Island Puerto Rican Research Articles

Cancer disparities between mainland and island Puerto Ricans

Examination of cancer rates in a single Hispanic subgroup-Puerto Ricans- and comparison of incidence rates among mainland Puerto Ricans living in the United States, island Puerto Ricans in Puerto Rico, and U.S. non-Hispanic whites to reveal ethnic-specific cancer patterns and disparities in Puerto Ricans. Incidence data were obtained from the cancer registries of Puerto Rico and three U.S. northeastern states (New York, New Jersey, and Connecticut) with a high density of mainland Puerto Ricans. Age-adjusted rates were compared by standardized rate ratios (SRRs). Total cancer incidence was the lowest in island Puerto Ricans, intermediate for mainland Puerto Ricans, and highest in U.S. non-Hispanic whites. Compared to mainland Puerto Ricans, islanders had significantly lower rates (p<0.05) for major cancers-lung (SRRs=0.36 in males and 0.29 in females), prostate (SRR=0.71), female breast (SRR=0.73), and colon-rectum (SRRs=0.74 in males and 0.65 in females)-as well as several less common cancers (urinary bladder; non-Hodgkin lymphoma; liver; kidney and renal pelvis; pancreas; thyroid; leukemia; and skin melanoma). Overall cancer rates in mainland Puerto Ricans were modestly lower than those in U.S. non-Hispanic whites, but mainland Puerto Ricans had the highest rates for stomach, liver, and cervical cancers among the three populations. Despite socioeconomic disadvantages, island Puerto Ricans have relatively low cancer incidence. Identifying contributing factors would be informative for cancer research, and understanding the reasons for increased cancer risk in their mainland counterparts would facilitate the development of ethnic-specific intervention programs.

Maternal Mental Health and Childhood Asthma among Puerto Rican Youth: The Role of Prenatal Smoking

Rationale. Childhood asthma is a major public health problem, with mainland and island Puerto Rican children having the highest asthma rates of any ethnic group in the United States. Objectives. To examine the relationship between maternal mental health problems, prenatal smoking, and risk of asthma among children in Puerto Rico and the Bronx, New York. Methods. A cross-sectional community-based study was conducted in the South Bronx in New York City and the San Juan Standard Metropolitan Area in Puerto Rico. Participants were Puerto Rican children 5 to 13 years of age and their adult caretakers with probability samples of children 5 to 13 years of age and their caregivers drawn at two sites: the South Bronx in New York City (n = 1,135) and San Juan and Caguas, Puerto Rico (n = 1,351). Measurements. Self-reported maternal mental health, prenatal smoking, and rates of childhood asthma. Results. Maternal mental health problems were associated with significantly higher levels of prenatal smoking, compared with that among women without mental health problems (p < 0.0001). Both maternal mental health problems and prenatal smoking appear to make a contribution to increased odds of asthma among youth. After adjusting for prenatal smoking, the relationship between maternal mental health problems and childhood asthma was no longer statistically significant. Conclusions. Previous research suggests children of Puerto Rican descent are especially vulnerable to asthma. Our results suggest that maternal mental health problems and prenatal smoking are both associated with increased odds of asthma among Puerto Rican youth and that prenatal smoking may partly explain the observed relationship between maternal psychopathology and childhood asthma. Future longitudinal and geographically diverse epidemiological studies may help to identify the role of both maternal mental health problems and prenatal smoking in the health disparities in childhood asthma.

The Reliability and Validity of a Spanish Translated Version of the Gifted Rating Scales

This study was a preliminary examination of the psychometric properties of a newly developed Spanish translated version of the Gifted Rating Scales-School Form (GRS-S). Data was collected from elementary and middle schools in northeastern Puerto Rico. Thirty teachers independently rated 153 students using the GRS-S Spanish Form. Results indicated strong internal consistency for teacher ratings with alphas ranging from .98 to .99. Intercorrelations between scales are moderate to strong, ranging from .88 to .97. Factor testing of two separate models supported a six factor model proposed by authors of the GRS-S. Results provided initial support for the GRS-S Spanish translated version as a reliable and potentially useful screening measure to assist in the identification of island Puerto Rican gifted students.

