Attitudes and beliefs about colorectal cancer among Mexican Americans in communities along the US-Mexico border

PURPOSE

The purpose of this study was to examine Mexican American knowledge, attitudes, and beliefs about colorectal cancer and barriers to receiving colorectal cancer screening exams.

DESIGN

We developed an open-topic focus group schedule that addressed knowledge, attitudes, and beliefs about screening for colorectal cancer and identified cultural issues to be considered when developing educational interventions to increase screening participation. Focus groups were used to elicit participant responses.

SETTING

Two small communities (colonias) along the US-Mexico border.

SUBJECTS

Mexican Americans ages > or = 50 years.

RESULTS

A total of 43 individuals (20 men and 23 women) participated in the focus groups, each of which lasted approximately 90 minutes. Few focus group participants had ever heard of colorectal cancer or specific screening exams to detect early forms of cancer. Participants identified cost of medical care and embarrassment about receiving colorectal exams as barriers to screening participation. Respondents commonly expressed fatalistic attitudes about their chances of recovering from cancer, some preferred not to know if they had cancer or believed that they would refuse treatment if diagnosed with cancer. Nevertheless, many participants noted that strong support from family and friends or a strong will would allow one to survive cancer.

CONCLUSION

Interventions to improve participation in screening services for colorectal cancer should focus on reducing the influences of cost and embarrassment and improving levels of knowledge about colorectal cancer and the need for screening.

Child Passenger Safety Behaviors in Latino Communities

Booster seats protect child occupants between 4 and 8 years of age. The objective of this study was to determine barriers and facilitators for booster seat use among Latino families. We conducted one-to-one elicitation interviews with 56 mothers and 35 fathers of booster-eligible Latino children in an urban county and a rural county in Washington State. Half of the parents did not consistently use booster seats. Interviews were recorded, transcribed, translated, and coded. Statements expressed by at least one-third of respondents were entered into explanatory models. Motivators for booster use were child safety and concern about getting a ticket. Facilitators for booster use included affordability, ease of use, and children liking the seat. Barriers were the belief that the child was too big/old, perceived child resistance, and cost. Rural parents preferred radio to television messages. Campaign messages highlighting the risks to child safety and the risk of a citation are likely to motivate booster seat use among Latino families.

A short acculturation scale for Mexican-American populations

Acculturation is important to examine variables that differentiate members of ethnic groups so that interventions can be appropriately targeted. By using a population-based sample of Mexican-origin adults, we sought to validate an acculturation scale for Mexican-American populations. The acculturation instrument included eight items adapted from the Acculturation Rating Scale for Mexican Americans (ARSMA). By using principal component analysis, we calculated eigenvalues for the eight items. The first principal component accounted for 66% of the variance. Language spoken most of the time, by itself, explained 62.4% of the variance of the full model, whereas birthplace, by itself, accounted for 74%. Slight increases in correlation values were observed beyond a four-item model that included language spoken most of the time, language thought, ethnic identity, and birthplace. Future studies should compare this scale with other multidimensional scales.

Health symptoms and exposure to organophosphate pesticides in farmworkers

BACKGROUND

Few studies have examined the relationship between reported health symptoms and exposure to organophosphate (OP) pesticides.

METHODS

Fisher's exact test was used to assess the relationship between self-reported health symptoms and indicators of exposure to OP pesticides in 211 farmworkers in Eastern Washington.

RESULTS

The health symptoms most commonly reported included headaches (50%), burning eyes (39%), pain in muscles, joints, or bones (35%), a rash or itchy skin (25%), and blurred vision (23%). Exposure to pesticides was prevalent. The proportion of detectable samples of various pesticide residues in house and vehicle dust was weakly associated with reporting certain health symptoms, particularly burning eyes and shortness of breath. No significant associations were found between reporting health symptoms and the proportion of detectable urinary pesticide metabolites.

