Physical activity and acculturation among adult Hispanics in the United States

Measurement challenges for childhood obesity research within and between Latin America and the United States

Childhood obesity is a major public health challenge across Latin America and the United States. Addressing childhood obesity depends on valid, reliable, and culturally sensitive measurements. Such progress within and between countries of the Americas could be enhanced through better measurement across different age groups, different countries, and in sending and receiving communities. Additionally, better and more comparable measurements could accelerate cross-border collaboration and learning. Here, we present (1) frameworks that influenced our perspectives on childhood obesity and measurement needs across the Americas; (2) a summary of resources and guidance available concerning measurement and adaptation of measures for childhood obesity research; and (3) three major areas that present challenges and opportunities for measurement advances related to childhood obesity, including parental behavior, acculturation, and the potential to incorporate ethnographic methods to identify critical factors related to economics and globalization. Progress to reduce childhood obesity across the Americas could be accelerated by further transnational collaboration aimed at improving measurement for better surveillance, intervention development and evaluation, implementation research, and evaluation of natural experiments. Additionally, there is a need to improve training related to measurement and for improving access to valid and reliable measures in Spanish and other languages common in the Americas.

Secular Trends in Physical Activity Among Immigrants in the United States, 2009-2018

BACKGROUND

The objective of this study was to evaluate secular trends in domain-specific physical activity in the immigrant population in the US between 2009 and 2018.

METHOD

A secondary data analysis from the 2009-2018 National Health and Nutrition Examination Survey; a total of 7282 immigrants in the US were included in this analysis. All domain-specific physical activity was assessed by a self-reported questionnaire. Tests for linear trends were performed to examine the trends of each physical activity time using orthogonal polynomial coefficients. Physical activity trends were assessed by the whole group and the various subgroups.

RESULTS

Total physical activity showed an upward linear trend in female (Ptrend = .04) and young adult (Ptrend = .009) immigrants. Work-related physical activity showed an upward linear trend in young adult immigrants (Ptrend = .01). Recreational physical activity showed an upward linear trend in young adult (Ptrend = .03) and Mexican American (Ptrend < .001) immigrants and in immigrants living in the US for 15-29 years (Ptrend = .02). In contrast, we observed downward linear trends in transit-related physical activity for immigrants across male (Ptrend = .04), middle-aged adult (Ptrend = .01), and non-Hispanic black groups (Ptrend = .004) and in immigrants living in the US for 15-29 years (Ptrend = .03).

CONCLUSION

There were no significant linear trends in the 4 domains of physical activity in the overall US immigrant population; however, trends in domain-specific physical activity in the US immigrant population differed by gender, age, race/ethnicity, and length of residence. These findings may inform physical activity promotion strategies targeting US immigrant populations with diverse sociocultural backgrounds.

Patterns of Sedentary Time in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Youth

BACKGROUND

Total sedentary time and prolonged sedentary patterns can negatively impact health. This study investigated rates of various sedentary pattern variables in Hispanic/Latino youth.

METHODS

Participants were 956 youths (50.9% female) in the Hispanic Community Health Study/Study of Latinos Youth, a population-based cohort study of Hispanic/Latino 8- to 16-year-olds from 4 geographic regions in the United States (2012-2014). Total sedentary time and 10 sedentary pattern variables were measured through 1 week of accelerometer wear. Differences were examined by sociodemographic characteristics, geographic location, weekdays versus weekends, and season.

RESULTS

On average, youth were sedentary during 67.3% of their accelerometer wear time, spent 24.2% engaged in 10- to 29-minute sedentary bouts, and 7.2% in ≥60-minute bouts. 8- to 12-year-olds had more favorable sedentary patterns (less time in extended bouts and more breaks) than 13- to 16-year-olds across all sedentary variables. Sedentary patterns also differed by Hispanic/Latino background, with few differences across sex, household income, season, and place of birth, and none between weekdays versus weekends.

CONCLUSIONS

Variables representing prolonged sedentary time were high among Hispanic/Latino youth. Adolescents in this group appear to be at especially high risk for unhealthy sedentary patterns. Population-based efforts are needed to prevent youth from engaging in increasingly prolonged sedentary patterns.

The association of acculturation with accelerometer-assessed and self-reported physical activity and sedentary behavior: The Hispanic Community Health Study/Study of Latinos

•

Associations between acculturation and physical activity varied across measurements.

•

Higher social acculturation was positively associated with self-reported physical activity.

•

Language acculturation, but not language preference, was positively associated with leisure-time physical activity.

•

Language acculturation, but not language preference, was negatively associated with occupational physical activity.

•

Among workers, greater acculturation was associated with lower occupational physical activity.

•

Longer residency in the US was associated with higher accelerometer-assessed moderate-to-vigorous physical activity.

•

Most acculturation measures were positively associated with self-report, but not accelerometer-assessed sedentary behavior.

The adoption of US culture among immigrants has been associated with higher leisure-time physical activity and sedentary behavior. However, most research to date assesses this association using single measures of acculturation and physical activity. Our objective was to describe the cross-sectional association between acculturation and both physical activity and sedentary behavior among US Hispanic/Latino adults. Participants included Hispanic/Latinos 18–74 years living in four US locations enrolled in the Hispanic Community Health Study/Study of Latinos from 2008 to 2011. Acculturation was measured using acculturation scales (language and social), years in the US, language preference, and age at immigration. Physical activity and sedentary behavior were measured using the Global Physical Activity Questionnaire (N = 15,355) and Actical accelerometer (N = 11,954). Poisson, logistic, and linear regression were used, accounting for complex design and sampling weights. English-language preference was positively associated with self-reported leisure-time and transportation physical activity and accelerometer-assessed moderate-to-vigorous physical activity (MVPA). Social acculturation was positively associated with self-reported leisure-time and transportation physical activity and MVPA. Years in the US and age at immigration were positively associated with accelerometer-assessed MVPA. Language acculturation, years in the US, and age at immigration were associated with occupational physical activity among those who reported employment. Most acculturation measures were associated with self-reported sitting but not with accelerometer-assessed sedentary behavior. Different measures of acculturation, capturing various domains acculturation, were associated with physical activity and sedentary behavior. However, the direction of the association was dependent on the measures of acculturation physical activity/sedentary behavior, highlighting the complexity of these relationships.

Rationale, design, and methodology for the healthy mothers-healthy children study: a randomized controlled trial

BACKGROUND

Hispanic women and children who become overweight or obese are at risk for developing prediabetes, type 2 diabetes, and cardiovascular disease later in life. Interdisciplinary interventions which target Hispanic women and their 3-5-year old children to improve nutrition and physical activity behaviors, manage adiposity and weight in mothers, and prevent excessive adiposity and weight gain trajectory in their children offer promise to break the intergenerational cycle.

METHODS

Using a randomized two-group, repeated measures experimental design, the goal of the proposed study is to investigate the efficacy of a 12-week nutrition and physical activity program including education, coping skills training, and home-based intervention in Hispanic women and their 3-5-year old children. The program includes 6 months of continued monthly contact to help overweight and obese Hispanic mothers and their children improve adiposity, weight (trajectory for children), health behaviors (nutrition and physical activity), and self-efficacy We will partner with two federally qualified health departments in Durham and Chatham counties, North Carolina to enroll participants. We will partner with community centers to deliver the intervention. A total of 294 Hispanic women with a BMI ≥ 25 kg/m2 and 294 Hispanic 3-5-year old children with a ≥ 25th BMI percentile will be enrolled over 4 years and randomized to the experimental or equal attention control group. Data will be collected at Time 1 (0 months [baseline]) to Time 2 (9 months [completion of the intervention]) and Time 1 to Time 3 (15 months [after 6 months with no contact from the study staff]). Data collected will include adiposity and weight in mothers and children (primary outcomes). Secondary outcomes will include health behaviors and self-efficacy in the mothers and in the children. We will also evaluate the cost of delivering the program for public health departments. We will use general linear mixed models to test the hypotheses.

DISCUSSION

Decreasing overweight and obesity in Hispanic women and slowing adiposity and weight gain trajectory in young Hispanic children is urgently needed to decrease morbidity, mortality, and future health care costs.

