Association Between Sugar-Sweetened Beverage Intake and Proxies of Acculturation Among U.S. Hispanic and Non-Hispanic White Adults

Helicopter Parenting Among Socio-Economically and Ethnically/Racially Diverse Emerging Adults: Associations with Weight-Related Behaviors

Helicopter parenting, a parenting style defined by over-involvement, may lead to poor health outcomes. However, research has primarily focused on children and adolescents from White, high socio-economic families, with little research examining weight-related health or with emerging adult children. The current study examined associations with emerging adult diet, physical activity, and body mass index (BMI) among a diverse population-based sample of parent and emerging adult dyads (n = 919). Helicopter parenting was highest among lower socioeconomic households and those identifying as Black, Indigenous, or people of color. Helicopter parenting was associated with both healthy and less healthy dietary behaviors across ethnic/racial groups, but was not associated with physical activity or BMI. Greater consideration of the cultural context related to helicopter parenting is needed before making conclusions about its benefits or harms.

Testing the effectiveness of narrative messages using critical health communication

BACKGROUND

Latinos suffer from health disparities associated with excessive consumption of sugar-sweetened beverages. This study aimed to test the effectiveness of messaging using critical health communication approaches and delivered by two narrative modalities (video and comic book) with similar content that aims to empower Latinos to advocate for social change and to make individual behavior change related to sugary beverage consumption.

METHODS

Participants (N = 129 Mexican American women between 18 and 29 years) completed an online survey before and after exposure to an embedded stimulus. Participants were randomly assigned to a stimulus, a narrative message in video or comic book format, both developed using critical health communication approaches that focused on individual harms and social causes of sugary beverage consumption.

RESULTS

Paired sample t-test results showed that both narrative messages increased intentions to reduce sugary beverage consumption (Video: P < 0.01; d = 0.43; Comic: P = 0.03; d = 0.28). Both groups also demonstrated significant improvements in sugary beverage-related media literacy (Video: P = 0.01, d = 0.34; Comic: P = 0.05, d = 0.25), public health literacy (Video: P = 0.05, d = 0.24; Comic: P = 0.01, d = 0.32), and empowerment to engage in sugary beverage-related community movements (Video: P = 0.003, d = 0.38; Comic: P = 0.034, d = 0.27).

CONCLUSIONS

This study provides initial evidence indicating the effectiveness of narrative messages in two modalities using critical health communication for promoting individual behavioral intention and social activation in reducing sugary beverage consumption.

Lifestyle Patterns of Children Experiencing Homelessness: Family Socio-Ecological Correlates and Links with Physical and Mental Health

Diet, screen time, physical activity, and sleep combine into lifestyle patterns with synergistic effects on health. This study aimed to identify lifestyle patterns in children without housing and assess their associations with physical and mental health and family socio-ecological factors. In the 2013 ENFAMS cross-sectional survey (children aged 6-12 experiencing homelessness, Greater Paris area, n = 235), parents reported socio-ecological factors, children's behaviours, and mental health (the latter was also child-reported). Nurses measured children's haemoglobin concentrations and body mass index. Principal component analysis was used to derive sex-specific lifestyle patterns. Hierarchical linear regressions and "outcome-wide" analyses assessed, respectively, these patterns' relations to health and family socio-ecological factors. A rather healthy lifestyle pattern-similarly characterized by diverse diet and high sleep time-was identified, with slight differences by sex. Scores for this pattern were higher for children in food-secure or higher-income households, whose parents were proficient in French, who slept longer, or who received more social support compared to their counterparts, with some nuances by sex. Higher scores for this pattern were associated with higher prosocial behaviour scores (girls) and lower anxiety and hyperactivity-inattention symptoms scores (boys), but not with physical health. For this underserved and understudied population, the results highlight the importance of family socio-ecological factors in shaping the lifestyles and mental health of children.

