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Diabetes is associated with liver disease and risk of hepatocellular carcinoma. In this study, we evaluated the association between liver fibrosis measured by transient elastography and four glucose metabolism measures in the Cameron County Hispanic Cohort, a population‐based, randomly selected cohort of Mexican American Hispanics with high rates of diabetes and liver cancer. We measured liver fibrosis (a risk factor for hepatocellular carcinoma) in 774 well‐characterized cohort participants using transient elastography. We evaluated the association of liver fibrosis with glycated hemoglobin (HbA1c), fasting blood glucose, insulin, and insulin resistance using multivariable linear regression models. In multivariable models, log‐transformed HbA1c had the strongest association with liver fibrosis (β = 0.37, 95% confidence interval [CI] 0.04‐0.69, P = 0.038), after controlling for waist circumference, aspartate aminotransferase, alanine aminotransferase, liver fat, and other known confounders. The association was statistically significant among women (β = 0.33, 95% CI 0.10‐0.56, P = 0.009) and similar but nonsignificant among men (β = 0.41, 95% CI −0.17 to 0.98, P = 0.593). Waist circumference, platelet count, aspartate transaminase, and liver steatosis were each associated with liver stiffness. Conclusions: Elevated HbA1c is associated with liver fibrosis, a key risk factor for HCC, particularly among women. Our results indicate that Mexican Americans with uncontrolled HbA1c may benefit from routine screening by liver elastography to identify individuals at risk of liver disease progression. [ABSTRACT FROM AUTHOR]

Background: Understanding the factors that contribute to physical activity (PA) in Mexican-origin adolescents is essential to the design of effective efforts to enhance PA participation in this population. Methods: Multivariable logistic regression was used to identify sociodemographic and behavioral correlates of self-reported PA in school and community settings in 1154 Mexican-origin adolescents aged 12-17 years in Houston, TX. Results: The majority of adolescents were born in the US (74%), approximately half (51%) were overweight or obese, and nearly three-quarters (73%) watched more than 2 hours of weekday television. Similarities and differences by setting and gender were observed in the relationships between sociodemographic and behavioral characteristics and PA. In boys, parental education and attending physical education (PE) were positively associated with PA across multiple PA outcomes. Adolescent linguistic acculturation was inversely associated with participation in community sports, whereas parental linguistic acculturation was positively associated with PA at school. In girls, PA in school and community settings was inversely associated with TV viewing and positively associated with PE participation. Conclusions: These findings highlight similarities and differences in correlates of PA among boys and girls, and point toward potential sources of opportunities as well as disparities for PA behaviors in Mexican-origin adolescents. [ABSTRACT FROM AUTHOR]

This study examined the association between widowhood and depressive symptoms and the extent to which the association is contingent upon risk and resiliency, including immigration status, functional limitations, financial strains, and intergenerational support, among older Mexican Americans. The sample included 344 parent-child pairs reported by 83 respondents. Clustered regression analysis showed that widowhood elevated risks for depressive symptoms. We found that having some functional limitations, having more children and living in the same city with children exacerbated the adverse effects of widowhood on depressive symptoms. We also found that living in the same city with children increased the detrimental effects of widowhood on the depressive symptoms in men, whereas we did not find this pattern in women. The findings highlight the heterogeneity within the widowed Mexican American older adults. Implications for future research and practice are discussed. [ABSTRACT FROM AUTHOR]

Immigrant health assimilation is often framed as a linear, individualistic process. Yet new assimilation theory and structural theories of health behavior imply variation in health assimilation as immigrants and their families interact with different US social institutions throughout the day. We test this idea by analyzing how two indicators of dietary assimilation-food acculturation and healthy eating-vary throughout the day as Mexican children in immigrant households consume food in different institutional settings. Using individual fixed-effects models and data from the National Health and Nutrition Examination Survey, we find that Mexican children in immigrant households (N = 2,337) engage in "dietary code-switching," eating more acculturated but not necessarily less healthy food in schools and more acculturated but less healthy food in restaurants compared to homes. Findings advance theory and knowledge about how social institutions condition dietary assimilation in particular and health assimilation more broadly. [ABSTRACT FROM AUTHOR]

Obesity and adipokines are associated with development of type 2 diabetes. However, limited longitudinal studies have examined their roles on declining β-cell function over time. This report assessed three adiposity measures (BMI, percent body fat, trunk fat), insulin resistance, and fifteen adipokines in relationship to longitudinal change in β-cell function measured by disposition index (DI) from frequently-sampled-intravenous-glucose-tolerance testing. The results showed that three factors were significantly and independently associated with rate of change in DI over time: rate of change in BMI (negative), rate of change in IL-6 (negative), and baseline adiponectin (positive). The association was the strongest for changing BMI and was largely explained by changing insulin resistance; the association with changing IL-6 was also largely explained by changing insulin resistance. Baseline adiponectin remained positively associated after adjustment for changing insulin resistance, suggesting an independent effect of adiponectin to preserve or improve β-cell function. These findings provide evidence and potential mechanisms for the role of obesity in promoting β-cell dysfunction, highlighting the potential importance of mitigating obesity and its metabolic effects in preventing and treating type 2 diabetes. [ABSTRACT FROM AUTHOR]

Objective: Epidemiologic analyses indicate a lack of association between BMI (kg/m2 ) and mortality among Hispanic adults. Because BMI provides only a surrogate for the real variable of interest, adiposity, this study evaluated associations between measures of body composition and mortality.Methods: Using data from US-residing Mexican Americans in the National Health and Nutrition Examination Survey (NHANES) III (n = 4,480) and NHANES 1999-2010 (n = 5,849), the association between seven measures of body composition measured via anthropometry and bio-electrical impedance analysis (i.e., waist circumference, waist-to-height ratios [WHtR], skinfolds, lean mass, fat mass, percent body fat, and BMI) and all-cause and cardiovascular and diabetes mortality were examined. Additional analyses were stratified by gender.Results: Waist circumference (hazard ratio [HR]: 1.04, 95% CI: 1.01-1.07) and WHtR (HR: 1.08, 95% CI: 1.03-1.14) were weakly associated with an increased all-cause mortality, while WHtR was associated with an increased risk of diabetes-related death (HR: 1.26, 95% CI: 1.07-1.49). In gender-stratified analyses, there was an increased risk of mortality in females who had increases in WHtR and waist circumference for all-cause mortality and cardiovascular deaths.Conclusions: Waist circumference and WHtR were associated with increased risk of all-cause and diabetes-related mortality in US-residing Mexican American adults. [ABSTRACT FROM AUTHOR]

While health inequalities related to race/ethnicity, nativity, and age are well documented, it remains unclear how these axes of stratification combine to shape health trajectories, especially in middle and late life. This study addresses gaps in the literature by drawing on both life course and intersectionality perspectives to understand inequalities in morbidity trajectories. Using growth curve models applied to data from the Health and Retirement Study, I examine the life course patterning of health inequalities among US- and foreign-born non-Hispanic whites, non-Hispanic blacks, and Mexican Americans between the ages of 51 and 80 (N = 16,265). Findings are consistent with premature aging and cumulative disadvantage processes: US- and foreign-born blacks and Mexican Americans experience earlier health deterioration than US-born whites, and they also tend to exhibit steeper health declines with age. Moreover, contrary to the common assumption of monolithic healthy immigrant and erosion processes, results show that these processes are contingent on both race/ethnicity and age: compared with US-born whites, white immigrants have a persistent health advantage, while black and Mexican American immigrants experience a health disadvantage that increases with age. These results suggest that among nonwhite immigrants, the immigrant health advantage may be offset by cumulative exposure to racialized immigrant incorporation processes. A wide array of health-related factors including socioeconomic resources, health behaviors, and medical care account for some, but not all, group differences in morbidity trajectories. Findings highlight the utility of life course and intersectionality perspectives for understanding health inequalities. [ABSTRACT FROM AUTHOR]