TRIAL REGISTRATION

NCT03866902. (March 7, 2019).

Neighborhood Environment Perceptions among Latinos in the U.S

In the U.S., immigrants and racial/ethnic minorities (e.g., Latinos) often report unfavorable neighborhood environments, which may hinder physical activity (PA). Among Latinos, PA levels are disproportionately lower in foreign-born, female, older, and low-education individuals. It is unclear whether these subgroups, including those from multiple disadvantaged backgrounds (e.g., low education, foreign-born), perceive worse neighborhood environments for PA. This cross-sectional study aimed to examine differences in neighborhood environment perceptions among Latinos in the 2015 National Health Interview Survey (N = 4643; 59% foreign-born). Logistic regression models examined nativity—and its interactions with age, gender, and education—in relation to the perceived presence of transportation infrastructure (two items) and destinations (four items), controlling for self-reported walking. Models used sample weights and accounted for the complex survey design. Nativity was not significantly associated with neighborhood environment perceptions. However, nativity interactions with age and education showed the greatest inequities (lowest perceptions) of neighborhood infrastructure (e.g., fewer sidewalks) or destinations (e.g., fewer places to relax) among disadvantaged U.S.-born (older or low education) and advantaged foreign-born (higher education) Latinos. Findings suggest neighborhood perceptions are shaped by complex interactions of nativity with structural (education) and contextual (age) factors. Additional research is needed to complement our findings and inform environmental interventions targeting Latinos.

The Longitudinal Relationship Between Social Support and Physical Activity in Hispanics

PURPOSE

Social support has been identified as a determinant of physical activity (PA), but research has been primarily cross-sectional, with mixed findings for different Hispanic subgroups and limited longitudinal research with Hispanics. The purpose of this study is to assess the longitudinal associations of social support with PA in Hispanics on the Texas-Mexico Border.

DESIGN AND SAMPLE

We used 2 time points of data collected from Hispanic adults in the Cameron County Hispanic Cohort (N = 588).

MEASURES

We collected social support for PA and self-reported leisure-time PA.

ANALYSIS

We used cross-lagged panel models to assess the association between friend support, family support, family punishment (criticizing or complaining) and PA over time.

RESULTS

Although social support overall was low for PA, fully adjusted cross-lagged panel models indicated that time 1 friend support was associated with time 2 PA (adjusted rate ratio = 1.02, 95% confidence interval = 1.00 -1.04), though family support was not associated with time 2 PA. In males, time 1 friend support was inversely associated with time 2 family punishment.

CONCLUSION

As expected, the directionality of the relation appears to be from social support to PA. Friend support appears to be predictive of PA in Hispanics, whereas family support is not. This should be considered in intervention development, particularly because familismo (commitment and mutual obligation to family) is considered to be a strong value in these communities.

Nativity and Occupational Determinants of Physical Activity Participation Among Latinos

INTRODUCTION

Latinos in the U.S. bear a disproportionate burden of cardiovascular risk factors, including physical inactivity. Previous research among Latinos has focused on leisure-time physical activity, limiting understanding of the different ways in which populations, particularly working-class groups, achieve recommended levels of physical activity. This study examined associations of race/ethnicity; nativity; and leisure-time, transportation, and occupation-related physical activity among Latino and non-Latino white adults.

METHODS

Participants sampled in the 2007-2012 waves of the National Health and Nutrition Examination Survey self-reported domain-specific physical activity. Data were analyzed in 2016-2017 using multivariable log binomial regression models to examine differences in meeting guidelines for each physical activity domain separately and as total physical activity among Latinos (n=4,692) and non-Latino whites (n=7,788). Models were adjusted for sociodemographic characteristics and health status and tested interactions between nativity and occupational categories.

RESULTS

In adjusted models, foreign-born Latinos (prevalence ratio=0.70, 95% CI=0.63, 0.77) and U.S.-born Latinos (prevalence ratio=0.85, 95% CI=0.76, 0.95) were least likely to meet physical activity guidelines through occupation-related and leisure time physical activity, when compared with non-Latino whites. By contrast, foreign-born Latinos were more likely to meet physical activity guidelines through transportation physical activity than non-Latino whites (prevalence ratio=1.26, 95% CI=1.01, 1.56) and were proportionately more likely to participate in vigorous modes of physical activity. Interaction results indicated that foreign-born Latinos were the least likely to meet physical activity guidelines compared with U.S.-born Latinos and non-Latino whites if they worked in non-manual occupational categories. All racial/ethnic groups working in manual occupations saw the largest increase (40%-50%) in meeting physical activity guidelines when occupation-related physical activity was combined with leisure-time and transportation physical activity.

CONCLUSIONS

These findings suggest variability in the relationship between nativity and the physical activity domain Latinos engage in compared with non-Latino whites, with occupation contributing substantially to meeting physical activity recommendations for all population groups.

The Role of Social Support and the Neighborhood Environment on Physical Activity in Low-income, Mexican-American Women in South Texas

Objectives

To determine the relationships between physical activity (PA), the neighborhood environment support for PA, and social support for PA among Mexican-American women living in South Texas. The Enlace study was a randomized controlled trial that tested the effectiveness of a promotora-led PA intervention among low-income Mexican origin women (n=614) living in colonias.

Methods

The dependent measures included accelerometer-measured average moderate to vigorous physical activity (MVPA) and sedentary breaks and the Community Health Activities Model Program for Seniors PA 41-item questionnaire. The independent measures included the Physical Activity and Neighborhood Environment Scale (PANES) and the 13-item Physical Activity Social Support (PASS) scale.

Results

Enlace participants were on average 40.4 (standard deviation, 10.3) years old, born in Mexico (86.1%), and uninsured (83.1%). Adjusted linear regression results indicated that each 1-point increment in the PANES overall score was associated with 0.050 (p<0.001) unit increase in sedentary break and a −0.043 (p=0.001) unit decrease in sedentary break duration. Both PANES (β=0.296; p=0.002) and PASS scores (β=0.076; p<0.001) were associated with weekly average self-reported MVPA. Interaction effects were observed between PASS scores and accelerometer-measured frequency of sedentary breaks and sedentary time duration.

Conclusions

The findings of this study indicate that the relationships between PA and built environment and social support are measure-dependent and suggest that reducing sedentary time in this population may require a closer assessment of social support for PA.

The relationship of education and acculturation with vigorous intensity leisure time physical activity by gender in Latinos

OBJECTIVES

Latinos have poorer health outcomes among certain conditions (e.g. diabetes, obesity, mental health) compared to non-Latino Whites in the U.S., in part due to difference in the amount of physical activity, which are heavily influenced by sociocultural factors such as educational attainment and acculturation. Vigorous-intensity leisure time physical activity (VLTPA) may provide health benefits with a shorter amount of time than moderate-to-light physical activity. However, VLTPA has been significantly understudied compared to LTPA in general. The purpose of this study is to examine the associations between educational attainment, acculturation, and VLTPA by gender among Latino adults in the U.S.

DESIGN

Nationally representative samples of Latino adults aged 25 years and older (n = 4393) from the 2010 National Health Interview Survey were analyzed. VLTPA was measured as the number of hours per week of VLTPA consisting of heavy sweating or large increases in breathing and heart rate. Acculturation was measured as the degree to which the English language versus the Spanish language was spoken most often. The zero-inflated Poisson regression model was constructed using the full information maximum likelihood estimation and controlling for a series of sociodemographic characteristics and relevant health behaviors.

RESULTS

Educational attainment was positively associated with VLTPA among Latino adults [exp(b) = 1.09, p < 0.05)]. Similarly, greater acculturation was associated with greater hours/week of VLTPA [exp(b) = 1.10, p < 0.05)]. Lastly, the effect of educational attainment on VLTPA significantly varied by gender.

CONCLUSIONS

Education had a positive association and acculturation had negative association with the hours/week of VLTPA among Latinos. Also, the association between education and VLTPA was significantly stronger among women than men. These findings inform culturally and socially sensitive approaches to improve the health of Latinos, in hopes to address health disparities by race/ethnicity the U.S.