Toward a Recipe for Deep versus Surface Level Tailoring: Mixed-Methods Validation of Message Features to Reduce Sugary Beverage Consumption

Targeted marketing contributes to the overconsumption of sugary beverages, which contributes to obesity and diabetes disparities among African American and Latino populations in the U.S. Health communicators can similarly use culturally tailored messages to decrease sugary beverage consumption among these groups, yet the specific strategies to operationalize cultural tailoring-the message components essential for such tailoring-are ill-described. We sought to identify and validate authentically created, culturally tailored messages using a multiple step mixed-methods approach. First, we used a snowball approach to identify nutrition education messages targeting ethnic minorities about reducing sugary beverage consumption (N = 85). Via content analysis, we assessed message features (character gender and race/ethnicity), level of change of the appeal (individual or social), and level of cultural tailoring (surface level tailoring in the form of matching character gender and race/ethnicity with target audience versus deep structural tailoring in the form of appealing to values is an effective message strategy). The highest-rated videos were then validated by a sample of the target audience using a quantitative survey and qualitative comments (N = 76). The results inform theorizing on message tailoring and provide a validated pool of culturally relevant messages intended both to reduce intentions to consume sugary beverages and to engage in social change actions.

Protocol: Effectiveness of message content and format on individual and collective efficacy in reducing the intention to consume sugar-sweetened beverages

The strategic use of media is a common approach to promote health. A large body of evidence identifies specific features that increase message efficacy, including tailoring messages to the target audience and using a storytelling format. Yet most message testing research has focused on individual-level outcomes, ignoring the social and environmental determinants of health behaviors, which require collective action and political will to change. Grounded in an ecological approach to communication, we will carry out two double-blinded randomized experiments to test the relative effectiveness of message tailoring (culturally-tailored vs. standard) and format (narrative vs. didactic) to increase the intention to reduce individual sugar-sweetened beverage consumption, the understanding of social and commercial determinants of health, and the sense of empowerment among young adult Latinas. Based on power analyses (80% power at alpha = 0.05), we will randomize 438 participants to two groups (traditional standard infographic and culturally-tailored infographic) in the first study, and 662 participants to two groups (culturally-tailored infographic and culturally-tailored comic book) in the second study. All participants will be measured by a pre-treatment test and an immediate post-treatment test. We hypothesize that culturally-tailored comic book will be most effective, and traditional standard infographic will be least effective, on all levels of outcomes. This study will provide empirical evidence in communication strategies to help young Latinos or other racial/ethnic minority young people to pursue positive dietary behaviors that both benefit themselves and contribute to change of social norms.

Prevalence of Cardiometabolic Risk Factors Among People Living with HIV in Southern Texas

The aim of this study is to estimate the prevalence of cardiometabolic risk factors among people living with HIV (PLWH) in the south Texas region between 2014 and 2018. A total of 2,808 PLWH from the southern Texas region were included using electronic medical records from a combination of health care system databases. The prevalence of cardiometabolic factors such as elevated blood pressure (BP), triglycerides, total cholesterol and blood glucose, low high-density lipoprotein cholesterol (HDL-C), and obesity was evaluated. The association between cardiometabolic risk factors and age, sex, race/ethnicity, and HIV-related variables was evaluated using logistic regression. Approximately 50.8% had elevated BP, followed by low HDL-C (41.7%), elevated glucose (40.3%), elevated triglycerides (35.5%), obesity (27.8%), and elevated total cholesterol (20%). Hispanics had a higher prevalence of low HDL-C (45.5% vs. 39.7%, p = .012), elevated glucose (48.9% vs. 36.3%, p < .001), elevated triglycerides (40.4% vs. 33.0%, p = .001), and obesity (31.3% vs. 26.0%, p = .004) than non-Hispanics. Females had a higher prevalence of low HDL-C (51.9% vs. 39.1%, p < .001), elevated total cholesterol (24.4% vs. 18.8%, p = .010), and obesity (49.5% vs. 21.8%, p < .001) than males. Variables such as age, sex, race/ethnicity, CD4⁺ T cell count, and viral load use were associated with multiple cardiometabolic risk factors. The prevalence of cardiometabolic risk factors remains high among PLWH in the southern Texas region, especially among Hispanics and females.

