Rurality and ethnicity in adolescent physical illness: are children of the growing rural Latino population at excess health risk?

Rural Latino health and the built environment: a systematic review

Objective: This study systematically reviewed literature examining the influence of the rural built environment on Latinos' health outcomes and behaviour in the United States. A secondary aim of the study was to identify strategies developed to address challenges in the rural built environment affecting Latinos' health.Design: This study followed the reporting guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles included in the final analysis clearly linked Latino health outcomes to characteristics of the rural built environment.Results: Of the nearly 2,500 articles identified in the initial search, the final review included approximately 146 full-text sources. The majority of the articles focused on aspects of Latinos' physical (n = 68), behavioural (n = 43), and mental health (n = 23).Conclusions: Rural Latino neighbourhoods in the United States possess limited access to health care, internet, transportation, and recreation infrastructure, which negatively impacts health outcomes and behaviours. Strategies developed to mitigate these issues include but are not limited to: the use of telecommunications to distribute health information; the use of community health workers and mobile clinics to increase awareness and availability of select health services; the use of worksite trainings and adaptations to the workplace; and the promotion of safety net programmes, such as the Supplemental Nutrition Programme for Women, Infants and Children (WIC). This review supports the need for a more robust research agenda documenting the health experiences of rural Latinos of various nationalities, age groups, and genders.

Contextual Determinants in Alcohol, Tobacco and Cannabis Consumption, Mood and Bullying during Adolescence

The present study aimed to explore the differences in the consumption of alcohol, tobacco and cannabis, mood and bullying between adolescents. A cross-sectional study was carried out in five regions of Northern Spain (one in Galiza and four in central Catalonia) that share similar socioeconomic characteristics and encompass around 10,000 inhabitants each. Students living in Burela, Galiza (N = 71) were compared to those of Central Catalonia (N = 193). The independent variable was the municipality of residence. The dependent variables encompassed: weekly available pocket money, Family Affluence Scale, self-classified academic qualification, place of origin, alcohol consumption, tobacco and cannabis smoking, negative mood and bullying. The mean age and their 95% confidence intervals (95% CI) of participants were similar between the regions (Burela: 15.90 years (15.68-16.13) and Central Catalonia: 15.36 years (15.28-15.44)). More than half of the participants were females (Burela, Galiza (53.5%) and Catalonia (54.9%)). Prevalence ratios (PR) and their 95% CI were estimated using Poisson regression models. In comparison with adolescents from Burela (Galiza), those living in Central Catalonia had higher prevalence of diverse academic levels (adjusted PR = 3.92 (1.78-8.66)), tobacco consumption (adjusted PR = 2.41 (1.47-3.97)) and negative mood (adjusted PR = 5.97 (3.05-11.70)). Even when dealing with regions with similar socioeconomic characteristics and number of inhabitants, differences exist in terms of the socioeconomic level, tobacco consumption, mood and bullying, as reported by adolescents.

Mirror, Mirror on the Wall: Children's Preferences and Self-Perceptions of Weight in a Rural Hispanic Community

INTRODUCTION

Although studies have documented parents' misperceptions regarding their children's weight, studies examining preadolescent children's self-perceptions of weight-in particular, Hispanic children's self-perceptions of weight-are limited.

METHOD

A convenience sample of 424 children from a rural community, aged 8 to 11 years and in grades 3 through 5, participated in this cross-sectional, descriptive, nonexperimental study. Using the Children's Body Image Scale, the children were asked to select a figure representing their actual body perception and a figure representing their ideal body perception. The children were weighed and measured, body mass index (BMI) was calculated, and each child was assigned to one of the Centers for Disease Control and Prevention weight categories: underweight, normal or healthy weight, overweight, or obese.

RESULTS

Only BMI category was found to be significantly associated with accurate perception, χ²(3) = 201.4, p < .001, with only 9% of overweight or obese children selecting figures representing their actual BMI category. Actual BMI category, χ²(3) = 8.8, p = .032, and grade level, χ²(2) = 6.7, p = .036, had a significant association with selection of an underweight ideal. Overall, 32% of children selected an underweight figure as ideal.

DISCUSSION

Prepubertal children who are either overweight or obese do not accurately perceive their weight status. Rather than focusing solely on weight reduction programs, emphasis should be placed on promoting healthy lifestyles and choices.

Chronic physical health conditions among children of different racial/ethnic backgrounds

OBJECTIVES

It is estimated that 20% of children in the USA are affected by at least one chronic disease. Although the burden of chronic conditions is greater for minority populations of children, research that has explored the prevalence and risk factors of chronic disease across different racial/ethnic groups is scarce. The aim of this study was to examine racial/ethnic disparities in the prevalence rates of common physical, chronic diseases in White, Black and Hispanic children; and assess the effect of several factors on the risk of having a chronic disease.

