians as well. Further research is needed to find explanations for the poorer survival of minority children with ALL and possible treatment implications.

Abstract P074: Substituting Homemade Fruit Juice for Sugar-Sweetened Beverages is Associated with Lower Odds of Metabolic Syndrome among Hispanic Adults

Introduction: Consumption of sugar sweetened beverages (SSB) has been consistently associated with metabolic syndrome (MetS), while results on the role of fruit juice intake are conflicting. Hispanics consume both SSB and traditional fruit-based beverages; however, studies conducted on such ethnic group are scarce. Given the high prevalence of MetS among Hispanics, describing putative contributors to this condition is essential in proposing approaches that may successfully reduce its prevalence and avoid further complications. Hypothesis: We assessed the hypothesis that substituting fruit-based beverages traditionally consumed by Hispanics for SSB may be associated with lower odds of MetS. Methods: To determine the cross-sectional association between beverages consumed by Hispanics, and MetS and its components, data were analyzed in 1,872 Costa Rican adults who served as controls of a population-based case-control study of coronary heart disease. Multivariate adjusted means were calculated for components of MetS by servings (never, <1/week, 2–6/week, ≥1/day) of two traditional fruit-based beverages (‘fresco’ and homemade fruit juice, separately) and two SSB (instant drinks and regular sodas, separately and combined). Prevalence ratio (PR) of MetS was calculated for each beverage, and odds ratio (OR) was calculated by substituting one serving of homemade fruit juice or water for one of SSB. Results: Significant positive trends were observed for increasing servings of instant drinks and combined SSB with plasma triglyceride and waist circumference, and for regular soda with waist circumference (all P -trend<0.001). Increasing servings of homemade fruit juice were associated positively with HDL-C ( P -trend=0.033). Consuming ≥1 serving/day of instant drinks was associated with higher PR of MetS (1.42, 95%CI: 1.11, 1.83) compared to no consumption; similar results were obtained for combined SSB. Substituting one serving of homemade fruit juice for instant drink was associated with 29% (95% CI=7, 47%) lower odds of MetS, and for regular soda with 30% (1, 50%) lower odds. Substituting water for combined SSB was marginally significant (OR=0.86 (0.74, 1.00). Conclusion: In conclusion, reducing consumption of SSB and substituting them with homemade fruit juices in moderation, may be a culturally-appropriate approach to lower metabolic syndrome among Hispanics. Our study provides the groundwork for interventions on beverage intake that aim to prevent MetS and type 2 diabetes in Hispanic ethnic subgroups, and may support current public health efforts on limiting availability and intake of SSB, while substituting with a healthy beverage.

Estimates of the population prevalence of injection drug users among hispanic residents of large US metropolitan areas.

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

Children's very low food security is associated with increased dietary intakes in energy, fat, and added sugar among Mexican-origin children (6-11 y) in Texas border Colonias.

BackgroundFood insecurity among Mexican-origin and Hispanic households is a critical nutritional health issue of national importance. At the same time, nutrition-related health conditions, such as obesity and type 2 diabetes, are increasing in Mexican-origin youth. Risk factors for obesity and type 2 diabetes are more common in Mexican-origin children and include increased intakes of energy-dense and nutrient-poor foods. This study assessed the relationship between children's experience of food insecurity and nutrient intake from food and beverages among Mexican-origin children (age 6-11 y) who resided in Texas border colonias.MethodsBaseline data from 50 Mexican-origin children were collected in the home by trained promotora-researchers. All survey (demographics and nine-item child food security measure) and 24-hour dietary recall data were collected in Spanish. Dietary data were collected in person on three occasions using a multiple-pass approach; nutrient intakes were calculated with NDS-R software. Separate multiple regression models were individually fitted for total energy, protein, dietary fiber, calcium, vitamin D, potassium, sodium, Vitamin C, and percentage of calories from fat and added sugars.ResultsThirty-two children (64%) reported low or very low food security. Few children met the recommendations for calcium, dietary fiber, and sodium; and none for potassium or vitamin D. Weekend intake was lower than weekday for calcium, vitamin D, potassium, and vitamin C; and higher for percent of calories from fat. Three-day average dietary intakes of total calories, protein, and percent of calories from added sugars increased with declining food security status. Very low food security was associated with greater intakes of total energy, calcium, and percentage of calories from fat and added sugar.ConclusionsThis paper not only emphasizes the alarming rates of food insecurity for this Hispanic subgroup, but describes the associations for food insecurity and diet among this sample of Mexican-origin children. Child-reported food insecurity situations could serve as a screen for nutrition problems in children. Further, the National School Lunch and School Breakfast Programs, which play a major beneficial role in children's weekday intakes, may not be enough to keep pace with the nutritional needs of low and very low food secure Mexican-origin children.

