Low-income Hispanic Women Research Articles

Exploration of Latina/Hispanic women’s experiences living with non-alcoholic fatty liver disease: a qualitative study with patients in Houston

ObjectivesA deeper understanding of the lived experiences of Hispanic patients with non-alcoholic fatty liver disease (NAFLD) can help guide the development of behavioural programmes that facilitate NAFLD management. This paper...

A Brief, Telephone-Administered Food Frequency Questionnaire Can Be Useful for Surveillance of Dietary Fat Intakes

A 13-item questionnaire designed for quick telephone administration was evaluated for use in surveillance of fat intake in the United States. Study populations included 560 middle-aged and older adults from Beaver Dam, WI, 252 middle-aged and older women from Wisconsin, 73 young, low income Hispanic women from Chicago, IL, 52 older adults from Arizona and 135 younger adults from Augusta, GA. Correlations between fat scores and fat intakes measured by multiple food records or recalls or by more extensive food frequency questionnaires ranged from 0.33 to 0.60, similar to results from other published questionnaire validation studies. Correlations with percentage of energy from fat were lower (0.26 to 0.42), except for the Chicago population, for which there was no correlation (-0.02). There was no systematic variation in correlations among other subgroups defined by demographic and health-related characteristics, including race (black vs. white). Most, but not all, of the substantial differences in fat intakes among subgroups were identified by the questionnaire. The questionnaire will not capture small differences in intakes among groups and is inappropriate when the sample size is limited or for populations with diets substantially different from the typical U.S. diets, such as the Chicago population. However, with attention to its limitations, the questionnaire is useful for surveillance.

Depression, perceived stress, and distress during pregnancy and EV-associated miRNA profiles in MADRES

BackgroundMicroRNA (miRNA) circulating in plasma has been proposed as biomarkers for a variety of diseases and stress measures, including depression, stress, and trauma. However, few studies have examined the relationship between stress and miRNA during pregnancy. MethodsIn this study, we examined associations between measures of stress and depression during pregnancy with miRNA in early and late pregnancy from the MADRES cohort of primarily low-income Hispanic women based in Los Angeles, California. Extracellular-vesicle- (EV-) associated miRNA were isolated from maternal plasma and quantified using the Nanostring nCounter platform. Correlations for stress-associated miRNA were also calculated for 89 matching cord blood samples. ResultsFifty miRNA were nominally associated with depression, perceived stress, and prenatal distress (raw p < 0.05) with 17 miRNA shared between two or more stress measures. Two miRNA (miR-150-5p and miR-148b-3p) remained marginally significant after FDR adjustment (p < 0.10). Fifteen PANTHER pathways were enriched for predicted gene targets of the 50 miRNA associated with stress. Clusters of maternal and neonate miRNA expression suggest a link between maternal and child profiles. LimitationsThe study evaluated 142 miRNA and was not an exhaustive analysis of all discovered miRNA. Evaluations for stress, depression and trauma were based on self-reported instruments, rather than diagnostic tools. ConclusionsDepression and stress during pregnancy are associated with some circulating EV miRNA. Given that EV miRNA play important roles in maternal-fetal communication, this may have downstream consequences for maternal and child health, and underscore the importance of addressing mental health during pregnancy, especially in health disparities populations.

Association Between Ambient Air Pollution and Birth Weight by Maternal Individual- and Neighborhood-Level Stressors

