1
|
Manusov EG, Diego VP, Almeida M, Ortiz D, Curran JE, Galan J, Leandro AC, Laston S, Blangero J, Williams-Blangero S. Genotype-by-Environment Interactions in Nonalcoholic Fatty Liver Disease and Chronic Illness among Mexican Americans: The Role of Acculturation Stress. Genes (Basel) 2024; 15:1006. [PMID: 39202366 PMCID: PMC11353877 DOI: 10.3390/genes15081006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/23/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024] Open
Abstract
This study examines the complex interplay of genetic and environmental interactions that shape chronic illness risk. Evidence is mounting for the role of genetic expression and the immune response in the pathogenesis of chronic disease. In the Rio Grande Valley of south Texas, where 90% of the population is Mexican American, chronic illnesses (including obesity, diabetes, nonalcoholic liver disease, and depression) are reaching epidemic proportions. This study leverages an ongoing family study of the genetic determinants of risk for obesity, diabetes, hypertension, hyperlipidemia, and depression in a Mexican American population. Data collected included blood pressure, BMI, hepatic transaminases, HbA1c, depression (BDI-II), acculturation/marginalization (ARSMA-II), and liver health as assessed by elastography. Heritability and genotype-by-environment (G×E) interactions were analyzed, focusing on the marginalization/separation measure of the ARSMA-II. Significant heritabilities were found for traits such as HbA1c (h2 = 0.52), marginalization (h2 = 0.30), AST (h2 = 0.25), ALT (h2 = 0.41), and BMI (h2 = 0.55). Genotype-by-environment interactions were significant for HbA1c, AST/ALT ratio, BDI-II, and CAP, indicating that genetic factors interact with marginalization to influence these traits. This study found that acculturation stress exacerbates the genetic response to chronic illness. These findings underscore the importance of considering G×E interactions in understanding disease susceptibility and may inform targeted interventions for at-risk populations. Further research is warranted to elucidate the underlying molecular pathways and replicate these findings in diverse populations.
Collapse
Affiliation(s)
- Eron G. Manusov
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA (J.E.C.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - Vincent P. Diego
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA (J.E.C.)
| | - Marcio Almeida
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA (J.E.C.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - David Ortiz
- School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA;
| | - Joanne E. Curran
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA (J.E.C.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - Jacob Galan
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA (J.E.C.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - Ana C. Leandro
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA (J.E.C.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - Sandra Laston
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA (J.E.C.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - John Blangero
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA (J.E.C.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| | - Sarah Williams-Blangero
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA (J.E.C.)
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX 78520, USA
| |
Collapse
|
2
|
Cai J, Pirzada A, Baldoni PL, Heiss G, Kunz J, Rosamond WD, Youngblood ME, Aviles-Santa ML, Gallo LC, Isasi CR, Kaplan R, Lash JP, Lee DJ, Llabre MM, Schneiderman N, Wassertheil-Smoller S, Talavera GA, Daviglus ML. Cumulative All-Cause Mortality in Diverse Hispanic/Latino Adults : A Prospective, Multicenter Cohort Study. Ann Intern Med 2024; 177:303-314. [PMID: 38437694 DOI: 10.7326/m23-1990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND All-cause mortality among diverse Hispanic/Latino groups in the United States and factors underlying mortality differences have not been examined prospectively. OBJECTIVE To describe cumulative all-cause mortality (and factors underlying differences) by Hispanic/Latino background, before and during the COVID-19 pandemic. DESIGN Prospective, multicenter cohort study. SETTING Hispanic Community Health Study/Study of Latinos. PARTICIPANTS 15 568 adults aged 18 to 74 years at baseline (2008 to 2011) of Central American, Cuban, Dominican, Mexican, Puerto Rican, South American, and other backgrounds from the Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California. MEASUREMENTS Sociodemographic, acculturation-related, lifestyle, and clinical factors were assessed at baseline, and vital status was ascertained through December 2021 (969 deaths; 173 444 person-years of follow-up). Marginally adjusted cumulative all-cause mortality risks (11-year before the pandemic and 2-year during the pandemic) were examined using progressively adjusted Cox regression. RESULTS Before the pandemic, 11-year cumulative mortality risks adjusted for age and sex were higher in the Puerto Rican and Cuban groups (6.3% [95% CI, 5.2% to 7.6%] and 5.7% [CI, 5.0% to 6.6%], respectively) and lowest in the South American group (2.4% [CI, 1.7% to 3.5%]). Differences were attenuated with adjustment for lifestyle and clinical factors. During the pandemic, 2-year cumulative mortality risks adjusted for age and sex ranged from 1.1% (CI, 0.6% to 2.0%; South American) to 2.0% (CI, 1.4% to 3.0%; Central American); CIs overlapped across groups. With adjustment for lifestyle factors, 2-year cumulative mortality risks were highest in persons of Central American and Mexican backgrounds and lowest among those of Puerto Rican and Cuban backgrounds. LIMITATION Lack of data on race and baseline citizenship status; correlation between Hispanic/Latino background and site. CONCLUSION Differences in prepandemic mortality risks across Hispanic/Latino groups were explained by lifestyle and clinical factors. Mortality patterns changed during the pandemic, with higher risks in persons of Central American and Mexican backgrounds than in those of Puerto Rican and Cuban backgrounds. PRIMARY FUNDING SOURCE National Institutes of Health.
Collapse
Affiliation(s)
- Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.C., M.E.Y.)
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois (A.P., M.L.D.)
| | - Pedro L Baldoni
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, and Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia (P.L.B.)
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (G.H., W.D.R.)
| | - John Kunz
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (J.K.)
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (G.H., W.D.R.)
| | - Marston E Youngblood
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.C., M.E.Y.)
| | - M Larissa Aviles-Santa
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland (M.L.A.)
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California (L.C.G., G.A.T.)
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York (C.R.I., S.W.)
| | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, and Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington (R.K.)
| | - James P Lash
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois (J.P.L.)
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida (D.J.L.)
| | - Maria M Llabre
- Department of Psychology, University of Miami, Miami, Florida (M.M.L., N.S.)
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Miami, Florida (M.M.L., N.S.)
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York (C.R.I., S.W.)
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, California (L.C.G., G.A.T.)
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois (A.P., M.L.D.)
| |
Collapse
|
3
|
Pirzada A, Cai J, Cordero C, Gallo LC, Isasi CR, Kunz J, Thyagaragan B, Wassertheil-Smoller S, Daviglus ML. Risk Factors for Cardiovascular Disease: Knowledge Gained from the Hispanic Community Health Study/Study of Latinos. Curr Atheroscler Rep 2023; 25:785-793. [PMID: 37773246 DOI: 10.1007/s11883-023-01152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE OF REVIEW The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) has made important contributions on the prevalence of and factors associated with cardiovascular disease (CVD) risk factors among diverse Hispanic/Latino adults in the US. This article summarizes the knowledge gained thus far on major CVD risk factors from this landmark study. RECENT FINDINGS HCHS/SOL demonstrated the sizeable burdens of CVD risk in all major Hispanic/Latino groups in the US, as well as the marked variations in prevalence of hypertension, hypercholesterolemia, diabetes, obesity, and smoking by sex and background. It also identified sociodemographic, lifestyle, and sociocultural characteristics associated with risk factors. HCHS/SOL has yielded an expanding body of literature on characteristics associated with adverse CVD risk factors in this population. Long-term follow-up of this cohort will shed further light on the observed heterogeneity in CVD risk across Hispanic/Latino groups and identify specific risk/protective factors driving these variations.
Collapse
Affiliation(s)
- Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, 1819 W. Polk Street, Suite 246, Chicago, IL, 60612, USA.
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John Kunz
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bharat Thyagaragan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | | | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, 1819 W. Polk Street, Suite 246, Chicago, IL, 60612, USA
| |
Collapse
|
4
|
Economos CD, Tovar A, Choumenkovitch S, Boulos R, Chui K, Gute DM, Hyatt RR, Metayer N, Pirie A, Must A. Results from "Live Well", a randomized controlled community-based participatory intervention to prevent obesity in new immigrant mother-child dyads. BMC Public Health 2023; 23:1893. [PMID: 37784070 PMCID: PMC10544478 DOI: 10.1186/s12889-023-16727-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/09/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Upon arrival, the prevalence of overweight and obesity is lower in new immigrants than their native counterparts in the U.S. With longer residency in the U.S., these differences converge over time, followed by higher prevalence among immigrants than native U.S. residents. Results from the Live Well project in the Greater Boston area demonstrate the viability of utilizing a culturally adapted, community-based participatory research (CBPR) approach to reduce weight gain among newly immigrated mother-child dyads. METHODS Haitian, Latina, and Brazilian mother-child dyads (n = 390), new to the U.S. (fewer than 10 years) were enrolled in a one- to two-year long CBPR lifestyle intervention that targeted dietary and physical activity behaviors. Attendance was recorded to establish dose. Demographics, anthropometrics, and relevant covariates were collected from participants at baseline, 6, 12, 18, and 24 months. Body Mass Index (BMI) was calculated using objectively measured height and weight. Linear mixed regression models were used to assess change in BMI and BMI z-score of mothers and children respectively. RESULTS At baseline, nearly 75% of mothers and 50% of children were either overweight or obese (BMI ≥ 25.0 and BMI z-score ≥ 85th percentile, respectively). Only 20% of mothers attended all 12 intervention sessions in year 1. Using intent-to-treat analyses, no significant time, intervention, or time × intervention effects were observed for weight change of mothers or children at follow-up. Mothers in the highest quantile (those who attended all 12 intervention sessions) had significant reductions in BMI at 18 months (1.76 units lower, 95%CI: -3.14, -0.37) and 24 months (2.61 units, 95%CI -3.92, -1.29) compared to mothers in the lower quantiles, including those with no exposure. Such dose effects on BMI z-scores were not noted for children. CONCLUSIONS Findings from Live Well demonstrate the viability of utilizing a CBPR approach to address overweight and obesity among immigrant mothers. Given the higher-than-expected prevalence of overweight and obesity among mother-child dyads by ~ 6 years of U.S. residency, and lower maternal participation rates in the intervention, additional research is necessary to identify the optimal intervention length, retention strategies, and approach to jointly support healthy maternal and child weight.
Collapse
Affiliation(s)
- Christina D Economos
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - Silvina Choumenkovitch
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | - Kenneth Chui
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - David M Gute
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA
| | | | - Nesly Metayer
- Center for Public Management, Suffolk University, Boston, MA, USA
| | - Alex Pirie
- Immigrant Service Providers Group/Health, Somerville, MA, USA
| | - Aviva Must
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| |
Collapse
|
5
|
Parizadeh M, Arrieta MC. The global human gut microbiome: genes, lifestyles, and diet. Trends Mol Med 2023; 29:789-801. [PMID: 37516570 DOI: 10.1016/j.molmed.2023.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/31/2023]
Abstract
A growing number of human gut microbiome studies consistently describe differences between human populations. Here, we review how factors related to host genetics, ethnicity, lifestyle, and geographic location help explain this variation. Studies from contrasting environmental scenarios point to diet and lifestyle as the most influential. The effect of human migration and displacement demonstrates how the microbiome adapts to newly adopted lifestyles and contributes to the profound biological and health consequences attributed to migration. This information strongly suggests against a universal scale for healthy or dysbiotic gut microbiomes, and prompts for additional microbiome population surveys, particularly from less industrialized nations. Considering these important differences will be critical for designing strategies to diagnose and restore dysbiosis in various human populations.
Collapse
Affiliation(s)
- Mona Parizadeh
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; International Microbiome Center, University of Calgary, Calgary, Alberta, Canada
| | - Marie-Claire Arrieta
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; International Microbiome Center, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
6
|
Abasilim C, Persky V, Sargis RM, Argos M, Daviglus ML, Freels S, Tsintsifas K, Day T, Cai J, Isasi CR, Peters BA, Talavera GA, Thyagarajan B, Turyk ME. Association of Acculturation and Hispanic/Latino Background with Endogenous Sex and Thyroid-Related Hormones Among Middle-Aged and Older Hispanic/Latino Adults: the HCHS/SOL Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01762-8. [PMID: 37620727 DOI: 10.1007/s40615-023-01762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Hormones are linked to cardiometabolic diseases and may be impacted by acculturation though multiple mechanisms. We evaluated associations of Hispanic/Latino background and acculturation with levels of sex- and thyroid-related hormones and the potential mediating effect of adiposity, lifestyle factors, and sleep apnea syndrome on these associations. METHODS We studied 1789 adults, aged 45-74, from a sub-cohort of the Hispanic Community Health Survey/Study of Latinos. Peri/pre-menopausal women and individuals on medications related to hormones were excluded. Our study assessed eleven sex- and thyroid-related hormones, Hispanic/Latino background, and five acculturation measures. Associations were assessed using multivariable linear and logistic regression adjusted for survey design and confounding variables. We explored potential mediation using a path analysis. RESULTS In postmenopausal women, acculturation score-MESA was associated with decreased thyroid-stimulating hormone (β = - 0.13;95%CI = - 0.22, - 0.03) while age at immigration greater than the median (vs US-born) was associated with decreased (β = - 14.6; 95%CI = - 28.2, - 0.99) triiodothyronine (T3). In men, language acculturation and acculturation score-MESA were associated with increased estradiol and sex hormone-binding globulin (SHBG) while age at immigration greater and lesser than the median (vs US-born) was associated with decreased SHBG. Hispanic/Latino background (Mexicans as reference) were selectively associated with sex- and thyroid-related hormone levels in both sexes. Current smoking and sleep apnea syndrome partially mediated the association of Cuban and Puerto Rican heritage (vs Mexican) with T3 levels in men and postmenopausal women, respectively. CONCLUSION Selected acculturation measures were associated with thyroid-related hormones in postmenopausal women and sex-related hormones in men. Understanding the mechanisms involved in the relationship of acculturation and Hispanic/Latino background with hormones warrants additional investigation.
Collapse
Affiliation(s)
- Chibuzor Abasilim
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA.