Intergenerational differences in dietary acculturation among Ghanaian immigrants living in New York City: a qualitative study

Dietary acculturation may explain the increasing risk of diet-related diseases among African immigrants in the United States (US). We interviewed twenty-five Ghanaian immigrants (Youth n 13, Age (Mean ± sd) 20 y ± 5⋅4, Parents (n 6) and Grandparents (n 6) age 58⋅7 ± 9⋅7) living in New York City (NYC) to (a) understand how cultural practices and the acculturation experience influence dietary patterns of Ghanaian immigrants and (b) identify intergenerational differences in dietary acculturation among Ghanaian youth, parents and grandparents. Dietary acculturation began in Ghana, continued in NYC and was perceived as a positive process. At the interpersonal level, parents encouraged youth to embrace school lunch and foods outside the home. In contrast, parents preferred home-cooked Ghanaian meals, yet busy schedules limited time for cooking and shared meals. At the community level, greater purchasing power in NYC led to increased calories, and youth welcomed individual choice as schools and fast food exposed them to new foods. Global forces facilitated nutrition transition in Ghana as fast and packaged foods became omnipresent in urban settings. Adults sought to maintain cultural foodways while facilitating dietary acculturation for youth. Both traditional and global diets evolved as youth and adults adopted new food and healthy social norms in the US.

Increasing obesity odds among foreign-born New Yorkers are not explained by eating out, age at arrival, or duration of residence: results from NYC HANES 2004 and 2013/2014

BACKGROUND

Among the foreign-born in the United States (US) dietary acculturation and eating out may increase obesity risk. Using the 2004 (N = 1952) and 2013/14 (N = 1481) New York City (NYC) Health and Nutrition Examination Surveys, we compared for the foreign-born and US-born by survey year: 1) odds of obesity; 2) association between eating out and obesity and 3) effect of age at arrival and duration of residence among the foreign-born. Weighted logistic regression estimated odds of obesity.

RESULTS

Compared to the US-born, the foreign-born had lower odds of obesity in 2004, (aOR = 0.51 (95%CI 0.37-0.70), P = <.0001). Odds were no different in 2013/14. In 2013/14 the foreign-born who ate out had lower obesity odds (aOR = 0.49 (95%CI 0.31-0.77), P = 0.0022). The foreign-born living in the US≥10 years had greater odds of obesity in 2004 (aOR = 1.73 (95%CI 1.08-2.79), P = 0.0233) but not in 2013/14.

CONCLUSIONS

Eating out does not explain increasing obesity odds among the foreign-born.

Migration as a determinant of childhood obesity in the United States and Latin America

International migration has economic and health implications. The acculturation process to the host country may be linked to childhood obesity. We use the Community Energy Balance (CEB) framework to analyze the relationship between migration and childhood obesity in Mexican households with international migrants. Using longitudinal data from the Mexican Family Life Survey (MxFLS), we examine how migrant networks affect childhood obesity in origin communities. We also review binational health programs that could be effective at tackling childhood obesity in migrant households from Mexico. Children embedded in migrant networks are at greater risk of developing overweight or obesity, suggesting a significant relationship between childhood obesity and international migration in Mexican households. Based on our search criteria, our analysis of health outreach programs shows that Ventanillas de Salud (VDS)/Health Windows has great promise to prevent childhood obesity in a culturally sensitive and trustful environment. The CEB framework is useful to understand how migration contributes to the risk of childhood overweight and obesity in migrant households. VDS is a feasible and replicable strategy with great potential to address childhood obesity among migrant families accounting for the dynamic and binational determinants of childhood obesity.