Fetal growth is precisely programmed and could be interrupted by environmental exposures during specific times during pregnancy. Insights on potential sensitive windows of air pollution exposure in association with birth weight are needed. To examine the association of sensitive windows of ambient air pollution exposure with birth weight and heterogeneity by individual- and neighborhood-level stressors. Data on a cohort of low-income Hispanic women with singleton term pregnancy were collected from 2015 to 2021 in the ongoing Maternal and Developmental Risks from Environmental and Social Stressors cohort in Los Angeles, California. Daily ambient particulate matter with aerodynamic diameter less than 10 μm (PM10) and aerodynamic diameter less than 2.5 μm (PM2.5), nitrogen dioxide (NO2), and 8-hour maximum ozone were assigned to residential locations. Weekly averages from 12 weeks before conception to 36 gestational weeks were calculated. Individual-level psychological stressor was measured by the Perceived Stress Scale. Neighborhood-level stressor was measured by the CalEnviroScreen 4.0. Sex-specific birth weight for gestational age z score (BWZ). The associations between air pollutant and BWZ were estimated using distributed lag models to identify sensitive windows of exposure, adjusting for maternal and meteorologic factors. We stratified the analyses by Perceived Stress Scale and CalEnviroScreen 4.0. We converted the effect size estimation in BWZ to grams to facilitate interpretation. The study included 628 pregnant women (mean [SD] age, 22.18 [5.92] years) and their newborns (mean [SD] BWZ, -0.08 [1.03]). On average, an interquartile range (IQR) increase in PM2.5 exposure during 4 to 22 gestational weeks was associated with a -9.5 g (95% CI, -10.4 to -8.6 g) change in birth weight. In stratified models, PM2.5 from 4 to 24 gestational weeks was associated with a -34.0 g (95% CI, -35.7 to -32.4 g) change in birth weight and PM10 from 9 to 14 gestational weeks was associated with a -39.4 g (95% CI, -45.4 to -33.4) change in birth weight in the subgroup with high Perceived Stress Scale and high CalEnviroScreen 4.0 scores. In this same group, NO2 from 9 to 14 gestational weeks was associated with a -40.4 g (95% CI, -47.4 to -33.3 g) change in birth weight and, from 33 to 36 gestational weeks, a -117.6 g (95% CI, -125.3 to -83.7 g) change in birth weight. Generally, there were no significant preconception windows for any air pollutants or ozone exposure with birth weight. In this cohort study, early pregnancy to midpregnancy exposures to PM2.5, PM10, and NO2 were associated with lower birth weight, particularly for mothers experiencing higher perceived stress and living in a neighborhood with a high level of stressors from environmental pollution.

Extracellular vesicle-enriched miRNA profiles across pregnancy in the MADRES cohort.

MicroRNA (miRNA) circulating in plasma have been proposed as biomarkers for a variety of conditions and diseases, including complications during pregnancy. During pregnancy, about 15–25% of maternal plasma exosomes, a small size-class of EVs, are hypothesized to originate in the placenta, and may play a role in communication between the fetus and mother. However, few studies have addressed changes in miRNA over the course of pregnancy with repeated measures, nor focused on diverse populations. We describe changes in miRNA in early and late pregnancy from the MADRES cohort of primarily low-income Hispanic women based in Los Angeles, CA. miRNA derived from extracellular-vesicles (EVs) were isolated from maternal blood plasma samples collected in early and late pregnancy. In this study, we identified 64 of 130 detectable miRNA which significantly increased with gestational age at the time of collection (GA), and 26 which decreased with GA. Possible fetal sex-specific associations were observed for 30 of these 90 significant miRNA. Predicted gene targets for miRNA significantly associated with GA were identified using MirDIP and were found to be enriched for Gene Ontology categories that included energetic and metabolic processes but were underrepresented in immune-related categories. Circulating EV-associated miRNA during pregnancy are likely important for maternal-fetal communication, and may play roles in supporting and maintaining a healthy pregnancy, given the changing needs of the fetus.

Lessons Learned From a Program to Reduce Diabetes Risk Among Low-Income Hispanic Women in a Community Health Clinic.

BackgroundThe Diabetes Prevention Program (DPP) and Look AHEAD studies demonstrated that modest weight loss and increased physical activity can significantly reduce the incidence of diabetes among overweight individuals with prediabetes. However, these studies involved costly interventions, all of which are beyond the reach of most real-world settings serving high-risk, low-income populations. Our project, De Por Vida, implemented a diabetes risk-reduction intervention for Hispanic women in a Federally Qualified Health Center and assessed the program’s efficacy. This report describes the methodology used to develop and implement De Por Vida, the cultural adaptations made, the community–academic partnership formed to carry out this program, and the barriers and challenges encountered through the implementation process.MethodsOur goal was to translate the DPP and Look AHEAD programs into an intervention to prevent diabetes and reduce diabetes complications among high-risk Hispanic women at a federally qualified health center in Hillsboro, Oregon, where more than half of clinic patients are Spanish-speaking, and nearly all live in poverty. This randomized clinical trial targeted overweight Spanish-speaking women at risk for, or diagnosed with, type 2 diabetes. We developed a 12-month behavioral diabetes risk-reduction intervention that was responsive to the cultural practices of the Hispanic population and that could be implemented in low-income clinical settings. Study planning and implementation involved close collaboration among the clinic leadership, a research team from the Kaiser Permanente Center for Health Research, and Arizona State University.DiscussionCreating a fully informed partnership between research and clinical institutions is the first step in successful cooperative research projects. The adoption of a bidirectional, rather than a top-down, approach to communication between researchers and health-care providers, and between clinic management and the clinic frontline staff, gave the research study team crucial information about barriers, constraints, and needs that clinic staff experienced in implementing the program. This allowed clinic management and front-line clinic staff to play an active role in study implementation, identifying problem areas, and collaborating in finding practical solutions.Clinical Trial Registration www.clinicaltrials.gov, NCT03113916.