A US/Mexico Study of Joint Associations of Physical Activity and Sedentary Behavior on Anthropometric Indicators, Migration Status, Country of Birth and Country of Residence

Background: This study examined the influence of migration status, nativity and country of residence on joint associations of physical activity (PA) and sedentary behavior (SB) in anthropometric indicators of Mexicans and Mexican-Americans living in the US and in Mexico. Methods: We examined data from two large national surveys, the National Health and Nutrition Examination Survey from the US (NHANES, 2011–2012) and Mexico (ENSANUT, 2012). Using self-reported minutes of moderate to vigorous physical activity and SB, we calculated four categories for analyses. Anthropometric measures consisted of body mass index (BMI) and waist circumference (WC). We used data of migration status, nativity and country of residence. Linear regression models examined how joint categories of PA and SB were associated with BMI and WC according to migration status, nativity and country of residence, controlling for health risk behaviors. Results: Analyses showed that even among those in the category with the lowest risk behavior, “physically active and low sedentary”, there were differences in BMI and WC by migration status, nativity and country of residence. Within this lower risk category, Mexican immigrants living in the US had the greatest association with high BMI, while US-born Mexican-Americans living in the US had the highest WC values when compared with the group of Mexicans living in Mexico. Conclusions: Joint categories of PA and SB were associated with BMI and WC by migration status, nativity and country of residence among populations with Mexican ethnicity.

Interactions between individual and perceived environmental factors on Latinas' physical activity

Background

Latinas have disproportionately low levels of physical activity (PA) and the ecological correlates of their PA remain unclear. This study aims to test interactions between individual and environmental factors on Latinas' PA.

Methods

We analyzed baseline data from 436 Latinas participating in a PA randomized controlled trial in San Diego, CA [Fe en Acción/Faith in Action]. Measures included demographics, perceived environment, PA and anthropometrics. Mixed effects models examined interactions between individual and environmental factors on self-reported leisure-time and transportation, and accelerometer-assessed PA.

Results

Significant positive associations were found between neighborhood aesthetics and leisure-time moderate-to-vigorous PA (MVPA) and between having destinations within walking distance from home and transportation PA (P < 0.05). We found significant interactions of income with aesthetics and sidewalk maintenance as well as between weight status and safety from crime. Favorable aesthetics was related to more leisure-time MVPA only among lower income women (odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18, 2.08); however, higher income women reporting better sidewalk maintenance reported more leisure-time MVPA (OR = 1.51; 95% CI: 1.06, 2.15). Higher perceived safety from crime was positively related to transportation PA only among overweight/obese women.

Conclusions

Subgroup differences should be considered when developing interventions targeting the neighborhood environment to promote Latinas' PA.

Perceived Environmental Barriers and Behavioral Factors as Possible Mediators Between Acculturation and Leisure-Time Physical Activity Among Mexican American Adults

BACKGROUND

The association between acculturation and physical activity (PA) among Mexican American (MA) adults is not understood. This study assessed potential mediating factors that may explain these associations among 75 healthy MA adults [age: 37.5 (9.3) y; 65.3% female].

METHODS

Secondary data analysis using hierarchical logistic regression examined whether perceived environmental barriers, social support, and intention to exercise potentially mediated relationships between acculturation level, and total and leisure-time moderate to vigorous PA (MVPA). Data were collected via questionnaire.

RESULTS

Most participants (67%) reported lower average household monthly incomes ($0-$3000), completed some college or obtained a college degree (64.4%), and were first generation immigrants (59%). Acculturation was associated with greater odds of engaging in total MVPA [odds ratio (OR) = 1.7; 95% confidence interval (CI), 1.2-2.4] and leisure-time MVPA (OR = 1.6; 95% CI, 1.1-1.2). Perceived environmental barriers were associated with greater odds of engaging in both total and leisure-time MVPA (OR = 4.3; 95% CI, 2.1-5.8 and OR = 5.5; 95% CI, 2.0-7.0, respectively), and social support was associated with greater odds for total MVPA (OR = 3.7; 95% CI, 1.1-6.4).

CONCLUSIONS

Results provide preliminary evidence for mediating factors that may explain the relationship between acculturation level and PA among MA adults. Contradicting prior evidence, results suggest that PA engagement, despite perceived environmental barriers, is possible among MA adults having stronger social support.

Reporting More but Moving Less? The Complex Relationship between Acculturation and Physical Activity Among US Adults

PURPOSE

To investigate the association between acculturation and physical activity (PA).

DESIGN

Cross sectional.

SETTING

The National Health and Nutrition Examination Surveys (NHANES) 2003 to 2006.

SUBJECTS

A total of 4029 adults (aged 20-64), including 2063 men and 1966 women.

MEASURES

The outcome measures included both self-reported PA and device-assessed PA. The acculturation measure was constructed based on nativity, language use at home, and length of residence in the United States.

ANALYSIS

Regressions with domain analysis were conducted to adjust for the influence of confounding factors and complex survey design.

RESULTS

For men, self-reported PA increased with acculturation, especially leisure-time PA. However, device-assessed PA decreased with acculturation. For women, the results were more mixed.

CONCLUSION

All evidence considered, we concluded that PA decreased with acculturation for US men.

Utilitarian and Recreational Walking Among Spanish- and English-Speaking Latino Adults in Micropolitan US Towns

BACKGROUND

Walking among Latinos in US Micropolitan towns may vary by language spoken.

METHODS

In 2011-2012, we collected telephone survey and built environment (BE) data from adults in six towns located within micropolitan counties from two states with sizable Latino populations. We performed mixed-effects logistic regression modeling to examine relationships between ethnicity-language group [Spanish-speaking Latinos (SSLs); English-speaking Latinos (ESLs); and English-speaking non-Latinos (ENLs)] and utilitarian walking and recreational walking, accounting for socio-demographic, lifestyle and BE characteristics.

RESULTS

Low-income SSLs reported higher amounts of utilitarian walking than ENLs (p = 0.007), but utilitarian walking in this group decreased as income increased. SSLs reported lower amounts of recreational walking than ENLs (p = 0.004). ESL-ENL differences were not significant. We identified no statistically significant interactions between ethnicity-language group and BE characteristics.

DISCUSSION

Approaches to increase walking in micropolitan towns with sizable SSL populations may need to account for this group's differences in walking behaviors.

Acculturation and Physical Activity Among Latinas Enrolled in a 12-Month Walking Intervention

This report evaluates the relationship between acculturation and assimilation with the physical activity (PA) outcomes of a 12-month walking intervention for postpartum Latinas ( n = 81, M age = 29.2 years, M BMI [body mass index] = 30.0). PA was measured by ActiGraph GT1M accelerometers. Acculturation and assimilation were measured by the Hazuda Acculturation and Assimilation Scales. Data were collected at baseline, 6 months, and 12 months. Results showed a trend for participants classified in the least acculturated groups to engage in more moderate-to-vigorous PA than participants classified in the higher acculturated/assimilated groups for two dimensions of acculturation (Adult Proficiency in English Versus Spanish, p = .002; Adult Pattern of English Versus Spanish Language Usage, p = .001) and two dimensions of assimilation (Childhood Interaction With Members of Mainstream Society, p = .028; Adult Functional Integration With Mainstream Society, p ≤ .001). No other significant effects were observed. Findings highlight the continued need to understand the context in which acculturation and assimilation influence PA.

Testing Direct and Indirect Effects of Identity, Media Use, Cognitions, and Conversations on Self-Reported Physical Activity Among a Sample of Hispanic Adults

This article presents the results of a study testing the direct and indirect effects of identity, media use, cognitions and conversations on physical activity (PA). The study was guided by the O-S-O-R model (Markus & Zajonc, 1985), and it used data collected from a sample of Hispanic adults (N = 268) living in the U.S. Southwest. Exercise identity and ethnic identity were defined as pre-orientations (O₁); use of PA-related media content was defined as the stimulus (S); reflective integration and conversations about PA-related media were post-orientations (O₂); and self-reported physical activity was the behavioral response (R). Structural equation modeling was used to analyze the data, and several compelling results emerged. Exercise identity had a significant positive direct effect on PA and PA-related media use, as well as a significant positive indirect effect on conversations about PA-related media. PA-related media use exerted a strong and significant positive effect on conversations about PA-related media, as well as a significant positive indirect effect on PA. Finally, conversations about PA-related media content had a significant positive direct effect on PA. The results indicate that identity acts as a filter influencing what media content are selected and that cognitions and conversations about media content can serve as a link between media use and health behavior. Key words: O-S-O-R model, physical activity, Hispanic adults, identity, media use, conversation.