Race/ethnicity and all-cause mortality in US adults: revisiting the Hispanic paradox.

We examined the association between race/ethnicity and all-cause mortality risk in US adults and whether this association differs by nativity status. We used Cox proportional hazards regression to estimate all-cause mortality rates in 1997 through 2004 National Health Interview Survey respondents, relating the risk for Hispanic subgroup, non-Hispanic Black, and other non-Hispanic to non-Hispanic White adults before and after controlling for selected characteristics stratified by age and gender. We observed a Hispanic mortality advantage over non-Hispanic Whites among women that depended on nativity status: US-born Mexican Americans aged 25 to 44 years had a 90% (95% confidence interval [CI] = 0.03, 0.31) lower death rate; island- or foreign-born Cubans and other Hispanics aged 45 to 64 years were more than two times less likely to die than were their non-Hispanic White counterparts. Island- or foreign-born Puerto Rican and US-born Mexican American women aged 65 years and older exhibited at least a 25% lower rate of dying than did their non-Hispanics White counterparts. The "Hispanic paradox" may not be a static process and may change with this population growth and its increasing diversity over time.

The Spanish Version of the Wisconsin Personality Disorders Inventory-IV (WISPI-IV): Tests of Validity and Reliability

Personality disorders (PD) are a prevalent class of mental disorders that interfere with functioning and cause subjective distress while increasing the intensity and duration of Axis I clinical syndromes, and therefore assessing PD is important even when PDs are not the focus of treatment. The purpose of these studies was to develop and test a new Spanish version of a self-report measure of PD, the Wisconsin Personality Inventory-IV (WISPI-IV) that would be psychometrically equivalent to the English version while also maintaining the same interpersonal content, which is based on Benjamin's analysis of the PD criteria using her Structural Analysis of Social Behavior (SASB) model (1974). Study 1 participants completed the WISPI-IV twice over a two-week interval. For Study 2, participants from two sites in Spain and one site in Argentina completed Spanish versions of the WISPI-IV and other personality measures. SASB-analysis of the translated items showed high correspondence between the interpersonal content of the English version and the Spanish version demonstrating theoretical validation in relation to other PD measures. The Spanish WISPI-IV showed satisfactory reliability based on test-retest correlations and alphas for internal consistency. Study 2 showed the Spanish WISPI-IV had good convergent validity with the Spanish versions of the IIP and SCID-II and performed similarly to the English versions of these measures. Our goal in translating the WISPI-IV was to extend this measure to Spanish-speakers in language that would be understood by different Hispanic sub-groups, however research team members and subjects had a variety of suggestions for changes in item wording. This reflects the difficulty with creating a "neutral" Spanish version of any assessment given regional differences.