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, USA.
| | - Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Robert M Sargis
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois Chicago and Medical Service, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Maria Argos
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, IL, USA
| | - Sally Freels
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Konstantina Tsintsifas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Tessa Day
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Mary E Turyk
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| |
Collapse
|
7
|
Devia C, Flórez KR, Costa SA, Huang TTK. Insights from a cross-sectional binational study comparing obesity among nonimmigrant Colombians in their home country and Colombian immigrants in the U.S. BMC Public Health 2023; 23:1495. [PMID: 37544992 PMCID: PMC10405453 DOI: 10.1186/s12889-023-16322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Latinos in the United States (U.S.) represent a heterogeneous minority population disproportionally impacted by obesity. Colombians in the U.S. are routinely combined with other South Americans in most obesity studies. Moreover, most studies among Latino immigrants in the U.S. solely focus on factors in the destination context, which largely ignores the prevalence of obesity and contextual factors in their country of origin, and warrant transnational investigations. METHODS Using 2013-17 data from the New York City Community Health Survey (NYC CHS, U.S.) and the National Survey of the Nutritional Situation (ENSIN, Colombia), Colombians that immigrated to the U.S. and are living in NYC (n = 503) were compared to nonimmigrant Colombians living in their home country (n = 98,829). Prevalence ratios (PR) for obesity (BMI ≥ 30 kg/m2) by place of residence were estimated using multivariable logistic regression adjusting for socio-demographic characteristics and daily consumption of sugar-sweetened beverages. RESULTS The prevalence of obesity was 49% greater for immigrant Colombians living in NYC when compared to nonimmigrant Colombians living in in their home country (PR = 1.49; 95% CI 1.08, 2.07). Colombian immigrant men in NYC were 72% more likely to have obesity compared to nonimmigrant men living in their home country (PR = 1.72; 95% CI 1.03, 2.87). No significant differences were found in the adjusted models among women. CONCLUSIONS Colombian immigrants in NYC exhibit a higher prevalence of obesity compared to their nonimmigrant counterparts back home and sex strengthens this relationship. More obesity research is needed to understand the immigration experience of Colombians in the U.S. and the underlying mechanisms for sex difference. Public health action focused on women in Colombia and both Colombian men and women immigrants in the U.S. is warranted to avert the long-term consequences of obesity.
Collapse
Affiliation(s)
- Carlos Devia
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY, 10027, USA
| | - Karen R Flórez
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY, 10027, USA
| | - Sergio A Costa
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY, 10027, USA
| | - Terry T-K Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY, 10027, USA.
| |
Collapse
|
8
|
Thomson JL, Landry AS, Walls TI. Similarities and Dissimilarities in Diet Quality Differences by Acculturation Level between Mexican Americans and Other Hispanic Americans: National Health and Nutrition Examination Survey 2015-2018. J Nutr 2023; 153:2401-2412. [PMID: 37330141 DOI: 10.1016/j.tjnut.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Evidence suggests dietary acculturation can increase obesity and chronic disease risks. However, acculturation effects on diet quality among subgroups of Hispanic Americans is not well studied. OBJECTIVES Estimating percentages of Hispanic Americans with low, moderate, and high acculturation using 2 proxy measures with different language variables was the first objective. Identifying similarities and dissimilarities in diet quality differences by acculturation level between Mexican Americans and other Hispanic Americans was the second objective. METHODS The study sample included 1733 Mexican American and 1191 other Hispanic participants aged ≥16 y from National Health and Nutrition Examination Survey 2015-2018. Proxy measures included in the 2 acculturation scales were nativity/United States residence length, immigration age, language spoken at home (home), and language of dietary recall (recall). Replicate 24-h dietary recalls were conducted, and diet quality was assessed using the 2015 Healthy Eating Index. Analyses included statistical methods for complex survey designs. RESULTS For Mexican Americans, 8%, 35%, and 58% had low, moderate, and high acculturation on the home scale compared with 8%, 30%, and 62% on the recall scale. For other Hispanics, 17%, 39%, and 43% had low, moderate, and high acculturation on the home scale compared with 18%, 34%, and 48% on the recall scale. Similarities between ethnicities included higher acculturation associated with lower intakes of fruits, vegetables, total protein foods, seafood and plant proteins, and saturated fats and greater intake of sodium. Dissimilarities included higher acculturation associated with more whole grains and added sugars intakes and less refined grains intake (Mexican Americans), and less total dairy and fatty acids intakes (other Hispanic Americans). CONCLUSIONS Higher acculturation is associated with worsening diet quality for fruits, vegetables, and protein foods in all Hispanic Americans. However, associations of higher acculturation with worsening diet quality for grains, added sugars, dairy, and fatty acids were present only in specific subgroups of Hispanic Americans.
Collapse
Affiliation(s)
| | - Alicia S Landry
- Department of Nutrition and Family Sciences, University of Central Arkansas, Conway, AR, United States
| | - Tameka I Walls
- USDA Agricultural Research Service, Stoneville, MS, United States
| |
Collapse
|
9
|
Velarde G, Bravo‐Jaimes K, Brandt EJ, Wang D, Douglass P, Castellanos LR, Rodriguez F, Palaniappan L, Ibebuogu U, Bond R, Ferdinand K, Lundberg G, Thamman R, Vijayaraghavan K, Watson K. Locking the Revolving Door: Racial Disparities in Cardiovascular Disease. J Am Heart Assoc 2023; 12:e025271. [PMID: 36942617 PMCID: PMC10227271 DOI: 10.1161/jaha.122.025271] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Racial disparities in cardiovascular disease are unjust, systematic, and preventable. Social determinants are a primary cause of health disparities, and these include factors such as structural and overt racism. Despite a number of efforts implemented over the past several decades, disparities in cardiovascular disease care and outcomes persist, pervading more the outpatient rather than the inpatient setting, thus putting racial and ethnic minority groups at risk for hospital readmissions. In this article, we discuss differences in care and outcomes of racial and ethnic minority groups in both of these settings through a review of registries. Furthermore, we explore potential factors that connote a revolving door phenomenon for those whose adverse outpatient environment puts them at risk for hospital readmissions. Additionally, we review promising strategies, as well as actionable items at the policy, clinical, and educational levels aimed at locking this revolving door.
Collapse
Affiliation(s)
- Gladys Velarde
- Department of CardiologyUniversity of FloridaJacksonvilleFL
| | | | | | - Daniel Wang
- Division of CardiologyUniversity of CaliforniaLos AngelesCA
| | - Paul Douglass
- Division of CardiologyWellstar Atlanta Medical CenterAtlantaGA
| | | | - Fatima Rodriguez
- Division of Cardiology and the Cardiovascular InstituteStanford University School of MedicinePalo AltoCA
| | | | - Uzoma Ibebuogu
- Division of CardiologyUniversity of Tennessee Health Science CenterMemphisTN
| | - Rachel Bond
- Division of CardiologyDignity HealthGilbertAZ
- Division Cardiology, Department of Internal MedicineCreighton University School of MedicineOmahaNE
| | - Keith Ferdinand
- Division of CardiologyTulane School of MedicineNew OrleansLA
| | | | - Ritu Thamman
- Division of CardiologyUniversity of PittsburghPittsburghPA
| | | | - Karol Watson
- Division of CardiologyUniversity of CaliforniaLos AngelesCA
| |
Collapse
|
10
|
Alemán JO, Almandoz JP, Frias JP, Galindo RJ. Obesity among Latinx people in the United States: A review. Obesity (Silver Spring) 2023; 31:329-337. [PMID: 36695058 PMCID: PMC9937439 DOI: 10.1002/oby.23638] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/11/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023]
Abstract
Obesity is a serious, chronic disease that is associated with a range of adiposity-based comorbidities, including cardiovascular disease, type 2 diabetes, and nonalcoholic fatty liver disease. In the United States, obesity is a public health crisis, affecting more than 40% of the population. Obesity disproportionately affects Latinx people, who have a higher prevalence of obesity and related comorbidities (such as cardiovascular disease, type 2 diabetes, and nonalcoholic fatty liver disease) compared with the general population. Many factors, including genetic predisposition, environmental factors, traditional calorie-dense Latinx diets, family dynamics, and differences in socioeconomic status, contribute to the increased prevalence and complexity of treating obesity in the Latinx population. Additionally, significant heterogeneity within the Latinx population and disparities in health care access and utilization between Latinx people and the general population add to the challenge of obesity management. Culturally tailored interventions have been successful for managing obesity and related comorbidities in Latinx people. Antiobesity medications and bariatric surgery are also important options for obesity treatment in Latinx people. As highlighted in this review, when managing obesity in the Latinx population, it is critical to consider the impact of genetic, dietary, cultural, and socioeconomic factors, in order to implement an individualized treatment strategy.
Collapse
|
11
|
Ajabshir S, Stumbar S, Lachica I, Gates K, Qureshi Z, Huffman F. Rate of Nutrition-Related Chronic Diseases Among a Multi-Ethnic Group of Uninsured Adults. Cureus 2022; 14:e28802. [PMID: 36225455 PMCID: PMC9534339 DOI: 10.7759/cureus.28802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
The prevalence of nutrition-related chronic diseases, such as obesity, cardiovascular disease, and type 2 diabetes, among adults in the U.S. is of increasing importance. These conditions adversely affect the overall public health, health care systems, and economy. Marginalized minority groups have been disproportionally affected by these conditions. Lack of or inadequate health insurance limits access to health care, which contributes to poor health outcomes among individuals with these conditions. South Florida is home to diverse racial/ethnic minority groups, many of whom are uninsured and do not have access to expert-delivered nutrition education services. It is imperative to thoroughly study the health needs of these underserved patient populations and examine the rate of nutrition-related conditions among them in order to develop medically and culturally tailored nutrition education programs for them. Therefore, the aim of this study was to assess the prevalence of nutrition-related diseases among multi-racial/ethnic uninsured individuals living in South Florida. A four-week electronic health record of adult patients (N=272) from a free clinic in South Florida was analyzed. Spearman`s correlation and binary regression models were used to assess the relationship between the variables. The sample included females (65%) and males (35%). The mean age was 49.08±14.56 years. Overall, 87% had at least one nutrition-related condition, with overweight/obesity being the most observed (75.2%), followed by hypertension (39%), dyslipidemia (27.2%), and diabetes (23.9%). BMI was a significant predictor of the prevalence of hypertension among Whites (p=0.008) and Blacks (p=0.002) but not Asians (p=0.536). Overall, a high rate of nutrition-related chronic diseases was found among uninsured adults in this study. This supports the need for increased medically, culturally, and economically tailored nutrition education programs in free clinic settings.
Collapse
|
12
|
Chen JZ, Wang HM, Zhu W. A Systematic Review and Meta-Analysis of the Associations between Immigration Status and Stroke Incidence and Mortality. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1926744. [PMID: 36060129 PMCID: PMC9439933 DOI: 10.1155/2022/1926744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
Methods We thoroughly searched PubMed, Embase, and MEDLINE databases for the literature on stroke risk for immigrants and host populations by January 2022. Fourteen relevant cohort studies from eight countries met the inclusion criteria, and their data were included in this meta-analysis. Heterogeneity and publication bias were assessed. Results The results showed that the immigrant groups suffered from a lower incidence rate of stroke compared with the host populations (HR = 0.81, 95% CI 0.71-0.91, P = 0.001), but there was nonsignificant higher mortality of stroke in immigrants (HR = 1.07; 95% CI 0.84-1.36). However, the pooled adjusted incidence HR reduced to 0.67 (95% CI 0.60-0.75) after adjustment for publication bias. Immigrants had a lower stroke incidence compared to long-term residents, but the association varied with the country of origin, socioeconomic status, residence (urban vs. rural), and comorbid conditions. Discussion. The present systematic review and meta-analysis implicated that stroke risks are different for immigrants and the host populations; therefore, this knowledge may be useful for developing targeted stroke prevention strategies.
Collapse
Affiliation(s)
- Jun-zhen Chen
- Department of Encephalopathy, Zibo Hospital of Traditional Chinese Medicine, Zibo, Shandong 255300, China
| | - Hai-mei Wang
- Department of Oncology, Zibo Central Hospital, Zibo, Shandong 255300, China
| | - Wenhao Zhu
- Department of Encephalopathy, Zibo Hospital of Traditional Chinese Medicine, Zibo, Shandong 255300, China
| |
Collapse
|
13
|
Dao MC, Yu Z, Maafs‐Rodríguez A, Moser B, Cuevas AG, Economos CD, Roberts SB. Perceived intrinsic, social, and environmental barriers for weight management in older Hispanic/Latino adults with obesity. Obes Sci Pract 2022; 9:145-157. [PMID: 37034568 PMCID: PMC10073816 DOI: 10.1002/osp4.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/07/2022] Open
Abstract
Background The burden of obesity and chronic disease is increasing in the older US Hispanic/Latino adult population. There is limited evidence on successful weight management strategies as perceived by this population. Assessing barriers and opportunities for weight management using mixed methods is a robust approach to collect in-depth information that can be applied to the development of well-tailored weight management interventions for this population. Objective The objective of this study was to assess perceived individual, interpersonal, and environmental factors that influence weight management in older Hispanic/Latino adults. Methods This community-based cross-sectional study included 23 Hispanic/Latino older (>50y) adults with obesity (BMI >30 kg/m2). Perceived barriers and opportunities for weight management were assessed through validated questionnaires and focus groups. Prospectively registered on ClinicalTrials.gov (NCT03978416) on 7 June 2019. Results In this demographically heterogeneous population, language acculturation was generally low, and the frequency of poor dietary behaviors was high. Participants linked financial strain to lower diet quality, as well as anxiety to uncontrolled eating and food cravings. Social support and trust in healthcare professionals were perceived as priorities for healthy eating. Structural and environmental barriers such as affordability and availability of culturally preferred foods were also identified as influences on food choices and eating behavior. Conclusions This study revealed opportunities for culturally tailored weight management interventions in older Hispanic/Latino adults with obesity. Clinical Trial Registry Number NCT03978416 (ClinicalTrials.gov).
Collapse
Affiliation(s)
- Maria Carlota Dao
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
- Department of Agriculture University of New Hampshire. Durham Nutritionand Food Systems NH United States Durham
| | - Zihan Yu
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
| | - Ana Maafs‐Rodríguez
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
- Friedman School of Nutrition Science and Policy Tufts University. Boston MA United States Boston
| | - Brandy Moser
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
| | - Adolfo G. Cuevas
- Department of Community Health School of Arts and Sciences Tufts University. Medford MA United States Boston
| | - Christina D. Economos
- Friedman School of Nutrition Science and Policy Tufts University. Boston MA United States Boston
| | - Susan B. Roberts
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
| |
Collapse
|
14
|
Gallo LC, Savin KL, Jankowska MM, Roesch SC, Sallis JF, Sotres-Alvarez D, Talavera GA, Perreira KM, Isasi CR, Penedo FJ, Llabre MM, Estrella ML, Chambers EC, Daviglus ML, Brown SC, Carlson JA. Neighborhood Environment and Metabolic Risk in Hispanics/Latinos From the Hispanic Community Health Study/Study of Latinos. Am J Prev Med 2022; 63:195-203. [PMID: 35365395 PMCID: PMC9308627 DOI: 10.1016/j.amepre.2022.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/21/2021] [Accepted: 01/23/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION This study examines the associations of neighborhood environments with BMI, HbA1c, and diabetes across 6 years in Hispanic/Latino adults. METHODS Participants from the Hispanic Community Health Study/Study of Latinos San Diego site (n=3,851, mean age=39.4 years, 53.3% women, 94.0% Mexican heritage) underwent assessment of metabolic risk factors and diabetes status (categorized as normoglycemia, prediabetes, and diabetes) at baseline (2008-2011) and approximately 6 years later (2014-2017). In the Study of Latinos Community and Surrounding Areas Study ancillary study (2015-2020), participant baseline addresses were geocoded, and neighborhoods were defined using 800-meter circular buffers. Neighborhood variables representing socioeconomic deprivation, residential stability, social disorder, walkability, and greenness were created using Census and other public databases. Analyses were conducted in 2020-2021. RESULTS Complex survey regression analyses revealed that greater neighborhood socioeconomic deprivation was associated with higher BMI (β=0.14, p<0.001) and HbA1c (β=0.08, p<0.01) levels and a higher odds of worse diabetes status (i.e., having prediabetes versus normoglycemia and having diabetes versus prediabetes; OR=1.25, 95% CI=1.06, 1.47) at baseline. Greater baseline neighborhood deprivation also was related to increasing BMI (β=0.05, p<0.01) and worsening diabetes (OR=1.27, 95% CI=1.10, 1.46) statuses, whereas social disorder was related to increasing BMI levels (β=0.05, p<0.05) at Visit 2. There were no associations of expected protective factors of walkability, greenness, or residential stability. CONCLUSIONS Neighborhood deprivation and disorder were related to worse metabolic health in San Diego Hispanic/Latino adults of mostly Mexican heritage. Multilevel interventions emphasizing individual and structural determinants may be most effective in improving metabolic health among Hispanic/Latino individuals.