A Comparison of Weight-Related Behaviors of Hispanic Mothers and Children by Acculturation Level

Hispanic mothers and children in the United States experience a high prevalence of obesity, which may be affected by maternal acculturation level. Little is known about the association of acculturation on weight-related behaviors. This study describes differences in weight-related behaviors by acculturation level of Hispanic mothers residing in the U.S. and compares them to behaviors of White mothers. Acculturation level was determined using personal acculturation and acculturation environment variables. Cluster analysis of acculturation variables identified three groups of Hispanic mothers: low personal and environmental acculturation (n = 46), high personal and low environmental acculturation (n = 65), and high personal and environmental acculturation (n = 38). Results indicate that, compared to White mothers (n = 340), the least acculturated cluster of Hispanic mothers tended to model physical activity less often and the most acculturated exerted more pressure on children to eat. Mothers in the least acculturated cluster tended to rate children’s health status lower, indicate that children had greater fruit juice and less milk intakes, have more meals in locations associated with less healthy meals, and have the least space and supports for physical activity. Findings highlight relationships between maternal acculturation level and weight-related behaviors and suggest strategies for helping acculturating Hispanic mothers create healthier lifestyles and home environments.

The impact of acculturation to the US environment on the dietary share of ultra-processed foods among US adults

This study examined the association between measures of acculturation to the US environment including place of birth, and language spoken at home and proportion of life in the US among foreign-born, in relation to the dietary contribution of ultra-processed foods. Ultra-processed foods, as defined by the NOVA food classification system, are formulations of macronutrients (starches, sugars, fats and protein isolates) with little, if any, whole food and often with added flavors, colors, emulsifiers and other cosmetic additives. We studied 14,663 participants from the National Health and Nutrition Examination Survey 2011-2016, aged 20+ years, who completed a 1-day 24-h dietary recall. Food items were classified using NOVA into ultra-processed or non-ultra-processed foods. Linear regression models adjusted for age, sex, family income, education and race/ ethnicity, showed significant associations between general acculturation measures and dietary contribution of ultra-processed foods. Foreign-born adults consumed less ultra-processed foods than US-born adults (45 vs. 58%, p < 0.001). Within foreign-born adults, ultra-processed food consumption increased with English permeation at home from 40% among individuals speaking non-English languages only to 50% among those speaking English only (p for linear trend <0.001). In addition, ultra-processed food consumption increased from 41% among foreign-born adults who spent less than 30% of their life in the US to 48% among those who lived in the US for more than 50% of their lives (p for linear trend <0.001). Race/ethnicity emerged as an important effect modifier for the observed associations.

Targeting family functioning, acculturative stress, and sugar-sweetened beverage consumption for obesity prevention: findings from the Hispanic community children's health study/study of Latino youth

Background

Maintaining a bond with one’s family as well coping with stress while acculturating to the US may protect Hispanic/Latino youth from increased sugar-sweetened beverages (SSB) consumption, which heightens the risk for overweight and obesity. This study aims to examine associations between acculturative stress, family functioning, and SSB consumption by acculturation status among U.S. Hispanic/Latino youth.

Methods

With cross-sectional data on 1465 youth 8-16y (49.6% females) participating in the Hispanic Community Children’s Health Study/Study of Latino Youth, we classified youths into four acculturation groups – assimilated, integrated, marginalized/separated, and unclassified. SSB consumption was assessed through two 24-h diet recalls and defined as intake frequency of soda, fruit juice, sweetened soft and fruit drinks. Multi-group path regression models were used to test associations of Hispanic/Latino youth’ acculturative stress and family functioning with SSB consumption, as well as the moderating role of acculturation status.

Results

When controlling for age, sex, and study site, acculturative stress (β = − 0.13, p = 0.01) was inversely associated with SSB, and poor family functioning (β = 0.11, p = 0.07) was only marginally associated with SSB consumption among youth classified as assimilated but not among youth classified as integrated, marginalized/separated, or unclassified.

Conclusions

A socio-ecological perspective that incorporates the role of key acculturation-related factors across multiple levels may aid efforts to identify mechanisms that influence the relationship between acculturation status and diet among Hispanic/Latino youth and their families.

