Urban Hispanics Research Articles

Influence of the Local Food Environment on Hispanics' Perceptions of Healthy Food Access in New York City.

Studies have characterized food environments and documented its impact on access and consumption of healthy foods as well as diet-related health conditions. This study aims to characterize the local food environment in New York City's Washington Heights and Inwood community and to examine its influence on Hispanics' perceptions of healthy food access. Person-level local food environments were created by spatially modeling food retailers selling fresh fruits and vegetables or low-fat products within a participant's 400- and 800-m residential radius buffers. Data were analyzed using multivariate binary logistic regression. Fruit/vegetable markets significantly increased participants' odds of perceiving the availability of a large selection as well as the high quality of fresh fruits and vegetables in their neighborhood. Medium-/large-size supermarkets/groceries within 400-m radius significantly increased participants' odds of perceiving the high quality of fresh fruits and vegetables in their neighborhood, whereas meat markets significantly lowered the odds. Fruit/vegetable markets and medium-/large-size supermarkets/groceries significantly increased participants' odds of perceiving the availability of a large selection of low-fat products in their neighborhood. Study findings advance our understanding of the relationships between local food environment and perceived healthy food access among urban Hispanics.

High Rates of Depressive Symptoms in Low-Income Urban Hispanics of Caribbean Origin with Poorly Controlled Diabetes: Correlates and Risk Factors

Little is known about diabetes and depression in disadvantaged urban Hispanic subgroups, particularly those of Caribbean origin. Using data from 360 urban Hispanics of Caribbean origin with poorly controlled diabetes, our objectives were to examine the prevalence and correlates of depressive symptoms and depression using the Euro-D, and the association of depressive symptoms and depression with diabetes self-management and clinical parameters of diabetes control, employing multivariate analyses. The prevalence of depression was 52.8%. Higher levels of depressive symptoms were related to female gender (p < .0001), antidepressant use (p < .0001), stressful life events (p < .0001), SSI (p = .0011), lower education (p < .0001), lower statin use (p = .0014), and less walking (p = .0152). Depression (Euro-D > 3), was associated significantly with female gender (OR = 2.30, 95%CI = 1.38- 3.82), SSI (OR = 2.44, 95%CI = 1.45-4.12), antidepressant use (OR = 2.94, 95%CI = 1.54-5.64), and stressful life events (OR = 1.93, 95%CI = 1.52-2.44). Depressive symptoms and depression were related to markers of adversity and two indicators of diabetes self-management, but not clinical parameters of diabetes control.

Prevalence of Glucose Abnormalities and Diagnostic Value of Fasting Glucose and Fasting Insulin in Urban Hispanics

The prevalence of glucose abnormalities (GAs) and the diagnostic value of fasting plasma glucose and insulin in detecting impaired glucose tolerance (IGT) and diabetes mellitus (DM) were determined in urban Latin Americans. An oral glucose tolerance test was conducted in 592 subjects after administration of 75 g of glucose. Employing American Diabetes Association (ADA) and World Health Organization guidelines, GAs were found in 34% of the subjects, defined as impaired fasting glucose (IFG) (13.3%), IGT (6.9%), combined IFG + IGT (7.8%), and newly diagnosed type-2-DM (6.5%). All newly diagnosed diabetics had 2-hour glucose levels ≥200 mg/dL, but only 46.1% had fasting glucose ≥126 mg/dL. In addition, nearly half of the subjects with IGT (47%) had fasting glucose levels <100 mg/dL. The sensitivity, specificity, positive and negative predictive values of IFG in predicting IGT was 52.9%, 83%, 36.8%, and 90.4 %, respectively. Fasting insulin levels were not sensitive for differentiating glucose tolerant, from IFG and IGT; only the subjects with combined IFG + IGT had increased fasting insulin levels (22% above IFG) (P < 0.01). Two-hour insulin was increased by 30% in IGT and newly diagnosed diabetics, and by 46% in the subjects with combined IFG + IGT. In summary, the very high prevalence of undetected GA encountered in "healthy" subjects living in Caracas, Venezuela, requires immediate sanitary attention. With 50% of diabetic patients being unaware of their condition, half of IGT and DM not detected by ADA guidelines, and the poor sensitivity/specificity of fasting glucose in predicting 2-hour abnormalities, we recommend that 2-hour postload glucose be included when screening for GAs. Measurements of fasting and/or postload insulin are not cost effective for the diagnosis of GA, because they provide little additional clinical information in this context.