A Quality Improvement Initiative: Improving Mammogram Screening Rates Among Low-income Hispanic Women in Primary Care.

Low-income women of predominantly Hispanic ethnicity between the ages of 50-74 who receive primary care services in a South Texas region experienced a 12% disparity gap for women completing a screening mammogram in the last 2 years when compared to Hispanic women nationally. The purpose of this quality improvement (QI) initiative is to design and implement interdisciplinary evidence-based interventions to improve the screening mammogram completion rates in a primary care clinical setting. Following a systematic review and selection of two evidence-based breast cancer risk screening tools, a pre-post intervention was conducted. The Knowledge-to-Action (KTA) framework was used to train staff and providers to implement the screening tools. The Breast Cancer Risk Assessment Tool (BCRAT) and the National Health Interview Survey (NHIS) provided triggers for initiating a screening mammogram. Evidence-based screenings triggered mammogram initiation resulting in a 7.21% improvement in screening mammogram completion rates over a 3-month time period. The outcomes discussed in this report provide guidance for new policy considerations and clinical protocol initiatives along with processes to improve mammogram completion rates.

Predictors of Gestational Weight Gain in a Low-Income Hispanic Population: Sociodemographic Characteristics, Health Behaviors, and Psychosocial Stressors.

Hispanic women have a higher prevalence of weight associated complications in pregnancy. This ethnic disparity is likely related to behavior patterns, social circumstances, environmental exposures, and access to healthcare, rather than biologic differences. The objective was to determine associations between sociodemographic characteristics, health behaviors, and psychosocial stressors and gestational weight gain (GWG) in low-income Hispanic women. During pregnancy, information on sociodemographic characteristics, health behaviors, and psychosocial stressors were collected. Linear regression estimated mean differences in GWG by selected predictors. Multinomial logistic regression estimated odds of inadequate and excessive GWG by selected predictors. Five-hundred and eight women were included, 38% had inadequate and 28% had excessive GWG; 57% with a normal pre-pregnancy BMI had inadequate GWG. Compared to women with normal BMI, women with overweight or obesity were more likely to have excessive GWG (aRRR = 1.88, 95% CI: 1.04, 3.40 and aRRR = 1.98, 95% CI: 1.08, 3.62, respectively). Mean total GWG was higher among women who were nulliparous (ß = 1.34 kg, 95% CI: 0.38, 2.29) and those who engaged in ≥3 h of screen time daily (ß = 0.98 kg, 95% CI: 0.02, 1.94), and lower among women who were physically active during pregnancy (ß = −1.00 kg, 95% CI: −1.99, −0.03). Eating breakfast daily was associated with lower risk of inadequate GWG (aRRR = 0.47, 95% CI: 0.26, 0.83). Depressive symptoms and poor adherence to dietary recommendations were prevalent, but none of the psychosocial or dietary variables were associated with GWG. In this cohort of primarily immigrant, low-income, Hispanic women, there were high rates of poor adherence to diet and physical activity recommendations, and a majority of women did not meet GWG guidelines. Modifiable health behaviors were associated with GWG, and their promotion should be included in prenatal care.

Total and trimester-specific gestational weight gain and infant anthropometric outcomes at birth and 6months in low-income Hispanic families.

