US Hispanic Adults Research Articles

National Cohort Data Suggests an Association Between Serious Mental Illness and Audiometric Hearing Loss.

To explore whether there is an association between serious mental illness (SMI) and hearing loss (HL) among USHispanic adults. Cross-sectional epidemiological study (Hispanic Community Health Study), including multicentered USvolunteers. Multivariable linear regressions were conducted to study the association between SMI and HL. Adjustments were made for potential confounders including age, sex, education, vascular disease (hypertension or diabetes mellitus), and cognition. SMI was defined by (1) antipsychotic medication classification and (2) the use of at least 1 antipsychotic medication specifically used to treat SMI in clinical psychiatric practice. HL was measured by pure tone audiometry. A total of 7581 subjects had complete data. The mean age was 55.2 years (SD = 7.5 years) and the mean pure tone average in the better ear was 16.8 dB (SD = 10.7 dB). A total of 194 (2.6%) subjects were taking a HCHS-defined antipsychotic and 98 (1.3%) were taking at least 1 antipsychotic specifically used to treat SMI. On multivariable regression, use of HCHS's classified antipsychotics was associated with 3.75 dB worse hearing (95% confidence interval [CI] = 2.36-5.13, P < .001) and use of antipsychotics specific for SMI was associated with 4.49 dB worse hearing (95% CI = 2.56-6.43, P < .001) compared to those not using antipsychotics. SMI, as defined by either the use of HCHS-defined antipsychotics or the use of antipsychotic medication specific for SMI, is associated with worse hearing, controlling for potential confounders. Whether SMI contributes to HL, antipsychotic medication (through ototoxicity) contributes to HL, or whether HL contributes to SMI is unknown and warrants further investigation.

Spanish-language bariatric surgery patient education materials fail to meet healthcare literacy standards of readability.

The Hispanic population is the fastest growing ethnic minority in the United States, contributing to nearly half of the population growth over the last decade. Unfortunately, this population suffers from lower-than-average health literacy rates, leading to poorer health outcomes. Per the American Medical Association and National Institutes of Health, patient education materials (PEMs) should be written at no higher than a 6th grade reading level. Given that US Hispanic adults have the second-highest obesity prevalence, this study aims to analyze the readability of Spanish-language PEMs regarding bariatric surgery available in US-based academic and medical centers. A total of 50 PEMs were found via the query ""cirugía de pérdida de peso" site: (edu OR.org)" on the Google search engine. Thirty-nine sources met the inclusion criteria of belonging to a US-based academic or medical center and containing information regarding the indications for bariatric surgery, descriptions of the types of bariatric surgery, what to expect before and after surgery, or the risks and benefits of bariatric surgery. The excerpts were analyzed according to three readability formulas designed specifically for the Spanish language and evaluated for their reading grade level. All 39 sources were at the college reading level per the Fry graph corrected for Spanish. Per the Spaulding formula, 37 sources were "Grade 12 + " and two sources were "Grade 8-10." Per the Fernandez-Huerta formula, 16 sources were at the 8th/9th grade reading level, 22 sources were at the 7th grade reading level, and one was at the 6th grade reading level. The Spanish-language bariatric surgery PEMs available online from US-based academic and medical centers are generally above the recommended 6th grade reading level. Failure to meet the recommended sixth-grade reading level decreases health care literacy for Spanish-speaking patients within the United States seeking bariatric surgery.

Association Between Hearing Loss and Multiple Negative Emotional States in the USHispanic Population.