Background: Trends in cardiovascular disparities are poorly understood, even as diversity increases in the United States. Objective: To examine U.S. trends in racial/ethnic and nativity disparities in cardiovascular health. Design: Repeated cross-sectional study. Setting: NHANES (National Health and Nutrition Examination Survey), 1988 to 2014. Participants: Adults aged 25 years or older who did not report cardiovascular disease. Measurements: Racial/ethnic, nativity, and period differences in Life's Simple 7 (LS7) health factors and behaviors (blood pressure, cholesterol, hemoglobin A1c, body mass index, physical activity, diet, and smoking) and optimal composite scores for cardiovascular health (LS7 score ≥10). Results: Rates of optimal cardiovascular health remain below 40% among whites, 25% among Mexican Americans, and 15% among African Americans. Disparities in optimal cardiovascular health between whites and African Americans persisted but decreased over time. In 1988 to 1994, the percentage of African Americans with optimal LS7 scores was 22.8 percentage points (95% CI, 19.3 to 26.4 percentage points) lower than that of whites in persons aged 25 to 44 years and 8.0 percentage points (CI, 6.4 to 9.7 percentage points) lower in those aged 65 years or older. By 2011 to 2014, differences decreased to 10.6 percentage points (CI, 7.4 to 13.9 percentage points) and 3.8 percentage points (CI, 2.5 to 5.0 percentage points), respectively. Disparities in optimal LS7 scores between whites and Mexican Americans were smaller but also decreased. These decreases were due to reductions in optimal cardiovascular health among whites over all age groups and periods: Between 1988 to 1994 and 2011 to 2014, the percentage of whites with optimal cardiovascular health decreased 15.3 percentage points (CI, 11.1 to 19.4 percentage points) for those aged 25 to 44 years and 4.6 percentage points (CI, 2.7 to 6.5 percentage points) for those aged 65 years or older. Limitation: Only whites, African Americans, and Mexican Americans were studied. Conclusion: Cardiovascular health has declined in the United States, racial/ethnic and nativity disparities persist, and decreased disparities seem to be due to worsening cardiovascular health among whites rather than gains among African Americans and Mexican Americans. Multifaceted interventions are needed to address declining population health and persistent health disparities. [ABSTRACT FROM AUTHOR]

Background: While associated with obesity, the cause of the rapid rise in prevalence of nonalcoholic fatty liver disease (NAFLD) in children, which is highest among Hispanics, is not well understood. Animal experiments have demonstrated that arsenic exposure contributes to liver injury. Our objective was to examine the association between arsenic exposure and NAFLD in humans and to determine if race/ethnicity modifies the association.Methods: Urinary inorganic arsenic concentrations among those ≥12 years in the National Health and Nutrition Examination Survey, 2005-2014 were used to assess the cross-sectional association with serum alanine aminotransferase (ALT) levels, a marker of liver dysfunction. We excluded high alcohol consumers (>4-5 drinks/day; n = 939), positive hepatitis B or C (n = 2330), those missing body mass index (n = 100) and pregnant women (n = 629) for a final sample of 8518. Arsenic was measured using liquid chromatography coupled with mass spectrometry and ALT was measured using standard methods. Sampling weights were used to obtain national estimates. Due to lack of normality, estimates were log transformed and are presented as geometric means. Logistic regression models controlling for age, sex, income, and weight category estimate adjusted odd ratios (aOR) of elevated ALT by quartile of arsenic and tested for effect modification by race/ethnicity and weight. Elevated ALT was defined as >25 IU/L and >22 IU/L for boys and girls ≤17 years, respectively and >30 IU/L and >19 IU/L for men and women, respectively.Results: Among all, aOR of elevated ALT were higher among those in the highest vs. lowest arsenic quartile (referent), 1.4 (95% confidence interval [CI]: 1.1, 1.7) with a borderline significant interaction (p = 0.07) by race/ethnicity but not weight (p = 0.4). In analysis stratified by race/ethnicity, aOR of elevated ALT among those in the 4th quartile were higher among Mexican Americans, 2.0 (CI: 1.3, 3.1) and non-Hispanic whites only, aOR 1.4 (CI: 1.1, 1.8) despite the fact that obesity prevalence was highest among non-Hispanic blacks.Conclusions: Our findings demonstrate a positive association between urinary arsenic exposure and risk of NAFLD among U.S. adolescents and adults that is highest among Mexican Americans and among those obese, regardless of race/ethnicity. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the genetic mechanisms of regional fat deposition, which is a strong risk factor for metabolic diseases beyond total adiposity.Methods: A genome-wide association study of 7,757,139 single-nucleotide polymorphisms (SNPs) in 983 Mexican Americans (nmale  = 403; nfemale  = 580) from the Insulin Resistance Atherosclerosis Family Study was performed. Association analyses were performed with and without sex stratification for subcutaneous adipose tissue, visceral adipose tissue (VAT), and visceral-subcutaneous ratio (VSR) obtained from computed tomography.Results: The strongest signal identified was SNP rs2185405 (minor allele frequencies [MAF] = 40%; PVAT  = 1.98 × 10-8 ) with VAT. It is an intronic variant of the GLIS family zinc finger 3 gene (GLIS3). In addition, SNP rs12657394 (MAF = 19%) was associated with VAT in males (Pmale  = 2.39×10-8 ; Pfemale  = 2.5 × 10-3 ). It is located intronically in the serum response factor binding protein 1 gene (SRFBP1). On average, male carriers of the variant had 24.6 cm2 increased VAT compared with noncarriers. Subsequently, genome-wide SNP-sex interaction analysis was performed. SNP rs10913233 (MAF = 14%; Pint  = 3.07 × 10-8 ) in PAPPA2 and rs10923724 (MAF = 38%; Pint  = 2.89 × 10-8 ) upstream of TBX15 were strongly associated with the interaction effect for VSR.Conclusions: Six loci were identified with genome-wide significant associations with fat deposition and interactive effects. These results provided genetic evidence for a differential basis of fat deposition between genders. [ABSTRACT FROM AUTHOR]

Liver enzymes alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) are markers for type 2 diabetes mellitus (T2DM); alkaline phosphatase is a marker of liver disease. Mexican-American adolescents are disproportionately affected by T2DM, while in Mexico its prevalence is emerging. We assessed liver biomarkers and lipid profiles among Mexican and Mexican-American adolescents 10–14 years old with high/low risk of T2DM through a cross-sectional, descriptive study (Texas n=144; Mexico n=149). We included family medical histories, anthropometry, and blood pressure. Obesity was present in one-third of subjects in both sites. ALT (UL) was higher (p<0.001) in high-risk adolescents (23.5 ± 19.5 versus 17.2 ± 13.4 for males, 19.7 ± 11.6 versus 15.1 ± 5.5 for females), in Toluca and in Texas (26.0 ± 14.7 versus 20.0 ± 13.2 for males, 18.2 ± 13.4 versus 14.6 ± 10.1 for females), as well as GGT (UL) (p<0.001) (18.7 ± 11.1 versus 12.4 ± 2.3 for males, 13.6 ± 5.8 versus 11.5 ± 3.9 for Mexican females; 21.0 ± 6.8 versus 15.4 ± 5.5 for males, 14.3 ± 5.0 versus 13.8 ± 5.3 for females in Texas). We found no differences by sex or BMI. Total cholesterol and HDL were higher among Mexican-Americans (p<0.001). In conclusion, multiple risk factors were present in the sample. We found differences by gender and between high and low risk for T2DM adolescents in all liver enzymes in both sites. [ABSTRACT FROM AUTHOR]