Abstract 9192: Genetic Ancestry is Associated with Left Ventricular Mass Among Hispanic Subgroups: The Multi-Ethnic Study of Atherosclerosis

Hispanics represent a recently admixed population of European, Native American and African parental populations. Hispanics have higher left ventricular mass (LVM) than non-Hispanic whites, and this relationship persists across Hispanic subgroups. However, the contribution of genetic ancestry to LVM across Hispanic subgroups is not known. Methods - We examined 705 Hispanic participants. Percent genetic ancestry for each Hispanic subgroup was estimated with 199 ancestry informative markers using the population genetics analysis program STRUCTURE. LVM from cardiac MRI was evaluated as a continuous measurement, with allometric methods that model height and weight in a regression analysis. Associations between ancestry and LVM were evaluated through linear regression models consisting of age, gender, both highest education level and annual income, and diabetes treatment, hypertension, physical activity, and body mass index. Results - Mexicans along with Central Americans had the highest Native American (74%) ancestry. Caribbean-Hispanics (Dominicans, Puerto Ricans and Cubans) had the highest African (35%) ancestry. Among Caribbean Hispanics (in age and gender adjusted analysis), each SD increase in African ancestry was associated with a 3.4 unit increase in LVM (p < 0.03). Among Mexican-origin Hispanics, each SD increase in Native American ancestry was associated with a 2.4 unit increase in LVM (p = 0.06). These relationships were not attributable to differences in socioeconomic status or clinical factors. In Caribbean-Hispanics, African ancestry explains 9.6% of the total variance in LVM in fully adjusted models. In Mexican-origin Hispanics, Native American ancestry explains 13.0% of the total variance in fully adjusted models. There was insufficient evidence in these data to detect an association between genetic ancestry and LVM in Central/South Americans. Conclusion - African and Native American ancestry was significantly associated with increasing LVM among Caribbean-Hispanics and Mexican-origin Hispanics, respectively. The findings persisted after accounting for LVM risk factors. These results highlight the heterogeneity of the Hispanic population and the relative importance of genetic ancestry in assessing LVM risk.

Association between parental nativity and autism spectrum disorder among US-born non-Hispanic white and Hispanic children, 2007 National Survey of Children’s Health

Background Limited studies suggest the prevalence of autism spectrum disorders (ASD) varies by whether maternal and child birth country are discordant. Objective/Hypothesis We explored associations between ASD and maternal and paternal nativity in a sample of US-born non-Hispanic white (NHW, n = 37,265) and US-born Hispanic (n = 4,690) children in the 2007 National Survey of Children’s Health (NSCH). Methods We assessed ASD prevalence within race-ethnicity and parental nativity subgroups. Prevalence ratios (aPR), comparing each group to NHW children with 2 US-born parents, were adjusted for child age, sex, and receipt of care in a medical home. Estimates were weighted to reflect US noninstitutionalized children. Standard errors were adjusted to account for the complex sample design. Results In NHW children with 2 US-born parents, ASD prevalence was 1.19%; estimates were similar for NHW children with a foreign-born mother or father. There was a striking heterogeneity between Hispanic children with 2 US-born versus 2 foreign-born parents (ASD prevalence 2.39% versus 0.31%, p = .05). Even after adjustment, PRs comparing ASD prevalence in Hispanic versus NHW children were vastly different for Hispanic subgroups, suggesting a substantially lower prevalence for Hispanic children with both parents foreign-born (aPR 0.2, 95% confidence interval 0.1-0.5) and a higher prevalence for Hispanic children with both parents US-born (aPR 2.0 [0.8-4.6]). Conclusions Previous studies comparing ASD prevalence between NHW and Hispanic children based on a composite Hispanic grouping without consideration of parental nativity likely missed important differences between these racial-ethnic groups. Continuing efforts toward improving early identification in Hispanic children are needed.