CONCLUSIONS

Certain self-reported health symptoms in farmworkers may be associated with indicators of exposure to pesticides. Longitudinal studies with more precise health symptom data are needed to explore this relationship further.

Use of Pap test among Hispanics and non-Hispanic whites in a rural setting

BACKGROUND

Hispanic women in the United States have a higher incidence of invasive cervical cancer than non-Hispanic whites. A key factor related to the relatively high incidence is the underutilization of cancer-screening services. Several previous investigations have reported that Hispanic women are less likely to comply with screening recommendations for Pap testing; some have identified factors that are associated with non-compliance with screening recommendations.

METHODS

Using baseline personal interview data from a randomized community trial on cancer prevention in a rural area, we assessed the association between health barriers and non-compliance with cervical screening recommendations.

RESULTS

Among Hispanic women (n = 382), those with a lower level of acculturation were more likely than highly acculturated Hispanic and non-Hispanic white women (n = 385) to report personal barriers as reasons for not getting an initial or subsequent screening exam. Such barriers include fear of finding cancer, fear of finding diseases other than cancer, and embarrassment about receiving a physical exam. Certain structural barriers, such as cost of care, no time off work, and lack of transportation, were reported to be associated with non-compliance with routine cervical cancer screening, especially among non-Hispanic white women.

CONCLUSIONS

Future research should examine barriers related to initial and subsequent screening among Hispanics with varying levels of acculturation.

Higher fat intake and lower fruit and vegetables intakes are associated with greater acculturation among Mexicans living in Washington State

OBJECTIVE

To examine associations of diet with acculturation among Hispanic immigrants from Mexico to Washington state and to compare dietary patterns of Hispanic with non-Hispanic white residents.

DESIGN

Data are part of the baseline assessment for a community-randomized cancer prevention trial. The Fat-Related Diet Habits questionnaire and the National 5-A-Day for Better Health program dietary assessment instruments were used to collect data on fat and fruit and vegetable intake, respectively. Data were also collected on demographic characteristics and acculturation status.

SUBJECTS/SETTING

A total of 1,689 adult Hispanic and non-Hispanic white residents of 20 communities in the Yakima Valley, WA, completed in-person interviews.

STATISTICAL ANALYSES PERFORMED

Mixed model regression analyses tested associations of acculturation with diet. These models compared the fat and the fruit and vegetable intake of Hispanics vs non-Hispanic white residents. Additional analyses compared the diets of highly acculturated Hispanics with low-acculturated Hispanics. All models included age, sex, income, and education and were also adjusted for the random effect of community.

RESULTS

Dietary patterns varied by ethnicity and acculturation status. On average, compared with non-Hispanic white residents, Hispanics consumed one more serving of fruits and vegetables per day (P<.001). Dietary habits changed as Hispanics acculturated to the United States. Highly acculturated Hispanics ate fewer servings of fruits and vegetables per day compared with those not highly acculturated (P<.05). Highly acculturated Hispanics had slightly higher, but not statistically significant, scores on the Fat-Related Diet Habits questionnaire, which corresponds to a higher fat intake, compared with low-acculturated Hispanics. The early dietary changes made on acculturation included adding fat at the table to breads and potatoes.

APPLICATIONS/CONCLUSIONS

Nutrition professionals should encourage their Hispanic clients to maintain their traditional dietary practices, such as a high intake of fruits and vegetables and eating bread and potatoes without added fat.