Occupational Physical Activity and Weight-Related Outcomes in Immigrant Mothers

INTRODUCTION

New immigrants are likely to be employed in occupations that provide physical activity; however, these positions may place workers at risk for adverse health outcomes. Relationships between occupational physical activity (OPA); weight-related behaviors; obesity; and depression remain underexplored among recent immigrants.

METHODS

Participants (N=385) were Brazilian, Haitian, and Latino mothers enrolled in a community-based participatory research lifestyle intervention among immigrant mothers (<10 years in U.S.). Baseline BMI was calculated using objectively measured height and weight. Self-reported baseline data included sociodemographics; physical activity (Pregnancy Physical Activity Questionnaire); depressive symptoms (Center for Epidemiological Studies-Depression Scale); and prepared food purchasing frequency. Logistic regression models estimated the odds of obesity (BMI ≥30.0); high depressive symptoms (score ≥16); and purchasing prepared foods (≥1 times/week) by OPA quartile. Models adjusted for covariates, including household composition, origin group, maternal age, education, household income, and recruitment year (2010, 2011). Data were analyzed in 2013.

RESULTS

Employed participants (49%) primarily worked as domestic workers, nursing assistants, and food service staff. In adjusted models, women in the highest OPA quartile versus lowest had 65% lower obesity odds (95% CI=0.16, 0.76) and approximately twice the odds of presenting high depressive symptoms (2.01, 95% CI=1.02, 4.27) and purchasing takeout food (1.85, 95% CI=0.90, 3.90), which was attenuated after adjusting for income and education (unadjusted OR=1.98, 95% CI=1.10, 3.52).

CONCLUSIONS

OPA contributes to energy expenditure and may protect against obesity among new immigrant mothers; however, it is also associated with high depressive symptoms. Implications for physical and psychosocial well-being are mixed.

In our country tortilla doesn't make us fat: cultural factors influencing lifestyle goal-setting for overweight and obese Urban, Latina patients

Obesity disproportionately affects Latina adults, and goal-setting is a technique often used to promote lifestyle behavior change and weight loss. To explore the meanings and dimensions of goal-setting in immigrant Latinas, we conducted four focus groups arranged by language ability and country of origin in an urban, public, primary care clinic. We used a narrative analytic approach to identify the following themes: the immigrant experience, family dynamics, and health care. Support was a common sub-theme that threaded throughout, with participants relying on the immigrant community, family, and the health care system to support their goals. Participants derived satisfaction from setting and achieving goals and emphasized personal willpower as crucial for success. These findings should inform future research on how goal-setting can be used to foster lifestyle behavior change and illustrate the importance of exploring the needs of Latino sub-groups in order to improve lifestyle behaviors in diverse Latino populations.

Associations of Acculturation With Self-Report and Objective Physical Activity and Sedentary Behaviors Among Latinas

BACKGROUND

Less than 50% of Latinas meet physical activity (PA) recommendations. Acculturation is a complex cultural phenomenon that may influence health behaviors, but associations between acculturation and Latinas' activity and sedentary levels are unclear.

AIM

To examine associations of acculturation with Latinas' domain-specific and total PA as well as sedentary time.

METHOD

We analyzed baseline data collected between 2011 and 2013 among 410 Latinas (18-65 years) from a PA promotion intervention in San Diego, CA ( Fe en Acción/ Faith in Action). Participants wore an accelerometer to assess moderate-to-vigorous PA (MVPA) and sedentary time and completed a survey assessing domain-specific PA, sociodemographics, and acculturation as measured by length of residence in the United States and the Bidimensional Acculturation Scale (BAS) for Hispanics. Higher acculturation was defined as longer residence in the United States or being either assimilated or bicultural as per scores on the Hispanic and Anglo domains of the BAS.

RESULTS

Based on weekly averages from the accelerometer, Latinas spent 103 minutes in MVPA and 76% of total activity in sedentary time. Only 32% met MVPA recommendations via self-reported leisure-time and transportation PA. Longer residence in the United States was inversely associated with reporting any transportation or occupational PA and meeting MVPA recommendations. Assimilated/bicultural Latinas had significantly less accelerometer-based total MVPA and higher sedentary time than their lower acculturated counterparts.

CONCLUSIONS

Overall, higher acculturation, based on either measure, was related to less activity. Our findings suggest interventions tailored to the acculturation levels of Latinas are needed to help reduce disparities in Latinas' PA and sedentary behaviors.

Rural-to-Urban Migration: Socioeconomic Status But Not Acculturation was Associated with Overweight/Obesity Risk

To investigate whether socioeconomic status (SES) and acculturation predict overweight/obesity risk as well as the mediating effect of physical activity (PA) in the context of internal migration. Cross-sectional study of 587 rural-to-urban migrants participating in the PERU MIGRANT study. Analyses were conducted using logistic regression and structured equation modeling. Interaction effects of SES and acculturation were tested. Models were controlled for age, gender and education. Only SES was a significant predictor of overweight/obesity risk. Lower SES decreased the odds of being overweight/obese by 51.4 %. This association did not vary by gender nor was it explained by PA. Mechanisms underlying the relationship between SES and overweight/obesity may differ depending on the geographic location and sociocultural context of the population studied. Research on internal migration and health would benefit from the development of tailored acculturation measures and the evaluation of exploratory models that include diet.

Latino Immigrants, Acculturation, and Health: Promising New Directions in Research

This article provides an analysis of novel topics emerging in recent years in research on Latino immigrants, acculturation, and health. In the past ten years, the number of studies assessing new ways to conceptualize and understand how acculturation-related processes may influence health has grown. These new frameworks draw from integrative approaches testing new ground to acknowledge the fundamental role of context and policy. We classify the emerging body of evidence according to themes that we identify as promising directions--intrapersonal, interpersonal, social environmental, community, political, and global contexts, cross-cutting themes in life course and developmental approaches, and segmented assimilation--and discuss the challenges and opportunities each theme presents. This body of work, which considers acculturation in context, points to the emergence of a new wave of research that holds great promise in driving forward the study of Latino immigrants, acculturation, and health. We provide suggestions to further advance the ideologic and methodologic rigor of this new wave.

Testing a Theoretical Model of Immigration Transition and Physical Activity

The purposes of the study were to develop a theoretical model to explain the relationships between immigration transition and midlife women's physical activity and test the relationships among the major variables of the model. A theoretical model, which was developed based on transitions theory and the midlife women's attitudes toward physical activity theory, consists of 4 major variables, including length of stay in the United States, country of birth, level of acculturation, and midlife women's physical activity. To test the theoretical model, a secondary analysis with data from 127 Hispanic women and 123 non-Hispanic (NH) Asian women in a national Internet study was used. Among the major variables of the model, length of stay in the United States was negatively associated with physical activity in Hispanic women. Level of acculturation in NH Asian women was positively correlated with women's physical activity. Country of birth and level of acculturation were significant factors that influenced physical activity in both Hispanic and NH Asian women. The findings support the theoretical model that was developed to examine relationships between immigration transition and physical activity; it shows that immigration transition can play an essential role in influencing health behaviors of immigrant populations in the United States. The NH theoretical model can be widely used in nursing practice and research that focus on immigrant women and their health behaviors. Health care providers need to consider the influences of immigration transition to promote immigrant women's physical activity.

Disparities in lifestyle habits and health related factors of Montreal immigrants: is immigration an important exposure variable in public health?