To describe total and trimester-specific gestational weight gain (GWG) among low-income Hispanic women and determine whether these GWG exposures are associated with infant anthropometric outcomes at birth and 6months. Data were from 448 mother-infant pairs enrolled in the Starting Early child obesity prevention trial. Prenatal weights were used to calculate total GWG and 2nd and 3rd trimester GWG rates (kg/week) and categorized as inadequate, adequate, and excessive according to the 2009 Institute of Medicine recommendations. Multivariable linear and modified Poisson regressions estimated associations of infant anthropometric outcomes (birthweight, small-for-gestational age [SGA], large-for-gestational age [LGA], rapid weight gain, and weight-for-age, length-for-age, and weight-for-length z-scores at 6months) with GWG categories. For total GWG, 39% and 27% of women had inadequate and excessive GWG, respectively. 57% and 46% had excessive GWG rates in the 2nd and 3rd trimesters, respectively, with 29% having excessive rates in both trimesters. Inadequate total GWG was associated with lower infant weight and length outcomes (ß range for z-scores=-0.21 to -0.46, p<0.05) and lower risk of LGA (adjusted Relative Risk, aRR=0.38; 95% confidence intervals, CI: 0.16, 0.95) and rapid weight gain (aRR=0.72; 95%CI: 0.51, 1.00). GWG rates above recommendations in the 2nd trimester or 2nd /3rd trimesters were associated with greater weight outcomes at birth and 6months (ß range for z-scores=0.24 to 0.35, p<0.05). Counseling women about health behaviors and closely monitoring GWG beginning in early pregnancy is necessary, particularly among populations at high-risk of obesity.

Personal PM2.5 Air Pollution Exposure and Mobility Patterns in Pregnant, Low Income Hispanic Women in Madres

Personal PM2.5 Air Pollution Exposure and Mobility Patterns in Pregnant, Low Income Hispanic Women in Madres

Hereditary Breast Cancer Risk Analysis in Uninsured Mexican-Origin Women Living in the U.S.-Mexico Border Region.

This article describes the risk of hereditary breast cancer (HBC) in low-income Hispanic women living on the U.S.-Mexico border using the Pedigree Assessment Tool (PAT). The PAT was administered as part of the El Paso and Hudspeth County Breast Cancer Education, Screening and NavigaTion program (BEST). Baseline data (n = 1,966) from this program was used to analyze risk factors for HBC. Analysis was conducted to determine significant covariates associated with the presence of any PAT risk factors. The PAT identified 17% (95% CI [15%, 19%]) of the women in the study as having some risk of HBC. Having had a mammogram within 3 years was significantly associated with having any PAT risk factors (odds ratio [OR] = 1.79, p = .006). Women who immigrated to the United States during childbearing age (OR = 0.610, p = .009) or during peri/menopause (OR = 0.637, p = .024) were significantly less likely to have any PAT risk factors. The PAT instrument detected a substantial pool of women who may be at risk for HBC. A significant proportion of these women were not up to date mammogram. The PAT is an effective tool to identify women at risk for HBC and encourage regular screening.

Correlates of Prenatal Diet Quality in Low-Income Hispanic Women

BackgroundLow-income Hispanic women are at-risk of poor prenatal diet quality. Correlates associated with prenatal diet quality in this group of women are understudied. ObjectiveThe objective of this study was to examine the associations between financial, cultural, psychosocial, and lifestyle correlates and prenatal diet quality in low-income Hispanic women. DesignThis cross-sectional analysis used data from pregnant women enrolled in the Starting Early Trial, a randomized-controlled trial of a primary-care based child obesity prevention program beginning in pregnancy. The trial enrolled women from clinics affiliated with a large urban medical center in New York City from 2012 to 2014. Financial, cultural, psychosocial, and lifestyle variables were collected using a comprehensive baseline questionnaire. Usual dietary intakes over the past year were assessed using the Block Food Frequency Questionnaire 2005 bilingual version. ParticipantsThe study enrolled low-income Hispanic women between 28 and 32 gestational weeks (N=519). Main outcome measuresPrenatal diet quality was measured by the Healthy Eating Index 2015. Statistical analyses performedUnadjusted and adjusted multivariable linear regression analyses were performed to determine independent associations between financial, cultural, psychosocial, and lifestyle correlates and Healthy Eating Index 2015 total score. ResultsOverall prenatal diet quality was poor (mean Healthy Eating Index 2015 total score=69.0±9.4). Most women did not meet the maximum score for total vegetables (65.3%), whole grains (97.1%), dairy (74.8%), fatty acids (84.4%), refined grains (79.8%), sodium (97.5%), saturated fats (92.9%), and added sugars (66.5%). Women who reported screen time ≤2 hours/day, physical activity before and/or during pregnancy, and being born outside the United States had higher mean Healthy Eating Index 2015 total score than women with screen time >2 hours/day, no physical activity, and those born in the United States. ConclusionsPrenatal diet quality of low-income pregnant Hispanic women was suboptimal. This cross-sectional study revealed associations between cultural and lifestyle factors and prenatal diet quality in low-income Hispanic women. Longitudinal studies are needed to determine long-term influences and specific behaviors to target for effective intervention studies.