We investigated the effect of chronic medical conditions including obesity on self-reported disability and mobility in Mexican Americans aged 75 or over using data from the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE) Wave 5 (2004-2005). Disability was assessed with a modified version of the Katz activities of daily living (ADL) scale and mobility was assessed with the Rosow Breslau scale of gross mobility function. The percentage of participants needing assistance with ADLs were as follows: 26.7% for transferring from a bed to chair, 26.6% for walking across a small room, 17.9% for dressing, 16.3% for using a toilet, 14.3% for grooming, and 8.2% for eating. Fifty percent reported limitation in the ability to walk 'A a mile and walking up and down stairs. Multivariate logistic regression analysis after controlling for all covariates showed that arthritis, diabetes, stroke, and obesity were significantly associated with any ADL limitation, walking up and down stairs, and walking 1/2 mile. Prevention of obesity and chronic medical conditions will help increase functional independence in this population. [ABSTRACT FROM AUTHOR]

Objective: Using the Healthy Eating Index-2010 (HEI-2010), the present study aimed to examine diet quality and the impact of overall diet quality and its components on central obesity among Mexican-American men and women.Design: Cross-sectional data from NHANES 1999-2012 were used. The HEI-2010 data, including twelve components for a total score of 100, were collected with a 24 h recall interview. Central obesity was defined as a waist circumference of ≥88 cm for women and ≥102 cm for men. Weighted logistic regressions were performed to assess associations between HEI-2010 scores and central obesity.Setting: National Health and Nutrition Examination Survey (NHANES) 1999-2012.Subjects: A total of 6847 Mexican Americans aged ≥20 years with reliable dietary recall status and non-pregnancy status.Results: Higher HEI-2010 total score was associated with lower odds of central obesity in Mexican-American men (OR; 95 % CI=0·98; 0·98, 1·00). Among all Mexican Americans, one-unit higher score of total fruit and sodium (i.e. lower level of intake) was associated with 4 % (0·96; 0·93, 0·99) and 2 % (0·98; 0·96, 0·99) lower odds of central obesity, respectively. However, a higher total proteins score was associated with higher odds of central obesity (1·08; 1·00, 1·16). In gender-specific analyses, a higher whole fruit or sodium score was inversely associated with central obesity in men but not in women.Conclusions: HEI-2010 scores of total fruit and sodium were inversely associated with central obesity among all Mexican Americans. However, total proteins score and central obesity was positively associated. In Mexican-American men, HEI-2010 total and whole fruit scores were inversely associated with central obesity. [ABSTRACT FROM AUTHOR]

Objective: Examine relationships of healthy and unhealthy dietary patterns with BMI, sex, age and acculturation among Mexican Americans.Design: Cross-sectional. Participants completed culturally tailored Healthy and Unhealthy Eating Indices. Multivariable mixed-effect Poisson regression models compared food pattern index scores and dietary intake of specific foods by BMI, sex, age and acculturation defined by language preference and generational status.Setting: Participants recruited from the Cameron County Hispanic Cohort study, Texas-Mexico border region, between 2008 and 2011.Subjects: Mexican-American males and females aged 18-97 years (n 1250).Results: Participants were primarily female (55·3 %), overweight or obese (85·7 %), preferred Spanish language (68·0 %) and first-generation status (60·3 %). Among first-generation participants, bilingual participants were less likely to have a healthy eating pattern than preferred Spanish-speaking participants (rate ratio (RR)=0·79, P=0·0218). This association was also found in males (RR=0·81, P=0·0098). Preferred English-speaking females were less likely to consume healthy foods than preferred Spanish-speaking females (RR=0·84, P=0·0293). Among second-generation participants, preferred English-speaking participants were more likely to report a higher unhealthy eating pattern than preferred Spanish-speaking participants (RR=1·23, P=0·0114). Higher unhealthy eating patterns were also found in females who preferred English v. females who preferred Spanish (RR=1·23, P=0·0107) or were bilingual (RR=1·26, P=0·0159). Younger, male participants were more likely to have a higher unhealthy eating pattern. BMI and diabetes status were not significantly associated with healthy or unhealthy eating patterns.Conclusions: Acculturation, age, sex and education are associated with healthy and unhealthy dietary patterns. Nutrition interventions for Mexican Americans should tailor approaches by these characteristics. [ABSTRACT FROM AUTHOR]

Hispanic Americans comprise the largest and fastest-growing ethnic minority in the USA. In Houston, Texas, 44% of the population is of Hispanic descent, with the majority being Mexican Americans (78%). This population is under-represented in health-related research despite their high prevalence of obesity and diabetes, which may predispose them to cancer and other chronic conditions. Recognizing the need for a greater research effort into the health risks of Hispanic Americans, the population-based Mexican American (Mano a Mano) Cohort study was launched in 2001. This is an open cohort with enrolment ongoing to 2019, and as of 30 June 2014, 23 606 adult participants from over 16 600 households were enrolled. Bilingual interviewers elicit information in person on demographics, acculturation, lifestyle, occupation, medical history, family cancer history, self-reported and measured height and weight, and other exposures. Urine, blood and saliva samples have been collected at baseline from 43%, 56% and 63% of participants, respectively. DNA samples are available for about 90% of participants. Incident cancers and other chronic diseases are ascertained through annual telephone re-contact and linkage to the Texas Cancer Registry and/or medical records. Molecular data such as genetic ancestry markers, blood telomere length and HbA1c, a marker of impaired glucose tolerance, are available for a substantial proportion of the participants. Data access is provided on request [manoamano@mdanderson.org]. For further information please visit [www.mano-mano.us]. [ABSTRACT FROM AUTHOR]

We previously identified a locus linked to total cholesterol (TC) concentration in Pima Indians on chromosome 19p. To characterize this locus, we genotyped > 2000 SNPs in 1838 Pimas and assessed association with log(TC). We observed evidence for association with log(TC) with rs2278426 (3.5% decrease/copy of the T allele; P = 5.045 × 10 − 6 ) in the ANGPTL8 (angiopoietin-like 8) gene. We replicated this association in 2413 participants of the San Antonio Mexican American Family Study (SAMAFS: 2.0% decrease per copy of the T allele; P = 0.005842). In a meta-analysis of the combined data, we found the strongest estimated effect with rs2278426 ( P = 2.563 × 10 − 7 ). The variant T allele at rs2278426 predicts an Arg59Trp substitution and has previously been associated with LDL-C and HDL-C. In Pimas and SAMAFS participants, the T allele of rs2278426 was associated with reduced HDL-C levels ( P = 0.000741 and 0.00002, respectively), and the combined estimated effect for the two cohorts was − 3.8% ( P = 8.526 × 10 − 8 ). ANGPTL8 transcript and protein levels increased in response to both glucose and insulin. The variant allele was associated with increased levels of cleaved ANGPTL3. We conclude that individuals with the variant allele may have lower TC and HDL-C levels due to increased activation of ANGPTL3 by ANGPTL8. [ABSTRACT FROM AUTHOR]

Purpose: To measure the association between physical activity and the metabolic syndrome risk in Mexican-Americans. Methods: Participants were drawn from the Cameron County Hispanic Cohort (n = 3,414), a randomly selected Mexican-American cohort in Texas on the US-Mexico border. Moderate and vigorous physical activity was assessed using reliable and validated instruments. The metabolic syndrome was defined as having 3 or more metabolic abnormalities. Results: One thousand five hundred and twenty-four participants of the cohort (45.02%) were found to have the metabolic syndrome. Compared to participants who did not meet US physical activity guidelines, participants who met physical activity guidelines of 150 moderate and vigorous minutes per week (≥ 600 MET adjusted minutes) had 36% lower risk for the metabolic syndrome (OR = 0.64; 95% CI: 0.42–0.98), and participants with total minutes per week of moderate and vigorous/strenuous activity greater than 743 MET adjusted minutes had 37% lower risk for the metabolic syndrome (OR = 0.63; 95% CI: 0.42–0.94) compared with their counterparts, after adjusting for age, gender, annual household income, body mass index, smoking and alcohol drinking status, total portions of fruit and vegetable intake, census tracts and blocks, and survey version for physical activity. Conclusions: Meeting or exceeding physical activity guidelines significantly was inversely associated with the risk for the metabolic syndrome in Mexican-Americans. Improving levels of physical activity appears to be an effective target for the metabolic syndrome prevention and control among Mexican-Americans independent of other factors. [ABSTRACT FROM AUTHOR]

