Immigrant generation and diabetes risk among Mexican Americans: the Sacramento area Latino study on aging.

OBJECTIVES: We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican-origin population. METHODS: We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes. RESULTS: Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant. CONCLUSIONS: Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.

[Immigrant generation and diabetes risk among Mexican Americans: the Sacramento Area Latino Study on Aging]. / Las generaciones de inmigrantes y sus descendientes y el riesgo de diabetes en la población de los Estados Unidos de origen o ascendencia mexicana: el Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA).

OBJECTIVE: We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican origin population. METHODS: We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes. RESULTS: Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant. CONCLUSIONS: Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.

Diabetes risk in older Mexican Americans: effects of language acculturation, generation and socioeconomic status.

The effect of language acculturation, socioeconomic status (SES), and immigrant generation on development of diabetes among Mexican Americans was evaluated in the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE). HEPESE is a longitudinal cohort study of 3,050 non-institutionalized Mexican Americans aged 65 years at baseline (1993-1994) from 5 Southwestern states. Diabetes incidence was ascertained in 4 follow-up surveys to 2004-05 by respondent self-reported physician-diagnosis of diabetes, high blood glucose, or sugar in the urine. Language of interview, immigrant generation, gender, age, education, family history of diabetes, smoking status, alcohol use, health insurance type and self-reported height and weight were assessed. High socioeconomic status (SES) was defined by high school graduation and non-Medicaid insurance. Cox's proportional hazards models were fit to evaluate the effects of language acculturation, generation and SES on incident diabetes. 845 of 3,050 (27.7%) Mexican Americans had diabetes at baseline and were younger, more educated, and more likely to have health insurance than those without diabetes. Risk of developing diabetes increased for Spanish-speaking respondents with low SES from 1st to 3rd generation (HR = 1.76, 95% CI = 1.02-3.03) and from 2nd to 3rd generation (HR = 2.15, 95% CI = 1.20-3.84). Among English-speaking, high SES participants, generation had a protective effect on developing diabetes: HR = 0.45 (95% CI = 0.22-0.91) when comparing 3rd versus 1st generation. The effect of language acculturation and immigrant generation on incident diabetes is moderated by SES status in HEPESE participants.

Las generaciones de inmigrantes y sus descendientes y el riesgo de diabetes en la población de los Estados Unidos de origen o ascendencia mexicana: el Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA) / Immigrant generation and diabetes risk among Mexican Americans: the Sacramento Area Latino Study on Aging

OBJETIVO: Se investigó si la aculturación de los inmigrantes y sus descendientes y la generación a la que pertenecen, un marcador de la asimilación, se relacionan con el riesgo de diabetes en una población de adultos mayores de ascendencia u origen mexicano. MÉTODOS: Se analizaron los datos sobre 1 789 adultos de 60 a 101 años de edad del Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA). Se determinó la presencia de diabetes tipo 2 con base en el uso de medicamentos antidiabéticos, la mención por el paciente del diagnóstico de un médico, o una glucosa en ayunas de 126 mg/dl o mayor. Se aplicó un modelo de regresión logística para la prevalencia de diabetes. RESULTADOS: Tras ajustar por edad y sexo, se observaron asociaciones significativas pero divergentes entre las generaciones de inmigrantes y sus descendientes, la aculturación y el riesgo de diabetes. En relación con los adultos de la primera generación, los de la segunda tuvieron una razón de posibilidades (odds ratio, OR) de padecer diabetes de 1,8 (intervalo de confianza [IC] de 95% = 1,4, 2,4) y los adultos de la tercera generación tuvieron una OR de 2,1 (IC de 95% = 1,4, 3,1). Sin embargo, una mayor aculturación a los Estados Unidos se relacionó con una tasa ligeramente menor de diabetes. En el modelo completo, tras la incorporación de ajustes para tener en cuenta los factores socioeconómicos y del modo de vida, la relación entre la generación y la diabetes seguía siendo significativa, no así la relación de esta última con la aculturación. CONCLUSIONES: El presente estudio respalda la idea, anteriormente cuestionada, de que la asimilación se relaciona con un mayor riesgo de diabetes entre los inmigrantes de origen mexicano. Los investigadores deben analizar más detalladamente la presencia de una relación causal entre la asimilación y la salud.