Association of Traits of Metabolic Syndrome With Glucose Abnormalities

The association of glucose abnormalities (GAs) with the early appearance of traits of the metabolic syndrome (MS) was studied in an unselected sample of apparently healthy Urban Hispanics. GAs were defined as impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and newly diagnosed diabetes mellitus (DM). Overall, GAs were associated with older age, abdominal obesity, low high-density lipoprotein cholesterol levels, hypertriglyceridemia, hyperinsulinemia, hypertension, and MS. Prevalence of MS defined as per NCPE-ATPIII was the greatest in subjects with DM (54.3%) and with combined abnormalities (IFG + IGT) (54.1%; P > 0.5). Similar prevalence of MS was found in subjects with isolated IFG (34.3%) and isolated IGT (36.8%) but higher than in normal fasting-glucose tolerant individuals (23.3%) (P < 0.01). The average number of traits of the MS coexisting in normal fasting glucose-tolerant individuals was 1.6 [95% confidence interval (CI), 1.5-1.8; median 2], in isolated IFG: 2.05 (95% CI, 1.8-2.2; median 2); isolated IGT: 2.16 (95% CI, 1.8-2.3; median 2); combined IFG + IGT: 2.7 (95% CI, 2.3-3.1; median 3); and DM: 2.7 (95% CI, 2.25-3.1; median 3) (P < 0.01). Postload insulin levels were higher in isolated IGT than in isolated IFG, whereas HOMA-IR was higher in IFG. Indices of early and total insulin secretion were markedly reduced in DM, IFG-IGT, and IGT. In conclusion, GAs are strongly associated with the number and severity of traits of the MS, defects in insulin secretion, and sustained hyperinsulinemia in response to oral glucose. Subjects with combined GA and newly diagnosed type 2 DM had not only an increased prevalence of MS, but also the MS was characterized by the presence of more than 3 traits, and by a greater severity of each of the coexisting traits.

1163 Proximal Advanced Adenomas are More Common Among Urban Hispanics Than African Americans Undergoing Average-Risk Screening Colonoscopy

1163 Proximal Advanced Adenomas are More Common Among Urban Hispanics Than African Americans Undergoing Average-Risk Screening Colonoscopy

Understanding Factors Related to Colorectal Cancer (CRC) Screening Among Urban Hispanics: Use of Focus Group Methodology

Colorectal cancer (CRC) is a major cause of cancer deaths among US Hispanics. Screening decreases mortality through early detection. To understand factors related to CRC screening among Hispanics, focus groups were conducted. Reasons for getting screened included peace of mind; influence from family and friends; and wanting to prevent CRC. Barriers included fear of finding cancer and fear of the examination. These results informed a survey to better understand CRC screening among Hispanics in a cross-sectional study. The information from both will direct the development of interventions to increase CRC screening among Hispanics.

Knowledge and Misconceptions Regarding Upper Respiratory Infections and Influenza Among Urban Hispanic Households: Need for Targeted Messaging

To characterize knowledge and misconceptions regarding viral upper respiratory infections (URI) among urban Hispanics and identify correlates of greater knowledge. In-home interviews conducted by trained research coordinators in 453 primarily Hispanic households (2,386 members) in northern Manhattan. The majority of respondents attributed URI to weather-related conditions. While most agreed that colds and flu were caused by viruses, 88.1% also agreed that they were caused by bacteria, and a small proportion reported that URI may be caused by evil eye ('mal de ojo', 7.1%) or sudden fright ('susto', 3.3%). Only 29.8% agreed that colds and flu would improve without medication; 89.9% stated that antibiotics are needed to treat viral throat infections. Most were well versed about influenza vaccination and reported that a recommendation from a healthcare provider would definitely influence them to get vaccinated. Misconceptions about the role of antibiotics in the treatment of viral infections pose considerable risk in this population. Explicit, targeted recommendations from healthcare providers regarding vaccination and judicious antibiotic use as well as media campaigns targeted to Hispanics should be effective strategies for reducing misconceptions and improving health behaviors.

The New York City Community Outreach Study: biomedical and mental health status among a community sample of urban Hispanics.