Agricultural task and exposure to organophosphate pesticides among farmworkers

Little is known about pesticide exposure among farmworkers, and even less is known about the exposure associated with performing specific farm tasks. Using a random sample of 213 farmworkers in 24 communities and labor camps in eastern Washington State, we examined the association between occupational task and organophosphate (OP) pesticide residues in dust and OP metabolite concentrations in urine samples of adult farmworkers and their children. The data are from a larger study that sought to test a culturally appropriate intervention to break the take-home pathway of pesticide exposure. Commonly reported farm tasks were harvesting or picking (79.2%), thinning (64.2%), loading plants or produce (42.2%), planting or transplanting (37.6%), and pruning (37.2%). Mixing, loading, or applying pesticide formulations was reported by 20% of our sample. Workers who thinned were more likely than those who did not to have detectable levels of azinphos-methyl in their house dust (92.1% vs. 72.7%; p = 0.001) and vehicle dust (92.6% vs. 76.5%; p = 0.002). Thinning was associated with higher urinary pesticide metabolite concentrations in children (91.9% detectable vs. 81.3%; p = 0.02) but not in adults. Contrary to expectation, workers who reported mixing, loading, or applying pesticide formulations had lower detectable levels of pesticide residues in their house or vehicle dust, compared with those who did not perform these job tasks, though the differences were not significant. Future research should evaluate workplace protective practices of fieldworkers and the adequacy of reentry intervals for pesticides used during thinning.

Attitudes and Beliefs Among Mexican Americans About Type 2 Diabetes

Hispanics in the United States have a disproportionately high risk for non-insulin-dependent diabetes mellitus (type 2 diabetes) compared with non-Hispanic whites. Little is known of the attitudes and beliefs about diabetes in this group. Using data from six focus groups of 42 Mexican Americans (14 men and 28 women), we characterized perceptions about the causes of and treatments for type 2 diabetes. Many participants believed diabetes is caused by having a family history of the disease, eating a diet high in fat or sugar, and engaging in minimal exercise. Experiencing strong emotions such as fright (susto), intense anger (coraje), or sadness and depression (tristeza) was also thought to precipitate diabetes. Nearly all participants expressed the belief that it is important to follow doctors' recommendations for diet and exercise, oral medication or insulin; many also cited herbal therapies, such as prickly pear cactus (nopal) and aloe vera (savila) as effective treatments. These findings may be useful in designing interventions to reduce the burden of diabetes in Hispanic populations.

Pesticide take-home pathway among children of agricultural workers: study design, methods, and baseline findings

Farmworkers are exposed to pesticides and may take home pesticide residues to their families. In this paper, self-reported pesticide exposure and home practices to reduce the amount of pesticide residues taken home were examined among 571 farmworkers. Urine samples from a subsample of farmworkers and children and dust samples from households and vehicles also assessed pesticide exposure. Overall, 96% of respondents reported exposure to pesticides at work. Many employers did not provide resources for hand washing. Farmworkers' protective practices to keep pesticide residues out of the home were at a low level. In a subset of respondents, pesticide levels above the limit of quantitation were seen in the urine of children and adults and in house and vehicle dust. The results support the take-home pathway of pesticide exposure. Ways must be found to reduce this pesticide exposure among children of farmworkers.

Assessing cervical cancer risk in Hispanics

Population-based cancer registries rely on various methods to assign Hispanic ethnic identifiers to patients in the registry. The methods may result in misclassification of patient ethnic identities. Such misclassification may obscure the real incidence of cervical cancer among Hispanic women. This review summarizes previous literature on the accuracy of methods used to ascertain Hispanic ethnicity in numerator and denominator data for the calculation of cancer incidence. In addition, cancer registry ethnicity ascertainment methods were examined for six United States states (California, Florida, Illinois, New Mexico, New York, and Texas) that have a high proportion of Hispanics. The percentage of persons classified as Hispanic who self-identified as Hispanic (predictive value positive) in various reported studies ranged from 54 to 76% for women. The accuracy of ethnicity assignments based on either the United States census list or the Generally Useful Ethnic Search System (GUESS) program show slight differences in percentages of self-identified Hispanics who were classified as Hispanic (sensitivity among women: 62-80% for 1980 United States census list, 63-82% for GUESS program). Higher sensitivity and lower predictive value positive is achieved with a greater number of sources used. In conclusion, decisions about collecting racial and ethnicity information are influenced by demographic changes, immigration trends, changes in ethnic and racial identity, legislative needs, and public policies. The rapidly growing Hispanic population and the excess incidence of cervical cancer in this population requires improving the accuracy of ethnicity information.

