Breast Cancer Fear Among Mexican American Women in the United States.

INTRODUCTION: Fear has been described as potentially important in affecting breast cancer screening completion. Limited information is available on the prevalence and determinants of fear among Mexican American women. This study describes perceived breast cancer fear and its association with personal characteristics and screening behavior among Mexican American women. METHODS: This is a secondary analysis of data collected during the implementation of the Breast Cancer Education, Screening and NavigaTion program among eligible uninsured women in two Texas border counties. Participants completed a 26-item survey to assess eligibility, risk status, prior screening, and breast cancer fear. Descriptive statistics and multivariable analyses were used to determine associations between the fear score, personal characteristics, and mammography screening. RESULTS: In all, 1916 of 2012 eligible women completed the study. The mean age was 57.3 years, 99.2% were Hispanic, and 88% were born in Mexico; 15% had a family history of breast cancer and 14% had never had a mammogram. The mean breast cancer fear score was 25.5 (standard deviation: 10.52; range: 8-40); 54.0 % (95% confidence interval: 52.1%-56.7%) had a high fear level. In multivariable analyses, better health status (P < .001), older age (P = .039), birth in the United States (P = .020), and having a regular doctor (P = .056) were associated with lower fear scores. There was no association between breast cancer fear and mammography screening. CONCLUSION: Breast cancer fear is high and varies by personal characteristics and health status among uninsured Mexican American border-residing women due for screening, but is not associated with screening behavior. Further research is needed to clarify the effect of interventions designed to help reduce breast cancer fear among these women, including educational interventions to reduce breast cancer fear.

Impact of a Culturally Tailored Diabetes Education and Empowerment Program in a Mexican American Population Along the US/Mexico Border: A Pragmatic Study.

BACKGROUND: The study purpose was to deliver a diabetes education program under real world conditions and evaluate its effect on diabetes-related clinical, self-management and psychosocial outcomes among Mexican Americans residing along the US/Mexico border. METHODS: A pragmatic study was conducted among adult patients with diabetes in three primary care clinics located along the US/Mexico border. A bilingual culturally tailored diabetes education program incorporating hands-on participatory techniques was delivered in 4 - 8 weekly group sessions. Clinical, self-management and psychosocial outcomes were evaluated pre- and post-intervention with surveys and medical record review. RESULTS: A total of 209 participants were enrolled; mean age was 58.9 years (range 23 - 94, standard deviation: 11.2); 68.4% were female; 91.1% were Hispanic. Significant improvements were observed in glycated hemoglobin (-1.1%, P < 0.001, n = 79), total cholesterol (-17.2 mg/dL, P = 0.041, n = 63), glucose self-monitoring (+1.3 times a week, P = 0.021, n = 115), exercise less than once a week (-18.2%, P < 0.001, n = 129), nutritional behavior (+2.23, P < 0.001, n = 115), knowledge (+1. 83, P < 0.001, n = 141) and diabetes-related emotional distress (-7.32, P = 0.002, n = 111). Benefits were observed with attendance rates as low as 50%. CONCLUSION: A clinic-based culturally competent diabetes education/self-management program resulted in significant improvements in outcomes among Hispanic participants. Experimentally tested culturally appropriate interventions adapted for real world situations can benefit Mexican American diabetic patients even when attendance is imperfect.

Physical Activity in Older Mexican Americans Living in Two Cities on the U.S.-Mexico Border.

BACKGROUND: There is limited information on physical activity in marginalized older populations like that on the U.S.-Mexico border. This study aims to understand physical activity engagement among older Hispanics residing in two U.S.-Mexico Border counties. METHODS: The International Physical Activity Questionnaire (IPAQ) was used to measure physical activity in El Paso and Cameron County, Texas. Physical activity levels were reported for vigorous, moderate, and walking met/mins. Adjusted and unadjusted modeling was conducted to determine county differences and sociodemographic covariates. RESULTS: There were 784 participants and 92.9% were less than 65 years of age. El Paso participants reported a significantly greater natural log met/mins of vigorous (ß = 1.34, p = 0.000) and walking (ß = 0.331, p = 0.006). Significant sociodemographic covariates in El Paso for vigorous met/mins were gender (females ß = -1.20, p = 0.003), having a regular doctor (ß = -0.779, p = 0.029), and acculturation (ß = 0.513, p = 0.019). Significant associations in Cameron County were having a regular doctor (ß = -1.03, p = 0.000) and fair/poor health status (ß = -0.475, p = 0.001). CONCLUSION: Level of physical activity may differ in older Hispanics by urban context on the U.S.-Mexico border. Future physical activity programs to promote physical activity should take context into consideration.