Collapse
Affiliation(s)
- Linda C Gallo
- San Diego State University/Universtiy of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
| | - Kimberly L Savin
- San Diego State University/Universtiy of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Marta M Jankowska
- Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, California
| | - Scott C Roesch
- San Diego State University/Universtiy of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - James F Sallis
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Gregory A Talavera
- San Diego State University/Universtiy of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Krista M Perreira
- Department of Social Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Carmen R Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Frank J Penedo
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, Florida
| | - Maria M Llabre
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, Florida
| | - Mayra L Estrella
- Institute for Minority Health Research, The University of Illinois College of Medicine, Chicago, Illinois
| | - Earle C Chambers
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Martha L Daviglus
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, Florida
| | - Scott C Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jordan A Carlson
- Department of Pediatrics, Children's Mercy Hospital and University of Missouri, Kansas City, Kansas City, Missouri
| |
Collapse
|
15
|
Carlson JA, Sallis JF, Jankowska MM, Allison MA, Sotres-Alvarez D, Roesch SC, Steel C, Savin KL, Talavera GA, Castañeda SF, Llabre MM, Penedo FJ, Kaplan R, Mossavar-Rahmani Y, Daviglus M, Perreira KM, Gallo LC. Neighborhood built environments and Hispanic/Latino adults' physical activity in the U.S.: The Hispanic community health study/study of Latinos community and surrounding areas study. Prev Med 2022; 160:107073. [PMID: 35513129 PMCID: PMC9756587 DOI: 10.1016/j.ypmed.2022.107073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/07/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
Despite experiencing health inequities, less is known about neighborhood environments and physical activity among Hispanic/Latino adults compared to other populations. We investigated this topic in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Hispanic/Latino adults in the San Diego, California area of the U.S. completed measures of overall moderate-to-vigorous physical activity (MVPA) via accelerometry and domain-specific MVPA via questionnaire at Visits 1 (2008-2011; n = 4086) and 2 (2014-2017; n = 1776), ~6 years apart. 800-m home neighborhood buffers were used to create objective measures of residential, intersection, and retail density, bus/trolley stops, greenness, parks, and recreation area at Visit 1. Regression models tested the association of each neighborhood feature with MVPA at Visit 1 and over 6 years, adjusting for individual characteristics and neighborhood socioeconomic deprivation. At Visit 1, those in neighborhoods with higher vs. lower retail density or recreation area (+1 vs. -1 standard deviation from the mean) engaged in 10% more overall MVPA and 12-22% more active transportation. Those in neighborhoods with higher vs. lower residential density engaged in 22% more active transportation. Those in neighborhoods with higher vs. lower greenness and park count engaged in 14-16% more recreational MVPA. Neighborhood features were unassociated with changes in MVPA over 6 years. Although changes in MVPA over time were similar across neighborhoods, Hispanic/Latino adults living in neighborhoods with design features supportive of walking and recreational activity (e.g., greater residential and retail density, more parks and recreation facilities) were consistently more active. Improving neighborhood environments appears important for supporting physical activity among Hispanic/Latino adults.
Collapse
Affiliation(s)
- Jordan A Carlson
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Kansas City, MO, USA.
| | - James F Sallis
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Marta M Jankowska
- Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Matthew A Allison
- Department of Family Medicine, University of California San Diego, La Jolla, CA, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Chelsea Steel
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kimberly L Savin
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Sheila F Castañeda
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Maria M Llabre
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Robert Kaplan
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| |
Collapse
|
16
|
Flórez KR, Day SE, Huang TTK, Konty KJ, D'Agostino EM. Latino Children's Obesity Risk Varies by Place of Birth: Findings from New York City Public School Youth, 2006-2017. Child Obes 2022; 18:291-300. [PMID: 34788125 PMCID: PMC9248336 DOI: 10.1089/chi.2021.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Research showing that place of birth (POB) predicts excess weight gain and obesity risk among Latino adults has not prompted similar research in Latino children, although childhood is a critical period for preventing obesity. Objective: To identify differences in obesity risk among Latino children by POB. Methods: Longitudinal cohort observational study on public school children self-identified by parent/guardian as Latino in grades K-12 for school years 2006-07 through 2016-17 with measured weight and height (n = 570,172students; 3,103,642observations). POB reported by parent/guardian was categorized as continental United States [not New York City (NYC)] (n = 295,693), NYC (n = 166,361), South America (n = 19,452), Central America (n = 10,241), Dominican Republic (n = 57,0880), Puerto Rico (n = 9687), and Mexico (n = 9647). Age- and sex-specific BMI percentiles were estimated based on established growth charts. Data were analyzed in 2020. Results: Prevalence of obesity was highest among US (non-NYC)-born girls (21%) and boys (27%), followed by NYC-born girls (19%) and boys (25%). Among girls, South Americans (9%) had the lowest prevalence of all levels of obesity, while Puerto Ricans (19%) and Dominicans (15%) had the highest prevalence. Among boys, South Americans also had the lowest prevalence of all levels of obesity (15%), while Puerto Ricans (22%) and Mexicans (21%) had the highest. In adjusted models, obesity risk was highest in US (non-NYC)-born children, followed by children born in NYC (p < 0.001). Immigrant Latino children exhibited an advantage even after controlling for individual and neighborhood sociodemographic features, particularly Dominicans, South Americans, and Puerto Ricans. Conclusions: The heterogeneity of obesity risk among Latino children highlights the importance of POB.
Collapse
Affiliation(s)
- Karen R. Flórez
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.,Address correspondence to: Karen R. Flórez, DrPH, Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY 10027, USA
| | - Sophia E. Day
- NYC Department of Health and Mental Hygiene, Office of School Health, Queens, NY, USA
| | - Terry T.-K. Huang
- Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Kevin J. Konty
- NYC Department of Health and Mental Hygiene, Office of School Health, Queens, NY, USA
| | - Emily M. D'Agostino
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
17
|
Coelho LE, Jenkins CA, Shepherd BE, Pape JW, Cordero FM, Padgett D, Ramirez BC, Grinsztejn B, Althoff KN, Koethe JR, Marconi VC, Tien PC, Willig AL, Moore RD, Castilho JL, Colasanti J, Crane HM, Gill MJ, Horberg MA, Mayor A, Silverberg MJ, McGowan C, Rebeiro PF. Weight gain post-ART in HIV+ Latinos/as differs in the USA, Haiti, and Latin America. LANCET REGIONAL HEALTH. AMERICAS 2022; 8:100173. [PMID: 35528706 PMCID: PMC9070999 DOI: 10.1016/j.lana.2021.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background An obesity epidemic has been documented among adult Latinos/as in Latin America and the United States (US); however, little is known about obesity among Latinos/as with HIV (PWH). Moreover, Latinos/as PWH in the US may have different weight trajectories than those in Latin America due to the cultural and environmental contexts. We assessed weight and body mass index (BMI) trajectories among PWH initiating antiretroviral therapy (ART) across 5 countries in Latin America and the Caribbean and the US. Methods ART-naÿve PWH ≥18 years old, enrolled in Brazil, Honduras, Mexico, Peru, and Haiti (sites within CCA-SAnet) and the US (NA-ACCORD) starting ART between 2000 and 2017, with at least one weight measured after ART initiation were included. Participants were classified according to site/ethnicity as: Latinos/as in US, non-Latinos/as in US, Haitians, and Latinos/as in Latin America. Generalized least squares models were used to assess trends in weight and BMI. Models estimating probabilities of becoming overweight/obese (BMI ≥25 kg/m2) and of becoming obese (BMI ≥30 kg/m2) post ART initiation for males and females were fit using generalized estimating equations with a logit link and an independence working correlation structure. Findings Among 59,207 PWH, 9% were Latinos/as from Latin America, 9% Latinos/as from the US, 68% non-Latinos/as from the US and 14% were Haitian. At ART initiation, 29% were overweight and 14% were obese. Post-ART weight and BMI increases were steeper for Latinos/as in Latin America compared with other sites/ethnicities; however, BMI at 3-years post ART remained lower compared to Latinos/as and non-Latinos/as in the US. Among females, at 3-years post ART initiation the greatest adjusted probability of obesity was found among non-Latinas in the US (15·2%) and lowest among Latinas in Latin America (8.6%). Among males, while starting with a lower BMI, Latinos in Latin America had the greatest adjusted probability of becoming overweight or obese 3-years post-ART initiation. Interpretation In the Americas, PWH gain substantial weight after ART initiation. Despite environmental and cultural differences, PWH in Latin America, Haiti and Latinos and non-Latinos in the US share similar BMI trajectories on ART and high probabilities of becoming overweight and obese over time. Multicohort studies are needed to better understand the burden of other metabolic syndrome components in PWH across different countries.
Collapse
Affiliation(s)
- Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Cathy A. Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean W. Pape
- Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
| | - Fernando Mejia Cordero
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social & Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Brenda Crabtree Ramirez
- Deparatmento de Infectologia, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán. Mexico City, Mexico
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - John R. Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vincent C. Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco (UCSF), and the Department of Veterans Affairs Medical Center. San Francisco, CA, USA
| | - Amanda L. Willig
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Jessica L. Castilho
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan Colasanti
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
| | | | | | - Michael A. Horberg
- Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD, US
| | - Angel Mayor
- Universidad Central del Caribe, Retrovirus Research Center, Bayamón, PR, US
| | | | - Catherine McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter F. Rebeiro
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - North American AIDS Collaboration on Research and Design (NA-ACCORD) and the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) of the International epidemiology Databases to Evaluate AIDS (IeDEA)
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto Hondureño de Seguridad Social & Hospital Escuela Universitario, Tegucigalpa, Honduras
- Deparatmento de Infectologia, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán. Mexico City, Mexico
- Johns Hopkins University, Baltimore, MD, USA
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
- Department of Medicine, University of California, San Francisco (UCSF), and the Department of Veterans Affairs Medical Center. San Francisco, CA, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Washington, Seattle, WA, US
- The University of Calgary, Calgary, AB, Canada
- Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD, US
- Universidad Central del Caribe, Retrovirus Research Center, Bayamón, PR, US
- Kaiser Permanente Northern California, Oakland, CA, US
| |
Collapse
|
18
|
Alegria K, Fleszar-Pavlović S, Hua J, Ramirez Loyola M, Reuschel H, Song AV. How Socioeconomic Status and Acculturation Relate to Dietary Behaviors Within Latino Populations. Am J Health Promot 2022; 36:450-457. [PMID: 35038263 DOI: 10.1177/08901171211059806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Despite having lower socioeconomic status, Latinos in the US experience fewer adverse health outcomes than non-Latinos. However, they are disproportionately affected by diet-related diseases. Among other racial/ethnic groups, high acculturation and low socioeconomic status are associated with worse dietary intake, yet, few studies have investigated these relationships among Latinos. DESIGN 2013-2014 NHANES analyzed to examine pathways through which acculturation, income, nativity, and food security are associated with dietary behaviors. SETTING U.S. population-based survey. SAMPLE Survey respondents >18 years old and identified as Latino/Hispanic (N = 1197; 53.88% female; Mage = 44.61). MEASURES Primary language spoken (acculturation), total household income (income), place of birth (nativity), Food security, and the Flexible Consumer Behavior Survey (dietary behavior). ANALYSIS Univariate and multivariate regressions in STATA. Covariates include length of time in the US, ethnicity/Hispanic origin (i.e., "Mexican American" or "Other Hispanic"), and gender. RESULTS Nativity (β = -1.16; SE = .19; P < .001) and income (β = .39; SE = .07; P < .001) were significant predictors of dietary behavior. Foreign-born Latinos and those with lower income consumed significantly lower numbers of fast-food or pizza. Food security was not a significant predictor of dietary behavior (β = .16; SE = .1; P > .05). CONCLUSIONS Results suggest that income is not a protective factor against unhealthy dietary behavior and a renewed importance of nativity as a predictor of health behavior among Latinos.
Collapse
Affiliation(s)
- Katie Alegria
- Department of Psychological Sciences, 33244University of California, Merced, CA, USA
| | - Sara Fleszar-Pavlović
- Department of Psychological Sciences, 33244University of California, Merced, CA, USA
| | - Jacqueline Hua
- Department of Psychological Sciences, 33244University of California, Merced, CA, USA
| | - Maria Ramirez Loyola
- Department of Psychological Sciences, 33244University of California, Merced, CA, USA
| | - Hope Reuschel
- Department of Psychological Sciences, 33244University of California, Merced, CA, USA
| | - Anna V Song
- Department of Psychological Sciences, 33244University of California, Merced, CA, USA
| |
Collapse
|
19
|
Wang Z, Usyk M, Vázquez-Baeza Y, Chen GC, Isasi CR, Williams-Nguyen JS, Hua S, McDonald D, Thyagarajan B, Daviglus ML, Cai J, North KE, Wang T, Knight R, Burk RD, Kaplan RC, Qi Q. Microbial co-occurrence complicates associations of gut microbiome with US immigration, dietary intake and obesity. Genome Biol 2021; 22:336. [PMID: 34893089 PMCID: PMC8665519 DOI: 10.1186/s13059-021-02559-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 11/23/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Obesity and related comorbidities are major health concerns among many US immigrant populations. Emerging evidence suggests a potential involvement of the gut microbiome. Here, we evaluated gut microbiome features and their associations with immigration, dietary intake, and obesity in 2640 individuals from a population-based study of US Hispanics/Latinos. RESULTS The fecal shotgun metagenomics data indicate that greater US exposure is associated with reduced ɑ-diversity, reduced functions of fiber degradation, and alterations in individual taxa, potentially related to a westernized diet. However, a majority of gut bacterial genera show paradoxical associations, being reduced with US exposure and increased with fiber intake, but increased with obesity. The observed paradoxical associations are not explained by host characteristics or variation in bacterial species but might be related to potential microbial co-occurrence, as seen by positive correlations among Roseburia, Prevotella, Dorea, and Coprococcus. In the conditional analysis with mutual adjustment, including all genera associated with both obesity and US exposure in the same model, the positive associations of Roseburia and Prevotella with obesity did not persist, suggesting that their positive associations with obesity might be due to their co-occurrence and correlations with obesity-related taxa, such as Dorea and Coprococcus. CONCLUSIONS Among US Hispanics/Latinos, US exposure is associated with unfavorable gut microbiome profiles for obesity risk, potentially related to westernized diet during acculturation. Microbial co-occurrence could be an important factor to consider in future studies relating individual gut microbiome taxa to environmental factors and host health and disease.