The dimensionality and measurement properties of alcohol outcome expectancies across Hispanic national groups

This study examines the psychometric properties of alcohol expectancies among Hispanic subgroups. Face-to-face interviews were conducted as part of the 2006 Hispanic Americans Baseline Alcohol Survey (HABLAS), which employed a multistage cluster sample design. A total of 5224 individuals (18 + years of age) representing four Hispanic national groups (Puerto Ricans, Cuban Americans, Mexican Americans, and South/Central Americans) were selected at random from the household population in five metropolitan areas (Miami, New York, Philadelphia, Houston, and Los Angeles). Alcohol expectancies included 18 items covering positive (e.g., laugh more, become more talkative) and negative dimensions (e.g., become aggressive, lose control) when alcohol is consumed. Confirmatory factor models replicated a previously proposed three-factor dimensional structure with a substantial majority of items exhibiting measurement invariance across Hispanic national group and gender. Items covering social extroversion were an exception, showing a lack of invariance for female Cuban and South/Central Americans. Latent mean differences across groups were detected for expectancies concerning emotional fluidity, and the pattern of differences largely mirrored known differences in alcohol consumption patterns. Results suggest that caution should be exercised in interpreting differences in expectancies concerning social extroversion across Hispanic groups, and additional work is needed to identify indices of this construct with invariant measurement properties. However, measures of emotional/behavioral impairment and emotional fluidity expectancies can be validly compared across gender and Hispanic national groups.

Ethnicity, Acculturation, and Offending: Findings from a Sample of Hispanic Adolescents

This study examines the relationship between ethnicity, acculturation, and crime among a sample of Hispanic adolescents drawn from the Project on Human Development in Chicago Neighborhoods (PHDCN) dataset. Prior research has shown that Hispanics who are more acculturated are more likely to engage in crime, but there is a lack of empirical evidence to explain why this is, and little research that has explored Hispanics relative to one another. In an effort to address these shortcomings, this study explores the impact of ethnicity on criminal offending among Hispanic adolescents. This study also examines whether acculturation, net of ethnicity, predicts criminal offending among this group. Using longitudinal data from the PHDCN, we assess the independent effects of ethnicity and generational status, as well as additional criminological variables on adolescent criminal offending. Findings indicated that, on average, Mexican adolescents were less likely than other Hispanics to report violent offending while Puerto Ricans were significantly more likely to report violent offending. No differences were observed between Hispanic subgroups with respect to property offending. Results from negative binomial regression revealed that ethnicity is rendered insignificant in multivariate analyses. Consistent with prior research, first generation immigrants were significantly less likely to engage in delinquent behavior, even after controlling for relevant criminological variables.

Nativity is associated with sugar-sweetened beverage and fast-food meal consumption among Mexican-origin women in Texas border colonias.

BackgroundTrends of increasing obesity are especially pronounced among Mexican-origin women. There is little understanding of dietary patterns among U.S.- and Mexico-born Mexican-origin individuals residing in new-destination immigrant communities in the United States, especially behaviors related to obesity, such as consumption of sugar-sweetened beverages (SSB) and fast-food meals (FFM).MethodsThe study used survey data of 599 adult Mexican-origin women from the 610 women who completed the 2009 Colonia Household and Community Food Resource Assessment (C-HCFRA), which was completed in person by trained promotora-researchers in 44 colonias near the Texas border towns of Progreso and La Feria. Data included demographic characteristics (age, education, nativity or country of birth, household income, household composition, and employment status), access to transportation, self-reported height and weight, food and nutrition assistance program participation, and consumption of SSB and FFM. Descriptive statistics were calculated by nativity (U.S.-born vs. Mexico-born); multivariable linear regression models were estimated for correlates of consumption of SSB and FFM.ResultsThere are three major findings related to nativity. First, U.S.-born women consumed more SSB and FFM than Mexican-born counterparts in the same areas of colonias. Second, in the combined sample and controlling for other population characteristics, being born in Mexico was independently associated with FFM (fewer FFM), but not with SSB. Third, in analyses stratified by nativity, FFM and SSB were associated with each other among both nativity groups. Among Mexico-born women only, age, presence of a child, or being a lone parent was significantly associated with SSB; full-time employment, being a lone parent, and SSB consumption were each independently associated with increased frequency of FFM.ConclusionsOur analyses revealed differences in prevalence and correlates of SSB and FFM based on country of birth. Nativity, as a proxy for acculturation, may indicate the extent that immigrants have adopted behaviors from their new environment. However, nativity could also indicate limited accessibility to resources such as food/nutrition assistance programs, transportation, and proper documentation. Additionally, future research should focus on expanding our understanding of the meaning of nativity among individuals who share common contextual factors, but may have different life course experiences and resources needed to transition into a new place. Additional measures should be considered such as educational and occupational background, migration history, documentation status, and dietary acculturation, which may better explain heterogeneity within Hispanic subgroups.