Air pollution and acute respiratory response in a panel of asthmatic children along the U.S.-Mexico border.

BACKGROUND: Concerns regarding the health impact of urban air pollution on asthmatic children are pronounced along the U.S.-Mexico border because of rapid population growth near busy border highways and roads. OBJECTIVES: We conducted the first binational study of the impacts of air pollution on asthmatic children in Ciudad Juarez, Mexico, and El Paso, Texas, USA, and compared different exposure metrics to assess acute respiratory response. METHODS: We recruited 58 asthmatic children from two schools in Ciudad Juarez and two schools in El Paso. A marker of airway inflammation [exhaled nitric oxide (eNO)], respiratory symptom surveys, and pollutant measurements (indoor and outdoor 48-hr size-fractionated particulate matter, 48-hr black carbon, and 96-hr nitrogen dioxide) were collected at each school for 16 weeks. We examined associations between the pollutants and respiratory response using generalized linear mixed models. RESULTS: We observed small but consistent associations between eNO and numerous pollutant metrics, with estimated increases in eNO ranging from 1% to 3% per interquartile range increase in pollutant concentrations. Effect estimates from models using school-based concentrations were generally stronger than corresponding estimates based on concentrations from ambient air monitors. Both traffic-related and non-traffic-related particles were typically more robust predictors of eNO than was nitrogen dioxide, for which associations were highly sensitive to model specification. Associations differed significantly across the four school-based cohorts, consistent with heterogeneity in pollutant concentrations and cohort characteristics. Models examining respiratory symptoms were consistent with the null. CONCLUSIONS: The results indicate adverse effects of air pollution on the subclinical respiratory health of asthmatic children in this region and provide preliminary support for the use of air pollution monitors close to schools to track exposure and potential health risk in this population.

[Environmental PM2.5 levels and distance from a heavy traffic road in Ciudad Juarez, Chihuahua, Mexico]. / Niveles ambientales de las PM2.5 y distancia a una vía de alto tránsito en Ciudad Juárez, Chihuahua, México.

OBJECTIVE: To assess PM2.5 levels at different distances from a heavy traffic road. MATERIAL AND METHODS: Daily measurements of PM2.5 were taken between August 26 and 30, 2002, at different distances from Tecnológico Avenue in Ciudad Juarez, Chihuahua, Mexico. Data analysis consisted of descriptive statistics for each distance and KruskalWallis and cross trend for ranks. RESULTS: We found a significantly decreasing trend of PM2.5 median levels with increasing distance from Tecnológico Avenue (p<0.001). At 100 m distance from the avenue, PM2.5 levels decreased by 9.5 microg/m3 (40.6%) when compared to median levels registered on the avenue. The results showed a highly significant negative correlation between PM2.5 measurements and the distance from the avenue (r=-0.70, n=20 and p=0.0005). CONCLUSIONS: PM2.5 median levels decreased significantly after 100 meters from heavy traffic roads. These results are of great relevance when assessing exposure to PM2.5 in epidemiological studies.

Niveles ambientales de las PM2.5 y distancia a una vía de alto tránsito en Ciudad Juárez, Chihuahua, México / Environmental PM2.5 levels and distance from a heavy traffic road in Ciudad Juarez, Chihuahua, Mexico

OBJETIVO: Evaluar los niveles de las PM2.5 a diferentes distancias de una vía de alto tránsito. MATERIAL Y MÉTODOS: Se realizaron mediciones diarias de PM2.5, del 26 al 30 de agosto de 2002, a diferentes distancias de la avenida Tecnológico, en Ciudad Juárez, Chihuahua, México. Se hizo estadística descriptiva para cada distancia considerada y análisis de las pruebas no paramédicas de Kruskal Wallis y de tendencias cruzadas en grupos ordenados. RESULTADOS: Se encontró una tendencia de decremento significativa de la mediana de las PM2.5 conforme se aleja el punto de medición de la avenida Tecnológico (p<0.00). A partir de los 100 metros de distancia se presentó una diferencia de la mediana de 9.5 µg/m³ (40.6 por ciento), en comparación con la mediana registrada sobre la avenida. Los resultados mostraron una correlación negativa, altamente significativa entre las mediciones de PM2.5 y la distancia (r=-0.70, n=20 y p=0.0005). CONCLUSIONES: Las PM2.5 decrecen de manera significativa a partir de los 100 m de distancia de las vías con alto tráfico. Estos resultados son de gran relevancia en la determinación de exposición en estudios epidemiológicos.