Hearing loss (HL) has been linked to commonly studied detrimental mood states, such as loneliness and depression. However, its relationship with other negative emotions remained largely unstudied. We explore the association between HL and anxiety, anger, hostility, poor self-esteem, and pessimism in a national cohort of USHispanic adults. Cross-sectional study. Multicentered USnational epidemiologic study (Hispanic Community Health Study). Subjects were ages 18 to 75 with completed audiometric and emotional survey data. Multivariable regressions controlling for age, gender, and education were conducted to analyze the association between HL, measured by 4-frequency pure-tone average (PTA), and emotional states. States included anxiety (Spielberger Trait Anxiety Scale-10), anger (Spielberger Trait Anger Scale), hostility (Cook Medley Cynicism Scale-13),poor self-esteem (Self-Esteem Scale-10), and pessimism (Revised Life Orientation Test). A total of 4120 to 4341 participants met inclusion criteria, depending on the specific survey; the average age was 46.7 years (standard deviation [SD] = 13.7), and the average PTA was 13.8 dB (SD = 10.1). Controlling for age, gender, and education, HL was associated with all outcomes. Specifically, for every 10 dB worsening in HL, the anxiety score worsened by 0.41 (0.23-0.60), the anger score worsened by 0.40 (0.22-0.58), the hostility score worsened by 0.16 (0.04-0.27), the self-esteem score worsened by 0.25 (0.12-0.38), and the pessimism score worsened by 0.17 (0.04-0.30) (all p < .01). HL is related to numerous negative mood states beyond loneliness and depression. This includes worse anxiety, anger, hostility, self-esteem, and pessimism. Future studies should investigate whether treating HL improves negative emotional states.

The Correlation Between the SNP rs1049594 and Type 2 Diabetes

Type 2 Diabetes (T2D) is the fifth leading cause of death within the Hispanic population in the United States. Composed of Puerto Ricans, Mexicans, Cubans as well as Central and South Americans, 50% of US Hispanic adults are expected to develop T2D. Diabetes can induce several serious health complications if left untreated such as cardiovascular disease and kidney disease. Single nucleotide polymorphisms (SNPs) are genetic markers used in research to associate risks of disease. SNPs such as rs1049549 have been linked to Type 2 Diabetes in current studies and the risk allele associated within this specific SNP is the T&gt;C allele. The primary objective for this study was to discern whether or not rs1049549 is linked to Type 2 Diabetes in the Hispanic population of Southern California. We tested 32 control and 24 diabetic samples taken from buccal swabs and the DNA extracted from these specimens were amplified using the polymerase chain reaction (PCR). The PCR amplicons were visualized using gel electrophoresis, digested using the enzyme BstN1, and visualized under gel electrophoresis to distinguish between both versions of the allele. The results from this study will be used to better understand the relationship of this SNP and diabetes within the Hispanic population in Southern California.

Racial and Ethnic Disparities in Multiple Sclerosis Prevalence.

Background and ObjectivesThe goal of this work was to determine whether the prevalence of multiple sclerosis (MS) varies by race and ethnicity.MethodsWe conducted a retrospective cohort study of >2.6 million adults from the multiethnic, community-dwelling members of Kaiser Permanente Southern California. The complete electronic health records of individuals with at least 1 ICD-9 code for MS between January 1, 2008 and December 31, 2010 were reviewed. MS prevalence and 95% CIs stratified by age, sex, and race and ethnicity among 2010 members were estimated with binomial regression. Age- and sex-standardized prevalence was estimated according to the 2010 US Census population.ResultsWe identified 3,863 patients with MS. The average age of patients with prevalent MS was 51.7 years (SD 13.1 years), and 76.8% were women. The female preponderance was more pronounced among Black (81.2%) and Asian (83.6%) than White (76.3%) or Hispanic (74.5%) individuals with MS. Age- and sex-standardized MS prevalence per 100,000 was similarly high among Black (225.8, 95% CI 207.1–244.5) and White (237.7, 95% CI 228.2–247.2) and significantly lower among Hispanic (69.9, 95% CI 64.4–75.5) and Asian (22.6, 95% CI 17.1–28.1) persons. MS prevalence was highest between the ages of 35 and 64 years and declined after 65 years of age across all racial and ethnic groups. Among adults 18 to 24 years of age, the crude MS prevalence was low but was highest among Black and Hispanic young adults, lower in White people, and lowest in Asian/Pacific Islander individuals (48.5, 25.0, 18.0, and 7.1 per 100,000, respectively).DiscussionMS prevalence varies by race and ethnicity, being similarly high in White and Black and significantly lower in Hispanic and Asian persons in Southern California. Taken together with previous studies, these findings indicate that the burden of MS in the US Black community has long been underrecognized. More studies are needed to determine whether MS is an emerging disease among US Hispanic adults and whether MS susceptibility and prevalence vary among Hispanic or Asian individuals from different cultures or ancestral backgrounds.