Asthma is an important environmental justice concern for first generation Mexican-Americans. Families experience disparities in housing conditions, access to care, and legal marginalization. Little is known about how Hispanic/Latina mothers of children with asthma navigate these oppressions. Problem: The purpose of this paper is to describe the discourses of environmental justice of a group Hispanic/Latina caregivers of children with asthma. Method: A photovoice design was used with Hispanic/Latina mothers (n=11) in Tacoma, Washington, to take, discuss, select and display phototexts to policymakers that communicated their experiences and opinions in managing asthma for their child. Using critical narrative analysis, phototexts were analyzed for the use of agency and structure in confronting environmental threats to asthma. Results: Participants produced 33 phototexts taking on the roles of teacher, parent, advocate, investigator, and storyteller. Narratives identified environmental threats (breathable, meteorological, medical, social, emotional, and ingestible) and promoted protective actions and social advocacy against such threats. Conclusion: Mothers' actions as teachers and advocates in the phototexts provided opportunities for promoting empowerment and solidarity with others in the face of multiple environmental oppressions. Critical narrative analysis of photo-texts provided an opportunity to identify important opportunities for furthering environmental justice in new immigrant groups. [ABSTRACT FROM AUTHOR]

Purpose. To compare the risk for diabetes in each of 4 categories of metabolic health and BMI. Methods. Participants were drawn from the Cameron County Hispanic Cohort, a randomly selected Mexican American cohort in Texas on the US-Mexico border. Subjects were divided into 4 phenotypes according to metabolic health and BMI: metabolically healthy normal weight, metabolically healthy overweight/obese, metabolically unhealthy normal weight, and metabolically unhealthy overweight/obese. Metabolic health was defined as having less than 2 metabolic abnormalities. Overweight/obese status was assessed by BMI higher than 25 kg/m2. Diabetes was defined by the 2010 ADA definition or by being on a diabetic medication. Results. The odds ratio for diabetes risk was 2.25 in the metabolically healthy overweight/obese phenotype (95% CI 1.34, 3.79), 3.78 (1.57, 9.09) in the metabolically unhealthy normal weight phenotype, and 5.39 (3.16, 9.20) in metabolically unhealthy overweight/obese phenotype after adjusting for confounding factors compared with the metabolically healthy normal weight phenotype. Conclusions. Metabolic health had a greater effect on the increased risk for diabetes than overweight/obesity. Greater focus on metabolic health might be a more effective target for prevention and control of diabetes than emphasis on weight loss alone. [ABSTRACT FROM AUTHOR]

Objective: Failure to adhere to treatment with antipsychotic medication is the most common cause of relapse among patients with schizophrenia. A novel multifamily group (MFG) intervention, informed by the Theory of Planned Behavior (TPB). demonstrated efficacy in increasing medication adherence and decreasing rehospitalizations in schizophrenia patients. This report explores the hypothesis that the improved outcomes obtained through the MFG approach were mediated by changes in the patients' attitudes toward medications, subjective norms-social influences, and perceived behavioral control of resources. Method: Data from a recently completed, randomized controlled trial of MFG was used to test the hypothesis that the improvement in adherence was mediated by the 3 TPB factors. Subjects were 174 Mexican American adults with schizophrenia-spectrum disorder who had participated in a study of MFG focused on improving medication adherence. Assessments occurred at baseline and at 4, 8, 12, 18, and 24 months. Results: Path analysis revealed that the increased adherence associated with MFG was mediated by improvements in subjective norms but not attitudes toward medications nor perceived behavioral control. Conclusion: An MFG treatment specifically tailored to increase medication adherence among Mexican Americans with schizophrenia achieved its benefits by leveraging social influences through teaching family members how to support medication adherence in their ill relatives. [ABSTRACT FROM AUTHOR]

Purpose. We investigated associations of acculturation with various types of activity (moderatevigorous leisure-time physical activity [LTPA], moderate-vigorous work- and transportation-related physical activity, and sedentary activity), and whether these activities mediated the acculturation-obesity association among Mexican-Americans. Design. Cross-sectional. Setting. National Health and Nutrition Examination Survey (NHANES) 2007-2010. Subjects. Mexican-American NHANES participants aged ≥ 20 years (n = 1902). Measures. Demographic characteristics, physical activity, sedentary behavior, acculturation, and body mass index. Analysis. Multinomial logistic regression was used to estimate associations of acculturation with categories of self-reported activity. Path analysis was used to test whether the activity measures mediated acculturation-obesity associations. Results. In adjusted models, compared to U.S.-born Mexican-Americans, foreign-bom Mexican- Americans living in the United States for less than 10 years were significantly less likely to be in the highest LTPA and sedentary activity categories, and more likely to be in the highest total and transportation activity categories. Foreign-bom Mexican-Americans living in the United States for 10 years or more were significantly less likely to engage in high sedentary activity but more likely to engage in high transportation activity. Sedentary behavior was the strongest mediator of the acculturation-obesity association, accounting for 40.7% and 57.1% of the total effect of acculturation on obesity among foreign-bom Mexican- Americans living in the United Slates for less than 10 years and for 10 years or more, respectively, compared to U.S.-born Mexican-Americans. Conclusion. Reducing sedentary behavior may lower the negative impact of acculturation on obesity. [ABSTRACT FROM AUTHOR]

Residents of distressed urban areas suffer early aging-related disease and excess mortality. Using a community-based participatory research approach in a collaboration between social researchers and cellular biologists, we collected a unique data set of 239 black, white, or Mexican adults from a stratified, multistage probability sample of three Detroit neighborhoods. We drew venous blood and measured telomere length (TL), an indicator of stress-mediated biological aging, linking respondents’ TL to their community survey responses. We regressed TL on socioeconomic, psychosocial, neighborhood, and behavioral stressors, hypothesizing and finding an interaction between poverty and racial-ethnic group. Poor whites had shorter TL than nonpoor whites; poor and nonpoor blacks had equivalent TL; and poor Mexicans had longer TL than nonpoor Mexicans. Findings suggest unobserved heterogeneity bias is an important threat to the validity of estimates of TL differences by race-ethnicity. They point to health impacts of social identity as contingent, the products of structurally rooted biopsychosocial processes. [ABSTRACT FROM PUBLISHER]

Obesity is a chronic metabolic disorder that may also lead to reduced white matter integrity, potentially due to shared genetic risk factors. Genetic correlation analyses were conducted in a large cohort of Mexican American families in San Antonio (N = 761, 58% females, ages 18-81 years; 41.3 ± 14.5) from the Genetics of Brain Structure and Function Study. Shared genetic variance was calculated between measures of adiposity [(body mass index (BMI; kg/m2) and waist circumference (WC; in)] and whole-brain and regional measurements of cerebral white matter integrity (fractional anisotropy). Whole-brain average and regional fractional anisotropy values for 10 major white matter tracts were calculated from high angular resolution diffusion tensor imaging data (DTI; 1.7 × 1.7 ×3mm; 55 directions). Additive genetic factors explained intersubject variance in BMI (heritability, h2 = 0.58), WC (h2 = 0.57), and FA (h2 = 0.49). FA shared significant portions of genetic variance with BMI in the genu (ρG = -0.25), body (ρG = -0.30), and splenium (ρG = -0.26) of the corpus callosum, internal capsule (ρG = -0.29), and thalamic radiation (ρG= -0.31) (all p's = 0.043). The strongest evidence of shared variance was between BMI/WC and FA in the superior fronto-occipital fasciculus (ρG = -0.39, p = 0.020; ρG = -0.39, p = 0.030), which highlights region-specific variation in neural correlates of obesity. This may suggest that increase in obesity and reduced white matter integrity share common genetic risk factors. [ABSTRACT FROM AUTHOR]