OBJECTIVE: We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican origin population. METHODS: We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes. RESULTS: Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant. CONCLUSIONS: Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.

Immigrant generation and diabetes risk among Mexican Americans: the Sacramento Area Latino Study on Aging.

OBJECTIVES: We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican-origin population. METHODS: We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes. RESULTS: Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant. CONCLUSIONS: Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.

Factors influencing time to diagnosis after abnormal mammography in diverse women.

BACKGROUND: Abnormal mammograms are common, and the risk of false positives is high. We surveyed women in order to understand the factors influencing the efficiency of the evaluation of an abnormal mammogram. METHODS: Women aged 40-80 years, identified from lists with Breast Imaging Reporting and Data System (BIRADS) classifications of 0, 3, 4, or 5, were surveyed. Telephone surveys asked about the process of evaluation, and medical records were reviewed for tests and timing of evaluation. RESULTS: In this study, 970 women were surveyed, and 951 had chart reviews. Overall, 36% were college graduates, 68% were members of a group model health plan, 18% were Latinas, 25% were African Americans, 15% were Asian, and 43% were white. Of the 352 women who underwent biopsies, 151 were diagnosed with cancer (93 invasive). Median time to diagnosis was 183 days for BIRADS 3 compared to 29 days for BIRADS 4/5 and 27 days for BIRADS 0. At 60 days, 84% of BIRADS 4/5 women had a diagnosis. Being African American (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.49-0.97, p=0.03), income < $10,000 (HR 0.55, 95% CI 0.31-0.98, p<0.04), perceived discrimination (HR 0.22, 95% CI 0.09-0.52, p<0.001), not fully understanding the results of the index mammogram (HR 0.49, 95% CI 0.32-0.75, p=0.001), and being notified by letter (HR 0.66, 95% CI 0.48-0.90, p=0.01) or telephone (HR 0.62, 95% CI 0.42-0.92, p=0.02) rather than in person were all associated with significant delays in diagnosis. CONCLUSIONS: Evaluation of BIRADS 0, 4, or 5 abnormal mammograms was completed in most women within the recommended 60 days. Even within effective systems, correctible communication factors may adversely affect time to diagnosis.

Disparities in cancer screening in individuals with a family history of breast or colorectal cancer.

BACKGROUND: Understanding racial/ethnic disparities in cancer screening by family history risk could identify critical opportunities for patient and provider interventions tailored to specific racial/ethnic groups. The authors evaluated whether breast cancer (BC) and colorectal cancer (CRC) disparities varied by family history risk using a large, multiethnic population-based survey. METHODS: By using the 2005 California Health Interview Survey, BC and CRC screening were evaluated separately with weighted multivariate regression analyses, and stratified by family history risk. Screening was defined for BC as mammogram within the past 2 years for women aged 40 to 64 years; for CRC, screening was defined as annual fecal occult blood test, sigmoidoscopy within the past 5 years, or colonoscopy within the past 10 years for adults aged 50 to 64 years. RESULTS: The authors found no significant BC screening disparities by race/ethnicity or income in the family history risk groups. Racial/ethnic disparities were more evident in CRC screening, and the Latino-white gap widened among individuals with family history risk. Among adults with a family history for CRC, the magnitude of the Latino-white difference in CRC screening (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.11-0.60) was more substantial than that for individuals with no family history (OR, 0.74; 95% CI, 0.59-0.92). CONCLUSIONS: Knowledge of their family history widened the Latino-white gap in CRC screening among adults. More aggressive interventions that enhance the communication between Latinos and their physicians about family history and cancer risk could reduce the substantial Latino-white screening disparity in Latinos most susceptible to CRC.

Early developments in gene-expression profiling of breast tumors: potential for increasing black-white patient disparities in breast cancer outcomes?