Within-subject effects of environmental and social stressors on pre- and post-partum obesity-related biobehavioral responses in low-income Hispanic women: protocol of an intensive longitudinal study

BackgroundDisproportionately high rates of maternal overweight and obesity among the Hispanic population before, during, and after pregnancy pose serious health concerns for both mothers (e.g., preeclampsia, gestational diabetes, weight retention) and children (e.g., elevated lifelong obesity risk). A growing body of evidence implicates environmental exposures (e.g., air pollution, metals) and social stressors (e.g., poverty, violence) in contributing to obesity-related biobehavioral processes, such as physical activity, dietary intake, perceived stress, and cortisol regulation. However, current understanding of the role of environmental exposures and social stressors on obesity-related biobehavioral processes is limited by infrequent, inter-individual measurement, and lack of personal exposure monitoring.MethodsThe “Maternal and Developmental Risks from Environmental and Social Stressors” (MADRES) real-time and personal sampling study examines the within-subject day-level effects of environmental and social stressors on maternal pre- and post-partum obesity-related biobehavioral responses. Among a cohort of 65 low-income, Hispanic women in urban Los Angeles, this study uses innovative personal, real-time data capture strategies (e.g., ecological momentary assessment [EMA], personal exposure monitoring, geolocation monitoring, accelerometry) to repeatedly assess obesity-related processes during the 1st and 3rd trimester, and at 4–6 months postpartum. Day-level effects of environmental exposures and social stressors on women’s physical activity, diet, perceived stress and salivary cortisol measured across repeated days will be tested using multilevel modeling.DiscussionHispanic women of childbearing age bear a disproportionately high burden of obesity, and this population is also unduly exposed to numerous obesogenic settings. By using innovative real-time data capture strategies, the current study will uncover the daily impacts of environmental and social stressor exposures on women’s obesity-related biobehavioral responses, which over time can lead to excessive gestational weight gain, postpartum weight retention and can pose serious consequences for both mother and child. Findings from the real-time and personal sampling study will identify key mechanistic targets for policy, clinical, and programmatic interventions, with the potential for broad-reaching public health impacts.

Assessment of Technology Use and Technology Preferences for HIV Prevention Among Hispanic Women.

HIV transmission presents an ongoing risk to Hispanic women, and prevention efforts remain a priority. The use of technology to prevent HIV transmission among Hispanic women and those of lower socioeconomic status underscore the need for effective implementation of technology. The purpose of this study is to describe technology preferences and predictors of the use of the internet for HIV prevention among low-income Hispanic women. A secondary analysis was conducted using baseline data from an intervention to prevent HIV among 320 Hispanic women. The parent study was SEPA, Salud (health), Educación (education), Promoción (promotion), y [and] Autocuidado (self-care). Most participants reported using personal technology, such as smartphones (90.6%), the internet (78.1%), and personal email (67.5%), every day. Most (71.3%) participants were open to learning about HIV education via the internet. In the logistic regression analysis, education and time since the last visit to the health care provider were significant predictors of the use of the internet to learn about HIV prevention, after controlling for age, living with the partner, and years living in the United States. Hispanic women demonstrated high levels of comfort with different forms of technology. These results indicated the potential to expand future HIV intervention efforts by implementing electronic dissemination of bilingual and culturally appropriate information for Hispanic women of diverse ages.

Self-reported Health Predicts Hispanic Women's Weight Perceptions and Concerns.