Collapse
Affiliation(s)
- Zheng Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Mykhaylo Usyk
- Departments of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yoshiki Vázquez-Baeza
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA USA
- Jacobs School of Engineering, University of California, San Diego, La Jolla, CA USA
| | - Guo-Chong Chen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | | | - Simin Hua
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Daniel McDonald
- Department of Pediatrics, University of California, San Diego, La Jolla, CA USA
| | | | | | - Jianwen Cai
- University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Kari E. North
- University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Rob Knight
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA USA
- Department of Pediatrics, University of California, San Diego, La Jolla, CA USA
- Department of Bioengineering, University of California, San Diego, La Jolla, CA USA
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA USA
| | - Robert D. Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY USA
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY USA
| | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
| |
Collapse
|
20
|
Wen H, DeVivo MJ, Heinemann AW, Krause JS, Robinson-Whelen S, Chen Y. Mortality Beyond the First Year After Spinal Cord Injury: Does Body Mass Index Matter? Arch Phys Med Rehabil 2021; 103:711-721. [PMID: 34800475 DOI: 10.1016/j.apmr.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/22/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the association between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and mortality after the first year post spinal cord injury (SCI) overall and across demographic and injury characteristics. DESIGN Cohort study. SETTING Sixteen Spinal Cord Injury Model Systems (SCIMS) centers. PARTICIPANTS SCIMS Database participants age 20 years or older and having a BMI assessment during the 2007-2011 wave of data collection. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES All-cause mortality rate. Life table method and log-rank test were used to estimate and compare mortality rates across BMI groups and other factors. Cox proportional hazard regression model was conducted to estimate hazard ratio (HR) and 95% confidence interval (CI). RESULTS A total of 2346 participants (N=2346) with SCI were classified into 1 of the 8 BMI groups: <18.5 (6.9%), 18.5-19.9 (7.3%), 20.0-22.49 (15.0%), 22.5-24.9 (18.8%), 25.0-27.49 (17.5%), 27.5-29.9 (13.2%), 30.0-34.9 (13.5%), and ≥35.0 (7.8%). Compared with people with BMI of 22.5-29.9, a higher mortality risk was observed among people with BMI<18.5 (HR, 1.76; 95% CI, 1.25-2.49), 18.5-19.9 (HR, 1.51; 95% CI, 1.06-2.15), and ≥35.0 (HR, 1.51; 95% CI, 1.11-2.07) after adjusting for confounding factors (sex, age at the time of BMI assessment, marital status, neurologic status). The U-shape BMI-mortality relationship varied by age, sex, neurologic status, and years since injury. CONCLUSIONS To improve life expectancy after SCI, health care professionals could focus on weight management among patients with relatively low and extremely high BMI, defined by demographic and injury-related characteristics. Future studies should explore factors that contribute to such a higher mortality after SCI, including pre-existing conditions, poor diet and/or nutrition, and cardiorespiratory fitness.
Collapse
Affiliation(s)
- Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Michael J DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Susan Robinson-Whelen
- TIRR Memorial Hermann, Houston, TX; Baylor College of Medicine, Houston, TX; University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL.
| |
Collapse
|
21
|
Fernández-Rhodes L, Butera NM, Lodge EK, Franceschini N, Llabre MM, Arredondo EM, Gallo LC, Arguelles W, Penedo FJ, Daviglus ML, Isasi CR, Smokowski P, Gordon-Larsen P, Aiello AE, Perreira KM, Sotres-Alvarez D, North KE. Demographic and sociocultural risk factors for adulthood weight gain in Hispanic/Latinos: results from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL). BMC Public Health 2021; 21:2064. [PMID: 34758813 PMCID: PMC8582171 DOI: 10.1186/s12889-021-11848-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND United States (US) Hispanic/Latinos experience a disproportionate burden of obesity, which may in part be related to demographic or sociocultural factors, including acculturation to an US diet or inactive lifestyle. Therefore, we sought to describe the association between adulthood weight histories and demographic and sociocultural factors in a large diverse community-based cohort of US Hispanic/Latinos. METHODS We estimated the effect of several factors on weight gain across adulthood, using multivariable linear mixed models to leverage 38,759 self-reported current body weights and weight histories recalled for 21, 45 and 65 years of age, from 15,203 adults at least 21 years of age at the baseline visit of the Hispanic Community Health Study/Study of Latinos (2008-2011). RESULTS The average rate of weight gain was nearly 10 kg per decade in early adulthood, but slowed to < 5 kg a decade among individuals 60+ years of age. Birth cohort, gender, nativity or age at immigration, Hispanic/Latino background, and study site each significantly modified the form of the predicted adulthood weight trajectory. Among immigrants, weight gain during the 5 years post-migration was on average 0.88 kg (95% CI: 0.04, 1.72) greater than the weight gain during the 5 years prior. The rate of weight gain appeared to slow after 15 years post-migration. CONCLUSIONS Using self-reported and weight history data in a diverse sample of US Hispanic/Latinos, we revealed that both demographic and sociocultural factors were associated with the patterning of adulthood weight gain in this sample. Given the steep rate of weight gain in this population and the fact that many Hispanic/Latinos living in the US immigrated as adults, efforts to promote weight maintenance across the life course, including after immigration, should be a top priority for promoting Hispanic/Latino health and addressing US health disparities more broadly.
Collapse
Affiliation(s)
- Lindsay Fernández-Rhodes
- grid.29857.310000 0001 2097 4281Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA Pennsylvania, USA ,grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, NC Chapel Hill, USA
| | - Nicole M. Butera
- grid.10698.360000000122483208Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC Chapel Hill, USA
| | - Evans K. Lodge
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC Chapel Hill, USA ,grid.10698.360000000122483208School of Medicine, University of North Carolina at Chapel Hill, NC Chapel Hill, USA
| | - Nora Franceschini
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC Chapel Hill, USA
| | - Maria M. Llabre
- grid.26790.3a0000 0004 1936 8606University of Miami, Miami, FL USA
| | - Elva M. Arredondo
- grid.263081.e0000 0001 0790 1491Department of Psychology, San Diego State University, CA San Diego, USA
| | - Linda C. Gallo
- grid.263081.e0000 0001 0790 1491Department of Psychology, San Diego State University, CA San Diego, USA
| | - William Arguelles
- grid.26790.3a0000 0004 1936 8606University of Miami, Miami, FL USA ,grid.418212.c0000 0004 0465 0852Baptist Health South Florida, Coral Gables, FL USA
| | - Frank J. Penedo
- grid.26790.3a0000 0004 1936 8606University of Miami, Miami, FL USA
| | - Martha L. Daviglus
- grid.185648.60000 0001 2175 0319Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL USA
| | - Carmen R. Isasi
- grid.251993.50000000121791997Albert Einstein College of Medicine, Bronx, NY USA
| | - Paul Smokowski
- grid.10698.360000000122483208School of Social Work, University of North Carolina at Chapel Hill, NC Chapel Hill, USA ,grid.266515.30000 0001 2106 0692School of Social Welfare, The University of Kansas, Lawrence, KS USA
| | - Penny Gordon-Larsen
- grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, NC Chapel Hill, USA ,grid.10698.360000000122483208Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC Chapel Hill, USA
| | - Allison E. Aiello
- grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, NC Chapel Hill, USA ,grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC Chapel Hill, USA
| | - Krista M. Perreira
- grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, NC Chapel Hill, USA ,grid.10698.360000000122483208School of Medicine, University of North Carolina at Chapel Hill, NC Chapel Hill, USA
| | - Daniela Sotres-Alvarez
- grid.10698.360000000122483208Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC Chapel Hill, USA
| | - Kari E. North
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC Chapel Hill, USA ,grid.10698.360000000122483208Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, NC Chapel Hill, USA
| |
Collapse
|
22
|
Vyas MV, Austin PC, Pequeno P, Fang J, Silver FL, Laupacis A, Kapral MK. Incidence of Stroke in Immigrants to Canada: A Province-wide Retrospective Analysis. Neurology 2021; 97:e1192-e1201. [PMID: 34408071 DOI: 10.1212/wnl.0000000000012555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate the association between immigration status and stroke incidence. METHODS We conducted a retrospective cohort study of 8 million adults (15% immigrants) residing in Ontario, Canada, on January 1, 2003, with no history of stroke or TIA. Participants were followed up until March 31, 2018, to identify incident stroke or TIA, defined as hospitalization or emergency room visit. We calculated adjusted hazard ratios (HRs) of stroke or TIA in immigrants compared to long-term residents using cause-specific hazard models, adjusting for demographics and comorbid conditions. We evaluated whether the association varied by age, stroke type, or country of origin of immigrants. RESULTS During 109 million person-years of follow-up, we observed 235,336 incident stroke or TIA events. Compared to long-term residents, immigrants had a lower rate of stroke or TIA (10.9 vs 23.4 per 10,000 person-years, HR 0.67, 95% confidence interval [CI] 0.66-0.68). This was true across all age groups and stroke types, with an HR in immigrants vs long-term residents for ischemic stroke of 0.71 (95% CI 0.69-0.72), for intracerebral hemorrhage of 0.89 (95% CI 0.85-0.93), for subarachnoid hemorrhage of 0.85 (95% CI 0.81-0.91), and for TIA of 0.53 (95% CI 0.51-0.54). The magnitude of the reduction in stroke risk associated with immigration status was less pronounced in immigrants from the Caribbean (HR 0.95, 95% CI 0.91-1.00), Latin America (HR 0.85, 95% CI 0.82-0.91), and Africa (HR 0.80, 95% CI 0.74-0.85) than in those from other world regions. DISCUSSION Immigrants have a lower rate of stroke or TIA than long-term residents with variation by age, stroke type, and country of origin. This knowledge may be useful for developing targeted primary stroke prevention strategies.
Collapse
Affiliation(s)
- Manav V Vyas
- From the Division of Neurology (M.V.V., F.L.S.) and Division of General Internal Medicine (M.K.K.), Department of Medicine, and Institute of Health Policy Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.); and ICES (M.V.V., P.C.A., P.P., J.F., F.L.S., A.L., M.K.K.), Toronto, Ontario, Canada.
| | - Peter C Austin
- From the Division of Neurology (M.V.V., F.L.S.) and Division of General Internal Medicine (M.K.K.), Department of Medicine, and Institute of Health Policy Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.); and ICES (M.V.V., P.C.A., P.P., J.F., F.L.S., A.L., M.K.K.), Toronto, Ontario, Canada
| | - Priscila Pequeno
- From the Division of Neurology (M.V.V., F.L.S.) and Division of General Internal Medicine (M.K.K.), Department of Medicine, and Institute of Health Policy Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.); and ICES (M.V.V., P.C.A., P.P., J.F., F.L.S., A.L., M.K.K.), Toronto, Ontario, Canada
| | - Jiming Fang
- From the Division of Neurology (M.V.V., F.L.S.) and Division of General Internal Medicine (M.K.K.), Department of Medicine, and Institute of Health Policy Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.); and ICES (M.V.V., P.C.A., P.P., J.F., F.L.S., A.L., M.K.K.), Toronto, Ontario, Canada
| | - Frank L Silver
- From the Division of Neurology (M.V.V., F.L.S.) and Division of General Internal Medicine (M.K.K.), Department of Medicine, and Institute of Health Policy Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.); and ICES (M.V.V., P.C.A., P.P., J.F., F.L.S., A.L., M.K.K.), Toronto, Ontario, Canada
| | - Andreas Laupacis
- From the Division of Neurology (M.V.V., F.L.S.) and Division of General Internal Medicine (M.K.K.), Department of Medicine, and Institute of Health Policy Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.); and ICES (M.V.V., P.C.A., P.P., J.F., F.L.S., A.L., M.K.K.), Toronto, Ontario, Canada
| | - Moira K Kapral
- From the Division of Neurology (M.V.V., F.L.S.) and Division of General Internal Medicine (M.K.K.), Department of Medicine, and Institute of Health Policy Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.); and ICES (M.V.V., P.C.A., P.P., J.F., F.L.S., A.L., M.K.K.), Toronto, Ontario, Canada
| |
Collapse
|
23
|
Rodriquez EJ, Coreas SI, Gallo LC, Isasi CR, Salazar CR, Bandiera FC, Suglia SF, Perreira KM, Hernandez R, Penedo F, Talavera GA, Daviglus ML, Pérez-Stable EJ. Allostatic load, unhealthy behaviors, and depressive symptoms in the Hispanic Community Health Study/Study of Latinos. SSM Popul Health 2021; 16:100917. [PMID: 34660875 PMCID: PMC8502772 DOI: 10.1016/j.ssmph.2021.100917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The Environmental Affordances Model (EAM) proposes that the effects of chronic stress on depression are moderated by unhealthy behaviors and race/ethnicity. The unique social structures and contexts of Hispanics/Latinos in the U.S. may influence such relationships. This study evaluated whether unhealthy behaviors weakened the relationship between allostatic load, a measure of chronic stress, and future elevated depressive symptoms among Hispanic Community Health Study/Study of Latinos participants. METHODS Longitudinal data (2008-2011 and 2014-2017) from 11,623 participants were analyzed. The exposure was allostatic load, an index of twelve established biomarkers categorized using clinically relevant cut points, at Visit 1. Elevated depressive symptoms were operationalized as a score of ≥10 (out of 30) on the CES-D 10 at Visit 2. An index of unhealthy behaviors, with one point each for cigarette smoking, excessive/binge drinking, sedentary behavior, and poor diet quality at Visit 1, was examined as an effect modifier. Multivariable logistic regression, in the overall sample and among Mexicans specifically and adjusted for demographic characteristics and elevated depressive symptoms at Visit 1, was used to model allostatic load, unhealthy behavior index (range: 0-4), and their interaction in relation to elevated depressive symptoms at Visit 2. RESULTS Overall, greater allostatic load was associated with higher odds of elevated depressive symptoms after at least 6 years (aOR = 1.06, 95% CI = 1.01, 1.10). Overall, individuals with greater allostatic load and an unhealthy behavior index = 1, compared to those with an unhealthy behavior index = 0, had lower odds of elevated depressive symptoms at follow-up (aβ = -0.065, 95% CI = -0.12, -0.007). CONCLUSIONS The relationship between chronic stress and depression was partially moderated among Hispanics/Latinos who engaged in unhealthy behavior, which may have reduced their risk of elevated depressive symptoms given more chronic stress.