Egocentric social networks, lifestyle behaviors, and body size in the Asian Community Health Initiative (CHI) cohort

BACKGROUND

Social networks have been shown to influence lifestyle behaviors in non-Latinx white (NLW) populations. We examined their influence in Asian American, Native Hawaiian and Pacific Islander (AANHPI) women.

METHODS

We included 477 AANHPI women from the Asian Community Health Initiative Study who provided egocentric (degree, density, composition) and epidemiologic (size, types of ties) social network data and data on alcohol intake, physical activity, smoking, diet, and body size. We used logistic regression to evaluate associations of social network measures and dichotomous outcomes, and linear regression for continuous outcomes.

RESULTS

In multivariable-adjusted analyses, higher degree and/or proportion of friends were significantly related to higher Western diet, higher odds of any alcohol consumption, and lower odds of physical inactivity and body mass index (BMI)≥23 kg/m2. Additionally, a higher proportion of NLW in women's networks was related to lower Asian diet but also lower waist size. Community participation was related to higher Western diet and lower Asian diet. By contrast, degree and/or proportion of relatives were positively related to BMI, waist size and to a higher odds of BMI≥23 kg/m2 and of ever smoking 100 cigarettes. Being married was related to fewer alcoholic drinks per week and higher Asian diet. A higher density of relationships with frequent contact was also associated with higher Asian diet.

CONCLUSIONS

AANHPI women with larger proportions of friends and NLWs in their networks had more Western health behaviors and smaller body size. Norms for health behaviors and body size may be influenced by the size, composition, and structure of social networks, relevant to chronic disease prevention.

A narrative review of the effects of sugar-sweetened beverages on human health: A key global health issue

The provision of healthy and safe food is vital for human health, and the addition of unnecessary sugars in foodstuffs is an important global issue, leading to multiple long- and short-term health issues and spiraling costs for individuals and governments alike. The negative effect of excess sugar consumption contributes to adverse health conditions, including obesity, type 2 diabetes, and poor oral health in both high and low resource settings. A key plank of governmental and health promotion bodies' nutritional guidance is to raise public awareness of "hidden" sugars, salt, and fats, such as found in processed foods and sugar-sweetened beverages (SSBs), and guide individuals to reduce their consumption. This rapid narrative review brings together some of the key issues identified in the literature around the consumption of SSBs, including patterns of consumption, the general impact on human health and nutrition, specific effects on oral health and the oral microbiome, and strategies to address over-consumption. The range of long-term adverse effects on health is often misunderstood or unknown by the public. However, some strategies have succeeded in reducing the consumption of SSBs, including public health strategies and interventions and the imposition of taxes or levies, and this article makes recommendations for action.

Exploration of Sugar-Sweetened Beverage Intake in a Latinx Population

OBJECTIVE

The purpose was to explore contributing factors of sugar-sweetened beverage (SSB) intake in Latinx residing in Southwest Ohio to inform the development of future interventions.

DESIGN

This was a qualitative study utilizing focus groups.

PARTICIPANTS AND SETTING

Latinx participants were recruited from local churches, community centers, and universities to participate in 1 of 6 focus groups (n = 43).

PHENOMENON OF INTEREST

Individual, relational, community, and sociocultural factors related to SSB consumption.

ANALYSIS

Constant comparative analysis of focused, axial, and selective coding to develop themes. Memo writing assisted with conceptualization of the data. Themes mirrored the Socioecological Model.

RESULTS

SSB consumption is rooted in cultural identity and social norms. Other factors include availability, taste, and energy. Suggestions for change consisted of finding acceptable substitutions, creating socially appropriate support networks, developing community and workplace policies, and countering the impact of advertising.

CONCLUSION AND IMPLICATIONS

This study highlights factors across the ecological model that contribute to Latinx SSB consumption in Southwest Ohio. Similar studies in other geographical areas in the US are warranted to confirm these findings. Individual, intrapersonal, community, and societal factors may be utilized in tailoring SSB interventions for Latinx adults to enhance cultural capital and create behavior change. Future interventions may explore and test these factors using the Model of Cultural Change.