Objectives In this study, we examined how self-reported health is related to low-income, Hispanic women's underestimation and concerns of weight status. Methods Seventy Hispanic women from Houston-area community centers reported their perceptions and concerns about their weight and health. Height and weight were measured to calculate body mass index. Cross-tabulations and Cohen's kappa determined agreement between women's perception of their weight status and measured weight status. Covariate-adjusted OLS regression models analyzed the association between women's self-reported health as a predictor of weight underestimation and concerns about becoming overweight. Results Forty-three percent of women misperceived their weight status [37% (N = 26) underestimated; 6% (N = 4) overestimated]. Overweight and obese women who reported their health as poor had 84% lower odds of underestimating their weight. Women who reported their health as poor health had 52% lower odds of being concerned about becoming overweight. Conclusions Self-reported poor health predicts perceptions of weight and concerns about future weight gain among low-income Hispanic women. Assessing patients' self-reported health status will allow practitioners to identify who may be at risk for underestimating their weight and being unconcerned about becoming overweight. This knowledge may help practitioners identify patients who would benefit from health education.

Role of Race/Ethnicity, Language, and Insurance in Use of Cervical Cancer Prevention Services Among Low-Income Hispanic Women, 2009-2013.

IntroductionHispanic women in the United States have an elevated risk of cervical cancer, but the existing literature does not reveal why this disparity persists.MethodsWe performed a retrospective cohort analysis of 17,828 low-income women aged 21 to 64 years seeking care at Oregon community health centers served by a hosted, linked electronic health record during 2009 through 2013. We assessed the odds of having had Papanicolaou (Pap) tests and receiving human papillomavirus (HPV) vaccine, by race/ethnicity, insurance status, and language.ResultsHispanic women, regardless of pregnancy status or insurance, had greater odds of having had Pap tests than non-Hispanic white women during the study period. English-preferring Hispanic women had higher odds of having had Pap tests than Spanish-preferring Hispanic women (OR, 2.08; 95% confidence interval [CI], 1.63–2.66) but lower odds of having received HPV vaccination (OR, 0.21; 95% CI, 0.12–0.38). Uninsured patients, regardless of race/ethnicity, had lower odds of HPV vaccine initiation than insured patients did. Once a single dose was received, there were no significant racial/ethnic differences in vaccine series completion.ConclusionIn this sample of low-income women seeking care at Oregon community health centers, we found minimal racial/ethnic disparities in the receipt of cervical cancer prevention services. Inequities by insurance status, especially in the receipt of HPV vaccine, persist. Community health center–based care may be a useful model to address racial/ethnic disparities in prevention, but this model would need further population-wide study.

Acculturation Influences Postpartum Eating, Activity, and Weight Retention in Low-Income Hispanic Women.

Low-income Hispanic women experience elevated rates of high postpartum weight retention (PPWR), which is an independent risk factor for lifetime obesity. Sociocultural factors might play an important role among Hispanic women; however, very few studies have examined this association. The purpose of our study was to examine the associations between acculturation and maternal diet, physical activity, and PPWR. This is a cross-sectional study of baseline data from 282 Hispanic women participating in the FitMoms/Mamás Activas study, a randomized controlled trial examining the impact of primarily an internet-based weight control program, in reducing PPWR among low-income women. We performed multivariable linear regression to examine the association of acculturation with diet quality, physical activity, and PPWR at study entry. A total of 213 (76%) women had acculturation scores reflecting Mexican orientation or bicultural orientation, whereas 69 (24%) had scores that represented assimilation to Anglo culture. Women who were more acculturated had lower intakes of fruits and vegetables, lower HEI scores, and lower physical activity levels than women who were less acculturated (p < 0.05). We found an association between acculturation and PPWR in that for every 1-unit increase in acculturation score, PPWR increased, on average, by 0.80 kg. Higher acculturation was associated with poorer diet and physical activity behaviors and greater PPWR.