Cancer prevention behaviors and socioeconomic status among Hispanics and non-Hispanic whites in a rural population in the United States

OBJECTIVES

Socioeconomic status is explored as a predictor of differences between Hispanics and non-Hispanic Whites in cancer prevention behavior.

METHODS

In a cross-sectional study, in-person interviews (n = 1795) were conducted in a population-based random sample of adults in 20 communities with a high proportion of Hispanics.

RESULTS

Hispanics were significantly less likely than non-Hispanic Whites to ever have had cervical (p < 0.001), breast (p = 0.007), or colorectal cancer (FOBT p = 0.008; sigmoidoscopy/colonoscopy p < 0.002) screening. After adjusting for socioeconomic status (education and having health insurance), only differences in cervical cancer remained significant (p = 0.024). After adjusting for socioeconomic status, Hispanics had a significantly higher intake of fruits and vegetables per day (4.84 servings) than non-Hispanic Whites (3.84 servings) (p < 0.001); and fat behavior score was marginally significant after adjustment for socioeconomic status (p = 0.053). Significantly fewer Hispanics were current smokers than non-Hispanic Whites (p < 0.001).

CONCLUSIONS

There is only limited support for the hypothesis that socioeconomic status is a major determinant of some cancer-related behaviors; specifically, socioeconomic status is related to mammography and colorectal screening, but not cervical cancer, dietary behavior, or smoking.

Factors related to cancer screening in Hispanics: a comparison of the perceptions of Hispanic community members, health care providers, and representatives of organizations that serve Hispanics

Hispanics have lower rates of screening for cervical, breast, and colon cancer than non-Hispanics. Activities to increase cancer screening in this population may not be informed by Hispanics, which may have implications for success rates of interventions. In this study, the perceptions about cancer screening behaviors in Hispanics are compared among three groups: a random sample of respondents (75% Hispanic) to a population-based survey, health care providers (primarily non-Hispanic), and representatives of organizations that serve Hispanics (36% Hispanic). While there was agreement that socioeconomic factors were important for cancer screening, differing views were expressed regarding the importance of cultural factors for cancer screening among Hispanics. Interventions developed by those who serve the Hispanic population may be based on inaccurate perceptions about the beliefs and practices of the population served. For effective interventions, it will be necessary to understand the factors important to Hispanics for cancer screening.

Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study

OBJECTIVE

To determine the extent to which uterine leiomyomas are associated with characteristics of pregnancy, labor, and neonatal outcome recorded on birth certificates.

METHODS

In a population-based series of women who delivered singleton live infants in Washington state from 1987-1993, we linked computerized birth certificates and hospital discharge records to investigate the relationship between uterine leiomyomas and complications in pregnancy and delivery. Subjects were 2065 women with uterine leiomyomas noted on computerized hospital discharge records. From the remaining records, a comparison group of women without uterine leiomyomas diagnoses were selected at random and frequency-matched by birth year to women with leiomyomas. We used unconditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of pregnancy or delivery complications in relation to uterine leiomyomas after multivariate adjustment.

RESULTS

Women with leiomyomas were more likely than controls to be over age 35 at delivery, nulliparous, or black. We observed independent associations between uterine leiomyomas and abruptio placentae (OR 3. 87, 95% CI 1.63, 9.17), first trimester bleeding (OR 1.82, 95% CI 1. 05, 3.20), dysfunctional labor (OR 1.85, 95% CI 1.26, 2.72), and breech presentation (OR 3.98, 95% CI 3.07, 5.16). The risk of cesarean was also higher among women with uterine leiomyomas (OR 6. 39, 95% CI 5.46, 7.50), but a portion of the excess risk might have been due to biased detection of leiomyomas at cesarean delivery.

CONCLUSION

Leiomyomas appear to increase likelihood of complications during pregnancy, labor, and delivery.