New prognostic tests, such as gene-expression profiling (GEP) of breast tumors, are expected to prolong survival and improve the quality of life for many breast cancer patients. In this article, we argue that GEP has not been adequately validated in minority populations, and that both biological and social factors might affect the broad utility of these tests in diverse populations. We suggest that the widespread use of this technology could potentially lead to suboptimal treatment for black women, resulting in a further increase in black-white patient disparities in treatment response, morbidity and mortality rates. We argue for the need to build a large and diverse evidence base for GEP and other emerging technologies in personalized medicine.

Immigrant generation and physical activity among Mexican, Chinese & Filipino adults in the U.S.

Migrant studies of physical activity (PA) can provide insight into the prevention of chronic disease. It is unclear, however, whether PA increases or decreases the longer migrants live in their host country. In the US, studies on immigrants' length of residence in the US and PA are inconclusive and many studies do not adequately consider the role of socioeconomic status (SES). Using California data, we examine relationships between immigrant generation and physical activity (PA) among Mexican, Chinese and Filipino adults, who represent the three largest immigrant groups in the US, and the extent to which the relationships are confounded by SES. Data from the 2000 US Census was linked with data on adults 18 years and older from the 2005 California Health Interview Survey. PA was measured in three different domains: leisure time (LTPA), non-leisure time (NLTPA) and any PA. Logistic regression was used to examine whether a wide range of SES factors, measured at the respondent and neighborhood levels, influenced the relationship between immigrant generation and PA in all domains and in different ethnic origin groups. Generation was significantly associated with LTPA among Mexican and Chinese adults and with NLTPA among all 3 ethnic origin groups; however the nature of the relationships varied. After adjusting for individual and neighborhood SES factors, a positive association between generation and LTPA remained among Mexican adults, and negative association between generation and NLTPA remained among Chinese and Filipino adults. These results underscore the importance of comparative studies of immigrant generation and PA and consideration of SES factors to identify pathways linking generation to PA. In the context of increasing rates of chronic disease, the study of transitions in PA among immigrants will continue to be critical to promoting the public health of diverse populations in countries such as the US.

Acculturation and colorectal cancer screening among older Latino adults: differential associations by national origin.

BACKGROUND: Although modest improvements in colorectal cancer (CRC) screening utilization have occurred, rates remain low among Latinos. It is unclear whether acculturation plays a role in the utilization of CRC screening. OBJECTIVE: This study aimed to examine the relationships between acculturation and CRC screening among older Mexican, Puerto-Rican and Cuban adults. DESIGN: Cross-sectional observational study. SUBJECTS: Latinos 50 years and older, never diagnosed with CRC, and who were surveyed in the 2000, 2003 and 2005 National Health Interview Survey (NHIS). MEASURES: We measured acculturation with US nativity and language of interview, and examined three different CRC screening outcomes: fecal occult blood test (FOBT) in the past year, up-to-date endoscopy and any up-to-date CRC screening. Logistic regression models were adjusted for predisposing, enabling and health-care need factors consistent with the behavioral model of health-care utilization. MAIN RESULTS: In adjusted analyses, US nativity was positively associated with up-to-date endoscopy among Mexicans (OR: 1.5; 95% CI: 1.1, 2.2), but negatively associated with FOBT in the past year among Puerto Ricans (OR: 0.3; 95% CI: 0.2, 0.7). In contrast to this latter finding among Puerto Ricans, English language interview was positively associated with FOBT in the past year (OR: 2.5; 95% CI: 1.1, 5.4). CONCLUSION: Results underscore the importance of stratification by national origin in studies of acculturation and cancer screening and of targeting less acculturated adults to promote CRC screening. Clinicians, however, should consider the complexity of acculturation and treat US nativity and language preference as independent dimensions among their Latino patients.

Pregnancy intention and preterm birth: differential associations among a diverse population of women.