Collapse
Affiliation(s)
- Erik J. Rodriquez
- Division of Intramural Research; National Heart, Lung, And Blood Institute; 3 Center Drive, Bethesda, MD, 20892-0311, USA
| | - Saida I. Coreas
- Division of Intramural Research; National Heart, Lung, And Blood Institute; 3 Center Drive, Bethesda, MD, 20892-0311, USA
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, 780 Bay Boulevard Suite 200, Chula Vista, CA, 91910, USA
| | - Carmen R. Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Christian R. Salazar
- UC Irvine Institute for Memory Impairment and Neurological Disorders, University of California, Irvine, 3227 Biological Sciences III, Irvine, CA, 92697, USA
| | - Frank C. Bandiera
- Division of Behavioral and Social Research, National Institute on Aging, 31 Center Drive, Bethesda, MD, 20892-2292, USA
| | - Shakira F. Suglia
- Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Krista M. Perreira
- School of Medicine, University of North Carolina, 333 South Columbia Street, Chapel Hill, NC, 27599-7240, USA
| | - Rosalba Hernandez
- School of Social Work, University of Illinois at Urbana-Champaign, 1010 West Nevada Street, Urbana, IL, 61801, USA
| | - Frank Penedo
- Department of Psychology, University of Miami, Flipse Building, 5th Floor, 5665 Ponce de Leon Blvd, Coral Gables, Florida, 33146, USA
| | - Gregory A. Talavera
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 100 / HH 138, San Diego, CA, 92123-4311, USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 West Polk Street Suite 246, Chicago, IL, 60612, USA
| | - Eliseo J. Pérez-Stable
- Division of Intramural Research; National Heart, Lung, And Blood Institute; 3 Center Drive, Bethesda, MD, 20892-0311, USA,Corresponding author. Division of Intramural Research; National Heart, Lung, And Blood Institute; 3 Center Drive, Bethesda, MD, 20892-0311, USA.
| |
Collapse
|
24
|
Maldonado LE, Adair LS, Sotres-Alvarez D, Mattei J, Mossavar-Rahmani Y, Perreira KM, Daviglus ML, Van Horn LV, Gallo LC, Isasi CR, Albrecht SS. Dietary Patterns and Years Living in the United States by Hispanic/Latino Heritage in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). J Nutr 2021; 151:2749-2759. [PMID: 34320207 PMCID: PMC8417926 DOI: 10.1093/jn/nxab165] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/08/2021] [Accepted: 05/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Previous diet findings in Hispanics/Latinos rarely reflect differences in commonly consumed and culturally relevant foods across heritage groups and by years lived in the United States. OBJECTIVES We aimed to identify and compare a posteriori heritage-specific dietary patterns (DPs) and evaluate their associations with "healthfulness" [using the Alternative Healthy Eating Index-2010 (AHEI-2010)] and years living in the United States. METHODS We used baseline data from a population-based cohort of 14,099 Hispanics/Latinos aged 18-74 y in the Hispanic Community Health Study/Study of Latinos. We performed principal factor analysis using two 24-h recalls to derive DPs, separately, in each heritage group (Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American), and identified overarching DPs based on high-loading foods shared by ≥2 groups. We used multivariable linear regression to test associations of DPs with AHEI-2010 and years living in the United States. RESULTS We identified 5 overarching DPs (Burgers, Fries, & Soft Drinks; White Rice, Beans, & Red Meats; Fish; Egg & Cheese; and Alcohol). All Burgers, Fries, & Soft Drinks DPs were inversely associated with AHEI-2010, whereas all Fish DPs (except Dominican) were positively associated with this index (all P-trend < 0.001). White Rice, Beans, & Red Meats DPs showed inverse associations in Cuban and Central American groups and positive associations in Mexican-origin individuals (all P-trend < 0.001). Fewer years living in the United States was associated with higher scores for White Rice, Beans, & Red Meats DPs in Cuban and Mexican heritage groups and lower scores on Burgers, Fries, & Soft Drinks DPs in Cuban, Mexican, and Puerto Rican groups (all P-trend < 0.01). CONCLUSIONS Our findings show substantial variation in DPs across Hispanics/Latinos and adherence to DPs by time in the United States, which could inform dietary interventions targeting this diverse US population. This trial was registered at clinicaltrials.gov as NCT02060344.
Collapse
Affiliation(s)
- Luis E Maldonado
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda S Adair
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniela Sotres-Alvarez
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Krista M Perreira
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Social Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago, IL, USA
| | - Linda V Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Carmen R Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sandra S Albrecht
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
25
|
Polk S, Leifheit KM, Brandt AJ, DeCamp LR. Comparing Healthcare Utilization and Diagnoses in Immigrant Versus Nonimmigrant Youth. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:98-106. [PMID: 34355584 DOI: 10.1177/15404153211036985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To inform efforts to provide healthcare to uninsurable, immigrant youth, we describe The Access Partnership (TAP) hospital-based charity care program and compare healthcare utilization and diagnoses among TAP and Medicaid patients. METHODS We use propensity scores to match each TAP patient to three Medicaid patients receiving care at a pediatric clinic from October 2010 to June 2015 on demographic characteristics. We use descriptive statistics to compare healthcare visits and diagnoses. RESULTS TAP (n = 78) and Medicaid patients (n = 234) had similar healthcare utilization, though Medicaid patients had more outpatient visits (10.8 vs. 7.7, p = .002), and TAP patients were more likely to have ever received subspecialty care (38.5% vs. 22.2%, p = .005). Diagnoses were similar between groups, with some exceptions: TAP patients more likely to present with genital and reproductive disease (33.3% vs. 19.7%, p = .013); Medicaid patients more likely to present with endocrine, metabolic, and nutritional disease (52.1% vs. 28.2%, p < .001), psychiatric, behavioral disease, and substance abuse (41.0, 26.9%, p = .026). CONCLUSIONS TAP patients had similar healthcare utilization and diagnoses to matched sample of Medicaid patients. Findings indicate policy proposals that extend public health insurance to all children would likely benefit immigrant children and not incur higher costs than those of low-income U.S. citizen children.
Collapse
Affiliation(s)
- Sarah Polk
- Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Kathryn M Leifheit
- Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.,Department of Health Policy and Management, Fielding School of Public Health, 25808University of California, Los Angeles, CA, USA
| | - Amelia J Brandt
- Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Lisa Ross DeCamp
- Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.,ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), Children's Hospital Colorado, 129263University of Colorado, Aurora, CO, USA
| |
Collapse
|
26
|
Devia C, Flórez KR, Costa SA, Huang TT. Prevalence of self-reported obesity among diverse Latino adult populations in New York City, 2013-2017. Obes Sci Pract 2021; 7:379-391. [PMID: 34401197 PMCID: PMC8346377 DOI: 10.1002/osp4.490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/02/2021] [Accepted: 01/24/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Latinos in the United States represent a heterogeneous population disproportionally impacted by obesity. Yet, the prevalence of obesity by specific Latino group is unclear. Using the New York City Community Health Survey (2013-2017), this study compared self-reported obesity in the city's largest Latino adult populations (Puerto Ricans, Mexicans, Dominicans, Ecuadorians, and Colombians). METHODS Age-standardized prevalence using the 2000 Census and prevalence ratios (PRs) for self-reported obesity (BMI ≥30 kg/m2) by country of origin were estimated using weighted multivariable logistic regression adjusting for socio-demographic characteristics, health status, and behaviors. RESULTS Obesity prevalence among Mexicans (36.8%; 95% CI [31.5, 42.4]) and Puerto Ricans (36.3%; 95% CI [31.7, 41.3]) was significantly higher than that among Colombians (23.8%; 95% CI [18.8, 29.5]), Ecuadorians (24.2%; 95% CI [20.7, 28.1]), and Dominicans (27.0%; 95% CI [25.0, 29.1]). After adjusting for covariates, compared to Mexicans, the PRs of obesity remained significantly lower for Colombians (PR = 0.80; 95% CI [0.64, 1.00]), Ecuadorians (PR = 0.72; 95% CI [0.61, 0.86]) and Dominicans (PR = 0.75; 95% CI [0.65, 0.85]). There was no significant difference between Mexicans and Puerto Ricans. CONCLUSION Obesity prevalence differs by country of origin, suggesting that clustering of Latinos in public health research may obscure unique risks among specific groups. Despite group differences, all Latino groups exhibit high prevalence of obesity and warrant renewed efforts tailored to the specific context and culture of each group to prevent and reduce obesity.
Collapse
Affiliation(s)
- Carlos Devia
- Center for Systems and Community DesignGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
- New York City Department of Health and Mental HygieneLong Island CityNew YorkUSA
| | - Karen R. Flórez
- Center for Systems and Community DesignGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
| | - Sergio A. Costa
- Center for Systems and Community DesignGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
| | - Terry T.‐K. Huang
- Center for Systems and Community DesignGraduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
| |
Collapse
|
27
|
Wen H, DeVivo MJ, Mehta T, Kaur Baidwan N, Chen Y. The impact of body mass index on one-year mortality after spinal cord injury. J Spinal Cord Med 2021; 44:563-571. [PMID: 31729925 PMCID: PMC8288132 DOI: 10.1080/10790268.2019.1688021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: Evaluate the association between body mass index (BMI, kg/m2) and one-year mortality among people who survived the first 90 days after spinal cord injury (SCI).Design: Cohort study.Setting: Eighteen SCI Model Systems centers throughout the United States.Participants: 6640 participants (men, 79.6%; mean age, 42.8 ± 17.7y; Whites, 62.3%) who had an SCI between October 2006 and March 2017.Interventions: Not applicable.Outcome Measures: All-cause mortality and causes of death. Life table method was used to estimate mortality rates, while Cox proportional hazard model was conducted to assess the impact of BMI on mortality after adjusting for demographic and injury-related factors.Results: Based on BMI obtained during initial rehabilitation, participants were classified into underweight (4.2%), normal weight (41.2%), overweight (30.9%) and obese (23.8%) groups, and their corresponding one-year mortality rates were 2.6%, 1.8%, 3.1%, 3.5%, respectively (P = 0.002). After adjusting for potential confounding factors, people with obesity had a higher mortality risk than those with normal weight (hazard ratio, 1.51; 95% confidence interval, 1.00-2.28). The most frequent causes of death for people with obesity were infective and parasitic diseases and respiratory diseases, while respiratory diseases were the most frequent for people with other BMI statuses.Conclusion: People with obesity who incur an SCI need special attention to prevent early mortality. Future studies should explore factors that contribute to such a higher mortality after SCI, such as preexisting conditions and comorbidities. The effects of BMI on long-term mortality also deserve further investigation.
Collapse
Affiliation(s)
- Huacong Wen
- Department of Physical Therapy, School of Health Professionals, University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael J. DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tapan Mehta
- Department of Health Services Administration, School of Health Professionals, University of Alabama at Birmingham, Birmingham, Alabama, USA,UAB-Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Alabama, USA
| | - Navneet Kaur Baidwan
- Department of Health Services Administration, School of Health Professionals, University of Alabama at Birmingham, Birmingham, Alabama, USA,UAB-Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Alabama, USA
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA,Correspondence to: Yuying Chen, Spain Rehabilitation Center, Room 515, 1717 Sixth Avenue South, Birmingham, AL35249-7330, USA; Ph: 205-934-3329.
| |
Collapse
|
28
|
Fernandez ML. Lifestyle Factors and Genetic Variants Associated to Health Disparities in the Hispanic Population. Nutrients 2021; 13:2189. [PMID: 34202120 PMCID: PMC8308310 DOI: 10.3390/nu13072189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
Non-communicable diseases including type 2 diabetes mellitus, coronary heart disease, hepatic steatosis, and cancer are more prevalent in minority groups including Hispanics when compared to Non-Hispanic Whites, leading to the well-recognized terminology of health disparities. Although lifestyle factors including inadequate dietary habits, decreased physical activity, and more prominently, an unhealthy body weight, may be partly responsible for this disproportion in chronic diseases, genetic variations also make a substantial contribution to this problem. In this review, the well-recognized obesity problem in Hispanics that has been associated with chronic disease is examined as well as the influence of diet on promoting an inflammatory environment leading to increased cardiometabolic risk, insulin resistance, fatty liver disease, and cancer. In addition, some of the more studied genetic variations in Hispanics and their association with chronic disease is reviewed.
Collapse
Affiliation(s)
- Maria Luz Fernandez
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
| |
Collapse
|
29
|
Joseph RP, Vega-López S, Han S. Physical Activity Patterns and Neighborhood Characteristics of First-Generation Latina Immigrants Living in Arizona: Cross-sectional Study. JMIR Form Res 2021; 5:e25663. [PMID: 33999003 PMCID: PMC8167607 DOI: 10.2196/25663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background Metabolic diseases, including obesity and type 2 diabetes, are a major health concern for Latina immigrants. Performing regular aerobic physical activity (PA) is a lifestyle behavior associated with the prevention and control of these conditions. However, PA levels of most Latina immigrants are below national guidelines. Neighborhood environmental factors may influence the PA levels of adults, but limited research has explored associations between the neighborhood environment and PA levels among Latina immigrants. Objective The objective of this study was to explore the PA patterns of first-generation US Latina immigrants and how neighborhood environmental factors are related to those PA patterns. Methods Using a cross-sectional study design, 50 first-generation Latina immigrants completed the International Physical Activity Questionnaire (IPAQ) and the Neighborhood Scales Questionnaire, which assessed 6 perceived neighborhood factors: (1) walking environment, (2) aesthetic quality, (3) safety, (4) violence, (5) social cohesion, and (6) activities with neighbors. Median self-reported metabolic equivalent (MET)-minutes/week of PA were used to summarize domain-specific (ie, work, domestic/household, leisure, and transportation) and intensity-specific (ie, walking, moderate, vigorous, moderate to vigorous) PA patterns. Logistic regression examined associations between neighborhood factors and engaging in leisure-time PA (ie, dichotomous outcome of some versus no leisure-time PA), transportation PA (ie, dichotomous outcome of some versus no transportation PA), and meeting national PA guidelines (ie, dichotomous outcome of meeting versus not meeting guidelines). Results Preliminary analyses showed that 10 participants reported excessively high PA levels and 1 participant had incomplete PA data; these women were excluded from analyses based on IPAQ scoring guidelines. The remaining 39 participants (mean age 40.5 years; mean length of US residency 4.6 years) reported a median of 4512 MET-minutes/week of total PA. The majority of PA was acquired through domestic activities (median 2160 MET-minutes/week), followed by leisure-time PA (median 396 MET-minutes/week), transportation PA (median 198 MET-minutes/week), and work PA (0 MET-minutes/week). Intensity-specific PA patterns showed a median of 594 MET-minutes/week of walking activity and 3500 MET-minutes/week of moderate-to-vigorous PA. Logistic regression models indicated that the neighborhood factors of walking environment, aesthetic quality, and safety were positively associated with engaging in leisure-time PA (odds ratios of 5.95, 95% CI 1.49-23.74; 2.45, 95% CI 1.01-5.93; and 3.30, 95% CI 1.26-8.67, respectively) and meeting national PA guidelines (odds ratios of 4.15, 95% CI 1.13-15.18; 6.43, 95% CI 1.45-28.39; and 2.53, 95% CI 1.00-6.36, respectively). The neighborhood factors of violence, social cohesion, and activities with neighbors were not significantly associated with PA outcomes. Conclusions Although most participants met national PA guidelines (ie, ≥500 MET-minutes/week of moderate-to-vigorous PA), the majority of their PA was achieved through domestic activities, with limited leisure, transportation, and work PA. Given that leisure-time PA in particular plays a significant role in improving health outcomes, findings suggest that many Latina immigrants could benefit from a leisure-time PA intervention. Such interventions should consider neighborhood environmental influences, as these factors may serve as determinants of PA.