Effect of cognitive impairment on risk of death in Hispanic/Latino adults over the age of 50 residing in the United States with and without diabetes: Data from the Health and Retirement Study 1995-2014.

To understand the relationship between mortality and cognitive function among older US Hispanic adults with and without diabetes. Data from the Health and Retirement Study (1995-2014) were analyzed. Cox proportional hazard models were used to estimate the association between mortality and cognitive function. Models were stratified by diabetes. Four thousand thirteen older US Hispanic adults were included. Fully adjusted models for individuals with diabetes showed those with mild cognitive impairment (MCI; hazard ratio [HR]: 1.61; 95% confidence interval [CI]: 1.06, 2.45; P=.025) and dementia (HR: 2.14; 95% CI: 1.25, 3.67; P=.006) had increased mortality compared to normal cognition. Fully adjusted models for individuals without diabetes showed those with MCI (HR: 1.87; 95% CI: 1.28, 2.74; P=.001) and dementia (HR: 3.25; 95% CI: 1.91, 5.55; P<.001) had increased mortality compared to normal cognition. Cognitive impairment is associated with increased mortality in older US Hispanic adults with and without diabetes. Clinicians should regularly assess cognitive function in this group to quickly identify declines and make appropriate referrals for support to optimize health and reduce mortality.

Experiences of ethnic discrimination among US Hispanics: Intersections of language, heritage, and discrimination setting

BackgroundInformed by Latino Critical Race Theory, the present study examined how intersections between English use/proficiency, Spanish use/proficiency, and heritage group shape the varying experiences of ethnic discrimination reported by US Hispanic adults. MethodsThe study utilized data from 7,037 Hispanic adults from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Multivariable binomial logistic regression modeled language use/proficiency, heritage, and demographic characteristics as predictors of past-year self-reported perceived ethnic discrimination, overall and in six different settings. ResultsBoth English and Spanish use/proficiency were positively associated with increased adjusted odds of reporting ethnic discrimination overall, in public, or with respect to employment/education/housing/courts/police; however, with respect to being called a racist name or receiving verbal/physical threats/assaults, a positive association was observed for English, yet not Spanish use/proficiency. Results also indicated a significant interaction between English use/proficiency and Spanish use/proficiency when predicting past-year ethnic discrimination overall or for any of the six types/settings examined, although the relationship between language use/proficiency and ethnic discrimination varied by Hispanic heritage group. ConclusionStudy findings emphasize that experiencing some form of ethnic discrimination is relatively common among US Hispanic adults, yet the prevalence and types or settings of ethnic discrimination vary widely on the basis of demographics, immigrant generation, heritage, and the interplay between English and Spanish use/proficiency.

Current Smoking Raises Risk of Incident Hypertension: Hispanic Community Health Study-Study of Latinos.

Hypertension has been implicated as a smoking-related risk factor for cardiovascular disease but the dose-response relationship is incompletely described. Hispanics, who often have relatively light smoking exposures, have been understudied in this regard. We used data from a 6-year follow-up study of US Hispanic adults aged 18-76 to address the dose-response linking cigarette use with incident hypertension, which was defined by measured blood pressure above 140/90 mm Hg or initiation of antihypertensive medications. Adjustment was performed for potential confounders and mediators, including urinary albumin-to-creatinine ratio which worsened over time among smokers. Current smoking was associated with incident hypertension, with a threshold effect above 5 cumulative pack-years of smoking (vs. never smokers, hazard ratio for hypertension [95% confidence interval] of 0.95 [0.67, 1.35] for 0-5 pack-years, 1.47 [1.05, 2.06] for 5-10 pack-years, 1.40 [1.00, 1.96] for 10-20 pack-years, and 1.34 [1.09, 1.66] for ≥20 pack-years, P = 0.037). In contrast to current smokers, former smokers did not appear to have increased risk of hypertension, even at the highest cumulative pack-years of past exposure. The results confirm that smoking constitutes a hypertension risk factor in Hispanic adults. A relatively modest cumulative dose of smoking, above 5 pack-years of exposure, raises risk of hypertension by over 30%. The increased hypertension risk was confined to current smokers, and did not increase further with higher pack-year levels. The lack of a smoking-hypertension association in former smokers underscores the value of smoking cessation.