METHODS

Using the 2007 National Survey of Childrens Health, prevalence estimates were calculated for asthma, hearing impairment, visual impairment, joint/bone/muscle problems, brain injury and other illnesses for each racial/ethnic group. Multivariate logistic regression analyses were conducted to examine the effects of several risk factors on the risk of each of these health conditions.

RESULTS

The findings show that the prevalence for all health conditions was significantly higher (25.3%) among Black children than White (19.8%) and Hispanic (18.6%) children. Furthermore, 19.5% of Black children have had or currently have asthma compared with 12.2% of White and Hispanic children. More Black and Hispanic children were covered by public health insurance, while 19% of Hispanic children were currently uninsured. White children whose mothers had a health problem were associated with asthma, hearing impairment, visual impairment and joint/bone/muscle problems, while Black children were more likely to report asthma and Hispanics reported visual impairment and joint/bone muscle problems. Hispanic children who were living in poverty or were uninsured were at lower risk for any chronic disease. Regardless of race/ethnicity, children living in a single-parent household were more likely to be associated with any health condition.

CONCLUSIONS

This study provides evidence that racial/ethnic disparities in chronic physical conditions and health care among US children are extensive. It underscores that uninsured children who do not have access to the healthcare system are not being screened for chronic diseases, or are not obtaining medical care for such health problems. Healthcare providers should educate families about prevention measures and community services that might be able to assist them in improving the health of their children.

Rural Latino adolescent health: preliminary examination of health risks and cultural correlates

Latino adolescents living in rural settings may be at increased risk of health problems; however, data describing the health status of this population are limited. This study examined 60 rural Latino adolescents and found high rates of health risk, including at-risk/clinical results for hemoglobin A1C (23.3%), high-density lipoprotein cholesterol (55%), systolic blood pressure (21.7%), and overweight/obesity (55%). Time in sedentary behaviors was high and physical activity was limited. Adolescent language use was associated with health risk status, with greater use of English associated with lower risk. Health psychologists could promote improved health by providing health behavior interventions to this underserved population.

Health related quality of life in a rural area with low racial/ethnic density

The purpose of this study was to compare the self-reported quality of life of racial/ethnic minorities and Caucasians living in a rural, northern New York county, where 94% of the population is Caucasian. Participants completed a 79-item survey online and in-person assessing health status, health-related quality of life, perceptions of health information, and health care access/use. Frequencies, Chi-Square, and ANOVA were used to analyze the results. A total of 1,039 surveys were completed. Racial/ethnic minorities earned significantly less income, F (1, 1031) = 29.306, P = .000, relied more on public health insurance, X ( 2 )(7, 1033) = 47.827, P = .000, were significantly less likely to see a doctor because of the cost, F(1,990) = 17.042, P = .000, and reported using health-related services significantly less often when compared to Caucasians, F(1, 1032) = 17.051, P = .000. In terms of quality of life, while there were no significant differences in self-reported physical health, racial/ethnic minorities were more likely to feel sad/blue/depressed, F(1, 1031) = 7.193, P = .011 and worried/tense/anxious, F(1, 1031) = 5.550, P = .040. Findings from this study offer some initial evidence that, while perceived health status is generally good, rural racial/ethnic minorities residing in predominantly Caucasian rural areas may experience more mental health problems that are risk factors for chronic diseases. This coupled with lower use of health care services increases the need for culturally competent health programs and services for this population.

Increasing healthy behaviors in adolescents of Mexican heritage in rural emerging Latino communities: results from a school-based health intervention pilot study

The rapid Latino population growth in emerging Latino communities (EmLCs) presents a challenge to health care providers as most current health interventions and health promotion programs intended for Latinas/os are based on characteristics of established Latino communities (EsLCs). This study addresses the gap in the literature by modifying and testing the beginning efficacy of a school-based health intervention for adolescents of Mexican heritage in a rural EmLC. Seventy adolescents of Mexican heritage attending a rural middle school participated in the intervention. Paired samples t-tests were performed to determine differences between healthy behaviors at post-intervention compared to pre-intervention. Significant improvements in participants' physical activity and healthy eating were observed between pre-intervention and post-intervention. A school-based health intervention designed to increase healthy behaviors of adolescents of Mexican heritage in a rural EmLC was successful.

Variability in childhood allergy and asthma across ethnicity, language, and residency duration in El Paso, Texas: a cross-sectional study

BACKGROUND

We evaluated the impact of migration to the USA-Mexico border city of El Paso, Texas (USA), parental language preference, and Hispanic ethnicity on childhood asthma to differentiate between its social and environmental determinants.