Study disparities in lifestyle habits and health characteristics of Canadian born population and immigrants with different duration of residence. Data are extracted from 2009 to 2010 public use micro-data files of Canadian Community Health Survey representing about 1.5 million people. Sixty-one percent of the study sample was born in Canada; 49 % males and 59 % below age 50. Amongst lifestyle habits, recent immigrants were less likely to be regular smokers, RR (95 % CI) 0.56 (0.36-0.88) and frequent consumers of alcohol 0.49 (0.27-0.89), but more likely to consume less fruits and vegetables 1.26 (1.04-1.53) than those born in Canada. Amongst health related factors, recent immigrants were less likely to be overweight 0.79 (0.62-0.99) and suffer from chronic diseases 0.59 (0.44-0.80), but more likely to have limited access to family medicine 1.24 (1.04-1.47) than Canada-born population. Immigration status is an important population characteristic which influenced distribution of health indicators. Prevention and promotion strategies should consider immigration status as an exposure variable in the development and implementation of public health programs.

Baseline Socio-demographic characteristics and self-reported diet and physical activity shifts among recent immigrants participating in the randomized controlled lifestyle intervention: "Live Well"

The goal of this paper is to describe the baseline characteristics of Live Well (intervention to prevent weight gain in recent immigrant mother-child dyads from Brazil, Haiti, and Latin America) participants, and to explore self-reported changes in diet and physical activity post-immigration. Baseline data from 383 mothers were used for this study. Dyads attended a measurement day where they completed self-administered surveys collecting information about socio-demographics, diet, physical activity, other psychosocial variables, and height and weight. Haitian mothers' socio-demographic profile differed significantly from that of Brazilians' and Latinas': they have been in the US for a shorter period of time, have higher rates of unemployment, are less likely to be married, more likely to have ≥3 children, more likely to be obese, and have immigrated for family or other reasons. In multivariate models, self-reported changes in diet and physical activity since migrating to the US were significantly associated with BMI with non-linear relationships identified. Future research is needed to understand how diet and physical activity change while acculturating to the US and explore the adoption of both healthy and unhealthy dietary changes.

Utility of Acculturation in Physical Activity Research in Latina Adults

Latina adults in the United States have a disproportionately higher prevalence of chronic diseases related to low physical activity levels than non-Hispanic women. Literature indicates that acculturation may be a contributing factor to being physically active, but the extent of this association remains unclear. An integrative review of literature was conducted on studies that examined acculturation as it relates to physical activity in Latinas in the United States. Our review of 33 studies revealed inconsistent measurement and conceptualization of acculturation and physical activity across studies. Findings from this review reinforce the importance and continued use of acculturation by behavioral researchers; however, acculturation, as conceptualized in the studies reviewed, may not have had an influence on health as much as traditions, life patterns, and resources of Latinas.

Obesity Among U.S.- and Foreign-Born Blacks by Region of Birth

INTRODUCTION

Large, recent migration streams from the non-Hispanic Caribbean islands and Africa have increased the share of U.S. blacks born outside of the U.S. Little is known about health patterns in these foreign-born populations. The purpose of this study is to compare obesity levels among self-identified U.S. blacks across birth regions and examine potential explanations for subgroup differences.

METHODS

Data were from the 2000-2013 National Health Interview Surveys. Three birthplace subgroups were examined: individuals born in the U.S., Caribbean/South America, and Africa, aged 25-59 years. Data were analyzed in 2013-2014.

RESULTS

Compared to U.S.-born participants, foreign-born participants had significantly lower obesity (BMI ≥30) odds. The AORs were 0.51 (Caribbean/South American-born, 95% CI=0.44, 0.58) and 0.41 (African-born, 95% CI=0.34, 0.50) with reference to U.S.-born individuals. Education, income, and cigarette smoking did not explain the favorable weight pattern of the foreign born. Among the foreign born, those residing in the U.S. for ≥15 years had 51% (95% CI=10%, 108%) higher obesity odds compared with those residing for <5 years. No statistically significant differences in obesity odds between those born in the Caribbean/South America and Africa were detected.

CONCLUSION

Foreign-born blacks generally had lower obesity levels compared to their U.S.-born counterparts, which was not explained by SES or smoking behaviors. Despite this advantage, obesity prevalence among foreign-born black women was around 30%, suggesting that obesity poses a significant health risk this population.

Low demanding parental feeding style is associated with low consumption of whole grains among children of recent immigrants

We explored the influence of immigrant mothers feeding style on their children's fruit, vegetable and whole grain intake and how this relationship differed by mother's time in the U.S. Baseline data were collected on mother-child (3-12 yrs) dyads enrolled in Live Well (n = 313), a community-based, participatory, randomized controlled lifestyle intervention (2008-2013). Socio-demographics, years of residence in the U.S., behavioral data, and responses to the Caregiver's Feeding Styles Questionnaire (CFSQ) were obtained from the mother. Measured heights and weights were obtained for both mother and child. Child dietary intake was assessed using the Block Food Screener. Separate multiple linear regression models were run, adjusting for child and mother covariates. Interactions between feeding styles and years in the U.S. (<5 and ≥ 5 years), ethnicity, and child age were tested. Sixty-nine percent of mothers were overweight or obese, 46% of the children were overweight or obese. For mothers in the U.S. for<5 years, having a low demanding/high responsive style was associated with lower child intake of whole grains in adjusted models vs. a high demanding/high responsive style (p < 0.05). This was not seen for mothers in the U.S. for≥5 years. Thus, the influence of feeding style on dietary intake may change with length of time in the U.S. These hypotheses-generating findings call for future research to understand how broader socio-cultural factors influence the feeding dynamic among immigrants.

English language proficiency and physical activity among Mexican-origin women in South Texas and South Carolina

OBJECTIVES

To examine the relationship between English language proficiency (ELP), physical activity, and physical activity-related psychosocial measures (i.e., exercise self-efficacy, exercise social support, perceptions of environmental supports) among Mexican-origin women in South Carolina and Texas.

DESIGN

Adjusted robust regression and interaction modeling to evaluate baseline questionnaire data on self-reported ELP with CHAMPS leisure-time moderate-to-vigorous physical activity (MVPA), accelerometry data, Physical Activity Self-Efficacy, Physical Activity Social Support, and Environmental Support for Physical Activity in 118 Mexican-origin women.

RESULTS

The adjusted regression revealed a significant association between ELP and perceived physical activity self-efficacy (β = 234.2, p = .004), but not with physical activity social support. In South Carolina, CHAMPS leisure-time MVPA (411.4 versus 114.3 minutes, p < .05) was significantly different between women in the high ELP quartile and those in the very low quartile. Among high ELP Mexican-origin women, participants in Texas reported significantly higher MVPA measured by accelerometry (p = .042) than those in South Carolina.

CONCLUSION

Our findings indicate that ELP was associated with physical activity and that contextual factors may also play a role.

The influence of parental nativity, neighborhood disadvantage and the built environment on physical activity behaviors in Latino youth

Little evidence exists examining if parental nativity, neighborhood disadvantage and built environment features are associated with physical activity behaviors in Latino youth. We used a representative sample of Latino youth (n = 616) living in New Jersey to examine parental nativity associations with active transport to school, active use of sidewalks, use of local neighborhood parks, and use of neighborhood physical activity facilities. We estimated prevalence ratios (PR) that accounted for the complex survey design. Latino youth with foreign-born parents were generally more active than their US-born peers, and those with parents in the US 10 years or less were more likely to engage in active transport to school (PR = 1.51, 95% CI 1.04-2.21), after adjusting for census-based neighborhood disadvantage, self-reported neighborhood measures, and geocoded distance to school. Parental nativity status should be considered in policies or interventions designed to increase physical activity among Latino youth.

Pathways between acculturation and health behaviors among residents of low-income housing: the mediating role of social and contextual factors

Acculturation may influence health behaviors, yet mechanisms underlying its effect are not well understood. In this study, we describe relationships between acculturation and health behaviors among low-income housing residents, and examine whether these relationships are mediated by social and contextual factors. Residents of 20 low-income housing sites in the Boston metropolitan area completed surveys that assessed acculturative characteristics, social/contextual factors, and health behaviors. A composite acculturation scale was developed using latent class analysis, resulting in four distinct acculturative groups. Path analysis was used to examine interrelationships between acculturation, health behaviors, and social/contextual factors, specifically self-reported social ties, social support, stress, material hardship, and discrimination. Of the 828 respondents, 69% were born outside of the U.S. Less acculturated groups exhibited healthier dietary practices and were less likely to smoke than more acculturated groups. Acculturation had a direct effect on diet and smoking, but not physical activity. Acculturation also showed an indirect effect on diet through its relationship with material hardship. Our finding that material hardship mediated the relationship between acculturation and diet suggests the need to explicate the significant role of financial resources in interventions seeking to promote healthy diets among low-income immigrant groups. Future research should examine these social and contextual mediators using larger, population-based samples, preferably with longitudinal data.