An Examination of Family Variables as Mediators of the Association of Acculturation With Sugar-Sweetened Beverage Consumption Among Latinx Adolescents

The objective of this study was to examine the mediating effects of family support for dietary habits and family meal frequency on the relationship between acculturation and sugar-sweetened beverage (SSB) consumption among Latinx adolescents (N = 131). Acculturation was positively associated with SSB consumption (B = 0.07, P < .01). Results suggest that family support for dietary habits and family meal frequency did not mediate the relationship between acculturation and SSB consumption. However, acculturation was negatively associated with family support for dietary habits (B = -0.10, P < .01) and family meal frequency (B = -0.11, P < .05). Future research should examine other family influences as mediators of the relationship between acculturation and SSB consumption.

Exploring the Social Determinants of Drinking Sugary Beverages Leading to Chronic Illness Among Latina/o Populations

INTRODUCTION

The aim of this qualitative study was to assess Latina/o students' sugary drink consumption patterns and understand the social determinants leading to this consumption behavior in order to design more effective health communication-based campaigns. This study examined the perceived reasons behind high levels of sugar-sweetened beverages (SSBs) consumption among college students of Hispanic origin in the Texas Panhandle region.

METHOD

Fifteen Latina/o students were interviewed via an innovative social media-based online interviewing protocol.

RESULTS

Subsequent analyses revealed that peer pressure, socializing, unavailability of packaged drinking water during social events, targeted advertisements, and poor lifestyle choices were perceived reasons for high intake of SSB in the focal population.

CONCLUSION

This study recommends designing public service announcements geared to Latino/a youth that increase awareness about the long-term health risks that can result from high consumption of SSBs. Moreover, the positive health benefits of drinking water should be highlighted and Latina/o parents should avoid glorifying SSBs and restrict their SSB consumption in front of their children. Further research should aim at designing educational messages, using theoretical backing, to test how Latina/o youth respond to them.

Perceptions of drinking water safety and their associations with plain water intake among US Hispanic adults

We described sociodemographic differences in perceptions of drinking water safety and examined associations between perceptions and plain water intake. We used the 2015 Estilos survey of 1,000 US Hispanic adults conducted in both Spanish and English. Outcome was water intake. Exposures were the level of agreement about water perceptions (My tap water is safe to drink; Community tap water is safe to drink; Bottled water is safer; I would buy less bottled water if my tap water was safe). Covariates were sociodemographics, region, Hispanic heritage, and acculturation. We used chi-square tests and multinomial logistic regression to examine associations of water perceptions and intake. Overall, 24% of Hispanic adults consumed water ≤1 time/day. Although 34% disagreed their home tap water was safe to drink, and 41% disagreed their community tap water was safe to drink, 65% agreed bottled water is safer than tap water, and 69% agreed they would buy less bottled water if they knew their tap water was safe. Perceptions differed by some covariates but were not significantly associated with plain water intake. In conclusion, negative perceptions of tap water were common among US Hispanic adults, which can inform efforts to increase awareness about safe public water systems.

Sugar sweetened beverage consumption during pregnancy is associated with lower diet quality and greater total energy intake

OBJECTIVE

Identify the socio-economic correlates of sugar sweetened beverage (SSB) consumption among pregnant women and analyze to what extent SSB consumption is associated with diet quality and total energy intake. Additionally, we aim to predict how diet quality scores and totally energy intakes would change if SSB consumption was artificially set to 0.

DESIGN

Repeated Cross Sectional Study.

SETTING

United States.

SUBJECTS

SSB consumption was estimated from 1-2 24-hour dietary recalls from 1,154 pregnant women who participated in the 1999-2006 National Health and Nutrition Examination Survey.

METHODS

Linear regression models were used to identify socioeconomic and demographic factors associated with SSB consumption and to assess the associations between SSB consumption and diet quality and total energy intake. Diet quality was measured with the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P).

