Correlates of dietary intake among men involved in the MAN for Health study

The Scale of Ethnic Experience long and short forms in Spanish and English: Psychometric findings from the HCHS/SOL Sociocultural Ancillary Study

OBJECTIVE

To evaluate the psychometric properties and cross-group equivalence of scores from Spanish and English long and short forms of the Scale of Ethnic Experience (SEE; Malcarne et al., 2006) in a multisite representative cohort from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study.

METHOD

Hispanic/Latino adults (N = 5,313) completed a battery of measures, including the original 32-item SEE, in their preferred language of Spanish or English. A 12-item version of the SEE, comprised of three items representing each of the four original subscales, was created and evaluated for invariance across language and self-identified heritage (Mexican, Puerto Rican, Cuban, Central American, Dominican, and South American). Internal consistency reliability and convergent/discriminant validity of the subscales were also evaluated.

RESULTS

Results of confirmatory factor analysis (CFA) did not support the four-subscale structure of the original 32-item SEE (Ethnic Identity, Perceived Discrimination, Social Affiliation, and Mainstream Comfort). Multigroup CFA supported the structural invariance of the SEE-Short Form across language and heritage groups. Patterns for convergent and discriminant validity were generally within expected effect sizes and directions, and consistent across language and heritage.

CONCLUSIONS

Psychometric findings support the utility of the newly developed 12-item short form of the SEE for measuring multiple dimensions of ethnic experience in Hispanic/Latino adults in the United States. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Acute and Chronic Effects of Exercise on Appetite, Energy Intake, and Appetite-Related Hormones: The Modulating Effect of Adiposity, Sex, and Habitual Physical Activity

Exercise facilitates weight control, partly through effects on appetite regulation. Single bouts of exercise induce a short-term energy deficit without stimulating compensatory effects on appetite, whilst limited evidence suggests that exercise training may modify subjective and homeostatic mediators of appetite in directions associated with enhanced meal-induced satiety. However, a large variability in responses exists between individuals. This article reviews the evidence relating to how adiposity, sex, and habitual physical activity modulate exercise-induced appetite, energy intake, and appetite-related hormone responses. The balance of evidence suggests that adiposity and sex do not modify appetite or energy intake responses to acute or chronic exercise interventions, but individuals with higher habitual physical activity levels may better adjust energy intake in response to energy balance perturbations. The effect of these individual characteristics and behaviours on appetite-related hormone responses to exercise remains equivocal. These findings support the continued promotion of exercise as a strategy for inducing short-term energy deficits irrespective of adiposity and sex, as well as the ability of exercise to positively influence energy balance over the longer term. Future well-controlled studies are required to further ascertain the potential mediators of appetite responses to exercise.

Frequency of Intake and Type of Away-from- Home Foods Consumed Are Associated with Diet Quality in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background

Away-from-home foods (AFHFs) influence diet quality, a modifiable obesity risk factor, with limited generalizable evidence in Hispanic/Latino adults.

Objective

We investigated associations between AFHF intake with diet quality and overweight or obesity among US Hispanic/Latino adults.

Methods

Cross-sectional baseline (2008-2011) analyses included adults (n = 16,045) aged 18-74 y in the national Hispanic Community Health Study/Study of Latinos. Participants self-reported AFHF consumption frequency from 10 different settings and dietary intake (2-d 24-h recall). The Alternate Healthy Eating Index-2010 (AHEI-2010) was used to measure diet quality; higher scores indicated a healthier diet and scores were categorized into tertiles. WHO classifications categorized overweight [body mass index (BMI; kg/m2): 25.0-29.9] and obesity (BMI ≥30). Multivariate-adjusted associations of AFHF frequency or type with AHEI-2010, overweight, or obesity were assessed by using complex survey logistic regression (ORs and 95% CIs).

Results

Almost half of participants (47.1%) reported eating AFHFs ≥5 times/wk. The mean ± SE AHEI-2010 score was 47.5 ± 0.2. More than one-third (37.2%) were classified as overweight and 39.6% classified as obese. Compared with consuming AFHFs ≥5 times/wk, consuming AFHFs <1 time/wk or 1-2 times/wk was associated with greater odds of being in higher AHEI-2010 tertiles, indicating a healthier diet [<1 time/wk-tertile 2: OR (95% CI): 1.6 (1.4, 1.9); tertile 3: 2.5 (2.1, 3.1); 1-2 times/wk-tertile 2: OR (95% CI): 1.4 (1.2, 1.6); tertile 3: 1.5 (1.2, 1.8)]. Consumption of AFHFs ≥1 time/wk from each AFHF setting, compared with consumption of any AFHFs <1 time/wk was associated with lower odds of being in higher AHEI-2010 tertiles. Increasing AFHF intake frequency was not associated with odds of overweight or obesity. Eating from on-street vendors ≥1 time/wk was associated with obesity (OR: 1.5; 95% CI: 1.1, 2.0).