OBJECTIVE: To assess PM2.5 levels at different distances from a heavy traffic road. MATERIAL AND METHODS: Daily measurements of PM2.5 were taken between August 26 and 30, 2002, at different distances from Tecnológico Avenue in Ciudad Juarez, Chihuahua, Mexico. Data analysis consisted of descriptive statistics for each distance and Kruskal Wallis and cross trend for ranks. RESULTS: We found a significantly decreasing trend of PM2.5 median levels with increasing distance from Tecnológico Avenue (p< 0.001). At 100 m distance from the avenue, PM2.5 levels decreased by 9.5 µg/m3 (40.6 percent) when compared to median levels registered on the avenue. The results showed a highly significant negative correlation between PM2.5 measurements and the distance from the avenue (r=-0.70, n=20 and p=0.0005). CONCLUSIONS: PM2.5 median levels decreased significantly after 100 meters from heavy traffic roads. These results are of great relevance when assessing exposure to PM2.5 in epidemiological studies.

Concentraciones de DDT/DDE y riesgo de hipospadias: un estudio piloto de casos y controles / DDT/DDE concentrations and risk of hypospadias: a case-control pilot study

OBJETIVO: Evaluar la asociación entre los niveles séricos maternos de DDT/DDE y el riesgo de hipospadias. MATERIAL Y MÉTODOS: Estudio de casos y controles, efectuado en la Ciudad de México durante el periodo 1997-1999, con 41 casos de hipospadias y 28 controles. La informacion obtenida por cuestionario y las muestras sanguíneas fueron evaluadas mediante modelos multivariados de regresión logística. RESULTADOS: Las concentraciones materna de DDT y DDE no mostraron asociación con el riesgo de hipospadias (RM 1.13; IC 95 por ciento 0.24-5.29 y RM 0.48; IC 95 por ciento 0.15-1.60, respectivamente). Los predictores encontrados fueron hijos de madres con mayor edad (RM 8.69; IC 95 por ciento 1.69-44.9), y la actividad laboral durante el embarazo (RM, 4.68; IC 95 por ciento 1.15-18.9). CONCLUSIONES: Dado que se cuenta con escasa información sobre los efectos endocrinos a diferentes concentraciones de DDT/DDE en humanos, la dosis pudiera ser un factor determinante sobre el tipo de efecto.

OBJECTIVE: To evaluate the association between maternal serum DDT/DDE levels and risk of hypospadias. MATERIAL AND METHODS: A case-control study in Mexico City was conducted during 1997-1999 among 41 subjects with hypospadias and 28 controls. Blood samples were obtained from study subjects. Information was obtained using a standardized questionnaire. Data were analyzed using multivariate logistic regression models. RESULTS: Maternal DDT and DDE levels showed no association with hypospadias (OR 1.13; 95 percent CI 0.24-5.29 and OR=0.48; 95 percent CI 0.15-1.60, respectively). Associated factors were older age of mothers (OR 8.69; 95 percent CI 1.69-44.9), and working during pregnancy (OR 4.68; 95 percent CI 1.15-18.9). CONCLUSIONS: Information about the endocrine effects of different levels of DDT/DDE in human subjects is scarce; dosage may be a determinant factor of the type of effect.

[DDT/DDE concentrations and risk of hypospadias. Pilot case-control study]. / Concentraciones de DDT/DDE y riesgo de hipospadias. Un estudio piloto de casos y controles.

OBJECTIVE: To evaluate the association between maternal serum DDT/DDE levels and risk of hypospadias. MATERIAL AND METHODS: A case-control study in Mexico City was conducted during 1997-1999 among 41 subjects with hypospadias and 28 controls. Blood samples were obtained from study subjects. Information was obtained using a standardized questionnaire. Data were analyzed using multivariate logistic regression models. RESULTS: Maternal DDT and DDE levels showed no association with hypospadias (OR 1.13; 95% CI 0.24-5.29 and OR = 0.48; 95% CI 0.15-1.60, respectively). Associated factors were older age of mothers (OR 8.69; 95% CI 1.69-44.9), and working during pregnancy (OR 4.68; 95% CI 1.15-18.9). CONCLUSIONS: Information about the endocrine effects of different levels of DDT/DDE in human subjects is scarce; dosage may be a determinant factor of the type of effect. The English version of this paper is available at:http://www.insp.mx/salud/index.html.