Mexican Americans are an understudied ethnic group for determinants of bone health, although the risk of age-related osteoporosis is high in this rapidly growing sector of the U.S. population. Thus, the objective of the present study was to establish the dietary calcium requirements for bone health in Mexican-American adolescents by measuring calcium retention calculated from balance in response to a range of dietary calcium intakes and to determine predictors of skeletal calcium retention. Adolescents aged 12--15 y were studied twice on paired calcium intakes ranging from 600 to 2300 mg/d using randomized-order, crossover 3-wk balance studies. Skeletal calcium retention was calculated as dietary calcium intake minus calcium excreted in feces and urine over the last 2 wk of balance. A linear model was developed to explain the variation in calcium retention. Boys (n = 20) were taller and had higher lean mass, usual dietary calcium intake, bone mineral content, and serum alkaline phosphatase compared with girls, whereas girls (n = 20) had higher Tanner scores and greater fat mass. Calcium retention increased with calcium intake (P< 0.0001) and did not differ by sex (P= 0.66). In boys and girls considered together, calcium intake explained 33% of the variation in calcium retention. Serum alkaline phosphatase explained an additional 11 % of the variation in calcium retention. Other variables measured, including the urine N-telopeptide of type I collagen/creatinine ratio, Tanner score, serum parathyroid hormone and 25-hydroxyvitamin D, weight, height, and body mass index, did not contribute to the variance in calcium retention. In adolescence, calcium retention in both Mexican-American boys and girls was higher than determined previously in adolescent nonHispanic white girls. [ABSTRACT FROM AUTHOR]

Background Both environmental and genetic factors impact type 2 diabetes (T2D). To identify such modifiers, we genotyped 15 T2D-associated variants from genome-wide association studies (GWAS) in 6,414 non-Hispanic whites, 3,073 non-Hispanic blacks, and 3,633 Mexican American participants from the National Health and Nutrition Examination Surveys (NHANES) and evaluated interactions between these variants and carbohydrate intake and fiber intake. Results We calculated a genetic risk score (GRS) with the 15 SNPs. The odds ratio for T2D with each GRS point was 1.10 (95% CI: 1.05-1.14) for non-Hispanic whites, 1.07 (95% CI: 1.02-1.13) for non-Hispanic blacks, and 1.11 (95% CI: 1.06-1.17) for Mexican Americans. We identified two gene-carbohydrate interactions (P < 0.05) in non-Hispanic whites (with CDKAL1 rs471253 and FTO rs8050136), two in non-Hispanic blacks (with IGFBP2 rs4402960 and THADA rs7578597), and two in Mexican Americans (with NOTCH2 rs1092398 and TSPAN8-LGRS rs7961581). We found three gene-fiber interactions in non- Hispanic whites (with ADAMT59 rs4607103, CDKN2A/2B rs1801282, and FTO rs8050136), two in non-Hispanic blacks (with ADAMT59 rs4607103 and THADA rs7578597), and two in Mexican Americans (with THADA rs7578597 and TSPAN8-LGRS rs796158) at the P < 0.05 level. Interactions between the GRS and nutrients failed to reach significance in all the racial/ethnic groups. Conclusion Our results suggest that dietary carbohydrates and fiber may modify T2D-associated variants, highlighting the importance of dietary nutrients in predicting T2D risk. [ABSTRACT FROM AUTHOR]

Prevalence of hepatitis C virus (HCV) antibody has been reported in Mexican Americans, but its prevalence in other US Hispanic/Latino groups is unknown. We studied 2 populations of US Hispanic/Latino adults; 3210 from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 and 11 964 from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Age-standardized prevalence of HCV antibody was similar in NHANES 2007–2010 (1.5%) and HCHS/SOL (2.0%) but differed significantly by Hispanic/Latino background in HCHS/SOL (eg, 11.6% in Puerto Rican men vs 0.4% in South American men). These findings suggest that the HCV epidemic among US Hispanics/Latinos is heterogeneous. [ABSTRACT FROM PUBLISHER]

Background: Little is known about long-term emotional and cognitive consequences of falls. We examined the association between falls and subsequent cognitive decline, and tested the hypothesis that depression would mediate any falls-cognition association among cognitively intact Hispanic Elders. Methods: We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly to examine change in Mini Mental State Examination (MMSE) scores over the 6-year period according to number of falls. All participants (N=1,119) had MMSE scores ⩾21 and complete data on Center for Epidemiologic Studies of Depression Scale, social and demographic factors, medical conditions (diabetes, heart attack, stroke, and hypertension), and hand grip muscle strength. Results: At baseline, participants' mean age was 80.8 years (range, 74-109), mean education was 6.3 years (range, 0-17), and mean MMSE was 25.2 (range, 21-30). Of the 1,119 participants, 15.8% experienced one fall and 14.4% had two or more falls. In mixed model analyses, having two or more falls was associated with greater decline in MMSE score (estimate =-0.81, standard error =0.19, P<0.0001) compared to having no fall, after adjusting for age, sex, marital status, and education. The magnitude of the association decreased (estimate =-0.65, standard error =0.19, P=0.0007) when adjustment was made for high depressive symptoms, suggesting a possible mediating effect of depression on the falls-cognition association. Female sex, high level of education, and high performance in hand grip muscle strength were associated with a slower decline in MMSE scores. Conclusion: Having two or more falls was independently associated with steeper decline in cognition over 6 years, with a possible mediating effect of depression on the falls-cognition association. [ABSTRACT FROM AUTHOR]

Objective. To compare cardiovascular disease (CVD) risk factors in a cohort of Mexican health workers with representative samples of US-born and Mexico-born Mexican-Americans living in the US. Materials and methods. Data were obtained from the Mexican Health Worker Cohort Study (MHWCS) in Mexico and the National Health and Nutrition Examination Survey (NHANES) IV 1999-2006 in the US. Regression analyses were used to investigate CVD risk factors. Results. In adjusted analyses, NHANES participants were more likely than MHWCS participants to have hypertension, high total cholesterol, diabetes, obesity, and abdominal obesity, and were less likely to have low HDL cholesterol and smoke. Less-educated men and women were more likely to have low HDL cholesterol, obesity, and abdominal obesity. Conclusions. In this binational study, men and women enrolled in the MHWCS appear to have fewer CVD risk factors than US-born and Mexico-born Mexican-American men and women living in the US. [ABSTRACT FROM AUTHOR]

Summary: Maternal exposure to significant prenatal stress can negatively affect infant neurobiological development and increase the risk for developmental and health disturbances. These effects may be pronounced in low SES and ethnic minority families. We explored prenatal partner support as a buffer of the impact of prenatal stress on cortisol reactivity of infants born to low-income Mexican American women. Women (N =220; age 18–42; 84% Spanish-speaking; 89% foreign born; modal family income $10,000–$15,000) reported on economic stress and satisfaction with spousal/partner support during the prenatal period (26–38 weeks gestation), and infant salivary cortisol reactivity to mildly challenging mother–infant interaction tasks was assessed at women's homes at six weeks postpartum. Multilevel models estimated the interactive effect of prenatal stress and partner support on cortisol reactivity, controlling for covariates and potential confounds. Infants born to mothers who reported high prenatal stress and low partner support exhibited higher cortisol reactivity relative to those whose mothers reported high support or low stress. The effects did not appear to operate through birth outcomes. For low-income Mexican American women, partner support may buffer the impact of prenatal stress on infant cortisol reactivity, potentially promoting more adaptive infant health and development. [ABSTRACT FROM AUTHOR]