Conclusions

Consumption of AFHFs was prevalent among Hispanic/Latino adults and was associated with poorer diet quality. Findings may help to identify dietary targets to improve diet quality and prevent obesity in US Hispanics/Latinos.

Behavioral HIV Prevention Interventions Among Latinas in the US: A Systematic Review of the Evidence

Compared to White women, Latinas are 4 times more likely to contract HIV. In an effort to determine the overall state of the science meant to address this disparity, we reviewed the current HIV prevention intervention literature for U.S. Latinas. We searched 5 online electronic databases from their inception through July, 2014, for HIV prevention interventions including a majority sample of Latinas. Of 1041 articles identified, 20 studies met inclusion criteria. We documented study designs, participant characteristics, outcomes, theories used, and other intervention characteristics. Overall, HIV knowledge and attitudes were the predominant outcome; a small minority of studies included self-reported condom use or STD incidence. Strategies used to address cultural factors specific to Latinas and HIV included; lay health advisors, using ethnographic narratives, or using the Theory of Gender and Power, however few of the interventions adopted these strategies. This study identified several gaps in the intervention literature that need to be addressed. In addition to including more direct measures of decreased HIV risk (ex. condom use), more systematic use of strategies meant to address gender and cultural factors that may place Latinas at increased risk (e.g., gender inequity, traditional gender role norms such as machismo and marianismo, and relationship power dynamics).

Correlates of Cervical Cancer Screening Among Adult Latino Women: A 5-Year Follow-Up

BACKGROUND

Latinas have the highest incidence rates of cervical cancer in the United States, and Latinas in the United States are less likely to utilize cervical cancer screening.

METHOD

We used secondary data analysis of a non-clinical convenience sample (n=316 women at baseline; n=285 at five-year follow-up) to examine correlates of cervical cancer screening among adult Latina women. Univariate and multiple logistic regression models using Generalized Estimated Equations (GEE) algorithm were utilized to assess the influence of the independent variables.

RESULTS

Women who reported their main healthcare source as community health clinics, women who were sexually active, and women who reported that a healthcare provider discussed HIV prevention with them were more likely to report having a cervical cancer screening (aOR=2.06; CI=1.20, 3.52).

CONCLUSION

The results suggest a need for continued efforts to ensure that medically underserved women (e.g., Latina women) receive counseling and education about the importance of preventive cancer screening.

Relationship Factors Associated with Sexual Risk Behavior and High-Risk Alcohol Consumption Among Latino Men Who Have Sex with Men: Challenges and Opportunities to Intervene on HIV Risk

The HIV epidemic continues to be a major public health concern, affecting communities with varying prevention and treatment needs. In the U.S., Latino men who have sex with men (MSM) bear a disproportionate burden of HIV incidence. While recent studies have highlighted the relevance of relationship factors for HIV transmission among MSM generally, the unique needs and experiences of Latino MSM have received relatively little attention. Consequently, associations between relationship factors and HIV risk among Latino MSM remain unknown. This mixed-method study examined relationship status and dynamics and potential HIV-related risk behaviors among Latino MSM. Quantitative analyses with 240 Latino MSM investigated associations between relationship status and engagement in condomless anal intercourse (CAI). Focus groups with 20 Latino male couples and 10 health service providers explored the impact of relationship dynamics on sexual behaviors, as well as opportunities to intervene on HIV risk. The majority of participants were predominantly Spanish speaking, most screened positive for high-risk alcohol consumption in the past month, more than half engaged in CAI in the past 3 months, and a majority reported multiple sexual partners in this period. Among participants in same-sex relationships (n = 175), approximately half reported multiple partners in the previous 3 months and more than two-thirds reported CAI in this time period. Being in a same-sex relationship was positively associated with high-risk alcohol consumption and being age 30 or older and negatively associated with having multiple partners. Moreover, being in a same-sex relationship significantly increased the likelihood that participants would report engaging in CAI. Qualitative analyses identified themes related to relationship dynamics and sexual behavior, as well as opportunities to intervene on HIV risk. Despite the challenges encountered by Latino male couples, most participants expressed commitment to and support for their partners. As such, prevention efforts involving Latino male couples must address relationship dynamics and the role they play in sexual health, including safer sex practices.