RESULTS

The mean SSB intake was 1.3 servings per day (sd 1.5). Having a household income ≤100% of the Federal Poverty Level, being born in the United States, and not being married or living with a partner were positively associated with SSB consumption. Every 12 oz. of SSBs consumed was associated with a 2.3 lower AHEI-P score (95% CI: 1.6, 2.9) and the consumption of 124 more calories (95% CI: 85, 163), after adjusting for age, country of birth, race/ethnicity, educational attainment, marital status, household income, survey year and day/s of the week the recall/s were collected. Our predictive models indicated that average AHEI-P would be 6.4 (5.4, 7.6) higher and average total energy intakes would be 203.5 calories (122.2, 284.8) lower if SSB intake was set to 0.

CONCLUSIONS

SSB consumption is associated with poorer diet quality and higher total energy intake among pregnant women.

Beyond fatalism: Information overload as a mechanism to understand health disparities

BACKGROUND

Fatalism - beliefs about the causes and controllability of disease - has been negatively associated with prevention behaviors. Fatalism has been suggested as a mechanism for health disparities because ethnic minorities are especially likely to hold fatalistic beliefs. However, the construct has been criticized: Fatalism fails to account for structural barriers to health faced by vulnerable populations that also score highly on measures of fatalism. Another critique suggests that operationalizations of fatalism expose communication failures: "Fatalism" rather reflects information overload from an environment riddled with misinformation and contradictions. This study aimed to expand understanding of one mechanism through which communication may contribute to disparities by considering the context of nutrition among bicultural Latinas, who face increased risk from dietary acculturation.

METHOD

Mixed-methods (semi-structured in-depth interview, survey) with Mexican-American women ages 18-29 (n = 24) in rural California.

RESULTS

Contrary to previous studies, the majority of this sample of Mexican-American women did not endorse fatalistic beliefs; most demonstrated clear understanding of the link between diet and risk of diseases: Diabetes and heart disease were understood to result from behaviors within one's control. Yet despite articulating links between diet and disease, participants felt overloaded and confused about conflicting information from public and interpersonal sources. Moreover, despite reporting feeling inundated with information, participants noted critical information gaps, distinguishing between information available and information needed.

CONCLUSIONS

We found minimal support for fatalistic beliefs among a sample of Mexican-American women, but considerable information overload and confusion, together with a desire for specific knowledge and skills. Results extend understanding of how communication may influence disparities: Information overload may be conflated with fatalism, challenging the notion that fatalism is a cultural belief. Moreover, inequalities in access to and ability to process information compound overload effects. We discuss opportunities to improve the clarity of communication about nutrition science and dietary recommendations.

Knowledge of Health Conditions Associated With Sugar-Sweetened Beverage Intake Is Low Among US Hispanic Adults

PURPOSE

To examine associations between knowledge of health conditions and sugar-sweetened beverage (SSB) intake among Hispanic adults.

DESIGN

Quantitative, cross-sectional study.

SETTING

The 2015 Estilos survey data.

PARTICIPANTS

One thousand US Hispanic adults (≥18 years).

MEASURES

The outcome variable was frequency of SSB intake (regular soda, fruit drink, sports/energy drink, and sweetened coffee/tea drink). Exposure variables were knowledge of 6 SSB-related health conditions (weight gain, diabetes, dental caries, high cholesterol, heart disease, and hypertension).

ANALYSIS

Six multinomial logistic regression models were used to estimate adjusted odds ratios for consuming SSBs ≥3 times/day (high intake), in relation to knowledge of SSB-related health conditions.

RESULTS

Overall, 58% of Hispanic adults consumed SSBs ≥2 times/day and 36% consumed SSBs ≥3 times/day. Although most identified that weight gain (75%) and diabetes (76%) were related to drinking SSBs, only half identified this relation with dental caries (57%) and hypertension (41%). Even fewer identified high cholesterol (32%) and heart disease (32%) as related. In crude analyses, SSB intake was significantly associated with knowledge of the associations between SSBs and weight gain, dental caries, and heart disease; however, after adjusting for sociodemographics and acculturation, associations were no longer significant.