We have constructed a latent dementia proxy, 'δ', and validated it in several datasets, including well characterized subjects participating in the Texas Alzheimer's Research and Care Consortium (TARCC) study. It may be possible to construct δ homologs from almost any ad hoc combination of cognitive and functional status measures. δ homologs may also be relatively immune to measurement error, including cultural, linguistic, or educational biases. These properties make factor scores derived from latent variables a potentially attractive solution for dementia case-finding in rural or minority populations. Here we have explored an alternative and briefer assessment by which to construct a δ homolog and validate the resulting latent variable (dMA) in Mexican-American (MA) TARCC subjects. dMA, composed of simple 'bedside' dementia screening instruments, achieves Areas Under the Receiver Operative Curve that rival those of δ itself. Ethnicity has a small effect on dMA's performance. These results suggest that it may be possible to validly export dMA into other MA populations, or to export δ homolog factor scores from one population to another. [ABSTRACT FROM AUTHOR]

Altered sex hormone levels are thought to play an important role in adult-onset diseases including obesity, cardiovascular disease, and diabetes. They contribute to these complex diseases through changes in their availability, which is influenced, in part, by binding proteins. Insulin resistance, which is characteristic of these diseases, along with increased insulin secretion, is a physiologic change that occurs normally during pregnancy. To determine the relationship between insulin resistance and sex hormone levels, we examined the associations of sex hormone- binding globulin (SHBG) and testosterone with measures of glycemia and insulinemia in a healthy pregnant population. We measured fasting serum SHBG and testosterone levels in 215 Hispanic mothers of Mexican ancestry from the HAPO Study cohort and tested for associations between SHBG and testosterone levels and maternal plasma glucose and C-peptide. After adjusting for confounding variables, serum total testosterone (TT) was positively associated with fasting C-peptide (0.18 μg/l higher for TT higher by 1 SD, p = 0.001) and 1-h C-peptide (0.79 μg/l higher for TT higher by 1 SD, p < 0.001). Free testosterone (FT) was also positively associated with fasting C-peptide (0.19 μg/l higher for FT higher by 1 SD, p < 0.001), and 1-h C-peptide (0.83 μg/l higher for FT higher by 1 SD, p < 0.001). Although these findings are from a single cohort, this study provides evidence for an association between testosterone and C-peptide during pregnancy in a nondiabetic Hispanic obstetric population. [ABSTRACT FROM AUTHOR]

In this article, we test for four potential explanations of the Hispanic Health Paradox (HHP): the 'salmon bias,' emigration selection, and sociocultural protection originating in either destination or sending country. To reduce biases related to attrition by return migration typical of most U.S.-based surveys, we combine data from the Mexican Health and Aging Study in Mexico and the U.S. National Health Interview Survey to compare self-reported diabetes, hypertension, current smoking, obesity, and self-rated health among Mexican-born men ages 50 and older according to their previous U.S. migration experience, and U.S.-born Mexican Americans and non-Hispanic whites. We also use height, a measure of health during childhood, to bolster some of our tests. We find an immigrant advantage relative to non-Hispanic whites in hypertension and, to a lesser extent, obesity. We find evidence consistent with emigration selection and the salmon bias in height, hypertension, and self-rated health among immigrants with less than 15 years of experience in the United States; we do not find conclusive evidence consistent with sociocultural protection mechanisms. Finally, we illustrate that although ignoring return migrants when testing for the HHP and its mechanisms, as well as for the association between U.S. experience and health, exaggerates these associations, they are not fully driven by return migration-related attrition. [ABSTRACT FROM AUTHOR]

Abstract: Exposure to second-hand smoke (SHS) is a major public health problem and a risk factor for morbidity and mortality. The objective of this randomized trial was to estimate the impact of a culturally-sensitive intervention to reduce SHS exposure in Mexican-American households. Method: A total of 91 households (with a child under 18years of age and two adults, one of whom was a smoker) were recruited from a population-based cohort of Mexican-American households and randomized to receive the experimental intervention (EI; n=47) or standard care (SC; n=44). Of these, 74 households (83%) provided baseline, 6-month, and 12-month survey and nicotine monitor data (EI, n=39; SC, n=35). The EI materials, designed to increase the participants'' likelihood of adopting a smoke-free indoor home air policy, included one culturally-appropriate bilingual comic book for children and two fotonovelas for adults. Results: Ambient nicotine levels significantly decreased over the 12 study months (F=13.6, DF=147; p <0.001); with a significantly greater decrease in the EI households compared to the SC households (F=4.1, DF=72; p <0.05). At 12months, 73% of EI households had banned smoking vs. 56% of SC households. Ambient nicotine levels, measured using nicotine air sampling monitors, were significantly associated with self-reported SHS exposure at the 12-month follow-up. Knowledge of the health effects of SHS increased from baseline to 6 and 12months in the EI condition but not in the SC condition (F=6.0, DF=238; p <0.01), and smokers and quitters in the EI group reported an increased perception of health vulnerability compared to those in the SC group. Conclusion: Our low-cost intervention impacted SHS-related knowledge and exposure among Mexican Americans. This culturally-appropriate intervention has the potential to decrease SHS-related health problems in the target population substantially. [Copyright &y& Elsevier]

Abstract: Reliability of self-reports in survey research is important. Little is known about the reliability of self-reports in the very old (aged 80+). The objective of this study is to evaluate the level of reliability in self-reports by assessing the level of agreement between a “respondents” and their “informants” (children) as they rate the respondent''s: hearing ability; vision capacity; and nine health conditions. Descriptive statistics, observed agreement, and kappa values are computed on 389 pairs using HEPESE Wave-7 data (2010–2011). Although further studies are required, there is evidence that self-reports on basic health conditions in the very old are reliable. [Copyright &y& Elsevier]

Abstract: Objective: Recent guidelines highlight the importance of improving cardiovascular health in the general population in addition to disease prevention among high risk individuals. We investigated factors associated with ethnic and nativity-related differences in the prevalence of low cardiovascular risk (optimal levels of all major cardiovascular risk factors). Methods: We used logistic regression to estimate differences in likelihood of being low risk (not currently smoking; no diabetes; untreated total cholesterol <200mg/dL; untreated blood pressure <120/<80; and body mass index <25kg/m2) among 8693 foreign- and U.S.-born Mexican-American and non-Hispanic White 2003–2008 U.S. National Health and Nutrition Examination Survey participants before and after adjustment for socioeconomic, lifestyle, and acculturation-related factors. Results: Foreign-born Mexican-Americans were more likely to be low risk than non-Hispanic Whites after adjustment for all covariates (Odds Ratio [OR]: 1.53; 95% Confidence Interval [CI]: 1.00, 2.34). In contrast, U.S.-born Mexican-Americans were less likely to be low risk compared to Whites (OR: 0.60; 95% CI: 0.43, 0.84). Differences between foreign-born and U.S.-born Mexican-Americans were largely attenuated after adjustment for acculturation indicators. Conclusions: Our findings support the healthy migrant hypothesis and suggest that acculturation-related factors may be important drivers of ethnic and nativity-related differences in low cardiovascular risk. [Copyright &y& Elsevier]