Machismo, Marianismo, and Negative Cognitive-Emotional Factors: Findings From the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

There is limited research on the traditional Hispanic male and female gender roles of machismo and marianismo, respectively, in relation to negative cognitions and emotions. Given the vulnerability of Hispanics to negative cognitions and emotions, it is important to examine sociocultural correlates of emotional distress. Therefore, we examined associations of machismo and marianismo with negative cognitive-emotional factors (i.e., depression symptoms; cynical hostility; and trait anxiety and anger) in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study, a cross-sectional cohort study of sociocultural and psychosocial correlates of cardiometabolic health. Participants were aged 18-74 years and self-identified as Hispanic of Central American, Cuban, Dominican, Mexican, Puerto Rican, South American, and other Hispanic background (N = 4,426). Results revealed that specific components of machismo (traditional machismo) and marianismo (family and spiritual pillar dimensions) were associated with higher levels of negative cognitions and emotions after adjusting for socio-demographic factors (p < .05); these associations remained consistent across sex, Hispanic background group, and acculturation. Findings can inform mental health interventions and contribute to our understanding of the importance of gender role socialization in the context of self-reported negative cognitive-emotional factors in Hispanics.

Integration of Social, Cultural, and Biomedical Strategies into an Existing Couple-Based Behavioral HIV/STI Prevention Intervention: Voices of Latino Male Couples

INTRODUCTION

Successful HIV prevention and treatment requires evidence-based approaches that combine biomedical strategies with behavioral interventions that are socially and culturally appropriate for the population or community being prioritized. Although there has been a push for a combination approach, how best to integrate different strategies into existing behavioral HIV prevention interventions remains unclear. The need to develop effective combination approaches is of particular importance for men who have sex with men (MSM), who face a disproportionately high risk of HIV acquisition.

MATERIALS AND METHODS

We collaborated with Latino male couples and providers to adapt Connect 'n Unite, an evidence-based intervention for Black male couples, for Latino male couples. We conducted a series of three focus groups, each with two cohorts of couples, and one focus group with providers. A purposive stratified sample of 20 couples (N = 40, divided into two cohorts) and 10 providers provided insights into how to adapt and integrate social, cultural, and biomedical approaches in a couples-based HIV/AIDS behavioral intervention.

RESULTS

The majority (N = 37) of the couple participants had no prior knowledge of the following new biomedical strategies: non-occupational post-exposure prophylaxis (nPEP); pre-exposure prophylaxis (PrEP); and HIV self-testing kits. After they were introduced to these biomedical interventions, all participants expressed a need for information and empowerment through knowledge and awareness of these interventions. In particular, participants suggested that we provide PrEP and HIV self-testing kits by the middle or end of the intervention. Providers suggested a need to address behavioral, social and structural issues, such as language barriers; and the promotion of client-centered approaches to increase access to, adaptation of, and adherence to biomedical strategies. Corroborating what couple participants suggested, providers agreed that biomedical strategies should be offered after providing information about these tools. Regarding culturally sensitive and responsive approaches, participants identified stigma and discrimination associated with HIV and sexual identity as barriers to care, language barriers and documentation status as further barriers to care, the couple-based approach as ideal to health promotion, and the need to include family topics in the intervention.

DISCUSSION

We successfully adapted an evidence-based behavioral HIV prevention intervention for Latino male couples. The adapted intervention, called Conectando Latinos en Pareja, integrates social, cultural, behavioral and biomedical strategies to address the HIV epidemic among Latino MSM. The study highlights the promise regarding the feasibility of implementing a combination approach to HIV prevention in this population.

"I AM a Man": Manhood, Minority Men's Health and Health Equity

OBJECTIVE

To consider how manhood is a key social determinant of minority men's health.

DESIGN

This commentary explicates how manhood intersects with other determinants of health to shape minority men's stress responses, health behaviors and health outcomes across the life course.