Incidence and Mortality Trends of Liver Cancer among Puerto Ricans, US Hispanics and Non-Hispanic US Population

Purpose: Hepatocellular carcinoma incidence rates vary greatly among different ethnic groups. Most of the information regarding the epidemiology of liver cancer in Hispanics is based on evaluation of databases in which there is negligible representation of island Puerto Ricans. The aim of this study was to assess the trends in the incidence and mortality rates of liver cancer in Puerto Ricans, United States (US) Hispanics and the US general population. Methods: We analyzed the databases of the Puerto Rico (PR) Cancer Registry, the US SEER 11, and the PR and US Vital Statistics for all cases of liver cancer diagnosed in the period 1992–2001. A trend analysis of the age-standardized liver cancer incidence/mortality rates (per 100,000) was performed using the direct method (Standard World Population 1960) from 1992–2001. Annual percent change (APC) was estimated with the Poisson model using as predictor year of diagnosis. Results: During the study period, Puerto Ricans and US Hispanics (US-H) showed the highest incidence and mortality trends for liver cancer. The incidence of liver cancer remained stable for Puerto Ricans (APC = 0.06%) yet rapidly increased in the US general population (APC = 4.0%) and US-H (APC = 3.73%). The incidence of liver cancer is increasing in all groups and sexes, except among Puerto Rican females who showed a decreasing incidence trend (APC = -1.99%). Puerto Ricans had the highest mortality rates from liver cancer for both sexes and across all age groups, despite exhibiting a decreasing trend during the study period (APC = -1.68). An increasing mortality trend was evident for both US (APC = 1.08) and US-H (APC = 1.14). Conclusion: Both US Hispanics and Puerto Ricans are disproportionately affected by liver cancer having a higher incidence and mortality rates, respectively, in comparison to the US general population. Further studies should explore the reasons for these ethnic disparities.

Health disparities between island and mainland Puerto Ricans

To detect health disparities among three populations--Puerto Ricans living in Puerto Rico as well as Puerto Ricans and non-Hispanic whites living on the United States (U.S.) mainland. Data from two similarly designed surveys conducted in 1999-2000 were analyzed. The Behavioral Risk Factor Surveillance System (BRFSS) provided data on Puerto Ricans living on the island and on non-Hispanic whites in the U.S. Another survey of Puerto Ricans living in New York City provided data on mainland Puerto Ricans. The age- and sex-standardized weighted prevalences of various health parameters (e.g., obesity, diabetes, smoking, and physical illness) and indicators of access to health care (e.g., frequencies of routine checkups and diabetes care) were compared between populations by means of standardized rate ratios (SRR). Puerto Ricans living on the mainland and those living on the island had a similar prevalence of obesity (21% to 22%). Compared with islanders, mainland Puerto Ricans had a higher prevalence of diabetes (SRR = 1.4; 95% confidence interval [95% CI] = 1.01 to 2.0); those with diabetes also showed higher prevalences of smoking (SRR = 4.2; 95% CI = 2.3 to 7.7) and physical illness (SRR = 1.5; 95% CI = 1.1 to 2.0) than Puerto Ricans living on the island. While mainland Puerto Ricans were similar to non-Hispanic whites in terms of their utilization of primary prevention and diabetes care, island Puerto Ricans trailed behind significantly. Puerto Ricans living on the U.S. mainland and those living in Puerto Rico both need to target lowering their prevalence of obesity and diabetes. For island Puerto Ricans, improved education about the significance of primary prevention and diabetes care is needed. For mainland Puerto Ricans, the accessibility of the primary health care system renders it a potentially effective venue for interventions, particularly for smoking cessation. More studies are warranted to identify factors associated with the poor health status observed in mainland Puerto Ricans.