METHODS

Allergy and asthma prevalence was surveyed among 9797 fourth and fifth grade children enrolled in the El Paso Independent School District. Parents completed a respiratory health questionnaire, in either English or Spanish, and a sub-sample of children received spirometry testing at their school. Here we report asthma and allergy outcomes across ethnicity and El Paso residency duration.

RESULTS

Asthma and allergy prevalence increased with longer duration of El Paso residency independent of ethnicity and preferred language. Compared with immigrants who arrived in El Paso after entering first grade (18%), lifelong El Paso residents (68%) had more prevalent allergy (OR, 1.72; 95% CI, 1.32 - 2.24), prevalent asthma (OR, 1.75; 95% CI, 1.24 - 2.46), and current asthma (OR, 2.01; 95% CI, 1.37 - 2.95). Spirometric measurements (FEV1/FVC and FEF25-75) also declined with increasing duration of El Paso residency (0.16% and 0.35% annual reduction, respectively).

CONCLUSION

These findings suggest that a community-wide environmental exposure in El Paso, delayed pulmonary development, or increased health of immigrants may be associated with allergy and asthma development in children raised there.

Suicidal behavior in Latinos: focus on the youth

The multicultural nature of American society presents clinicians and mental health providers with the unique challenge of working with mentally ill patients from many different cultural backgrounds. Although research investigating suicidal behavior among Latinos is limited, the literature suggests the presence of two distinct phenomena: (a) the prevalence of completed suicide among Latinos as a group is lower than the national rate and (b) the prevalence of suicidal behavior among Latino youth between the ages of 10-24 years is greater than in other ethnic groups, especially among females. Acculturation, family conflicts, physical abuse and sexual abuse, among other factors, have been suggested to increase the risk of depression and suicide among young Latinos. To ameliorate suicidal behavior among Latino youth, more research is needed about specific risk factors, diagnosis, treatment, and ultimately, suicide prevention. Research focused on identifying risk and mediating factors for suicidal behavior in young Latinos is particularly relevant, given the size and rapid growth of the Latino population in the United States of America.

Educating youth about health and science using a partnership between an academic medical center and community-based science museum

Declining student interest and scholastic abilities in the sciences are concerns for the health professions. Additionally, the National Institutes of Health is committed to promoting more research on health behaviors among US youth, where one of the most striking contemporary issues is obesity. This paper reports findings on the impact of a partnership between Oregon Health and Science University (OHSU) and the Oregon Museum of Science and Industry linked to a 17-week exhibition of BodyWorlds3 and designed to inform rural underserved youth about science and health research. Self-administered survey measures included health knowledge, attitudes, intended health behaviors, and interest in the health professions. Four hundred four surveys (88% of participants) were included in analyses. Ninety percent or more found both the BodyWorlds (n = 404) and OHSU (n = 239) exhibits interesting. Dental care habits showed the highest level of intended behavior change (Dental = 45%, Exercise = 34%, Eating = 30%). Overall, females and middle school students were more likely than male and high school students, respectively, to state an intention to change exercise, eating and dental care habits. Females and high school students were more likely to have considered a career in health or science prior to their exhibit visit and, following the exhibit, were more likely to report that this intention had been reinforced. About 6% of those who had not previously considered a career in health or science (n = 225) reported being more likely to do so after viewing the exhibits. In conclusion, high quality experiential learning best created by community-academic partnerships appears to have the ability to stimulate interest and influence intentions to change health behaviors among middle and high school students.

Social and economic aspects of immigration

The absolute size of the foreign-born U.S. population is at a historical high, but neither the share of the population that is foreign born nor the share of children in immigrant families is high compared with the beginning of the 20th century. While poverty rates for immigrants and children in immigrant families are substantial, poverty is concentrated among certain groups, particularly Hispanics and blacks, non-citizens, and recent arrivals. The general economic well-being of immigrants improves with the move to the United States and as time in the United States increases. However, immigrants remain disadvantaged in terms of health insurance coverage. The economic situation of children in immigrant families has declined since the late 1960s, despite the high labor force participation of immigrant men and the lower prevalence of single-parent households among immigrant families. Still, children in immigrant families are at least as healthy as children in native families and are less likely to engage in risky behaviors. With socioeconomic factors taken into account, children in immigrant families do as well as other children in school. Analyses of the socioeconomic well-being of immigrants have been hampered by lack of information in major data sets about legal status and about the visa status of legally present immigrants, as well as by limited availability of longitudinal data.