RESULTS

Manhood, which perpetually needs to be proven, is an aspirational identity that is defined by the intersection of age, race/ethnicity and other identities. Minority men seek to and successfully embody US-cultural and ethnic-specific aspects of manhood in their daily lives by engaging in behaviors that constantly reaffirm their gender identity through a complex internal and social calculus that varies by intra-personal characteristics and context. Manhood and health are relational constructs that highlight how the salience of masculinities are shaped by perceived and actual social norms and expectations. A life course perspective adds a framework for considering how some gendered beliefs, goals and behaviors change over time while others remain static. Three life course frameworks highlight different mechanisms through which minority men's life experiences and physiological and behavioral responses to gendered social norms, beliefs and expectations become embodied as premature mortality and other health outcomes over the life course.

CONCLUSION

Manhood represents an important lens to understand how minority men's identities, goals and priorities affect their health, yet the role of manhood in minority men's health is understudied and underdeveloped. To achieve health equity, it is critical to consider how manhood shapes minority men's lives and health across the life course, and to address how manhood affects gendered and non-gendered mechanisms and pathways that explain minority men's health over time.

Increasing Cervical Cancer Screening Among US Hispanics/Latinas: A Qualitative Systematic Review

Hispanic/Latina women experience the highest cervical cancer incidence rates of any racial/ethnic group in the USA and tend to present with more severe cases and experience higher mortality compared to most other populations. The goals of this qualitative systematic review were to explore existing interventions to increase cervical cancer screening among US Hispanics/Latinas and to identify characteristics of effective interventions and research gaps. Six online databases were searched from their inception through June 30, 2013, using designated search terms and keywords. Peer-reviewed articles that documented an intervention designed to improve screening for cervical cancer among Hispanics/Latinas ages 18 years and older living in the USA were reviewed. Data were abstracted using a standardized form to document intervention characteristics and results. Forty-five articles, describing 32 unique interventions, met inclusion criteria. Identified interventions consisted primarily of educational programs and/or provision of screening. Interventions used lay health advisors (LHAs), clinic-based outreach/delivery strategies, partnerships with churches, and mass media campaigns. Twelve interventions resulted in significant increases in cervical cancer screening rates. Interventions developed utilizing theory, applying community-based participatory research approaches, and using LHAs were identified as having the greatest potential for improving cervical cancer screening among Hispanics/Latinas. There continues to be a need for the development of interventions in geographic areas with new and emerging Hispanic/Latino populations and that are comprehensive, follow participants for longer periods of time, and broaden the roles and build the capacities of LHAs.

Contextual factors and weight change over time: a comparison between U.S. Hispanics and other population sub-groups

In recent decades there has been an increasing interest in understanding the role of social and physical contexts in influencing health behaviors and outcomes. This is especially true for weight, which is considered to be highly dependent on environmental factors. The evidence linking neighborhood characteristics to weight in the United States, however, is mixed. Many studies in this area are hampered by cross sectional designs and a limited scope, insofar as they investigate only one dimension of neighborhood context. It is also unclear to what extent neighborhood characteristics account for racial/ethnic disparities in weight. Using longitudinal data from the Los Angeles Family and Neighborhood Survey (L.A. FANS), we compare patterns of weight change between Hispanics and other racial and ethnic groups in order to evaluate whether we observe a pattern of unhealthy assimilation in weight among Hispanic immigrants and to identify differences in the rate at which different groups gain weight over time. We also explore the extent to which patterns of weight change are related to a wider range of community characteristics. We find that weight increases across all groups between the two study waves of L.A. FANS and that the increases are significant except for Asians/Pacific Islanders. With respect to differences in the pace of weight change, second and higher generation Hispanic women and black men gain weight more rapidly than their first generation Hispanic counterparts. Although the evidence presented indicates that first generation Hispanics gain weight, we do not find evidence for convergence in weight since the U.S.-born gain weight at a more rapid rate. The inclusion of community-level variables does not alter the relationships between the race, ethnicity, and immigrant generation categories and weight change. Of the six types of community characteristics considered, only collective efficacy is consistently and significantly associated with weight change, although the protective effect of neighborhood collective efficacy is seen only among women.

Efficacy of a store-based environmental change intervention compared with a delayed treatment control condition on store customers' intake of fruits and vegetables

OBJECTIVE

The present store-based intervention was designed to promote sales of fruits and vegetables (F&V) to increase intake among store customers--specifically customers of tiendas, small-to-medium-sized Latino food stores.

DESIGN

Four tiendas were randomized to a 2-month environmental change intervention or a delayed treatment control condition. Employees and managers were trained to promote F&V sales, including how to implement a food marketing campaign and installing store equipment to promote fresh fruits and vegetables. The primary outcome was self-reported daily intake of F&V among a convenience sample of customers (at least forty per store) collected at baseline prior to randomization and then 4 months later. In addition, changes in availability of F&V in the tiendas, using unobtrusive observational methods, provided evidence of intervention fidelity.