CONTEXT: Studies published to date provide mixed evidence on the relationship between unintended pregnancy and preterm birth, and none take into consideration that the meaning of unintended pregnancy may vary across racial and ethnic groups. METHODS: Data from the 1999-2003 rounds of the Maternal and Infant Health Assessment, a population-based, representative survey of postpartum women in California, were used to assess the relationship between pregnancy intention and preterm birth. For racial and ethnic groups in which an association was found, sequential logistic regression was conducted to further examine the relationship while controlling for socioeconomic characteristics. RESULTS: In unadjusted results, pregnancy intention was associated with preterm birth among both whites and immigrant Latinas, but not among blacks or U.S.-born Latinas. Among whites, compared with women who reported that their pregnancy was intended, those who were unsure about their pregnancy had elevated odds of preterm birth (odds ratio, 1.4), as did those who reported their pregnancy was unwanted (1.7) or mistimed (1.4). Among immigrant Latinas, those who reported being unsure about their pregnancy were at higher risk of preterm birth than were those who reported an intended pregnancy (1.6). After adjustment for socioeconomic factors, the association remained significant for immigrant Latinas who were unsure about their pregnancy (1.5), but none of the associations remained significant for whites. CONCLUSIONS: Women's interpretations of questions about pregnancy intention and their social experiences regarding pregnancy intention may vary by race or ethnicity. Studies on the association between pregnancy intention and preterm birth may need to be group-specific.

Provider practice models for and costs of delivering medication abortion -- evidence from 11 US abortion care settings.

PURPOSE: Understanding practice models and provider costs for medication abortion (MAB) provision may elucidate ways to facilitate MAB integration into a larger arena of health care services. This study provides descriptive data on the diverse MAB practice models currently being utilized by US health care providers and the costs associated with the components of those models. METHOD: Data were gathered from a sample of 11 abortion care settings, using clinic administrative records and patient satisfaction surveys. RESULTS: Practice models varied dramatically, with a wide range in the type of staff employed to provide MAB. The total episode cost for providing MAB ranged from 252 to 460 US Dollars, and patient satisfaction was high across all practices. CONCLUSION: Information from this study can be used to guide decisions regarding MAB integration into practices not currently providing abortion or which provide only aspiration abortions. The information may also be useful for providers wishing to refine their MAB services.

Acculturation and the sexual and reproductive health of Latino youth in the United States: a literature review.

CONTEXT: The high birthrate among Latina teenagers in the United States has generated increased interest in the role of acculturation in their sexual and reproductive health. It is critical to identify gaps in the existing research and to ascertain the relationship between acculturation and Latino sexual behavior. METHODS: PUBMED, ERIC and POPLINE were searched for journal articles published between 1985 and 2006 that explicitly examined acculturation and sexual and reproductive health among Latino youth. All fertility-related outcomes (pregnancy, birth, abortion) and their proximate determinants (attitudes, knowledge, norms, sexual activity, contraceptive use) were considered sexual or reproductive health outcomes. Eligible studies used a cross-sectional or longitudinal design; had a sample of males, females or both aged 25 or younger; and included Latino-specific analyses. RESULTS: Seventeen studies met the screening criteria, and these studies used 23 distinct measures of acculturation that captured four primary dimensions: time (duration of exposure to U.S. culture), language, culture and residence. The measures' robustness varied, and none of the studies was widely generalizable. Ten studies investigated sexual initiation, and eight of these found a positive association between the likelihood of this outcome and acculturation. Acculturation also was associated with increased condom use and with beliefs and norms related to healthy outcomes, although the evidence was less conclusive. CONCLUSIONS: Ideal studies of acculturation would stratify analyses by gender and country of origin, and would include time measures related to acculturation. When feasible, studies should be population-based and longitudinal, and should build on existing theories of the relationship between acculturation and the sexual behavior, norms and beliefs that are unique to Latino culture.

A positive orientation toward early motherhood is associated with unintended pregnancy among New Orleans youth.