Collapse
Affiliation(s)
- Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Sonia Vega-López
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States.,Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, United States
| | - SeungYong Han
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| |
Collapse
|
30
|
Osibogun O, Ogunmoroti O, Mathews L, Okunrintemi V, Tibuakuu M, Michos ED. Greater Acculturation is Associated With Poorer Cardiovascular Health in the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2021; 10:e019828. [PMID: 33834848 PMCID: PMC8174160 DOI: 10.1161/jaha.120.019828] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Greater acculturation is associated with increased risk of cardiovascular disease. However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association's 7 CVH metrics. We investigated the association between acculturation and ideal CVH among a multi-ethnic cohort of US adults free of clinical cardiovascular disease at baseline. Methods and Results This was a cross-sectional analysis of 6506 men and women aged 45 to 84 years of 4 races/ethnicities. We examined measures of acculturation(birthplace, language spoken at home, and years lived in the United States [foreign-born participants]) by CVH score. Scores of 0 to 8 indicate inadequate, 9 to 10 average and 11 to 14 optimal CVH. We used multivariable regression to examine associations between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. The mean (SD) age was 62 (10) years, 53% were women, 39% non-Hispanic White-, 26% non-Hispanic Black-, 12% Chinese- and 22% Hispanic-Americans. US-born participants had lower odds of optimal CVH (odds ratio [OR]: 0.63 [0.50-0.79], P<0.001) compared with foreign-born participants. Participants who spoke Chinese and other foreign languages at home had greater odds of optimal CVH compared with those who spoke English (1.91 [1.08-3.36], P=0.03; and 1.65 [1.04-2.63], P=0.03, respectively). Foreign-born participants who lived the longest in the United States had lower odds of optimal CVH (0.62 [0.43-0.91], P=0.02). Conclusions Greater US acculturation was associated with poorer CVH. This finding suggests that the promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the United States was associated with poorer CVH.
Collapse
Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology Robert Stempel College of Public Health and Social Work Florida International University Miami FL
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD.,Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Lena Mathews
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD.,Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | | | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD.,Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD.,Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| |
Collapse
|
31
|
Scarinci IC, Hansen B, Kim YI. A Cluster-Randomized Controlled Trial to Evaluate a Community-Based Healthy Eating and Nutrition Label Interpretation Intervention Among Latinx Immigrant Mothers and Their Daughters. J Community Health 2021; 46:313-323. [PMID: 32671515 DOI: 10.1007/s10900-020-00885-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We evaluated outcomes from a healthy eating/nutrition label interpretation intervention among Latinx immigrant mothers and their daughters, aged 9-12 years, in Alabama. Between May 2013-October 2017, this cluster randomized controlled trial assigned 299 mother-daughter dyads to either a healthy eating (intervention) or HPV vaccination (control) study arm. Participants attended four group sessions delivered in Spanish by Lay Health Educators covering portion sizes, healthy eating/cooking strategies, and nutrition label reading/interpretation. An individual session in participants' homes reviewed pantries and developed healthy eating plans. Identical interviewer-administered surveys were completed at baseline and 7-month follow-up by both study arms. Retention rate at follow-up was 93.4% in intervention arm (92.6% in control arm). Positive changes in healthy eating behaviors and proficiency in nutrition label interpretation were assessed. Adjusting for marital status, employment status, and health insurance coverage status, when compared to controls, mothers in the intervention arm had greater odds of increasing daily fruit and vegetable consumption (OR 3.66, 95% CI 2.14-6.27, p < 0.001), decreasing weekly fried food intake (OR 4.3, 95% CI 2.3-8.04, p < 0.001), decreasing daily sweetened beverages (OR 2.07, 95% CI 1.22-3.52, p < 0.01), increasing frequency of reading nutrition labels (OR 12.58, 95% CI 6.81-23.22, p < 0.001), and correctly interpreting nutrition labels (OR 4.45, 95% CI 2.64-7.48, p < 0.001). Significant positive changes in targeted behaviors were not observed among daughters. A community-based, culturally relevant intervention that includes nutrition label interpretation can positively influence eating habits among Latinx immigrant mothers.
Collapse
Affiliation(s)
- Isabel C Scarinci
- Division of Preventive Medicine, University of Alabama At Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA.
| | - Barbara Hansen
- Division of Preventive Medicine, University of Alabama At Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA
| | - Young-Il Kim
- Division of Preventive Medicine, University of Alabama At Birmingham, 1717 11th Ave South, Birmingham, AL, 35205, USA
| |
Collapse
|
32
|
Valencia A, Zuma BZ, Spencer-Bonilla G, López L, Scheinker D, Rodriguez F. The Hispanic paradox in the prevalence of obesity at the county-level. Obes Sci Pract 2021; 7:14-24. [PMID: 33680488 PMCID: PMC7909595 DOI: 10.1002/osp4.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/17/2020] [Accepted: 09/20/2020] [Indexed: 11/09/2022] Open
Abstract
Objective The percentage of Hispanics in a county has a negative association with prevalence of obesity. Because Hispanic individuals are unevenly distributed in the United States, this study examined whether this protective association persists when stratifying counties into quartiles based on the size of the Hispanic population and after adjusting for county‐level demographic, socioeconomic, healthcare, and environmental factors. Methods Data were extracted from the 2018 Robert Wood Johnson Foundation County Health Rankings. Counties were categorized into quartiles based on their percentage of Hispanics, 0%–5% (n = 1794), 5%–20% (n = 962), 20%–50% (n = 283), and >50% (n = 99). For each quartile, univariate and multivariate regression models were used to evaluate the association between prevalence of obesity and demographic, socioeconomic, healthcare, and environmental factors. Results Counties with the top quartile of Hispanic individuals had the lowest prevalence of obesity compared to counties at the bottom quartile (28.4 ± 3.6% vs. 32.7 ± 4.0%). There was a negative association between county‐level percentage of Hispanics and prevalence of obesity in unadjusted analyses that persisted after adjusting for all county‐level factors. Conclusions Counties with a higher percentage of Hispanics have lower levels of obesity, even after controlling for demographic, socioeconomic, healthcare, and environmental factors. More research is needed to elucidate why having more Hispanics in a county may be protective against county‐level obesity.
Collapse
Affiliation(s)
- Areli Valencia
- Stanford University School of Medicine Stanford California USA
| | - Bongeka Z Zuma
- Stanford University School of Medicine Stanford California USA
| | - Gabriela Spencer-Bonilla
- Division of Cardiovascular Medicine and Cardiovascular Institute Stanford University School of Medicine Stanford California USA
| | - Lenny López
- School of Medicine University of California San Francisco San Francisco California USA.,The San Francisco VA Medical Center University of California San Francisco San Francisco California USA
| | - David Scheinker
- Department of Management Science and Engineering Stanford University School of Engineering Stanford California USA.,Clinical Excellence Research Center Stanford University School of Medicine Stanford California USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute Stanford University School of Medicine Stanford California USA
| |
Collapse
|
33
|
Aylward LL, Schneider KL, Sanchez-Johnsen L. Misreporting Weight and Height Among Mexican and Puerto Rican Men. Am J Mens Health 2021; 15:15579883211001198. [PMID: 33759632 PMCID: PMC7995458 DOI: 10.1177/15579883211001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022] Open
Abstract
Most obesity prevalence data rely on self-report, which typically differs when compared to objectively measured height, weight, and body mass index (BMI). Given that Latino men have high rates of obesity in the United States and demonstrate greater misreporting compared to Caucasian men, examining the factors that contribute to misreporting among Latino men is warranted. This study examined BMI, Latino ethnic background (Mexican or Puerto Rican), and social desirability in relation to misreporting of BMI, as defined as the discrepancy between self-reported and measured height and weight, in Latino men. Participants were 203 adult Mexican and Puerto Rican men, average age 39.41 years, who participated in a larger study. Participants self-reported their weight and height, had their weight and height objectively measured, and completed a measure of social desirability. Measured BMI was the strongest predictor of misreporting BMI, such that the greater the participants' BMI, the greater the discrepancy in BMI (p < .001). Misreporting of BMI did not vary based on ethnic background, and measured BMI did not moderate the relationship between social desirability and misreporting of BMI. When normative error was distinguished from misreporting in post-hoc analyses, results showed that only 34.5% of participants demonstrated misreporting. Findings highlight the importance of identifying normative error when examining misreporting in order to improve the accuracy of self-reported BMI data. Future research on misreporting for Latino men should include weight awareness, acculturation, and length of U.S. residency as these variables may be related to self-reported weight and height.
Collapse
Affiliation(s)
- Laura L. Aylward
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Kristin L. Schneider
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Lisa Sanchez-Johnsen
- Departments of Psychiatry, Surgery, and Psychology, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
34
|
Langellier BA, Fleming PJ, Kemmick Pintor JB, Stimpson JP. Allostatic Load Among U.S.- and Foreign-Born Whites, Blacks, and Latinx. Am J Prev Med 2021; 60:159-168. [PMID: 33339663 DOI: 10.1016/j.amepre.2020.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/16/2020] [Accepted: 08/05/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The objective of this study is to examine how allostatic load, a multidimensional measure of the body's cumulative response to stressors experienced throughout the life course, has changed over time and by age among U.S.- and foreign-born Whites, Blacks, and Latinx. METHODS Data were from 26,818 adult participants in the 2005-2018 National Health and Nutrition Examination Survey, a national repeated cross-sectional study. Allostatic load was measured based on 10 indicators of cardiovascular, metabolic, and immunologic risk. The analyses were conducted in March 2020. RESULTS Allostatic load increased over time across all groups. The difference between the first and last survey cycle was greatest among U.S.-born Black women (from 2.74 in 2005-2006 to 3.02 in 2017-2018), U.S.-born Latino men (from 2.69 to 3.09) and foreign-born Latino men (from 2.58 to 2.87). Aging gradients in allostatic load were steepest among foreign-born Blacks of both genders and foreign-born Latina women and flattest among U.S.-born and foreign-born Whites. CONCLUSIONS Chronic exposure to stressors leads to an erosion of health that is particularly severe among foreign-born Blacks and Latinx. Policies should seek to reduce exposure to structural and environmental risks and to ensure equitable opportunities to achieve optimal health among racial/ethnic minorities and immigrants.
Collapse
Affiliation(s)
- Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
| | - Paul J Fleming
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jessie B Kemmick Pintor
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Jim P Stimpson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| |
Collapse
|
35
|
Stickel AM, Tarraf W, Gonzalez KA, Isasi CR, Kaplan R, Gallo LC, Zeng D, Cai J, Pirzada A, Daviglus ML, Goodman ZT, Schneiderman N, González HM. Central Obesity, Cardiometabolic Risk, and Cognitive Change in the Study of Latinos - Investigation of Neurocognitive Aging. J Alzheimers Dis 2021; 82:1203-1218. [PMID: 34151803 PMCID: PMC10792520 DOI: 10.3233/jad-210314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The relationships between obesity and cognitive decline in aging are mixed and understudied among Hispanics/Latinos. OBJECTIVE To understand associations between central obesity, cognitive aging, and the role of concomitant cardiometabolic abnormalities among Hispanics/Latinos. METHODS Participants included 6,377 diverse Hispanics/Latinos enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and SOL-Investigation for Neurocognitive Aging (SOL-INCA). Participants were 45 years and older at the first cognitive testing session (Visit 1). Cognitive outcomes (z-score units) included global composite and domain specific (learning, memory, executive functioning, processing speed) measures at a second visit (SOL-INCA, on average, 7 years later), and 7-year change. We used survey linear regression to examine associations between central obesity (waist circumference≥88 cm and≥102 cm for women and men, respectively) and cognition. We also tested whether the relationships between obesity and cognition differed by cardiometabolic status (indication of/treatment for 2 + of the following: high triglycerides, hypertension, hyperglycemia, low high-density lipoprotein cholesterol). RESULTS Central obesity was largely unassociated with cognitive outcomes, adjusting for covariates. However, among individuals with central obesity, cardiometabolic abnormality was linked to poorer cognitive function at SOL-INCA (ΔGlobalCognition =-0.165, p < 0.001) and to more pronounced cognitive declines over the average 7 years (ΔGlobalCognition = -0.109, p < 0.05); this was consistent across cognitive domains. CONCLUSION Central obesity alone was not associated with cognitive function. However, presence of both central obesity and cardiometabolic abnormalities was robustly predictive of cognition and 7-year cognitive declines, suggesting that in combination these factors may alter the cognitive trajectories of middle-aged and older Hispanics/Latinos.
Collapse
Affiliation(s)
- Ariana M. Stickel
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, La Jolla, CA
| | - Wassim Tarraf
- Institute of Gerontology & Department of Healthcare Sciences, Wayne State University, Detroit, Michigan
| | - Kevin A. Gonzalez
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, La Jolla, CA
| | - Carmen R. Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine
| | - Robert Kaplan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois at Chicago, College of Medicine, Chicago, IL
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, College of Medicine, Chicago, IL
| | | | | | - Hector M. González
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, La Jolla, CA
| |
Collapse
|
36
|
Gill C, Lee M, Vatcheva KP, Rianon N, Smulevitz B, McPherson DD, McCormick JB, Fisher-Hoch SP, Laing ST. Association of Visceral Adipose Tissue and Subclinical Atherosclerosis in US-Born Mexican Americans but not First Generation Immigrants. J Am Heart Assoc 2020; 9:e017373. [PMID: 33054499 PMCID: PMC7763390 DOI: 10.1161/jaha.120.017373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Excess visceral adipose tissue (VAT) is a primary driver for the cardiometabolic complications of obesity; VAT-associated cardiovascular disease risk varies by race, but most studies have been done on Non-Hispanics. This study aimed to evaluate the clinical and metabolic correlates of VAT, its association with subclinical atherosclerosis, and the factors affecting this association in Mexican Americans. Methods and Results Participants (n=527) were drawn from the Cameron County Hispanic Cohort (CCHC), on whom a carotid ultrasound to assess carotid intima media thickness and a dual-energy X-ray absorptiometry scan to assess for VAT were obtained. Those in the highest quartiles of VAT were more likely to have hypertension, hypertriglyceridemia, low high-density lipoprotein, diabetes mellitus, and metabolic syndrome. Increased carotid intima media thickness was more prevalent in those in the highest quartile for VAT (57.4% versus 15.4% for the lowest quartile; P<0.001). There was a graded increase in mean carotid intima media thickness with increasing VAT, after adjusting for covariates; for every 10 cm2 increase in VAT, there was an increase of 0.004 mm (SE=0.002; P=0.0299) in mean carotid intima media thickness. However, this association was only seen among second or higher generation US-born Mexican Americans but not among first generation immigrants (P=0.024). Conclusions Excess VAT is associated with indicators of metabolic disorders and subclinical atherosclerosis in Mexican Americans regardless of body mass index. However, acculturation appears to be an important modulator of this association. Longitudinal follow-up with targeted interventions among second or higher generation Hispanics to lower VAT and improve cardiometabolic risk may help prevent premature cardiovascular disease in this cohort.