This report provides a snapshot of health behavior and risk in one low-income, urban, Latino community. As part of a community health and education program, 200 adult residents were asked about their health status and behavior and screened for conditions known to constitute significant health risk. A random sample of 10 buildings around a large community-based organization (CBO) service area was selected to receive personal invitation and/or door-to-door flyers announcing several days of free health screening and education at the CBO. All individuals age > or = 18 years were eligible. Those who received screening were mailed lay descriptions of their results along with recommendations and locations for follow-up, if appropriate. Participants were adult residents of an economically and medically under-served district in New York City, where Latinos make up approximately 75% of the population. Free screening for high blood pressure, diabetes, high cholesterol, obesity, and depression was provided. The clinical outcomes of the aforementioned tests constitute the main outcomes of this report. Compared to national estimates for Hispanics, health risk was quite high in this sample, particularly with regard to diabetes and cholesterol. Moreover, participants were much less likely to have insurance or to have a regular source of health care than reported in national studies of Hispanics. Though site specific, these data provide critical information to local CBOs and can be used as a tool for comparison with national data and Healthy People 2010 goals.

Rural Residence and Hispanic Ethnicity: Doubly Disadvantaged for Diabetes?

Hispanics are at increased risk for diabetes, while rural residents have historically had decreased access to care. To determine whether living in a rural area and being Hispanic confers special risks for diagnosis and control of diabetes. We analyzed the Third National Health and Nutrition Examination Survey (1988-1994). Hispanics and non-Hispanic white adults were classified according to rural/urban residence to create 4 ethnicity-residence groups. Investigated outcomes were previously diagnosed and undiagnosed diabetes. Among those with diagnosed diabetes, we investigated control of glucose, hypertension, and lipids. The prevalence of diagnosed diabetes was greatest for rural residents, especially for rural Hispanics (8.2%) versus that for urban whites (4.6%), rural whites (6.5%), or urban Hispanics (4.5%), (P < .01). However, urban Hispanics were most likely to have undiagnosed diabetes at 3.7%, versus 2.3% of rural whites, 2.8% of urban whites, and 2.7% of rural Hispanics (P = .04). Among people with diagnosed diabetes, there was no difference in glycemic control between the 4 groups. Rural Hispanics with diagnosed diabetes had the greatest prevalence of elevated systolic blood pressure at 45%, compared to 37% of urban whites, 29% of rural whites, 28% of urban Hispanics (P = .01). In regression models controlling for potential confounders, there were no differences among urban and rural whites and Hispanics in the likelihood of undiagnosed diabetes or in glycemic control for those with diagnosed diabetes. Initiatives that target Hispanic health, and especially diabetes, should acknowledge rural/urban Hispanic health differences.

Correlates of Colorectal Cancer Screening Compliance Among Urban Hispanics

Colorectal cancer (CRC) is the second most common cancer among Latinos; screening can reduce mortality from CRC. The aims of this study are; to assess the current compliance with free colorectal cancer screening among Hispanic women who are participating in a national breast and cervical cancer screening program (NBCCEDP), and to examine the effects of a set of key constructs from the HBM and the TPB on compliance with the Fecal Occult Blood Test (FOBT). We consecutively recruited 950 women from among those attending an initial appointment at an NBCCEDP site in northern Manhattan, and administered a questionnaire. Patients were offered a free Hemoccult kit, alongside instructions and print materials. The rate of FOBT compliance (in kit return) was 77.3%. Fatalism remained a statistically significant influence on FOBT compliance in the multivariate models, and there was a trend for higher FOBT return among West Indies women (primarily from the Dominican Republic). The findings of this study demonstrate the feasibility and acceptability of distributing FOBT kits through an existing national program for cancer screening of women. The results justify replication in a more heterogeneous group of Hispanics, with longer-term followup.

Adolescent motherhood among low-income urban Hispanics: familial considerations of mother-daughter dyads.

A family systems perspective was used to investigate adolescent motherhood among low-income Hispanic families living in high-crime areas. The study focused primarily on the mother-daughter relationship. A semistructured interview was administered separately to mother and daughter in 11 mother-daughter dyads. Using open and axial coding of the data, a grounded theory of adolescent motherhood emerged. The study identified adolescent motherhood as an attempt to restore a sense of stability and balance not only to the life of the teenager but also to that of her mother. The finding that participants became more dependent on and were more supervised by their mothers after their pregnancies raised some paradoxical questions concerning the issue of separation and individuation.