Perceptions of drinking water safety and their associations with plain water intake among US Hispanic adults.

We described sociodemographic differences in perceptions of drinking water safety and examined associations between perceptions and plain water intake. We used the 2015 Estilos survey of 1,000 US Hispanic adults conducted in both Spanish and English. Outcome was water intake. Exposures were the level of agreement about water perceptions (My tap water is safe to drink; Community tap water is safe to drink; Bottled water is safer; I would buy less bottled water if my tap water was safe). Covariates were sociodemographics, region, Hispanic heritage, and acculturation. We used chi-square tests and multinomial logistic regression to examine associations of water perceptions and intake. Overall, 24% of Hispanic adults consumed water ≤1 time/day. Although 34% disagreed their home tap water was safe to drink, and 41% disagreed their community tap water was safe to drink, 65% agreed bottled water is safer than tap water, and 69% agreed they would buy less bottled water if they knew their tap water was safe. Perceptions differed by some covariates but were not significantly associated with plain water intake. In conclusion, negative perceptions of tap water were common among US Hispanic adults, which can inform efforts to increase awareness about safe public water systems.

Knowledge of Health Conditions Associated With Sugar-Sweetened Beverage Intake Is Low Among US Hispanic Adults.

To examine associations between knowledge of health conditions and sugar-sweetened beverage (SSB) intake among Hispanic adults. Quantitative, cross-sectional study. The 2015 Estilos survey data. One thousand US Hispanic adults (≥18 years). The outcome variable was frequency of SSB intake (regular soda, fruit drink, sports/energy drink, and sweetened coffee/tea drink). Exposure variables were knowledge of 6 SSB-related health conditions (weight gain, diabetes, dental caries, high cholesterol, heart disease, and hypertension). Six multinomial logistic regression models were used to estimate adjusted odds ratios for consuming SSBs ≥3 times/day (high intake), in relation to knowledge of SSB-related health conditions. Overall, 58% of Hispanic adults consumed SSBs ≥2 times/day and 36% consumed SSBs ≥3 times/day. Although most identified that weight gain (75%) and diabetes (76%) were related to drinking SSBs, only half identified this relation with dental caries (57%) and hypertension (41%). Even fewer identified high cholesterol (32%) and heart disease (32%) as related. In crude analyses, SSB intake was significantly associated with knowledge of the associations between SSBs and weight gain, dental caries, and heart disease; however, after adjusting for sociodemographics and acculturation, associations were no longer significant. Although SSB intake was very high, knowledge of SSB-related health conditions was low and was not related to high SSB intake among US Hispanic adults. Education efforts alone may not be adequate for Hispanic adults to change their behaviors.

Maximum Lifetime Body Mass Index and Mortality in Mexican American Adults: the National Health and Nutrition Examination Survey III (1988-1994) and NHANES 1999-2010.

IntroductionStudies in US Hispanic adults indicate no deleterious association between obesity and death. We tested the hypothesis that accounting for weight history would provide more insight into this nonassociation. MethodsWe used the National Health and Nutrition Examination Survey (NHANES) to examine associations between maximum lifetime body mass index (BMI) and all-cause and cause-specific mortality among US-residing Mexican American adults. BMI was classified as underweight (<18.5 kg/m2), normal weight (18.5–24.9), overweight (25.0–29.9), obese class I (30.0–34.9), and obese class II (≥35.0). We used Cox proportional hazards to examine the association between maximum lifetime BMI and BMI at survey and all-cause and specific causes of death (ie, cardiovascular disease, cancer, diabetes, and other) controlling for age, sex, and smoking in 6,242 Mexican American adults enrolled in NHANES III (1988–1994) and NHANES 1999–2010.ResultsMexican Americans categorized as obese class II at maximum lifetime and time of survey had increased risk of all-cause mortality (hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.54 - 2.93 and HR, 1.52; 95% CI, 1.10–2.10). Those reporting a maximum lifetime BMI of class I or class II obesity but who were classified as normal weight at survey had increased risk of all-cause mortality (HR = 2.49; 95% CI, 1.72–3.61 and HR = 3.56; 95% CI, 1.15–11.06, respectively).ConclusionIncreased all-cause mortality risk in Mexican Americans with a lifetime BMI of 35 or greater refutes prior studies, suggesting that maximum lifetime BMI should be included when evaluating obesity–mortality associations in this population.