Analysis of physical activity and acculturation among Turkish migrants in Germany and England (.)

Recent literature shows that migrant populations in Western countries are generally less physically active than their host populations. The purpose of the present study was to expand research investigating associations between physical activity (PA) and acculturation and their relationship with several socio-demographic factors among Turkish migrants in Germany and England. The sample consisted of 521 Turkish migrants. Migrant generation, length of residence, and language proficiency were used as indicators of acculturation. Acculturation was not associated with PA among migrants in Germany and England. PA of migrants was significantly associated with migrant's host country, age, sex, marital status, and education. The total PA of migrants in Germany was higher than that of migrants in England; the large majority of females in both Germany and England had low PA, whereas most males had moderate PA. Seemingly, PA in Turkish migrant populations will not necessarily increase as a result of greater acculturation to the host society.

Use of the Stanford Brief Activity Survey for physical activity assessment in postpartum Latinas: a validation study of a linguistically translated Spanish version

This study assessed the concurrent validity of the English and a linguistic Spanish translation of the Stanford Brief Activity Survey (SBAS) with pedometer-measured physical activity (PA) among postpartum Latinas. Latinas (n 97) completed the SBAS in either English (n 47) or Spanish (n 50) and wore pedometers 7 days at three different assessment periods. The English version demonstrated significant trends (p .01) for differentiating aerobic walking steps (AWS) and aerobic walking time (AWT) across SBAS intensity categories at two of the three assessment periods. The Spanish version showed marginally significant trends for differentiating AWS (p .048) and AWT (p .052) across SBAS intensity categories at only one assessment period. The English version of the SBAS is effective in assessing PA status among Latinas; however, the Spanish version indicates a need for research to further explore cultural and linguistic adaptations of the SBAS.

A qualitative study of acculturation and diabetes risk among urban immigrant Latinas: implications for diabetes prevention efforts

PURPOSE

The purpose of this qualitative study was to understand how acculturation influences diabetes risk among urban immigrant Latinas (Hispanic women).

METHODS

Five focus groups were conducted with 26 urban immigrant Latinas who were at high clinical risk for developing diabetes. The focus group sessions were audiotaped and transcribed verbatim. The authors independently analyzed transcripts using an inductive method of open coding and established themes by consensus.

RESULTS

All participants were foreign born and had low levels of acculturation. During the acculturation process, they noted changes in their lifestyle behaviors and the family context in which those behaviors are shaped. They reported that since living in the United States, their improved economic circumstances led to increased consumption of less healthy foods and beverages and a more sedentary lifestyle. They also described changing family roles and responsibilities, including working outside the home, which constrained healthy food choices. However, they perceived that their position of influence within the family offered opportunities to help family members prevent diabetes.

CONCLUSIONS

Lifestyle interventions to prevent diabetes in Latinas should address their acculturation experiences, which affect family functioning and health behaviors related to diabetes risk. For example, given the perceived link between Latinas' improved economic circumstances and their diabetes risk, prevention programs should incorporate strategies to help Latinas avoid adopting less healthy lifestyle behaviors that become affordable during the acculturation process.

Patterns and predictors of health behaviors among racially/ethnically diverse residents of low-income housing developments

PURPOSE

To examine behavioral patterns and sociodemographic predictors of diet, inactivity, and tobacco use among a diverse sample of residents from low-income housing developments.

DESIGN

In this cross-sectional survey study, households and residents were randomly selected using multistage cluster sampling. Setting . The study was conducted in 20 low-income housing developments in the Boston, Massachusetts, metropolitan area.

SUBJECTS

Subjects were 828 residents who completed the survey (response rate = 49.3%). Forty-one percent of participants were Hispanic and 38% were non-Hispanic Black. Measures . Outcomes measured were diet, inactivity, and tobacco use. Predictors measured were age, race/ethnicity, gender, education, country in which the subject was born, language spoken, and financial hardship. Analysis . Logistic regression analyses were conducted to examine the association of three health behaviors with sociodemographic factors.

RESULTS

Age, gender, language spoken, and financial hardship showed significant relationships with all three behaviors. For example, those who reported less financial hardship (odds ratio [OR] = 1.75) were more likely to eat healthier. Residents who spoke no English, or at least one language in addition to English, were significantly more likely to report healthier eating (OR = 2.78 and 3.30, respectively) than those who spoke English only. Men were significantly more likely to report less healthy eating (OR = 0.65) than were women. Similar trends emerged for inactivity and tobacco use.

CONCLUSION

Effective health promotion interventions in low-income housing developments that leverage protective factors while addressing risk factors have the potential to reduce income-related health disparities in these concentrated resource-deprived neighborhoods.

Effectiveness of the modified progressive aerobic capacity endurance run test for assessing aerobic fitness in Hispanic children who are obese

The purpose of this study was to evaluate the effectiveness of the progressive aerobic capacity endurance run (PACER) and a newly designed modified PACER (MPACER) for assessing aerobic fitness in Hispanic children who are obese. Thirty-nine (aged 7-12 years) children who were considered obese (≥ 95 th body mass index [BMI] percentile) and 16 children who were considered normal weight (<85th BMI percentile) participated in this study. Performance outcomes included test duration (in minutes) and exercise heart rate (HR) (first-stage and peak HR) for each test. Ninety-five percent confidence intervals and independent t-tests were used to assess differences in primary outcomes. Mean PACER test duration was 1.6 ± 0.6 and 3.1 ± 1.3 minutes for children who were obese and normal weight, respectively. Modified PACER duration was higher than 3 minutes for the obese (3.6 ± 0.6 minutes) and normal weight (5.3 ± 1.2 minutes) groups. Children first-stage HR, expressed as a percent of peak HR, was above the predicted anaerobic threshold during the PACER, but below the anaerobic threshold during the MPACER. Relative first-stage HR was not significantly different between groups for the PACER, but they were significantly different between groups for the MPACER. In conclusion, the MPACER was a better alternative than the PACER for assessing aerobic fitness in Hispanic children who were normal weight and obese. When validated, this modified field test could be used to assess aerobic fitness in Hispanic children, particularly those who are overweight or obese. Additionally, the study provides evidence in which physical educators, personal trainers, and others most apt to assess aerobic fitness in children who are obese, should modify tests originally designed for the population who are normal weight.

Immigrating to the US: what Brazilian, Latin American and Haitian women have to say about changes to their lifestyle that may be associated with obesity

Our goal was to explore the perceived determinants of obesity in Brazilian, Latin American and Haitian women. This is part of an ongoing community-based participatory intervention. Focus groups by immigrant group were conducted and themes extracted. Women expressed differences in beliefs, attitudes, and barriers regarding diet and physical activity in the US versus their home country. Participants thought food in the US is "less natural," there is less time for preparation, and there is more variety. The weather is a barrier to physical activity in the US and work is more physically demanding. Job-related efforts were not considered physical activity. They reported higher levels of stress, less control of their time and less social support in the US. Providing immigrants with appropriate support and education early in the acculturation process has the potential to help prevent obesity.

Ethnic-immigrant disparities in total and abdominal obesity in the US

OBJECTIVES

To examine sex-specific disparities in total and abdominal obesity prevalence across 6 ethnic-immigrant groups and explore whether the observed differences were attributable to diet and physical activity (PA).

METHODS

Data were from 4331 respondents age 18-64 from the 2003-2006 National Health and Nutrition Examination Survey. Sex-specific multiple logistic regression analyses were performed.