What does skin color have to do with infant health? An analysis of low birth weight among mainland and island Puerto Ricans

This study investigates the relationship between maternal skin tone and low birth weight among Puerto Ricans, a group with a complex ancestry and skin tones that range from very light to very dark. Using data from a representative sample of Puerto Rican mothers, we assess whether skin tone has different implications for low birth weight in three geographic areas (Puerto Rico; New York City; other eastern states). The analysis shows that skin tone is unrelated to low birth weight in Puerto Rico and New York City. However, in the other eastern states in our sample, mothers with dark skin have a high risk of bearing a low birth-weight infant, relative to mothers with light skin. We interpret our findings in light of differences in the social meaning of phenotypic differences across locales.

Parental Mental Health, Childhood Psychiatric Disorders, and Asthma Attacks in Island Puerto Rican Youth

Previous research documents an association of poor parental mental health with asthma in children. This study aims to determine whether the associations between parental mental health problems and childhood asthma attacks persist after controlling for childhood anxiety and depression and other confounding factors. A community household sample of youth ages 4 to 17 years and their primary caregivers from the US Commonwealth of Puerto Rico was studied to determine the associations between parental mental health and childhood asthma attacks. Regression models that predicted asthma attacks in youth controlled for parental mental health problems, childhood anxiety and depression, zone of residence, and parents' age, education, and perception of poverty. After adjusting for children's depressive and anxiety disorders as well as other important confounders, associations between parental depression, suicide attempts, ataque de nervios, and history of mental health treatment and asthma attacks in offspring, by parental report, persisted. Additionally, the frequency of parental mental health problems was associated with children's asthma attacks. Parents with mental health problems were more likely to report histories of asthma attacks in their children compared with parents without mental health problems in Puerto Rico. These associations were not attributable to internalizing disorders in youth but persisted independent of childhood psychopathology and other confounding factors. Clinicians and researchers should recognize the relations between poor parental mental health and childhood asthma and explore the potential role of family psychosocial and behavioral factors related to the manifestation of the disease.

STUDENTJAMA. Faith-based treatment for addiction in Puerto Rico.

IN 1997 THE US DRUG ENFORCEMENT ADMINISTRATION IDENtified Puerto Rico as the Caribbean epicenter of illicit cocaine and heroin trade between Latin America and the United States and in 2001 designated it as a zone of high-intensity drug traffic. In 1998 a household-based survey of Puerto Rican adults aged 15 to 64 years found that 5.6% of the population was in need of substance abuse treatment. Furthermore, between 2000 and 2003, Puerto Rico’s drug-related homicide rate was 3 times the US average. At that time, the Puerto Rican legislature voted to define drug dependence as a spiritual and social problem, rather than simply a mental health disorder. The resolution reflected the high prevalence of faith-based programs for addiction treatment. Indeed, the Puerto Rican Mental Health and Anti-Addiction Services Administration found that as of 1998, faith-based residential addiction treatment centers comprised 75% of all state-registered drug treatment programs. This convergence of faith-based initiatives and drug treatment facilities has been due to a number of factors. As of January 2003, Puerto Rico had an unemployment rate twice the US median. Much of the illicit drug trade, such as sex work, is related to economic pressures. Concomitant with this trend over the past few decades, evangelical Protestant churches have risen to prominence in a region that historically has been dominated by Catholicism. In fact, one third of all island Puerto Ricans reportedly identify themselves as Protestant. Low-income, urban converts to evangelical Protestantism in Latin America often cite the church’s antialcohol and antidrug stance as a reason for their conversion. In an atmosphere of both active evangelism and drug trade, Puerto Rican addiction ministries have multiplied and claimed a professional niche as providers of faith-based residential addiction programs. Largely founded by ex-addicts who mirror mainland US Christian drug treatment models such as Teen Challenge, Puerto Rican addiction ministries offer peer and pastoral counseling, prayer, and bible study as methods toward recovery. In a review of ongoing drug abuse studies evaluating the interaction of social support systems with drug addiction among Hispanics, the authors reported that involvement with religious institutions had a significant impact on the drugusing behaviors of Hispanics. However, in a crosssectional survey from an Alcoholics Anonymous group in Los Angeles, several interventional models, some of which did not emphasize spirituality, were found to be equivalent in effectiveness. Despite their frequent lack of medication and clinical staff, faith-based ministries continue to thrive as a main option for drug addiction treatment, in part due to policies the Puerto Rican government has pursued in the last decade. Starting in 1994 the government began privatizing the health care system, causing most public addiction treatment programs and mental health centers to close. This compounded an existent problem of diminishing funds for drug abuse recovery in Puerto Rico, which has fewer subsidies for addiction treatment than any of the 50 US states. Residential programs that these ministries administer are actually underenrolled, while partial hospital and methadone maintenance programs are often overenrolled. This suggests that, despite continued growth in faith-based initiatives for addiction treatment, current levels still do not meet treatment demand.