OBJECTIVE: Characterizing young women's willingness to enter motherhood is critical to understanding the high rates of unintended pregnancy among women under 20 years. Our objectives were to discuss a measure called Positive Orientation towards Early Motherhood (POEM), and investigate its association with self-reported unintended pregnancy experience. METHODS: We used data from 332 African-American women 13-19 years old recruited at public family planning and prenatal clinics in New Orleans. Using a series of ANOVAs and multinomial logistic regression, we assessed differences in POEM between four different outcome groups: women who were never pregnant and those who had only intended pregnancies, only unintended pregnancies and both unintended and intended pregnancies. RESULTS: The data suggested that young women perceive pregnancy as an opportunity to assert responsibility, become closer with their families and achieve greater intimacy with their boyfriends. Multiple regression analysis indicated that this positive orientation toward early motherhood independently raised the likelihood that young women experienced unintended pregnancies. In particular, the perception that a pregnancy makes a young woman feel more responsible was associated with an increased likelihood that a young woman had only unintended pregnancies compared to no pregnancies at all. Interestingly, this perception did not differentiate young women who had only intended pregnancies from those who were never pregnant. CONCLUSION: When interpreting reports of unintended pregnancy, more attention should be given to young women's orientation toward early motherhood. Doing so will inform policies that address both personal and structural factors that contribute to persistently high rates of unintended pregnancy among adolescents.

Understanding pregnancy in a population of inner-city women in New Orleans--results of qualitative research.

Unintended pregnancy has conventionally been defined as a pregnancy that is mistimed or unwanted, and this classification has been widely used in survey research. This study explores the utility of these constructs for women who visited a family planning clinic and a prenatal clinic in inner-city New Orleans, LA, and, by extension, for women of similar background and experience. We used semi-structured, open-ended research to explore sexual debut and history, contraceptive knowledge and use, pregnancy history, partner relations, and service use among 77 women (73 of whom were African-American). This study addresses the apparent paradox of high-risk sexual and contraceptive behavior in the presence of expressed preferences to postpone childbearing. It provides some insight into the cultural and social context in which these events and decisions take place and explores the multiple dimensions that shape women's sexual behaviors and their desires for pregnancy. The dimensions explored include perceptions of and experiences with sex/sexuality, values concerning childbearing/motherhood, relationships with partners, experiences with contraception, and attitudes toward abortion. The apparent ambivalence seen in reports of women asked whether a pregnancy was intended, such as statements that they did not want to get pregnant but were either not using contraception or using it irregularly, calls into question the idea that intendedness can be routinely and easily inferred from survey research. Correspondingly, it is not possible to simply assume that either intentionality or future intentions directly affect decisions to use contraception. The problem is that the many factors-structural and individual-affect women's preferences and ability to postpone a pregnancy or to use contraception.

Measuring factors underlying intendedness of women's first and later pregnancies.

CONTEXT: Unintended pregnancy is associated with poor health outcomes for mothers and infants, and is indicative of gaps in family planning services. Conventional measures of pregnancy intendedness do not reflect the multiple factors affecting a woman's pregnancy-related intentions and attitudes. METHODS: Data collected between March 2002 and February 2003 from 701 women in a public family planning clinic and 671 women in a public prenatal clinic in New Orleans were analyzed to examine factors underlying intendedness (including attitudes toward pregnancy and motivations to achieve or avoid pregnancy). RESULTS: In factor analyses, variables measuring pregnancy intendedness were represented by a single latent factor, pregnancy desirability. For first pregnancy, variables that best captured desirability were those measuring happiness, effort in achieving the pregnancy, extent of looking forward to telling friends, whether the pregnancy was intended (i.e., came at the right time or later), and whether the woman wanted to have a baby with her partner. For last or current pregnancies that were second or higher order ones, they were happiness, pregnancy wantedness, effort in achieving the pregnancy, whether the pregnancy was planned and whether the woman wanted to have a baby with her partner. Among women younger than 18 at first pregnancy, happiness and whether a woman wanted a baby with her partner were the only items that captured pregnancy desirability. CONCLUSIONS: Future surveys on pregnancy intendedness could reduce the number of questions used to capture pregnancy desirability. This should help standardize surveillance systems and permit better assessment of trends in pregnancy desirability over time.