RESULTS

Regardless of race-ethnicity, immigrants exhibited lower prevalence of total and abdominal obesity than natives. Among the US-born, Whites had the lowest total obesity prevalence followed by Hispanics and then Blacks; but racial-ethnic disparities for immigrants were different. In abdominal obesity, US-born white men had the highest prevalence. PA helped explain some ethnic-immigrant disparities.

CONCLUSIONS

Complex interactions of sex by race-ethnicity and nativity exist for obesity prevalence.

Change in self-reported health status among immigrants in the United States: associations with measures of acculturation

Although acculturation may have positive effects for immigrants, including better socioeconomic profiles and increased occupational opportunities, their health profiles deteriorate with longer duration in the U.S. Prior research indicates that increasing acculturation is associated with some poorer health outcomes among immigrants in the U.S. However, most of these studies have used length of stay or English language proficiency as proxies for acculturation, and have mainly examined self-reported “current” health outcomes. This study advances knowledge on associations between acculturation and health among immigrants by explicitly examining self-reported “change” in health since immigration, in relation to acculturation-related variables. We use data from the New Immigrant Survey (NIS; 2003-2004), a cross-sectional study of legal immigrants to the U.S. In addition to testing more conventionally examined proxies of acculturation (length of stay and English proficiency), we also examine English language use and self-reported change in diet. Multivariable logistic regression analyses on 5,982 participants generally supported previous literature indicating a deleterious impact of acculturation, with increasing duration of stay and greater self-reported change in diet being associated with a poorer change in health since moving to the U.S. Although English language proficiency and use were associated with greater odds of reporting a worse change in health when examined individually, they were non-significant in multivariable models including all acculturation measures. Findings from this study suggest that when taking into account multiple measures of acculturation, language may not necessarily indicate unhealthy assimilation and dietary change may be a pathway leading to declines in immigrant health. Increasing duration in the U.S. may also reflect the adoption of unhealthy behaviors, as well as greater exposure to harmful sources of psychosocial stress including racial and anti-immigrant discrimination. Our study suggests that multiple indicators of acculturation may be useful in examining the effect of acculturation on changes in health among immigrants.

Racial and Ethnic Disparities in Leisure-time Physical Activity in California: Patterns and Mechanisms

Evidence has shown that racial-ethnic minorities in the U.S. are less likely than whites to engage in leisure-time physical activity (LTPA); yet few studies to date have included Asian subgroups in the analyses and mechanisms underlying these disparities are not well-known. This study uses data from the 2007 California Health Interview Survey (N=37,164) to examine racial-ethnic disparities in self-reported adherence to LTPA recommendations and explore the mediating roles of socioeconomic status (SES), acculturation, and neighborhood perceptions. Nine racial-ethnic groups were included: non-Hispanic whites, non-Hispanic blacks, Mexicans, and six largest Asian subgroups. Results confirm that racial-ethnic minorities are, in general, less likely than whites to meet LTPA recommendations, whereas heterogeneity is also evident across Asian subgroups. No significant disparity is revealed for the Japanese and Filipinos but whites are advantaged compared to all other Asian groups. Educational attainment, percent of lifetime spent in the U.S., and access to park, playground, or open space are significantly associated with meeting the LTPA recommendations. SES and acculturation play differential roles in explaining group disparities for blacks, Mexicans, and some Asian subgroups. Perceived neighborhood environment does not mediate LTPA disparities by race-ethnicity. Net of these mediators, the advantages of whites in meeting LTPA recommendations persist for blacks, Mexicans, the Chinese, and Koreans. Future research should theorize and operationalize additional multilevel pathways linking race-ethnicity and LTPA while assessing measurement errors in the existing constructs.

Clashing paradigms: an empirical examination of cultural proxies and socioeconomic condition shaping Latino health

OBJECTIVE

Much debate exists regarding the role of culture versus socioeconomic position in shaping the health of Latino populations. We propose that both may matter for health and explicitly test their independent and joint effects on smoking and physical activity.

METHODS

We used the 2010 National Health Interview Survey, a population-based survey of the U.S. population, to estimate the prevalence of smoking and physical activity by language use (cultural proxy) and education among Latino adults (n = 4929). We fit log binomial regression models to estimate prevalence ratios and test for interaction.

RESULTS

English-language use and educational attainment were each independently associated with smoking and physical activity. Joint effect models showed that individuals with both greater use of the English language and low levels of education were nearly three times more likely to smoke (prevalence ratio, 2.59; 95% confidence interval, 1.83-3.65) than those with low English language use and high education (referent group); high acculturation and high education were jointly associated with increased activity (prevalence ratio 2.24, 95% confidence interval, 1.79-2.81).

CONCLUSIONS

Cultural proxies such as language use and educational attainment are both important determinants of health among Latinos. Their joint effect suggests the need to simultaneously consider Latinos' socioeconomic position and their increased risk of adopting health-damaging behaviors while addressing culturally-specific factors that may mitigate risk.

Feeding styles and evening family meals among recent immigrants

The protective effect of family meals on unhealthy weight gain and diet has been shown across multiple age groups; however, it is unknown whether a similar effect is present among diverse immigrant populations. In addition, little research has focused on factors associated with the frequency of evening family meals, such as feeding styles (how parents interact with their child around feeding). Therefore the goals of this paper are to explore the 1) association between the frequency of evening family meals and child weight status among new immigrant families, and 2) influence of immigrant mothers’ feeding styles on the frequency of evening family meals.

Baseline self-reported socio-demographic information and measured heights and weights were collected for both mother and child (age range: 3–12 years) among 387 mother-child dyads enrolled in Live Well, a community-based, participatory-research, randomized controlled lifestyle intervention to prevent excessive weight gain in recent (<10 years in the U.S.) immigrant mothers and children. For children, height and weight measurements were transformed into BMI z-scores using age-and sex-specific CDC standards and categorized as overweight (85^th–94^th percentile) and obese (≥95^th percentile); mothers’ BMI was calculated. Frequency of evening family meals, eating dinner in front of the TV, acculturation and responses to the Caregiver’s Feeding Styles Questionnaire (CFSQ) were also obtained from the mother. Children were categorized as “eating evening family meals regularly” if they had an evening family meal ≥5 times per week.

Overall, 20% of children were overweight and 25% were obese. Less than half (40.9%) of families had regular evening family meals. In multivariate analyses, adjusting for covariates, children who were overweight/obese were significantly less likely to have ≥5 evening family meals/week compared with normal weight children (OR = 0.51, 95% CI 0.32-0.82) . Mothers who had a low demanding/high responsive or a low demanding/low responsive feeding style, were less likely to have ≥5 evening family meals/week compared to mothers with a high demanding/high responsive feeding style (OR = 0.41, 95% CI 0.18-0.0.96, OR = 0.33, 95% CI 0.13-0.87, respectively). Future interventions and programs that seek to help parents establish healthy household routines, such as family meals, may consider tailoring to specific maternal feeding styles.

Diabetes-related behaviors in Latinas and non-Latinas in California

OBJECTIVE

Certain dietary and physical activity behaviors have been associated with the risk of developing type 2 diabetes, yet little is known about the prevalence of these behaviors among Latinas (Latino women). The purpose of this cross-sectional study was to compare the prevalence of diabetes-related behaviors in Latinas and non-Latinas.

RESEARCH DESIGN AND METHODS

Using data from the 2009 California Health Interview Survey, we compared self-reported diabetes-related behaviors of Latinas (n = 4,321) to non-Latinas (n = 21,112) after excluding women who were pregnant or had diabetes. For six behaviors, we determined the cut point for the least healthy tertile: walking, doing moderate to vigorous physical activity, and consuming fried potatoes, sugar-sweetened beverages (SSBs), desserts, and fast food. We used logistic regression to examine the association between Latina ethnicity and being in the least healthy tertile compared with the other two tertiles for each of these behaviors.

RESULTS

In multivariate models adjusted for age, income, education, marital status, health status, smoking, and acculturation, Latinas had a higher risk (odds ratio [95% CI]) of being in the least healthy tertile for the consumption of fast food (1.94 [1.63-2.31]), SSBs (1.53 [1.29-1.82]), and fried potatoes (1.32 [1.18-1.67]), and lower risk for desserts (0.82 [0.70-0.95]). Latinas and non-Latinas had similar physical activity levels.