Exposure to organophosphate and carbamate pesticides can lead to neurotoxic effects through inhibition of Cholinesterase enzymes. The paraoxonase {PON 1) enzyme can detoxify oxon derivatives of some organophosphates. Lower POA/1, acetylcholinesterase, and butyrylcholinesterase activities have been reported In newborns relative to adults, suggesting increased susceptibility to organophosphate exposure in young children. We determined PON 1, acetylcholinesterase, and butyrylcholinesterase activities in Mexican-American mothers and their 9-year-old children (n = 202 pairs) living in an agricultural community. We used Wllcoxon signed-rank tests to compare enzymatic activities among mothers and their children, and analysis of variance to identify factors associated with enzyme activities. Substrate-specific PONI activities were slightly lower In children than their mothers; however, these differences were only statistically significant for the paraoxon substrate. We observed significantly lower acetylcholinesterase but higher butyrylcholinesterase levels in children compared with their mothers. Mean butyrylcholinesterase levels were strongly associated with child obesity status (body mass index Z scores >95%). We observed highly significant correlations among mother-child pairs for each of the enzymatic activities analyzed; however, PON1 activities did not correlate with acetylcholinesterase or butyrylcholinesterase activities. Our findings suggest that by age 9 years, PON1 activities approach adult levels, and host factors including sex and obesity may affect key enzymes involved in pesticide metabolism. [ABSTRACT FROM AUTHOR]

This study estimated the prevalence, severity, and extent of periodontitis in the adult U.S. population, with data from the 2009 and 2010 National Health and Nutrition Examination Survey (NHANES) cycle. Estimates were derived from a sample of 3,742 adults aged 30 years and older, of the civilian non-institutionalized population, having 1 or more natural teeth. Attachment loss (AL) and probing depth (PD) were measured at 6 sites per tooth on all teeth (except the third molars). Over 47% of the sample, representing 64.7 million adults, had periodontitis, distributed as 8.7%, 30.0%, and 8.5% with mild, moderate, and severe periodontitis, respectively. For adults aged 65 years and older, 64% had either moderate or severe periodontitis. Eighty-six and 40.9% had 1 or more teeth with AL ≥ 3 mm and PD ≥ 4 mm, respectively. With respect to extent of disease, 56% and 18% of the adult population had 5% or more periodontal sites with ≥ 3 mm AL and ≥ 4 mm PD, respectively. Periodontitis was highest in men, Mexican Americans, adults with less than a high school education, adults below 100% Federal Poverty Levels (FPL), and current smokers. This survey has provided direct evidence for a high burden of periodontitis in the adult U.S. population. [ABSTRACT FROM PUBLISHER]

Purpose: This study examined genetic associations of patatin-like phospholipase domain containing 3 gene(PNPLA3) polymorphisms and liver aminotransferases in an extensively documented, randomly recruited Mexican American population at high risk of liver disease. Methods: Two single nucleotide polymorphisms (SNP) in the PNPLA3 gene (i.e., rs738409 and rs2281135)were genotyped in 1532 individuals. Population stratification was corrected by the genotyping of 103 ancestry informative markers (AIMs) for Mexican Americans. Results: Both PNPLA3 SNPs showed highly significant association with alanine aminotransferase (ALT) levels, but was also, in males, associated with aspartate aminotransferase (AST) levels. Haplotypic association test of the two SNPs suggested stronger genetic association with rs738409 than rs2281135. Obvious sex effects were observed: rs738409-sex interaction in ALT levels P=8.37x10-4; rs738409-sex interaction in AST levels P=5.03x10-3. Conclusions: This population study highlights a sex-specific association of PNPLA3 polymorphisms and elevated liver enzymes in a population-based study, independent of common pathological factors of the metabolic syndrome. The strong genetic association found in women≤50 years old, but not in women>50 years old, suggests that sex hormones may mediate the sex effect. [ABSTRACT FROM AUTHOR]

Objectives: Our study examines the differences in estimated risk of developing hypertension in Whites, Blacks, and Mexican-Americans aged ≥50 for a period of 11 years. Design, Setting, and Participants: Data came from 9,259 respondents who reported being hypertension-free at the baseline in the Health and Retirement Study (HRS) with up to five time intervals (1998-2006). Discrete-time survival models were used to analyze ethnic variations in the probability of developing hypertension. Main Outcome Measure: Estimated odds of developing hypertension. Results: The risk of newly diagnosed hypertension increased between 1995 and 2006 for HRS participants aged ≥50. After adjusting for demographic and health status, the probability of incident hypertension among Black Americans was .10 during the period of 1995/96-1998, which increased steadily to .17 in 2004-2006, with cumulative incidence over the 11-year period at 51%. In contrast, among White Americans the risk was .07 during 1995/96-1998 and .13 in 2004-2006, with cumulative incidence at 43%. For Mexican-Americans, the probability also increased from .08 during 1995/96-1998 to .14 during 2004-2006, with cumulative incidence at 42%. Conclusions: Relative to White and Mexican-Americans, Black Americans had an elevated risk of incident hypertension throughout the 11 -year period of observation. These variations persisted even when differences in health behaviors, socioeconomic status, demographic, and time-varying health characteristics were accounted for. [ABSTRACT FROM AUTHOR]

Over the last fifty years the nature of the provision and financing of health services, and the composition of the foreign-born population in the USA have both evolved significantly. The rapid growth of Mexican immigration in the last fifteen years has created new challenges. Ironically, the Patient Protection and Affordable Care Act of 2010, the sweeping legislation designed to ensure that almost all Americans can obtain health insurance, may reduce access to care for many immigrants by isolating them from the general, formerly uninsured, population. Bi-national and cross-border initiatives between the USA and Mexico along the lines of some developments in Europe are worth encouraging to help ease the current and future barriers to health care for immigrants. [ABSTRACT FROM AUTHOR]

Abstract: Neuroticism is associated with greater susceptibility to the adverse effects of stress and greater exposure to the stressors associated with acculturation in U.S. born Mexican Americans. Neuroticism and acculturation have been associated with injury to crucial stress response systems and are known risk factors for certain mood and anxiety disorders. The purpose of the current study was to examine the effects of neuroticism, and acculturation on the cortisol awakening response (CAR) in healthy Mexican-American adults. Salivary cortisol samples were collected at awakening and 30, 45, and 60min thereafter, on two consecutive weekdays from 59 healthy Mexican American adult males (26) and females (33), ages 18 to 38years. Participants were assessed for level of neuroticism and acculturation. Data were analyzed using a mixed effects regression model with repeated measures at four time points. Results showed a significant Neuroticism×Acculturation×Time interaction. The CAR was virtually eliminated in highly acculturated Mexican Americans with greater Anglo orientation and high neuroticism compared with less acculturated Mexican Americans with greater Mexican orientation and lower neuroticism. Findings suggest that some Mexican Americans with high levels of neuroticism may be particularly susceptible to certain challenges and stressors associated with acculturation leading over time to the development of allostatic load, desensitization of the Hypothalamic CRF system and attenuation of the CAR. [Copyright &y& Elsevier]

Our aim was to examine the effects of food acculturation on Mexican Americans' (MA) diets, taking the Mexican diet as reference. We used nationally representative samples of children (2-11 y) and female adolescents and adults (12-49 y) from the Mexican National Nutrition Survey 1999 and NHANES 1999-2006 to compare the diets of Mexicans (n = 56781, MA born in Mexico (MAMX) (n = 1488), MA born in the United States (MAUS) (n = 3654), and non-Hispanic white Americans (NH-White) (n 5473). One 24-h diet recall was used to examine the percentage consuming and percentage energy consumed from selected food groups. Most of the food groups analyzed displayed a fairly linear increase or decrease in percent energy/capita intake in this order: Mexican, MAMX, MAUS, NH-White. However, few significant differences were observed among the US subpopulations, especially among MAUS and NH-Whites. Overall, compared to Mexicans, the US subpopulations had greater intakes of saturated fat, sugar, dessert and salty snacks, pizza and French fries, low-fat meat and fish, high-fiber bread, and low-fat milk, as well as decreased intakes of corn tortillas, low-fiber bread, high-fat milk, and Mexican fast food. Furthermore, the patterns were similar in all age groups. Although we found a mix of positive and negative aspects of food acculturation, the overall proportion of energy obtained from unhealthy foods was higher among the US subpopulations. Our findings indicate that within one generation in the US, the influence of the Mexican diet is almost lost. In addition, our results reinforce the need to'discourage critical unhealthfu( components of the American diet among MA. [ABSTRACT FROM AUTHOR]