Factor structure and construct validity of the Anxiety Sensitivity Index among island Puerto Ricans

The factor structure and convergent and discriminant validity of the Anxiety Sensitivity Index (ASI) were examined among a sample of 275 island Puerto Ricans. Results from a confirmatory factor analysis (CFA) comparing our data to factor solutions commonly reported as representative of European American and Spanish populations indicated a poor fit. A subsequent exploratory factor analysis (EFA) indicated that a two-factor solution (Factor 1, Anxiety Sensitivity; Factor 2, Emotional Concerns) provided the best fit. Correlations between the ASI and anxiety measures were moderately high providing evidence of convergent validity, while correlations between the ASI and BDI were significantly lower providing evidence of discriminant validity. Scores on all measures were positively correlated with acculturation, suggesting that those who ascribe to more traditional Hispanic culture report elevated anxiety.

Puerto Rican Abusive and Non-Abusive Mothers' Beliefs About Appropriate and Inappropriate Child Discipline

This article presents the findings of a study conducted with a purposive sample of 40 abusive and non-abusive island Puerto Rican mothers about their knowledge and use of disciplinary practices. The mothers were interviewed using open-ended questions and vignettes. The questions required them to identify the behavior problems they most frequently confronted in their children; their knowledge of different disciplinary practices; and their assessment of the appropriateness or inappropriateness of child disciplinary practices. Mothers were then presented with the ten vignettes and asked to respond to the following questions: (1) How do you think each of these described situations should be managed? (2) Have you ever confronted such a problem? and (3) If so, how did you handle it? Both abusive and non-abusive mothers knew and used a wide repertoire of disciplinary practices that combined verbal-rational and punitive-controlling methods. Differences between abusive and non-abusive mothers were noted with more abusive mothers experiencing stressful socioeconomic conditions, confronting problems with their children, and more frequently, recommending and using punishments. Discussion addresses hypotheses for further research and recommendations for social work practitioners.

Association of psychiatric disorders and different indicators of asthma in island Puerto Rican children.

We examined the relationship between three different indicators of childhood asthma (asthma diagnosis, ever had an asthma attack, and asthma hospitalization) and having any psychiatric disorder, comorbid disorders, or specific disorders. Three study hypotheses were examined: 1) there will be subject variability in responses to the asthma indicators; 2) there will be different observed associations between the three asthma indicators and psychiatric disorders; and 3) maternal mental health, family income, and maternal education will confound the associations between childhood asthma and psychiatric disorders. Data were drawn from a community-based, random sample of 1,891 island Puerto Rican children aged 4-17 years. Information was collected through direct interview with children and adolescents and their primary caretakers. The Diagnostic Interview Schedule for Children (DISC) was used to determine DSM-IV diagnoses. Thirty-two percent of the children had been diagnosed with asthma but only 22 % had ever experienced an asthma attack. Seventeen percent of the children had been hospitalized for asthma. Having been hospitalized for asthma was not associated with any of the psychiatric disorders, having a diagnosis was associated with some of the disorders, and having experienced an asthma attack was associated with almost all the disorders, after controlling for family income and maternal education and mental health. Determining and measuring asthma may be difficult because of confusion and differing perceptions of what constitutes asthma or an asthma attack. Future studies should consider the problems in capturing perceptions of asthma and severity in Puerto Rican children and should continue to explore the relationship between asthma and mental illness.