CONCLUSIONS

Dietary differences between Latinas and non-Latinas (particularly in the consumption of fast food and SSBs) may be the focus of interventions to prevent diabetes in Latinas. Further research among Latinas is needed to understand and modify these dietary behaviors.

Acculturation and gestational weight gain in a predominantly Puerto Rican population

Background

Identifying risk factors that affect excess weight gain during pregnancy is critical, especially among women who are at a higher risk for obesity. The goal of this study was to determine if acculturation, a possible risk factor, was associated with gestational weight gain in a predominantly Puerto Rican population.

Methods

We utilized data from Proyecto Buena Salud, a prospective cohort study of Hispanic women in Western Massachusetts, United States. Height, weight and gestational age were abstracted from medical records among participants with full-term pregnancies (n=952). Gestational weight gain was calculated as the difference between delivery and prepregnancy weight. Acculturation (measured via a psychological acculturation scale, generation in the US, place of birth and spoken language preference) was assessed in early pregnancy.

Results

Adjusting for age, parity, perceived stress, gestational age, and prepregnancy weight, women who had at least one parent born in Puerto Rico/Dominican Republic (PR/DR) and both grandparents born in PR/DR had a significantly higher mean total gestational weight gain (0.9 kg for at least one parent born in PR/DR and 2.2kg for grandparents born in PR/DR) and rate of weight gain (0.03 kg/wk for at least one parent born in PR/DR and 0.06 kg/wk for grandparents born in PR/DR) vs. women who were of PR/DR born. Similarly, women born in the US had significantly higher mean total gestational weight gain (1.0 kg) and rate of weight gain (0.03 kg/wk) vs. women who were PR/ DR born. Spoken language preference and psychological acculturation were not significantly associated with total or rate of pregnancy weight gain.

Conclusion

We found that psychological acculturation was not associated with gestational weight gain while place of birth and higher generation in the US were significantly associated with higher gestational weight gain. We interpret these findings to suggest the potential importance of the US “obesogenic” environment in influencing unhealthy pregnancy weight gains over specific aspects of psychological acculturation.

The built environment and risk of obesity in the United States: racial-ethnic disparities

Using data from the 2003-2008 waves of the continuous National Health Nutrition Examination Survey merged with the 2000 census and GIS-based data, this study conducted genderspecific analyses to explore whether neighborhood built environment attributes are significant correlates of obesity risk and mediators of obesity disparities by race-ethnicity. Results indicate that the built environment is a significant correlate of obesity risk but is not much of a mediator of obesity disparities by race-ethnicity. Neighborhood walkability, density, and distance to parks are significant covariates of obesity risks net of individual and neighborhood controls. Gender differences are found for some of these associations.

Associated pathways between neighborhood environment, community resource factors, and leisure-time physical activity among Mexican-American adults in San Diego, California

PURPOSE

To examine pathways between individual, social, and environmental factors associated with leisure-time physical activity (LTPA) among Mexican-American adults.

DESIGN

Cross-sectional design using random-digit dialing to administer a structured telephone interview.

SETTING

Mexican-American adults living in a U.S.-Mexican border community in San Diego, California (N = 672).

MEASURES

Data were collected on LTPA, demographic characteristics, acculturation, and other psychosocial and environmental factors associated with LTPA.

ANALYSIS

Structural equation modeling to test an a priori model of LTPA.

RESULTS

Participants were mostly female (71%) with a mean age of 39 years (SD = 13). Only 32% of participants met PA guidelines in their leisure time, with men (39%) meeting the guidelines more than women (29%). Using structural equation modeling, neighborhood factors, both social and environmental, showed indirect relationships with meeting PA guidelines through community resource factors. Significant covariates included marital status and age.

CONCLUSION

Individual, social, and environmental factors were associated with LTPA in this sample of Mexican-American adults. These findings can inform intervention studies that aim to increase LTPA in this population.

Influence of individual and social contextual factors on changes in leisure-time physical activity in working-class populations: results of the Healthy Directions-Small Businesses Study

BACKGROUND

As part of the Harvard Cancer Prevention Program Project, we sought to address disparities reflected in social class and race/ethnicity by developing and testing a behavioral intervention model that targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity in working-class, multiethnic populations.

METHODS

This paper examined the associations between change in leisure-time physical activity and individual and social contextual factors in participants employed in small businesses (n = 850) at both baseline and at 18-month final.

RESULTS

In bivariate analyses, age, language acculturation, social ties, and workplace social capital were significantly associated with physical activity at final. In multivariable analyses, being younger and having high language acculturation were significantly associated with greater leisure-time physical activity at final; high workplace social capital was significantly associated with a decline in physical activity at final.

CONCLUSION

These findings have implications for understanding factors that are integral to promoting change in physical activity among working-class, multiethnic populations.

Feeding styles and child weight status among recent immigrant mother-child dyads

BACKGROUND

Research has shown that parental feeding styles may influence children's food consumption, energy intake, and ultimately, weight status. We examine this relationship, among recent immigrants to the US. Given that immigrant parents and children are at greater risk for becoming overweight/obese with increased time in the US, identification of risk factors for weight gain is critical.

METHODS

Baseline data was collected on 383 mother-child dyads enrolled in Live Well, a community-based, participatory, randomized controlled lifestyle intervention to prevent weight gain in recent immigrant mothers. Socio-demographic information together with heights and weights were collected for both mother and child. Acculturation, behavioral data, and responses to the Caregiver's Feeding Styles Questionnaire (CFSQ) were also obtained from the mother.

RESULTS

The children's average age was 6.2 ± 2.7 years, 58% male. Mothers had been in the country for an average of 6.0 ± 3.3 years, and are Brazilian (36%), Haitian (34%) and Latino (30%). Seventy-two percent of the mothers were overweight/obese, while 43% of the children were overweight/obese. Fifteen percent of mothers reported their feeding style as being high demanding/high responsive; 32% as being high demanding/low responsive; 34% as being low demanding/high responsive and 18% as being low demanding/low responsive. In bivariate analyses, feeding styles significantly differed by child BMIz-score, ethnic group, and mother's perceived stress. In multiple linear regression, a low demanding/high responsive feeding style was found to be positively associated (ß = 0.56) with a higher child weight as compared to high demanding/high responsive, controlling for known covariates (p = 0.01).

CONCLUSIONS

Most mothers report having a low demanding/high responsive feeding style, which is associated with higher child weight status in this diverse immigrant population. This finding adds to the growing literature that suggests this type of feeding style may be a risk factor for childhood obesity. Further research is needed to help understand the larger socio-cultural context and its influence on feeding dynamics among immigrant families and families of lower incomes. How parents establish a certain feeding style in their home country compared to when they move to the US "obesogenic" environment, should also be explored.

Systematic exposure to recreation centers increases use by Latino families with young children

BACKGROUND

Living near community recreation centers (CRC) is associated with increases in adolescent and adult physical activity, but the efficacy of efforts to increase use among Latino parents and young children is unknown. We hypothesized that Latino parent-child dyads with exposure to a CRC through culturally tailored programming would be more likely to use the facility for physical activity a year after programming ended than dyads living in the same geographic area who were not exposed to the programming.

METHODS

Self-identified Latino parent-child dyads who had participated in a randomized controlled trial (RCT) of a culturally tailored healthy lifestyle program and completed a 12-month follow-up assessment constituted the "exposed" group (n = 66). The "unexposed" group included 62 parent-child dyads living in the same zip codes as the exposed group, all within a 5-mile radius of the CRC. Participants completed in-person structured interviews.

RESULTS

Approximately two-thirds of exposed parents reported more than monthly use of the CRC for themselves a year after programming ended, compared to one-third of unexposed Latino families with the same geographic access (χ(2) = 11.26, p < 0.01). Parents in the exposed group were four times more likely than the unexposed group to use the CRC with their children on a monthly basis (odds ratio = 4.18, p < 0.01).

CONCLUSIONS

CRCs that develop culturally tailored programs that invite Latino families inside can increase sustained CRC use for physical activity in this population at heightened risk for childhood obesity.