Feasibility and acceptability of a Mediterranean-style diet intervention to reduce cardiovascular risk for low income Hispanic American women

ABSTRACTObjective: Evidence for the cardioprotective effects of a Mediterranean-style (Med-style) diet is strong, however few Med-style dietary interventions have been developed for and tested among Hispanic Americans (HAs), especially younger HAs of reproductive age whose dietary habits may strongly influence dietary intake for all family members.Design: We adapted a previously tested and evidence-informed lifestyle intervention to reduce CVD risk and evaluated its feasibility, acceptability, and effects on self-reported lifestyle behaviors in this study enrolling low-income HA women attending a Title X family planning clinic in eastern North Carolina. The 3-month long intervention, given to all participants, promoted a Med-style dietary pattern with a focus on increasing consumption of foods commonly consumed by HA that have high quality dietary fats (polyunsaturated and monounsaturated fats primarily from plant sources and fish) and carbohydrates (fruits, vegetables, and whole grains). The intervention also recommended increasing physical activity and was given during 2 face-to-face counseling sessions and 2 telephone counseling sessions. Major outcomes were engagement with study activities and intervention acceptability; lifestyle behavior change at 3-month follow-up is also reported.Results: Baseline characteristics (n = 36) were: mean age 33 years, 35 (97%) without health insurance, 32 (89%) born in Mexico, and mean BMI 30 kg/m2. Engagement was high among the 36 participants with 33 (92%) completing the intervention and follow-up measures. At follow-up, most participants thought the intervention was helpful (range: 85–100%) and acceptable (100% agreed ‘I would recommend the program to others’). The mean dietary fat quality score improved by 0.5 units (95% CI: 0.0–1.1) and the mean fruit-vegetable servings/day improved by 0.7/day (95% CI: 0.1–1.3).Conclusion: Intervention engagement and acceptability were high and there was improvement in self-reported dietary behaviors. This type of Med-style dietary pattern intervention should be evaluated in randomized trials enrolling HAs at risk for CVD.

Medicaid Expansions and Cervical Cancer Screening for Low-Income Women.

Medicaid coverage for low-income women may play an important role in ensuring access to preventive care. This study examines how Medicaid eligibility expansions to nonelderly adults impact cervical cancer screening among low-income women. We use data from the Behavioral Risk Factor Surveillance System from 2000 to 2010. The primary outcome of interest is whether women in the relevant guideline consistent age range reported having a Pap test in the previous year. We use a difference-in-differences approach with matched treatment and comparison states and a simulated eligibility approach based on a continuous measure of Medicaid generosity. Our results indicate that cervical cancer screening increased among low-income women in expansion states relative to comparison states. Increases in screening rates are largest among low-income Hispanic women. Medicaid expansions during the period from 2000 to 2010 were associated with improved cervical cancer screening rates, which is critical for early cervical cancer detection and prevention of cancer morbidity and mortality in women. The results suggest that more widespread Medicaid expansions may have positive effects on preventive health care for women.

Motherhood, fatherhood and midlife weight gain in a US cohort: Associations differ by race/ethnicity and socioeconomic position

While there is an association of greater short-term weight gain with childbearing among women, less is known about longer-term weight gain, whether men have similar gains, and how this varies by race/ethnicity and socioeconomic position. Our cohort consisted of a nationally representative sample of 7356 Americans with oversampling of Black and Hispanic populations. We estimated the associations between number of biological children and parental weight, measured as both change in self-reported body mass index (BMI) from age 18 and overweight/obese status (BMI ≥ 25) at age 40. We performed multivariate linear and logistic regression analysis and tested for effect modification by gender. For change in BMI, men gained on average 0.28 BMI (95% CI: (0.01, 0.55)) units per child, while women gained 0.13 units per child (95% CI: (-0.22, 0.48)). The adjusted odds ratios for overweight/obesity associated with each child were 1.32 (95% CI: (1.11, 1.58)) for men and 1.15 (95% CI: (1.01, 1.31)) for women. Stratified analyses by race/ethnicity and socioeconomic position suggested that the observed full-cohort differences were driven primarily by gendered differences in low-income Hispanics and Whites – with the greatest associations among Hispanic men. For example, among low-income Hispanic men we observed a positive relationship between the number of children and weight change by age 40, with average weight change of 0.47 units per child (95%CI: (-0.65, 1.59 For low-income Hispanic women, however, the average weight change was -0.59 units per child (95%CI: (-1.70, 0.47), and the P-value for the test of interaction between gender and number of children was P < 0.001. Our findings suggest that the shared social and economic aspects of raising children play an important role in determining parental weight at mid-life.