Knowledge of Sugar-Sweetened Beverage-Related Health Conditions and Sugar-Sweetened Beverage Intake among US Hispanic Adults

We examined associations between knowledge of sugar-sweetened beverages (SSBs)-related health conditions and SSB intake among Hispanic adults. This cross-sectional study used the 2015 Estilos data involving 1,000 Hispanic adults (≥18 years) from an online panel survey. The outcome measure was frequency of SSB intake (regular soda, fruit drink, sports/energy drink, sweetened coffee/tea drink). Exposure measures were knowledge of six SSB-related health conditions: weight gain, diabetes, cavities, high cholesterol, heart disease, and hypertension. Six multinomial logistic regression models were used to estimate adjusted odds ratios (AOR) for consuming SSBs ≥3 times/day based on knowledge of SSB-related health conditions using <1 time/day as the reference category. Overall, 36% of Hispanic adults consumed SSBs ≥3 times/day. Although most identified that weight gain (75%) and diabetes (76%) are related to drinking SSBs, only half identified that cavities (57%) and hypertension (41%) are related to drinking SSBs. Even fewer adults identified high cholesterol (32%) and heart disease (32%) as related to drinking SSBs. In crude analyses, lower SSB intake was associated with knowledge of the relationships between SSBs and weight gain, cavities, and heart disease (p<0.05, χ2 test); however, after adjusting for age, sex, education, marital status, income, weight status, region, country of origin, and acculturation, these associations were no longer significant. Most Hispanic adults knew that SSB intake was related to weight gain and diabetes, but knowledge was limited for other health conditions. Knowledge of SSB-related health conditions alone may not be related to reported SSB intake, and therefore insufficient for Hispanic adult behavior change.

Abstract 13457: ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk: Implications for US Hispanics/Latino Based on fFndings From the HCHS-SOL

Introduction: Hispanic/Latinos are the largest ethnic minority in United States with significant cultural and racial heterogeneity. The recent cholesterol treatment guidelines are mainly based on estimates from non-Hispanic white and black cohorts. Aim: To estimate the proportion of US Hispanic adults potentially affected by recent changes in recommendations for statin therapy eligibility under the 3rd National Cholesterol Education Program Adult Treatment Panel (NCEP/ATP III) and the new 2013 ACC/AHA cholesterol treatment guidelines. Methods: HCHS/SOL is a large multi-center study of Hispanics/Latinos in US communities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) (n=16,415; mean age 41 years, 40% males) . We evaluated weighted prevalence of statin-treated individuals and the proportion of target population that met the eligibility criteria for statin therapy under NCEP/ATP III versus 2013 ACC/AHA cholesterol treatment guidelines. Results: A total of 1,716 (10.4%) were treated with statins in HCHS/SOL cohort. However, 3,366 (20.5%) and 5,268 (32.1%) were eligible for statin therapy under NCEP/ATP III and 2013 ACC/AHA guidelines respectively. The proportion of statin-eligible adults increased primarily among older adults from 44% to 87% and males from 19% to 39% under NCEP/ATP III guidelines and 2013 ACC/AHA guidelines respectively (Figure 1). There was also an increase in eligibility for statin therapy in middle aged adults (44% to 65%). Conclusions: Regardless of the definition for statin eligibility, Hispanics are grossly undertreated (only half and only a third of those statin-eligible under the ATP III or the new ACC/AHA guidelines respectively are receiving treatment). The eligibility of statin therapy almost doubles consistently across all Hispanic/Latinos subgroups of under the new 2013 ACC/AHA guidelines.