A Systematic Review of HIV/AIDS Survival and Delayed Diagnosis Among Hispanics in the United States

HIV/AIDS disproportionately affects Hispanics. Our objective was to determine the risk of late diagnosis and rate of survival after HIV/AIDS diagnosis among Hispanics compared to other racial/ethnic groups. We performed a systematic review of the PubMed database for peer-reviewed articles published between January 2000 and September 2010. Primary outcomes included survival after HIV/AIDS diagnosis and delayed diagnoses. The definition of delayed diagnosis varied by study, ranging from concurrent HIV/AIDS diagnosis to diagnosis of AIDS within 3 years of HIV diagnosis. We found that Hispanics are at significantly greater risk for delayed diagnosis than non-Hispanic whites. Hispanic males and foreign-born Hispanics had the highest risk of late diagnosis. Available data on survival were heterogeneous, with better outcomes in some Hispanic subgroups than in others. Survival after antiretroviral initiation was similar between Hispanics and Whites. These findings emphasize the need for culturally-sensitive strategies to promote timely diagnosis of HIV infection among Hispanics and to examine the health outcomes and needs of high risk Hispanic subgroups.

Seroprevalence of herpes simplex virus 2 among Hispanics in the USA: National Health and Nutrition Examination Survey, 2007–2008

To examine the seroprevalence of herpes simplex virus type 2 (HSV-2) among Hispanics in the USA, we used the cross-sectional, nationally representative National Health and Nutrition Examination Survey to compare the seroprevalence of HSV-2 between Hispanic persons of Mexican heritage and non-Mexican heritage aged 14-44 years, from survey years 2007-2008. The overall HSV-2 seroprevalence among Hispanics aged 14-44 years was 17.5% (95% confidence interval [CI], 15.2, 20.1) in the USA. HSV-2 seroprevalence was significantly lower among Mexican Americans than among other Hispanics (11.7% vs. 27.8%, P < 0.01). Prevalence of HSV-2 was also significantly associated with gender and age. The significant difference in HSV-2 seroprevalence between Hispanic persons of Mexican heritage and non-Mexican heritage suggested that targeting specific subgroups of Hispanics for preventive interventions may be a strategy to reduce the transmission of HSV-2 and HIV among Hispanics in the USA.

Adherence to Physician Recommendation to Colorectal Cancer Screening Colonoscopy Among Hispanics

Colorectal cancer (CRC) is the second most commonly diagnosed cancer among Hispanics in the United States (US), yet the use of CRC screening is low in this population. Physician recommendation has consistently shown to improve CRC screening. To identify the characteristics of Hispanic patients who adhere or do not adhere to their physician's recommendation to have a screening colonoscopy. A cross-sectional study featuring face-to-face interviews by culturally matched interviewers was conducted in primary healthcare clinics and community centers in New York City. Four hundred Hispanic men and women aged 50 or older, at average risk for CRC, were interviewed. Two hundred and eighty (70%) reported receipt of a physician's recommendation for screening colonoscopy and are included in this study. Dependent variable: self report of having had screening colonoscopy. sociodemographics, healthcare and health promotion factors. Of the 280 participants, 25% did not adhere to their physician's recommendation. Factors found to be associated with non-adherence were younger age, being born in the US, preference for completing interviews in English, higher acculturation, and greater reported fear of colonoscopy testing. The source of colonoscopy recommendation (whether it came from their usual healthcare provider or not, and whether it occurred in a community or academic healthcare facility) for CRC screening was not associated with adherence. This study indicates that potentially identifiable subgroups of Hispanics may be less likely to follow their physician recommendation to have a screening colonoscopy and thus may decrease their likelihood of an early diagnosis and prompt treatment. Raising physicians' awareness to such patients' characteristics could help them anticipate patients who may be less adherent and who may need additional encouragement to undergo screening colonoscopy.