Objectives: To examine racial/ethnic disparities in oral health among older Americans. Methods: Differences in frequency of edentulism and number of decayed, missing, and filled teeth were assessed in 2,679 non-Hispanic white, 742 non-Hispanic black, and 934 Mexican-American individuals aged 60 and older from the National Health and Nutrition Examination Survey (1999-2004). Results: Controlling for potential confounding variables, blacks and Mexican-Americans had significantly higher numbers of decayed teeth but fewer numbers of filled teeth than whites. Although blacks had a lower likelihood of being edentulous than whites, dentate blacks had a higher number of missing teeth. Compared with whites, Mexican-Americans were less likely to be edentulous, and dentate Mexican-Americans had fewer missing teeth. Our study also showed that blacks and Mexican-Americans had less frequent dental checkups than whites. Conclusions: Oral health disparities are persistent across racial/ethnic groups for older Americans despite the fact that the differences between groups typically diminish when socioeconomic, health-related, and behavioral factors are considered in the models. Our study suggests that reducing racial/ethnic oral health disparities requires multiple clinical approaches. [ABSTRACT FROM AUTHOR]

Purpose. To document the prevalence of obese Mexican-Americans never advised by health professionals regarding exercise and diet, and to determine risk factors for no advice. Methods. Data came from 1787 obese Mexican-American adults (body mass index ≥ 30; age ≥ 18 years) in the Medical Expenditure Panel Survey. The survey included self-reported receipt of health care provider advice on exercise and diet as well as sociodemographic, health-related, and provider-related factors. Multivariable logistic regression models were performed separately for advice regarding exercise and advice regarding diet. Results. Overall, 45% of respondents reported that they had never received advice from a doctor or health care professional to exercise more, and 52% reported that they have received advice to eat fewer higher-fat/high-cholesterol foods. Men, nonmarried respondents, lower- educated respondents, those who preferred to speak Spanish at home, and those without comorbid chronic conditions were less likely to receive advice. Discussion. Results suggest that obese Mexican-Americans are insufficiently advised by health care providers regarding exercise and diet. Given the seriousness of obesity- related health risks and the increasing prevalence of overweight status and obesity among Mexican-Americans, it is vital that providers are involved in finding ways to effectively educate and/or treat overweight patients. [ABSTRACT FROM AUTHOR]

This paper examines childhood trauma, depression and psychological family and cultural stress among Mexican American male non-injecting users (NIU) of heroin in San Antonio, Texas. The research enhances the findings from a National Institute on Drug Abuse (NIDA) study, "Drug Related Gang Violence in South Texas", conducted from 1995-1997. A high rate of non-injecting heroin use among these young male Mexican-American gang members emerged as a special concern because of the serious health consequences associated with non-injecting heroin use. HIV and AIDS among Hispanics are attributed primarily to injecting drug use, followed by sexual transmission among heterosexuals and male-to-male sexual contact. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To compare culturally relevant factors associated with ever having used an effective method of contraception among a cohort of predominantly Mexican American females. Design: Face to face interviews were conducted in either English or Spanish. The survey used was developed directly for this study based on qualitative research with this population as well as the existing literature. Women were grouped as either adolescents (ages 13–20) or young adults (ages 21–25) for study purposes. Setting: Two community-based outpatient clinics on Chicago’s West Side. Participants: Non-pregnant Latina females between 13–25 years of age. Main Outcome Measures: Comparison of familial, cultural and psychosocial factors associated with use of effective contraception using bivariate and multivariable analyses. Results: Final analysis included 267 participants. Multivariable models yielded three factors found to be statistically significant predictors of effective contraception use, but only one was significant for both age groups. Number of children was a strong predictor of effective contraceptive use among both Latina adolescents and young adults (P < 0.001 for adolescents and P = 0.049 for young adults). Partner communication predicted effective contraceptive use among Latina adolescents (P = 0.001). Acculturation level strongly predicted effective contraceptive use among Latina young adults (P < 0.001). Conclusions: Findings demonstrate the need to tailor messages to Latina adolescent and young adults to reduce unintended pregnancy. Interventions to improve effective contraceptive use among Latina adolescents should promote effective forms of contraception in conjunction with communication with their partners about birth control. In contrast, efforts to address unintended pregnancy among Latina young adults should be sensitive to degree of acculturation. [Copyright &y& Elsevier]

We examine the importance of the maintenance and reinvention of tradition to the food choices described by Mexican-American focus group participants recruited from nutritional health settings in central Texas. The pressures experienced while coping with changes in their food environment, such as shift-work and working outside the home, and transformations experienced in the food production system, provided structural barriers and opportunities to the reformation of the cultural tools employed in their food-related behaviors. Food choices varied along temporal and value dimensions, and along the process-oriented stages of food choice identified by Marjorie DeVault, namely provisioning, processing and feeding. Eating was added to DeVault's stages to capture the importance participants placed on the health consequences of consumption, and to describe how tradition was employed to enable and rationalize food choices across these stages and dimensions. We also identify how coping with new pressures from the food environment was gendered work, specifically the work of women. [ABSTRACT FROM AUTHOR]

Background. Because cognitive impairment and frailty share common risk factors (eg, high proinflammatory cytokines), we examined whether poor cognition predicts subsequent risk of frailty in initially nonfrail Mexican Americans aged 67 years and older. Methods. Frailty was defined as meeting one or more of the following components: (a) unintentional weight loss of >10 pounds, (b) weakness, (c) self-reported exhaustion, and (d) slow walking speed. Sociodemographic factors, Mini-Mental State Examination, medical conditions (stroke, heart attack, diabetes, arthritis, cancer, and hypertension), and depressive symptoms were obtained. Main outcome measure was risk of becoming frail over 10 years. Results. Out of 942 participants who were nonfrail at baseline (1995–1996), 57.8% were women and the mean age was 73.7 years (SD = 5.3). In general estimation equation models testing the relationship between Mini-Mental State Examination (<21 vs. ≥21) and the risk of becoming frail over a 10-year period, there was a significant association (odds ratio = 1.09, 95% confidence interval = 1.00–1.19; p = .0310)] between the cognition-by-time interaction and odds of becoming prefrail or frail over time. This association was independent of age, sex, marital status, education, time, and medical conditions, indicating that nonfrail participants with poor cognition had a 9% odds per year of becoming frail over time compared with those with good cognition. Conclusion. Low Mini-Mental State Examination score was independently associated with increased risk of frailty over a 10-year period in older Mexican Americans. Low Mini-Mental State Examination score may be an early marker for future risk of frailty. [ABSTRACT FROM PUBLISHER]

Immigrants’ lower rates of cancer testing may be due to lack of fluency in English and other skills and knowledge about navigating US health care markets, lack of access to health services, or both. We analyzed 9,079 Mexican-American respondents to the 2001 California Health Interview Survey (CHIS) grouped as born in the US, living in the US 10 or more years, or living in the US less than 10 years. The CHIS provides the largest Mexican-American sample in a US survey. Access to care meant having health insurance coverage and a usual source of care. English proficiency meant the respondent took the interview in English. Multivariate logistic regression was used to predict outcomes. Respondents reporting more time in the US were more likely to report access to medical care and to report getting a cancer screening exam. Regardless of time in the US, respondents reporting access had similar test rates. Regression results indicate that time in the US and primary language were not significant relative to use of cancer screening tests, but access to care was. Cancer screening tests that are covered by Every Woman Counts, California’s breast and cervical cancer early detection program, had smaller gaps among groups than colorectal cancer screening which is not covered by a program. California is the only state with a survey able to monitor changes in small population groups. Understanding barriers specific to subgroups is key to developing appropriate policy and interventions to increase use of cancer screening exams. [ABSTRACT FROM AUTHOR]