Occupational sunscreen use among US Hispanic outdoor workers.

BackgroundOccupational ultraviolet radiation (UVR) exposure is a risk factor for skin cancer, and Hispanic individuals are over-represented in a number of outdoor occupations (e.g., farming, landscaping). This study examined predictors of occupational sunscreen use in a group of US Hispanic adults who work outdoors.ResultsA population-based sample of outdoor workers (n = 149, 85 % male) completed survey measures regarding their demographics, melanoma risk, perceived skin cancer risk, skin cancer knowledge, and their occupational sunscreen use. Sixty-nine percent of the sample reported never or rarely wearing sunscreen while working outdoors. Being female (p = .02), having a higher level of education (p = .03), and residing at a higher latitude (p = .04) were associated with more frequent sunscreen use.ConclusionsThis study highlights the importance of interventions to promote sun protection behaviors among US Hispanic outdoor workers, and identifies potential intervention targets.

Accelerometer adherence and performance in a cohort study of US Hispanic adults.

This study described participant adherence to wearing the accelerometer and accelerometer performance in a cohort study of adults. From 2008 to 2011, 16,415 US Hispanic/Latino adults age 18-74 yr enrolled in the Hispanic Community Health Study/Study of Latinos. Immediately after the baseline visit, participants wore an Actical accelerometer for 1 wk. This study explored correlates of accelerometer participation and adherence, defined as wearing it for at least three of a possible six days for ≥10 h·d. Accelerometer performance was assessed by exploring the number of different values of accelerometer counts per minute for each participant. Overall, 92.3% (n = 15,153) had at least 1 d with accelerometer data and 77.7% (n = 12,750) were adherent. Both accelerometer participation and adherence were higher among participants who were married or partnered, reported a higher household income, were first-generation immigrants, or reported lower sitting time. Participation was also higher among those with no stair limitations. Adherence was higher among participants who were male, older, employed or retired, not US born, preferred Spanish over English, reported higher work activity or lower recreational activity, and with a lower body mass index. Among the sample that met the adherence definition, the maximum recorded count per minute was 12,000, and there were a total of 5846 different counts per minute. On average, participants had 112.5 different counts per minute over 6 d (median, 106; interquartile range, 91-122). The number of different counts per minute was higher among men, younger ages, normal weight, and those with higher accelerometer-assessed physical activity. Several correlates differed between accelerometer participation and adherence. These characteristics could be targeted in future studies to improve accelerometer wear. The performance of the accelerometer provided insight into creating a more accurate nonwear algorithm.

Accelerometer Adherence and Performance in a Cohort Study of US Hispanic Adults

Accelerometer Adherence and Performance in a Cohort Study of US Hispanic Adults

Linguistic Acculturation and Skin Cancer–Related Behaviors Among Hispanics in the Southern and Western United States

To examine the association between linguistic acculturation (assessed using the Language Use and Linguistic Preference subscales from the Bidimensional Acculturation Scale for Hispanics) and skin cancer-related behaviors among US Hispanic adults to determine whether, compared with Hispanics denoted as Spanish-acculturated, English-acculturated Hispanics would report less frequent shade seeking and use of sun protective clothing and higher rates of sunscreen use, sunbathing, and indoor tanning. Online survey study conducted in September 2011. Five southern and western US states. A population-based sample of 788 Hispanic adults drawn from a nationally representative web panel. Self-reported sunscreen use, shade seeking, use of sun protective clothing, sunbathing, and indoor tanning. Multivariate regression analyses were conducted to examine predictors of the skin cancer-related behaviors. As hypothesized, English-acculturated Hispanics had lower rates of shade seeking and use of sun protective clothing and reported higher rates of sunbathing and indoor tanning than Spanish-acculturated Hispanics. English-acculturated Hispanics and bicultural Hispanics (ie, those with high Spanish and high English acculturation) reported comparably high rates of sunbathing and indoor tanning. Results suggested that bicultural Hispanics seek shade and wear sun protective clothing less often than Spanish-acculturated Hispanics but more often than English-acculturated Hispanics. Acculturation was not associated with sunscreen use. Hispanic adults do not routinely engage in behaviors that reduce their risk of skin cancer. Bicultural and English-acculturated Hispanics are particularly in need of skin cancer prevention interventions.