Collapse
Affiliation(s)
- Clarence Gill
- Division of Cardiology Department of Internal Medicine at The University of Texas Health Science Center at Houston Houston TX
| | - Miryoung Lee
- School of Public Health The University of Texas Health Science Center at Houston Brownsville TX
| | - Kristina P Vatcheva
- School of Mathematical and Statistical Science The University of Texas at Rio Grande Valley Brownsville TX
| | - Nahid Rianon
- Division of Geriatric Medicine Department of Internal Medicine McGovern Medical School at The University of Texas Health Science Center at Houston Houston TX
| | - Beverly Smulevitz
- Division of Cardiology Department of Internal Medicine at The University of Texas Health Science Center at Houston Houston TX
| | - David D McPherson
- Division of Cardiology Department of Internal Medicine at The University of Texas Health Science Center at Houston Houston TX
| | - Joseph B McCormick
- School of Public Health The University of Texas Health Science Center at Houston Brownsville TX
| | - Susan P Fisher-Hoch
- School of Public Health The University of Texas Health Science Center at Houston Brownsville TX
| | - Susan T Laing
- Division of Cardiology Department of Internal Medicine at The University of Texas Health Science Center at Houston Houston TX
| |
Collapse
|
37
|
Peters BA, Yi SS, Beasley JM, Cobbs EN, Choi HS, Beggs DB, Hayes RB, Ahn J. US nativity and dietary acculturation impact the gut microbiome in a diverse US population. THE ISME JOURNAL 2020; 14:1639-1650. [PMID: 32210364 PMCID: PMC7305110 DOI: 10.1038/s41396-020-0630-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 02/03/2023]
Abstract
Little is known regarding the impact of immigrant acculturation on the gut microbiome. We characterized differences in the gut microbiome between racially/ethnically diverse US immigrant and US-born groups, and determined the impact of dietary acculturation on the microbiome. Stool samples were collected from 863 US residents, including US-born (315 White, 93 Black, 40 Hispanic) and foreign-born (105 Hispanic, 264 Korean) groups. We determined dietary acculturation from dissimilarities based on food frequency questionnaires, and used 16S rRNA gene sequencing to characterize the microbiome. Gut microbiome composition differed across study groups, with the largest difference between foreign-born Koreans and US-born Whites, and significant differences also observed between foreign-born and US-born Hispanics. Differences in sub-operational taxonomic unit (s-OTU) abundance between foreign-born and US-born groups tended to be distinct from differences between US-born groups. Bacteroides plebeius, a seaweed-degrading bacterium, was strongly enriched in foreign-born Koreans, while Prevotella copri and Bifidobacterium adolescentis were strongly enriched in foreign-born Koreans and Hispanics, compared with US-born Whites. Dietary acculturation in foreign-born participants was associated with specific s-OTUs, resembling abundance in US-born Whites; e.g., a Bacteroides plebeius s-OTU was depleted in highly diet-acculturated Koreans. In summary, we observed that US nativity is a determinant of the gut microbiome in a US resident population. Dietary acculturation may result in loss of native species in immigrants, though further research is necessary to explore whether acculturation-related microbiome alterations have consequences for immigrant health.
Collapse
Affiliation(s)
- Brandilyn A. Peters
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA ,0000000121791997grid.251993.5Present Address: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Stella S. Yi
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA
| | - Jeannette M. Beasley
- 0000 0004 1936 8753grid.137628.9Department of Medicine, NYU School of Medicine, New York, NY USA
| | - Emilia N. Cobbs
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA
| | - Hee Sun Choi
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA
| | - Dia B. Beggs
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA
| | - Richard B. Hayes
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA ,0000 0004 1936 8753grid.137628.9NYU Perlmutter Cancer Center, New York, NY USA
| | - Jiyoung Ahn
- 0000 0004 1936 8753grid.137628.9Department of Population Health, NYU School of Medicine, New York, NY USA ,0000 0004 1936 8753grid.137628.9NYU Perlmutter Cancer Center, New York, NY USA
| |
Collapse
|
38
|
Rodriguez CB, Wei Y, Terry MB, Wyka K, Athilat S, Albrecht SS, Tehranifar P. Associations of Nativity, Age at Migration, and Percent of Life in the U.S. with Midlife Body Mass Index and Waist Size in New York City Latinas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072436. [PMID: 32260163 PMCID: PMC7178279 DOI: 10.3390/ijerph17072436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022]
Abstract
Migration to the U.S. has been associated with increased body size and obesity risk in Latinas, but results for Caribbean immigrant women are limited and inconclusive. Emerging evidence also suggests that early-life environment associations with women's midlife body mass index (BMI) may be different for larger and smaller women, but this has not been tested within migration life-course history. We examined the associations of nativity and migration timing with midlife body size in a sample of majority Caribbean Latinas and whether these associations varied across the body size distribution. We used interview data from 787 self-identified Latinas (ages 40-65 years) and assessed overall obesity using BMI (kg/m2) and central obesity based on waist circumference (WC, cm). We used linear and quantile regression to examine the association of migration history with BMI and WC and logistic regression for the probability of obesity. Foreign birthplace, later migration age, and lower percent of life in the U.S. were associated with lower BMI and WC means and lower odds of overall and central obesity. Quantile regression showed only inverse associations in the upper quantiles of BMI and WC. For example, relative to U.S.-born women, women living <50% of their lives in the U.S. had lower BMI in the 75th BMI percentile (β = -4.10, 95% CI: -6.75, -0.81), with minimal differences in the 25th (β = 0.04, 95% CI: -1.01, 0.96) and 50th BMI percentiles (β = -1.54, 95% CI: -2.90, 0.30). Our results support that migration to and increasing time in the U.S. are associated with greater body size in midlife Latina women, with stronger influences at higher body size distribution.
Collapse
Affiliation(s)
- Carmen B. Rodriguez
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (C.B.R.); (M.B.T.); (S.A.); (S.S.A.)
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY 10027, USA;
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (C.B.R.); (M.B.T.); (S.A.); (S.S.A.)
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY 10027, USA;
| | - Shweta Athilat
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (C.B.R.); (M.B.T.); (S.A.); (S.S.A.)
| | - Sandra S. Albrecht
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (C.B.R.); (M.B.T.); (S.A.); (S.S.A.)
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA; (C.B.R.); (M.B.T.); (S.A.); (S.S.A.)
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
- Correspondence:
| |
Collapse
|
39
|
Durazo EM, Haan MN, Dang K, Aiello AE, Torres JM. Nativity, Neighborhoods, and Body Composition in the Sacramento Area Latino Study on Aging. THE GERONTOLOGIST 2020; 60:239-249. [PMID: 31774118 PMCID: PMC7039378 DOI: 10.1093/geront/gnz139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Globally, obesity influences the risk of many major chronic diseases. Our study examines the association between individual nativity and neighborhood level concentration of immigrants with 10-year changes in weight, body mass index (BMI), and waist circumference (WC) among older Latinos. RESEARCH DESIGN AND METHODS The Sacramento Area Latino Study on Aging (SALSA) is a population-based prospective study of community-dwelling older adults of Mexican origin (baseline ages 58-101 years). The primary outcome was repeated measures of weight over a 10-year period for 1,628 respondents. Nativity was defined by participants' reported place of birth (US-born or Latin American foreign born). Neighborhood immigrant concentration was measured as the percentage of foreign born at census tract level (2000 US Census). We used linear mixed models with repeated measures of weight, height, BMI, and WC as dependent variables (level 1), clustered within individuals (level 2) and neighborhood migrant concentration (level 3). RESULTS Foreign born (FB) respondents had lower baseline weight than the US-born (mean, 160 vs. 171 lbs, p < .0001). Over time, weight differences between the FB and the US-born decreased by 1.7 lbs/5 years as US-born weight decreased more rapidly. We observed a significant interaction between individual nativity and neighborhood immigrant concentration (p = .012). We found similar patterns for BMI, but did not find statistically significant differences in WC trajectories. DISCUSSION AND IMPLICATIONS Our study observed significant differences by foreign born vs. US nativity in baseline weight/BMI and in their trajectories over time. Additionally, we found weight/BMI differences in neighborhood immigrant concentration for the FB, but not for the US-born.
Collapse
Affiliation(s)
- Eva M Durazo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
- Center for the Study of Adversity and Cardiovascular Disease (NURTURE Center), Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Mary N Haan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Kristina Dang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Allison E Aiello
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Jacqueline M Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| |
Collapse
|
40
|
Gallo LC, Fortmann AL, Bravin JI, Clark TL, Savin KL, Ledesma DL, Euyoque J, Sandoval H, Roesch SC, Gilmer T, Talavera GA, Philis-Tsimikas A. My Bridge (Mi Puente), a care transitions intervention for Hispanics/Latinos with multimorbidity and behavioral health concerns: protocol for a randomized controlled trial. Trials 2020; 21:174. [PMID: 32051005 PMCID: PMC7014646 DOI: 10.1186/s13063-019-3722-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Multimorbidity affects four of ten US adults and eight of ten adults ages 65 years and older, and frequently includes both cardiometabolic conditions and behavioral health concerns. Hispanics/Latinos (hereafter, Latinos) and other ethnic minorities are more vulnerable to these conditions, and face structural, social, and cultural barriers to obtaining quality physical and behavioral healthcare. We report the protocol for a randomized controlled trial that will compare Mi Puente (My Bridge), a cost-efficient care transitions intervention conducted by a specially trained Behavioral Health Nurse and Volunteer Community Mentor team, to usual care or best-practice discharge approaches, in reducing hospital utilization and improving patient reported outcomes in Latino adults with multiple cardiometabolic conditions and behavioral health concerns. The study will examine the degree to which Mi Puente produces superior reductions in hospital utilization at 30 and 180 days (primary aim) and better patient-reported outcomes (quality of life/physical health; barriers to healthcare; engagement with outpatient care; patient activation; resources for chronic disease management), and will examine the cost effectiveness of the Mi Puente intervention relative to usual care. Methods Participants are enrolled as inpatients at a South San Diego safety net hospital, using information from electronic medical records and in-person screenings. After providing written informed consent and completing self-report assessments, participants randomized to usual care receive best-practice discharge processes, which include educational materials, assistance with outpatient appointments, referrals to community-based providers, and other assistance (e.g., with billing, insurance) as required. Those randomized to Mi Puente receive usual-care materials and processes, along with inpatient visits and up to 4 weeks of follow-up phone calls from the intervention team to address their integrated physical-behavioral health needs and support the transition to outpatient care. Discussion The Mi Puente Behavioral Health Nurse and Volunteer Community Mentor team intervention is proposed as a cost-effective and culturally appropriate care transitions intervention for Latinos with multimorbidity and behavioral health concerns. If shown to be effective, close linkages with outpatient healthcare and community organizations will help maximize uptake, dissemination, and scaling of the Mi Puente intervention. Trial registration ClinicalTrials.gov: NCT02723019. Registered on 30 March 2016.
Collapse
Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego State University, San Diego CA, USA.
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla CA, USA
| | - Julia I Bravin
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - Taylor L Clark
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - Kimberly L Savin
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | | | - Johanna Euyoque
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla CA, USA
| | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla CA, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego CA, USA
| | - Todd Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | | | | |
Collapse
|
41
|
Camplain R, Sotres-Alvarez D, Alvarez C, Wilson R, Perreira KM, Castañeda SF, Merchant G, Gellman MD, Chambers EC, Gallo LC, Evenson KR. The association of acculturation with accelerometer-assessed and self-reported physical activity and sedentary behavior: The Hispanic Community Health Study/Study of Latinos. Prev Med Rep 2020; 17:101050. [PMID: 32021761 PMCID: PMC6994298 DOI: 10.1016/j.pmedr.2020.101050] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 12/16/2019] [Accepted: 01/11/2020] [Indexed: 01/09/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Ricky Camplain
- Northern Arizona University, Center for Health Equity Research, 1395 S. Knoles Drive, ARD Building, Suite 140, Flagstaff, AZ 86011, USA.,University of North Carolina, Department of Epidemiology, 123 W. Franklin St. Building C CB 8050, Suite 410, Chapel Hill, NC 27599-8050, USA
| | - Daniela Sotres-Alvarez
- University of North Carolina at Chapel Hill, Department of Biostatistics, 123 W. Franklin St., Building C, Suite 450, Chapel Hill, NC 27516, USA
| | - Carolina Alvarez
- University of North Carolina at Chapel Hill, Thurston Arthritis Research Center, 3300 Thurston Bldg., CB #7280, Chapel Hill, NC 27599-7280, USA
| | - Rebbecca Wilson
- University of North Carolina at Chapel Hill, Department of Biostatistics, 123 W. Franklin St., Building C, Suite 450, Chapel Hill, NC 27516, USA
| | - Krista M Perreira
- University of North Carolina, Department of Social Medicine, 333 S. Columbia St., 342B MacNider Hall, Chapel Hill, NC 27599, USA
| | - Sheila F Castañeda
- San Diego State University, South Bay Latino Research Center, 780 Bay Blvd, Sute 200 Chula Vista, CA 91910, USA
| | - Gina Merchant
- University of California, San Diego, Department of Medicine, 9500 Gilman Drive #0881, La Jolla, CA 92093-0881, USA
| | - Marc D Gellman
- University of Miami, Department of Psychology, Flipse Building, 5665 Ponce de Leon Blvd., Coral Gables, FL 33146, USA
| | - Earle C Chambers
- Albert Einstein College of Medicine, Department of Family and Social Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Block Room 408, Bronx, NY 10461, USA
| | - Linda C Gallo
- San Diego State University, Department of Psychology, 5500 Campanile Drive, San Diego, CA 92182-4611, USA
| | - Kelly R Evenson
- University of North Carolina, Department of Epidemiology, 123 W. Franklin St. Building C CB 8050, Suite 410, Chapel Hill, NC 27599-8050, USA
| |
Collapse
|
42
|
Cuevas AG, Chen R, Slopen N, Thurber KA, Wilson N, Economos C, Williams DR. Assessing the Role of Health Behaviors, Socioeconomic Status, and Cumulative Stress for Racial/Ethnic Disparities in Obesity. Obesity (Silver Spring) 2020; 28:161-170. [PMID: 31858741 PMCID: PMC6927482 DOI: 10.1002/oby.22648] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/13/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study aimed to examine the explanatory role of health behaviors, socioeconomic position (SEP), and psychosocial stressors on racial/ethnic obesity disparities in a multiethnic and multiracial sample of adults. METHODS Using data from the Chicago Community Adult Health Study (2001-2003), Oaxaca-Blinder decomposition analysis was conducted to quantify the extent to which health behaviors (fruit and vegetable consumption and physical activity), SEP, and cumulative stressors (e.g., perceived discrimination, financial strain) each explained differences in obesity prevalence in Black, US-born Hispanic, and non-US-born Hispanic compared with non-Hispanic White participants. RESULTS SEP and health behaviors did not explain obesity differences between racial/ethnic minorities and White individuals. Having high levels of stress in four or more domains explained 4.46% of the differences between Black and White individuals, whereas having high levels of stress in three domains significantly explained 14.13% of differences between US-born Hispanic and White. Together, the predictors explained less than 20% of differences between any racial/ethnic minority group and White individuals. CONCLUSIONS Exposure to stressors may play a role in obesity disparities, particularly among Black and US-born Hispanic individuals. Other obesity-related risk factors need to be examined to understand the underlying mechanisms explaining obesity disparities.