A flexible Bayesian hierarchical model of preterm birth risk among US Hispanic subgroups in relation to maternal nativity and education

BackgroundPrevious research has documented heterogeneity in the effects of maternal education on adverse birth outcomes by nativity and Hispanic subgroup in the United States. In this article, we considered the risk of preterm birth (PTB) using 9 years of vital statistics birth data from New York City. We employed finer categorizations of exposure than used previously and estimated the risk dose-response across the range of education by nativity and ethnicity.MethodsUsing Bayesian random effects logistic regression models with restricted quadratic spline terms for years of completed maternal education, we calculated and plotted the estimated posterior probabilities of PTB (gestational age < 37 weeks) for each year of education by ethnic and nativity subgroups adjusted for only maternal age, as well as with more extensive covariate adjustments. We then estimated the posterior risk difference between native and foreign born mothers by ethnicity over the continuous range of education exposures.ResultsThe risk of PTB varied substantially by education, nativity and ethnicity. Native born groups showed higher absolute risk of PTB and declining risk associated with higher levels of education beyond about 10 years, as did foreign-born Puerto Ricans. For most other foreign born groups, however, risk of PTB was flatter across the education range. For Mexicans, Central Americans, Dominicans, South Americans and "Others", the protective effect of foreign birth diminished progressively across the educational range. Only for Puerto Ricans was there no nativity advantage for the foreign born, although small numbers of foreign born Cubans limited precision of estimates for that group.ConclusionsUsing flexible Bayesian regression models with random effects allowed us to estimate absolute risks without strong modeling assumptions. Risk comparisons for any sub-groups at any exposure level were simple to calculate. Shrinkage of posterior estimates through the use of random effects allowed for finer categorization of exposures without restricting joint effects to follow a fixed parametric scale. Although foreign born Hispanic women with the least education appeared to generally have low risk, this seems likely to be a marker for unmeasured environmental and behavioral factors, rather than a causally protective effect of low education itself.

A flexible Bayesian hierarchical model of preterm birth risk among US Hispanic subgroups in relation to maternal nativity and education

A flexible Bayesian hierarchical model of preterm birth risk among US Hispanic subgroups in relation to maternal nativity and education

An inequality study of ambient nitrogen dioxide and traffic levels near elementary schools in the Tampa area

Environmental equity has been identified as a challenge and goal of national to global air quality management. Here, relationships between traffic-related air pollution measures and the social demographics of elementary schools are investigated. Ogawa passive samplers were used to measure ambient nitrogen dioxide (NO 2) levels near 75 randomly selected elementary schools in the county containing Tampa, FL over one week in March 2008. Concentrations were determined using colorimetric reaction using Hach nitrite reagent and photometric detection at 545 nm. NO 2 levels, two metrics of traffic (highest annual average daily traffic count within 500 m and 1000 m), and school enrollment data by demographic subgroup (racial/ethnic and socioeconomic) were then compared. Data were analyzed for distribution statistics, linear correlations, and differences in subgroup category means. Weighted average values of NO 2 and traffic count were also calculated for each subgroup. All measured NO 2 levels were low, with a mean of 2.7 ppbv and range from 0.8 to 4.7 ppbv. Values were largest at sites near downtown. Results from all analyses show comparatively higher potential exposures to measured NO 2 and traffic count for black school children, and lower values for white and Asian or Pacific Islander school children. The economically disadvantaged and Hispanic subgroups were also associated with higher levels of NO 2 and traffic counts, but the relationship was not as strong or robust. Although measured NO 2 levels were low and the differences between groups are small, results suggest disparities by racial/ethnic and economic status in children’s exposures to air pollution for the Tampa area.