White, Black, or Puerto Rican? Racial Self-Identification among Mainland and Island Puerto Ricans

Recent studies have examined the implications of exposure to U.S. race relations for the racial and ethnic identities of migrants to the U.S. Most investigations are based exclusively on U.S. data. There are few, if any, comparisons of the identities of migrants and their offspring to those of nonmigrants in their country of origin. Using data from a survey of Puerto Rican mothers in the U.S. and Puerto Rico, this study provides such a comparison. Responses to an open-ended race question show that mainland and island Puerto Ricans most often designate their race as Puerto Rican, but responses of women who do not self-identify as Puerto Rican diverge between the U.S. and Puerto Rico. Island women primarily identify themselves as white, black, or triguena, while mainland women identify themselves as Hispanic/Latina, Hispanic American, or American. Mainland-island differences cannot be explained by parental ethnicity, skin tone, demographic factors, and socioeconomic status. The findings suggest that mainland Puerto Ricans more strongly reject the conventional U.S. notion of race than do their island counterparts.

Self-reliance, mental health need, and the use of mental healthcare among island Puerto Ricans.

This paper examines the relationship between self-reliance (preference to solve emotional problems on one's own) and 5 mental healthcare utilization outcomes for Puerto Ricans living in low-income areas. A random probability community sample of noninstitutionalized Puerto Ricans, ages 18-69, living in low-income areas of the island were selected and interviewed in 1992-93 and 1993-94. A series of logistic regression models tested the association between self-reliance and 5 mental health utilization measures, after adjusting for covariates measuring predisposing, enabling, need and barrier factors: any use of mental health services, any use of general health services for mental healthcare, any use of specialty care, use of psychotropic medications, and retention in mental healthcare. Self-reliance was found to be negatively associated with all 5 dependent service utilization measures. Those with a positive self-reliant attitude were 40% less likely to use care on any of the 5 outcome measures. An interaction was also observed between definite need for mental healthcare and having a self-reliant attitude when predicting mental health service use. Definite needers with a self-reliant attitude were 54%-58% less likely to use mental health services compared with definite needers who did not have a self-reliant attitude. Further, decreases in self-reliant attitude over the two data collection periods were associated with increases in mental health service use. Our findings suggest that self-reliance is a significant and robust predictor of mental healthcare utilization among Puerto Ricans living in low-income areas of the island.

RESIDENTIAL STATUS AND HIV RISK BEHAVIORS AMONG PUERTO RICAN DRUG INJECTORS IN NEW YORK AND PUERTO RICO*

This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p <. 001), and more New York IDUs lived in their own home (30% vs. 14%, p <. 001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.

From austerity to prosperity? Migration and child poverty among mainland and island Puerto Ricans

Analyses of migrants' economic circumstances typically use the native-born in the destination as a comparison group. We use the 1990 Census Public Use Microdata Samples for the United States and Puerto Rico to demonstrate the benefits of a comparative approach that includes data from both the origin and the destination. Specifically, the primary objective is to determine how and why the risk of child poverty is associated with migration from Puerto Rico to the United States. The results show that migration reduces the risk of child poverty, partly because better jobs are available on the mainland. Employment, human capital, family structure, and public assistance cannot completely explain observed differences. The results also show that the economic benefits of migration continue for the native-born on the mainland and that return migration to Puerto Rico is associated with impoverishment.