Collapse
Affiliation(s)
| | - Ruijia Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD
| | - Katherine A Thurber
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Norbert Wilson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Chris Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA
| |
Collapse
|
43
|
Kaplan RC, Wang Z, Usyk M, Sotres-Alvarez D, Daviglus ML, Schneiderman N, Talavera GA, Gellman MD, Thyagarajan B, Moon JY, Vázquez-Baeza Y, McDonald D, Williams-Nguyen JS, Wu MC, North KE, Shaffer J, Sollecito CC, Qi Q, Isasi CR, Wang T, Knight R, Burk RD. Gut microbiome composition in the Hispanic Community Health Study/Study of Latinos is shaped by geographic relocation, environmental factors, and obesity. Genome Biol 2019; 20:219. [PMID: 31672155 PMCID: PMC6824043 DOI: 10.1186/s13059-019-1831-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hispanics living in the USA may have unrecognized potential birthplace and lifestyle influences on the gut microbiome. We report a cross-sectional analysis of 1674 participants from four centers of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), aged 18 to 74 years old at recruitment. RESULTS Amplicon sequencing of 16S rRNA gene V4 and fungal ITS1 fragments from self-collected stool samples indicate that the host microbiome is determined by sociodemographic and migration-related variables. Those who relocate from Latin America to the USA at an early age have reductions in Prevotella to Bacteroides ratios that persist across the life course. Shannon index of alpha diversity in fungi and bacteria is low in those who relocate to the USA in early life. In contrast, those who relocate to the USA during adulthood, over 45 years old, have high bacterial and fungal diversity and high Prevotella to Bacteroides ratios, compared to USA-born and childhood arrivals. Low bacterial diversity is associated in turn with obesity. Contrasting with prior studies, our study of the Latino population shows increasing Prevotella to Bacteroides ratio with greater obesity. Taxa within Acidaminococcus, Megasphaera, Ruminococcaceae, Coriobacteriaceae, Clostridiales, Christensenellaceae, YS2 (Cyanobacteria), and Victivallaceae are significantly associated with both obesity and earlier exposure to the USA, while Oscillospira and Anaerotruncus show paradoxical associations with both obesity and late-life introduction to the USA. CONCLUSIONS Our analysis of the gut microbiome of Latinos demonstrates unique features that might be responsible for health disparities affecting Hispanics living in the USA.
Collapse
Affiliation(s)
- Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Zheng Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Mykhaylo Usyk
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | | | - Gregory A. Talavera
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA USA
| | - Marc D. Gellman
- Department of Psychology, University of Miami, Miami, FL USA
| | - Bharat Thyagarajan
- Division of Molecular Pathology and Genomics, University of Minnesota, Minneapolis, MN USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Yoshiki Vázquez-Baeza
- Jacobs School of Engineering, University of California, San Diego, La Jolla, CA USA
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA USA
| | - Daniel McDonald
- Department of Pediatrics, University of California, San Diego, La Jolla, CA USA
| | | | - Michael C. Wu
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Kari E. North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Justin Shaffer
- Department of Pediatrics, University of California, San Diego, La Jolla, CA USA
| | | | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
| | - Rob Knight
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA USA
- Department of Pediatrics, University of California, San Diego, La Jolla, CA USA
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA USA
- Department of Bioengineering, University of California, San Diego, La Jolla, CA USA
| | - Robert D. Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY USA
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY USA
| |
Collapse
|
44
|
Explaining Chronic Illness and Self-Rated Health Among Immigrants of Five Hispanic Ethnicities. J Racial Ethn Health Disparities 2019; 7:177-191. [PMID: 31654338 DOI: 10.1007/s40615-019-00647-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/05/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
The largest racial/ethnic minority group in the United States, Hispanics, especially Hispanic immigrants, have been considered healthier than groups of other ethnicity (including Whites, the majority). However, chronic illnesses such as cancer and diabetes are often seen in this culturally, ethnically diverse group. The present study had two aims. First was to explain two health outcomes, which were presence of chronic illness (any of the five common conditions cardiovascular disease, stroke, hypertension, cancer, and/or diabetes/prediabetes) and self-rated health, in terms of links to certain factors in acculturation, social status, health, social support, and lifestyle. Second was to determine how uniform these links might be across five ethnic groups: Mexican, Puerto Rican, Cuban, Dominican, Central/South American. We combined data from 17 years of the National Health Interview Survey (1999-2015) and subjected these secondary measures to logistic and linear regression, separately by ethnicity, to explain both outcomes. With few exceptions, results generally linked illness/health to the tested independent variables. Additionally, results confirmed ethnicity to moderate the outcomes' associations with the independent variables. Ethnicity-specific analysis showed the two outcomes to exhibit dissimilar relationships with certain independent variables across ethnic groups. Research that (as has been common) lumps together respondents whose Hispanic ethnicities may differ disregards some meaningful variation rather than accounting for it. In future research-and in subsequent evidence-based policy/practice development-all essential sociocultural factors, including ethnicity, should be carefully outlined, advancing good health for the entire Hispanic immigrant population.
Collapse
|
45
|
Fuster M, González E. Traditional diets in everyday life: Perspectives from Hispanic Caribbean communities in New York City. FOOD AND FOODWAYS 2019. [DOI: 10.1080/07409710.2019.1673016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Melissa Fuster
- Health and Nutrition Sciences, Public Health Nutrition, City University of New York Brooklyn College, Brooklyn, New York, USA
| | | |
Collapse
|
46
|
Acculturative stress and emotional eating in Latino adolescents. Eat Weight Disord 2019; 24:905-914. [PMID: 30367385 DOI: 10.1007/s40519-018-0602-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/19/2018] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Despite data that suggest Latino adolescents experience acculturative stress (i.e., feeling overwhelmed by conflicting cultural practices, language problems, and ethnic self-consciousness) and endorse elevated levels of emotional eating, there has been an absence of research examining the relations between acculturative stress and emotional eating in this population. The purpose of the present study was to (1) examine the associations between acculturative stress, emotional eating, and change in BMIz scores in Latino adolescents over a 3-month period, and (2) compare Latino and non-Latino adolescents on measures of acculturative stress, emotional eating, and body mass index (BMI). METHODS The sample comprised 168 Latino (mean age 13.69 years; SD 0.88) and 278 non-Latino (mean age 13.68 years; SD 0.79) middle and high school students. Participants completed the Emotional Eating Scale for Children and Adolescents (EES-C), the Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale for Children (SAFE-C), and a demographic questionnaire. Participants had their height and weight measured after completing the questionnaires and at a second-time point, approximately 3 months after time 1 measurements. Independent samples t tests and Cohen's d effect sizes were used to investigate whether there were differences between Latino adolescents and non-Latino adolescents. Pearson correlations were computed to examine associations between acculturative stress, emotional eating, and change in BMIz scores in the Latino sample. RESULTS Latino adolescents endorsed significantly higher acculturative stress on the SAFE-C compared to non-Latino adolescents (Latino mean 30.81; non-Latino mean 25.64; p < 0.001; Cohen's d effect size = 0.35). In the Latino sample, acculturative stress was associated with higher levels of emotional eating. Latino and non-Latino adolescents endorsed similar levels of emotional eating. CONCLUSIONS The present findings provide preliminary evidence that acculturative stress may serve as a risk factor for emotional eating among Latino adolescents. Future obesity prevention and intervention programs developed for Latino adolescents may benefit from addressing acculturative stress, particularly among more recent Latino immigrants. LEVEL OF EVIDENCE Level 3, case-control analytic study.
Collapse
|
47
|
Perera MJ, Chirinos DA, Brintz CE, Schneiderman N, Daviglus M, Talavera GA, Perreira KM, Giacinto RAE, Qi Q, Llabre MM. Body Mass of U.S. Hispanics/Latinos From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL): How Do Diet Quality and Sedentary Time Relate? HISPANIC HEALTH CARE INTERNATIONAL 2019; 18:55-63. [PMID: 31565964 DOI: 10.1177/1540415319874809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little evidence exists on diet quality- and sedentary time-related differences in body mass index (BMI) among immigrant and nonimmigrant Hispanics/Latinos with different lengths of U.S. residence. A total of 13,962 (80.2% foreign-born) Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants aged 18 to 60 from four U.S. cities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) underwent standardized interviews and fasting blood tests. Diet quality was total Alternative Healthy Eating Index score. Sedentary time was number of <100 counts/minute over 3 to 6 days. BMI was examined using regression models adjusted for age, income, Hispanic/Latino background, HCHS/SOL site, and tobacco use. Two three-way interactions (diet or sedentary time length of residence sex) were tested to examine health behavior-related differences in BMI among immigrant and nonimmigrant males and females. The diet length of residence sex interaction was significant (b = .005, 95% confidence interval [-.003, .008]). For a 10-unit Alternative Healthy Eating Index difference, the BMI difference was greater among immigrant females in the United States longer (0 years = .84 kg/m2; 10 years = 1.64 kg/m2). Diet-related obesity prevention efforts may start soon after migration, particularly for immigrant women.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Qibin Qi
- Einstein College of Medicine, New York, NY, USA
| | | |
Collapse
|
48
|
Wen H, Botticello AL, Bae S, Heinemann AW, Boninger M, Houlihan BV, Chen Y. Racial and Ethnic Differences in Obesity in People With Spinal Cord Injury: The Effects of Disadvantaged Neighborhood. Arch Phys Med Rehabil 2019; 100:1599-1606. [PMID: 30922881 DOI: 10.1016/j.apmr.2019.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/11/2019] [Accepted: 02/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the role of neighborhood in the relation between race and obesity in people with spinal cord injury (SCI). DESIGN A cross-sectional analysis of survey data from National SCI Database linked with neighborhood data from American Community Survey by census tract. SETTING A total of 17 SCI Model Systems centers. PARTICIPANTS Individuals (N=3385; 2251 non-Hispanic whites, 760 non-Hispanic blacks, 374 Hispanics) who completed a follow-up assessment during 2006-2017 (mean duration of injury, 8.3±9.9y) and resided in 2934 census tracts. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Body mass index (BMI) (kg/m2). RESULTS The overall prevalence of obesity was 52.9% (BMI≥25.0) and 23.3% (BMI≥30.0). Hispanics were 67.0% more likely to be obese (BMI≥30.0 kg/m2) relative to non-Hispanic whites (odds ratio, 1.67; 95% confidence interval, 1.27-2.18), after controlling for demographic and injury-related characteristics. Most of the non-Hispanic blacks (66.8%) were living in neighborhoods with high concentrated disadvantaged index (CDI), compared to 35.0% of Hispanics and 9.2% of non-Hispanic whites living in this similar neighborhood status (P<.0001). After accounting for CDI, the odds of being obese in Hispanics decreased (odds ratio, 1.51; 95% confidence interval, 1.15-1.99). Regardless of race and ethnicity, people with SCI from disadvantaged neighborhoods were 42.0%-70.0% more likely to be obese than those from minimal CDI neighborhoods. CONCLUSIONS Neighborhood characteristics partially diminish racial differences in obesity. Weight management for the SCI population should target those who are Hispanic and living in the disadvantaged neighborhoods.
Collapse
Affiliation(s)
- Huacong Wen
- Department of Physical Therapy, School of Health Professionals, University of Alabama at Birmingham, Birmingham, AL, the United States; Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, the United States
| | - Amanda L Botticello
- Kessler Foundation, West Orange, NJ, the United States; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, the United States
| | - Sejong Bae
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, the United States
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL, the United States; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, the United States
| | - Mike Boninger
- Departments of Physical Medicine and Rehabilitation, Bioengineering, and Rehabilitation Science and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, the United States
| | - Bethlyn Vergo Houlihan
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, the United States; Spaulding Rehabilitation Hospital, Boston, MA, the United States
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, the United States.
| |
Collapse
|
49
|
An Analysis of Acculturation Status and Healthcare Coverage for the Needs of Mental Health Service Utilization among Latinos in Mississippi, Louisiana, and Alabama. PSYCH 2019. [DOI: 10.3390/psych1010035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The use of mental health services by Latinos is only 7.3%, despite the high prevalence of depression rates of between 27.0% and 38.0% in the United States. Research is limited concerning Latinos’ acculturation status and healthcare coverage on mental healthcare service utilization in Mississippi, Louisiana, and Alabama. Therefore, the objective of this study is to examine the association of acculturation status and healthcare coverage with mental health service utilization in the Latino population. Methods: During 2011–2012, a Latino Community Health Needs Assessment was administered by a trained bilingual interviewer using participants’ preferred language. Four hundred and eleven community members and leaders participated in the study. Acculturation status and self-reported mental health service utilization were retrieved from the survey instrument. Multivariate logistic regression analyses were performed. Results: In multivariate logistic regression that included gender, education level, healthcare coverage, depression, and acculturation status, individuals with a high acculturation score (3–5) were 1.53 times more likely to utilize mental health services compared to those with a low acculturation score (0–2). Individuals with healthcare coverage were 2.75 times more likely to utilize mental health services compared to those with not having healthcare coverage. Healthcare coverage is only a significant determinant of mental health service utilization. Conclusions: This result underscores the importance of having healthcare coverage for the need of mental health service utilization. Future research should consider the impact of acculturation and healthcare coverage on mental health service utilization.
Collapse
|
50
|
Chatham RE, Mixer SJ. Cultural Influences on Childhood Obesity in Ethnic Minorities: A Qualitative Systematic Review. J Transcult Nurs 2019; 31:87-99. [PMID: 31423926 DOI: 10.1177/1043659619869428] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction: Childhood obesity remains an unrelenting public health problem disproportionately affecting ethnic minorities. Although research has examined ethnicity as a factor of childhood obesity, few studies have examined cultural influences. The purpose of this systematic review was to examine the qualitative evidence of cultural influences on childhood obesity in ethnic minority groups. Methodology: Selective sampling of studies since 2008 yielded 251 articles. Twelve articles that addressed cultural influences on childhood obesity were identified for review. The Culture Care Theory Sunrise Enabler factors were used as an a priori framework for theme coding. Results: Nine themes emerged: child feeding, family, gender roles, food, healthy child appearance, physical activity, sedentary activity, food cost, and obesogenic environment. Discussion: Cultural care practices such as traditional foods and family meals are protective factors in childhood obesity and should be encouraged by nurses caring for and working with ethnic minority populations.
Collapse
|