PUERTO RICAN AND MEXICAN-AMERICAN SMALL-FOR-GESTATIONAL-AGE(SGA) RATES REMAIN DISPARATE AMONG LOW-RISK URBAN MOTHERS: A POPULATION-BASED STUDY.† 1619

There are limited available data on the prevalence of SGA infants among urban Hispanics. We used 1982-83 Illinois vital records and 1980 U.S. census income data to determine the association of maternal ethnicity and SGA(weight-for-gestational-age < 10th percentile) rates among Hispanics in Chicago. This older cohort was chosen to avoid the confounding effect of cocaine associated with its increased local availability after 1985. The SGA rate was 3.3% for infants with Puerto Rican (PR) mothers (N=3,483) and 2.1% for infants with U.S.-born Mexican-American mothers (N=2,253) compared to 1.4% for infants with foreign-born Mexican-American mothers (N=8,746); OR=2.4(1.8-3.1) and 1.5(1.1-3.1), respectively. Most striking, the PR but not U.S.-born Mexican-American disadvantage persisted as maternal risk status improved (Table). In a multiple logistic regression model that included maternal age, education, marital status, parity, prenatal care, and community income, the adjusted OR of SGA for PR was 2.9(1.4-4.5). We conclude that 1) the relationship of Puerto Rican ethnicity to the risk of intrauterine growth retardation is independent of commonly cited risk factors and 2) the “epidemiologic paradox” is confined to foreign-born Mexican-Americans.

582 ETHNIC DIFFERENCE IN PERINATAL OUTCOME: BLACKS, HIS PANICS AND WHITES

Although urban Hispanics (H), share many socioeconomic disadvantage with the blacks (B), Hispanic perinatal and neonatal mortalities rates (PMR and NMR) are superior to black, and similar to white (W) rates. To delineate contributing factors for these differences between ethnic groups, we compared prenatal, socio-economic, and health status of 6211 H, 8381 B and 17,084 W mothers delivering in our network in 1982-83. RESULTS: Some variables of significantly different distribution (P<0.0001) were: Medicaid and selfpayment; H=64%, B=81%, W=22%, Teenage pregnancy (<19 yrs), H-14%, B=25%, W=6%, Smoking, H=12%, B=34%, W=26%, Anemia, H=4%, B=13%, W=2%. NMR and PMR (per 1000) were similar between H and W: H=6.05 and 14.2, W=5.2 and 11.7: but higher in black: 11.9 and 22.7 (P<0.0001). Low and very low B.Wt rates (<2500 and <1500 gr), were: H=6.3 and 1.1%, White=6.7 and 1.2%, and B=13.7 and 2.7% (P<0.0001). Since weight specific death rates were similar between groups, we determined the source of NMR, PMR variation using a logit chi-square, which revealed that when all adverse factors, including socio-economic and ethnicity were held constant, the single most influencing factor on NMR was the birthweight distribution (Chi-square 1402, P<0.0001). Conclusion: Although health and socio-economic status varied widely between ethnic groups their influence on NMR and PMR are indirect; through their influence on birthweight distribution. A better birthweight distribution in H. favored better NMR, and a two fold increase in low and very low b. wt. rates in blacks increased their NMR by two fold.

Food frequency related to folacin status in adolescents ,

Food frequency data for 372 adolescents from urban and rural low-income households were evaluated. The urban group consisted of blacks (N = 161) and Hispanics (N = 32); blacks (N = 58) and whites (N = 121) composed the rural group. A food frequency questionnaire with 24 food groups categorized according to nutrient contribution was completed for each subject by a trained interviewer. Urban blacks selected folacin-dense foods more frequently than urban Hispanics or rural blacks. This difference corresponded with a higher prevalence of poor folacin status in urban Hispanics vs. urban blacks and in rural blacks vs. urban blacks. Rural whites also consumed a higher frequency of folacin-dense food groups than rural blacks, which, again, corresponded with differences in folacin status. The infrequent consumption of vegetables and fruits, particularly by rural black and urban Hispanic adolescents, provides an explanation for the poor folacin status of the adolescents.

Manic-depressive illness among poor urban Hispanics.

Manic-depressive illness is reported to occur infrequently among some racial or ethnic groups and among lower socioeconomic groups. The authors investigated the incidence of manic-depressive illness among a random sample of 90 lower socioeconomic Hispanic patients admitted to the psychiatric inpatient unit of an urban hospital. They made a retrospective diagnosis based on DSM-III criteria and independent of the hospital diagnosis. Ten patients (11%) were diagnosed as manic-depressive--a rate three times the national admission rate. The authors discuss the significance of this finding and its relationship to sociocultural aspects of the Hispanic patient.