The pragmatics and perceptions of multicultural Puerto Ricans

Integrating natural observation, interviews, and quantitative analysis, this study used a recursive research approach to compare the sociolinguistic judgments of four groups: 38 Puerto Ricans who were encultured on the US mainland, 38 return migrants to Puerto Rico, 161 Americans encultured in the Greater New York metropolitan area (continental Americans), and 86 bilingual Puerto Ricans encultured on the island of Puerto Rico (island Puerto Ricans). These participants evaluated alternative sociolinguistic strategies to critical incidents presented in English. Four alternative responses to five critical incidents were surveyed (20 responses in all). Discriminant analysis of group judgments on three subscales (evaluation, social cooperation, and dynamism) showed that while the participants had much in common, there were significant differences and surprising similarities on one or more subscales for 17 of the 20 alternate responses to the critical incidents. Bilingual-bicultural experts and group members interpreted the data in open-ended interviews; analysis of the interview transcripts revealed both subtle and striking differences in the norms and values underlying sociolinguistic behavior in one or another community. Mainland and migrant Puerto Ricans were surprisingly alike in their judgments, which in the majority of cases were more like those of Island Puerto Ricans than of continental Americans. Nevertheless, differences revealed possibilities for misunderstandings with mainland and migrant Puerto Ricans in their interactions with both continental Americans and island Puerto Ricans. Areas identified with the potential for sociopragmatic failure included obligations to strangers, the categorization of truth and lies, the use of time in caring for others, approaches to conflict resolution, and balancing social responsibilities

Island Puerto Rican and Continental American Responses to Critical Incidents: An Intercultural Study of Language, Norms, and Values

Island Puerto Rican and Continental American Responses to Critical Incidents: An Intercultural Study of Language, Norms, and Values

Culture and Class Influences on Anglo and Puerto Rican Mothers' Beliefs Regarding Long-Term Socialization Goals and Child Behavior

These 2 studies examine culture and socioeconomic status as simultaneous possible sources for group differences in mothers' beliefs regarding desirable and undesirable long-term socialization goals and child behavior. In Study 1, 100 mothers of young toddlers aged 12-24 months from 5 sociocultural groups participated: middle- and lower-class Anglo, middle- and lower-class island Puerto Rican, and lower-class migrant Puerto Rican. Results indicate that culture and socioeconomic status contribute independently to group differences, but that cultural effects appear to be stronger. Study 2 examined cultural differences in perceptions of behaviors using middle-class Anglo and Puerto Rican mothers only. The findings support those of Study 1, suggesting that Anglo and Puerto Rican mothers place differential value on the constructs of Self-Maximization and Proper Demeanor, even when socioeconomic status is controlled for. The findings of these studies have important implications for the culturally sensitive study of the relation between parental beliefs and behaviors.

Mental health status among Puerto Ricans, Mexican Americans, and Non‐Hispanic whites

Compared mental health characteristics of island Puerto Ricans to three groups from the Los Angeles Epidemiologic Catchment Area Study: Mexican American immigrants, U.S.-born Mexican Americans, and Non-Hispanic whites. The Diagnostic Interview Schedule was used to obtain both diagnostic and symptom scale information about affective disorders, alcohol abuse/dependence, somatization, phobic disorder, and psychotic disorder. Mexican American immigrants had the fewest mental health problems of all groups. Puerto Ricans had more somatization disorder, but less affective and alcohol disorders than U.S.-born Mexican Americans or non-Hispanic whites. Results are considered in the light of selection factors, relative disadvantage of groups and methodological problems.

Mental health status among Puerto Ricans, Mexican Americans, and Non-Hispanic whites

Compared mental health characteristics of island Puerto Ricans to three groups from the Los Angeles Epidemiologic Catchment Area Study: Mexican American immigrants, U.S.-born Mexican Americans, and Non-Hispanic whites. The Diagnostic Interview Schedule was used to obtain both diagnostic and symptom scale information about affective disorders, alcohol abuse/dependence, somatization, phobic disorder, and psychotic disorder. Mexican American immigrants had the fewest mental health problems of all groups. Puerto Ricans had more somatization disorder, but less affective and alcohol disorders than U.S-born Mexican Americans or non-Hispanic whites. Results are considered in the light of selection factors, relative disadvantage of groups and methodological problems.