SETTING

Tiendas in central North Carolina.

SUBJECTS

Participants included 179 customers who were recent immigrants from Mexico and Central America.

RESULTS

A group-by-time interaction approached significance on daily servings of F&V; intervention customers reported an increase in F&V intake over time and as a function of the intervention (P < or = 0.06). Unexpectedly, self-efficacy for consuming more fruits (P < or = 0.01) and more vegetables (P < or = 0.06) decreased. In our store-level analyses, a group-by-time interaction was observed for availability of fresh and canned vegetables; the intervention increased availability of vegetables but not fruit.

CONCLUSIONS

Environmental change strategies to promote healthy eating are needed given the rates of obesity and diabetes in the Latino population. A store-based intervention was moderately effective at increasing customers’ reported F&V intake. Such strategies can have a public health impact on underserved populations.

Measuring masculinity in research on men of color: findings and future directions

The purpose of this study was to examine the association between masculinity and the health of US men of color aged 18 years and older. We identified 22 population-based studies that included a measure of masculinity and a measure of health behavior, mental health, or physical health. The associations between masculinity and health were complex and varied by construct and health outcome, though they generally were significant in the hypothesized directions. Future research should explore the centrality of masculinity versus other identities and characteristics, how the relationship between masculinity and health varies by health outcome, and the identification of the conceptions and aspects of masculinity that are most relevant to and associated with specific health behaviors and health outcomes.

Association between proximity to and coverage of traditional fast-food restaurants and non-traditional fast-food outlets and fast-food consumption among rural adults

OBJECTIVE

The objective of this study is to examine the relationship between residential exposure to fast-food entrées, using two measures of potential spatial access: proximity (distance to the nearest location) and coverage (number of different locations), and weekly consumption of fast-food meals.

METHODS

Traditional fast-food restaurants and non-traditional fast-food outlets, such as convenience stores, supermarkets, and grocery stores, from the 2006 Brazos Valley Food Environment Project were linked with individual participants (n = 1409) who completed the nutrition module in the 2006 Brazos Valley Community Health Assessment.

RESULTS

Increased age, poverty, increased distance to the nearest fast food, and increased number of different traditional fast-food restaurants, non-traditional fast-food outlets, or fast-food opportunities were associated with less frequent weekly consumption of fast-food meals. The interaction of gender and proximity (distance) or coverage (number) indicated that the association of proximity to or coverage of fast-food locations on fast-food consumption was greater among women and opposite of independent effects.

CONCLUSIONS

Results provide impetus for identifying and understanding the complex relationship between access to all fast-food opportunities, rather than to traditional fast-food restaurants alone, and fast-food consumption. The results indicate the importance of further examining the complex interaction of gender and distance in rural areas and particularly in fast-food consumption. Furthermore, this study emphasizes the need for health promotion and policy efforts to consider all sources of fast-food as part of promoting healthful food choices.

Lifestyle Behaviours and Plasma Vitamin C and β-Carotene Levels from the ELAN Population (Liège, Belgium)

Several factors, including fruit and vegetables intakes, have been shown to significantly influence the plasma concentrations of the two antioxidants vitamin C and β-carotene. Deficiency levels of 6 mg/L (34.2 μM) for vitamin C and of 0.22 mg/L (0.4 μM) for β-carotene have been suggested below which cardiovascular risk might be increased. The present study performed on 897 presumably healthy subjects aged 40–60 years aimed to examine how modifiable lifestyle factors may be related to vitamin C and/or β-carotene deficiency. Gender, smoking, lack of regular physical activity and of daily fruit consumption (≥2/day), and social status (in particular, unemployment) were found to be significant risk factors for vitamin C deficiency. For β-carotene deficiency, the same factors were identified except social status; moreover, overweight and OC use in women were also found to have a deleterious effect. For non exposed subjects, the probability of developing vitamin C deficiency was 4% in men and 2.4% in women. This probability increased to 66.3% for men and to 44.3% for women (and even to 50.4% under OC use), when all risk factors were present. For β-carotene deficiency, the corresponding probabilities were equal to 29.7% in men and 13.7% in women (no risk factor present), and to 86.1% for men and 69.9% (91.6% for OC use) for women (all factors present), respectively.