Skin cancer surveillance behaviors among US Hispanic adults

Little skin cancer prevention research has focused on the US Hispanic population. This study examined the prevalence and correlates of skin cancer surveillance behaviors among Hispanic adults. A population-based sample of 788 Hispanic adults residing in 5 southern and western states completed an online survey in English or Spanish in September 2011. The outcomes were ever having conducted a skin self-examination (SSE) and having received a total cutaneous examination (TCE) from a health professional. The correlates included sociodemographic, skin cancer-related, and psychosocial factors. The rates of ever conducting a SSE or having a TCE were 17.6% and 9.2%, respectively. Based on the results of multivariable logistic regressions, factors associated with ever conducting a SSE included older age, English linguistic acculturation, a greater number of melanoma risk factors, more frequent sunscreen use, sunbathing, job-related sun exposure, higher perceived skin cancer risk, physician recommendation, more SSE benefits, and fewer SSE barriers. Factors associated with ever having a TCE were older age, English linguistic acculturation, a greater number of melanoma risk factors, ever having tanned indoors, greater skin cancer knowledge, higher perceived skin cancer severity, lower skin cancer worry, physician recommendation, more TCE benefits, and fewer SSE barriers. The cross-sectional design limits conclusions regarding the causal nature of observed associations. Few Hispanic adults engage in skin cancer surveillance behaviors. The study highlights Hispanic subpopulations that are least likely to engage in skin cancer surveillance behaviors and informs the development of culturally appropriate interventions to promote these behaviors.

Cross-border health care utilization among the Hispanic population in the United States: implications for closing the health care access gap

Objectives. To examine predictors of health care service utilization in Mexico or any other country in Latin America among the US Hispanic population. Methods. This study used data from the 2007 Pew Hispanic Healthcare Survey, a nationally representative survey of 4013 Hispanic adults. Using the Behavioral Model of Health Service Use (BMHSU) model, we examined three levels of predictive factors: (1) predisposing characteristics (e.g., language proficiency), (2) enabling resources (e.g., health insurance status), and (3) need (e.g., self-perceived health status). Multivariate logistic regression analyses were conducted to predict odds of seeking health care services in Mexico or any other country in Latin America. Results. As hypothesized, lack of continuous health insurance coverage, perceived lack of quality health care, and low English proficiency increased the likelihood of seeking health care in Mexico or any other Latin American country among US Hispanic adults. Self-reported health status and usual source of care, however, were not significant predictors. Conclusions. Hispanic immigrants face critical access gaps to health care in the United States. Implications for closing the access gap for this population are discussed within the context of health care system reform and immigration reform in the United States.

Factors associated with serum retinol, α-tocopherol, carotenoids, and selenium in Hispanics with problems of HIV, chronic hepatitis C, and drug use

The effects of hepatitis and drug use on nutritional problems in HIV infection have rarely been examined despite the importance of drug use in the global HIV pandemic. We examined the effects of HIV, hepatitis C, and drug use on serum micronutrients in 300 US Hispanic adults. Chronic hepatitis C infection was associated with lower serum retinol (-8.2 microg/dl, P < 0.0001), alpha-tocopherol (-0.10 ln microg/dl, P = 0.024), and carotenoids (-19.8 microg/dl, P < 0.0001). HIV infection was associated with lower selenium (-6.1 microg/l, P = 0.028). Elevated triglycerides in HIV infection were associated with higher serum retinol and alpha-tocopherol. Drug use was not independently associated with micronutrient alterations. We conclude that hepatitis C is an important determinant of low serum micronutrients, and should be considered in any nutritional assessment of HIV infected populations. As the safety of micronutrient supplementation is not established, policy for appropriate HIV clinical care should distinguish between populations with and without hepatitis coinfection.