CONCLUSIONS

Although SSB intake was very high, knowledge of SSB-related health conditions was low and was not related to high SSB intake among US Hispanic adults. Education efforts alone may not be adequate for Hispanic adults to change their behaviors.

Association of added sugar intake and caries-related experiences among individuals of Mexican origin

OBJECTIVE

Determine the association between key dental outcomes and added sugar intake using a survey instrument to assess added sugars, which was specifically tailored to immigrant and US-born adults of Mexican origin.

METHODS

Hispanic adults of Mexican origin (n = 326; 36.2 ± 12.1 years) completed a self-administered survey to gather acculturation, self-reported dental experiences and self-care practices (eg brushing, flossing, pain, bleeding gums), and socio-demographic information. The survey included a culturally tailored 22-item Added Sugar Intake Estimate (ASIE) that assessed added sugar intake from processed foods and sugar-sweetened beverages in a semiquantitative food frequency questionnaire format. Linear regression, 2-sample t test, and ANOVA were used to evaluate associations of demographic and dental outcomes with daily added sugar intake.

RESULTS

Of the mean total daily added sugar intake (99.6 ± 94.6 g), 36.5 ± 44.4 g was derived from sugar-containing foods and snacks, and 63.1 ± 68.2 g from beverages. Participants who reported greater added sugar intake were more likely to have reported the presence of a toothache in the preceding 12 months, having been prescribed antibiotics for dental reasons, being less likely to floss daily, have reported eating or drinking within 1 hour before bed and have lower psychological acculturation (P < .05 for all). Results were comparable when assessing intake from sugar-containing foods/snacks and sugar-sweetened beverages.

CONCLUSIONS

This study confirmed the association between added sugar intake and self-reported dental outcomes among adults of Mexican origin and points to an urgent need to improve dietary behaviours in this population.

Questioning the Dietary Acculturation Paradox: A Mixed-Methods Study of the Relationship between Food and Ethnic Identity in a Group of Mexican-American Women

BACKGROUND

Epidemiological studies have described an "acculturation paradox." Increased acculturation to the United States is associated with increased consumption of dietary fat and decreased consumption of fruits/vegetables.

OBJECTIVE

To expand understanding of the dietary acculturation paradox, this study examined how bicultural Mexican-American women construct ethnic identity and how these identities and identity-making processes relate to perceptions of health and nutrition.

DESIGN

We utilized embedded mixed methods (in-depth interviews; survey).

PARTICIPANTS/SETTING

We analyzed a purposive sample of English-speaking Mexican-American women aged 18 to 29 years (n=24) in rural California to assess ethnic identity and diet beliefs.

RESULTS

Participants described food as central to expressing cultural identity, usually in terms of family interactions. Mexican food traditions were characterized as unhealthy; many preferred American foods, which were seen as healthier. Specifically, Mexican-American women perceived Mexican patterns of food preparation and consumption as unhealthy. In addition, traditional Mexican foods described as unhealthy were once considered special-occasion foods. Among the participants who expressed a desire to eat healthfully, to do so meant to reject Mexican ways of eating.

CONCLUSIONS

This study raises questions about the nature of the "dietary acculturation paradox." While food-the eating of Mexican foods-is central to the maintenance of ethnic identity throughout acculturation, negative perceptions about the healthfulness of Mexican foods introduce tension into Mexican-American women's self-identification. This study suggests a subtle contradiction that may help to explain the dietary acculturation paradox: While previous research has suggested that as Mexicans acculturate to the United States they adopt unhealthy diets, this study finds evidence that they do so at least in part due to perceptions that American diets are healthier than Mexican diets. Implications for interventions to improve Latinos' diets include an emphasis on the family and use of Spanish linguistic cues. Finally, messages that simply advocate for "traditional" diets should be reconsidered because that message is discordant with perceptions of the healthfulness of such foods.