Self-reported diabetes in Mexican Americans: HHANES 1982-84

"No sufro, estoy bien/I am not suffering, so I am doing OK": A mixed method exploration of individual and network-level factors and Type 2 Diabetes Mellitus (T2DM) among Mexican American adults in New York City

INTRODUCTION

The prevalence of type 2 Diabetes Mellitus (T2DM) is 2-3 times greater among Mexican Americans than non-Latino whites, and Mexican Americans are more likely to develop T2DM at younger ages and experience higher rates of complications. Social networks might play a crucial role in both T2DM etiology and management through social support, access to resources, social engagement, and health behavioral norms.

OBJECTIVE

To quantitatively identify the social network features associated with glycated hemoglobin (HbA1c) in a community sample of Mexican immigrants residing in New York City, and to explore the extent to which these quantitative findings converge with qualitative narratives of their lived experiences.

METHODS

This study used a convergent mixed methods design. To collect personal network data, we used EgoWeb, and obtained 1,400 personal network ties from 81 participants. HbA1c readings were collected using dried blood spots and categorized according to the laboratory criteria of the American Diabetes Association. Additional survey data were collected using Qualtrics software. To investigate the significance of the network-level factors after accounting for the socioeconomic and demographic individual-level factors that the literature indicates to be associated with T2DM, we used a multiple regression model on quantitative data sources. For the qualitative portion of the study, we selected a subset of individuals who participated in the quantitative portion, which represented 500 personal network ties from 25 participants. We conducted in-depth interviews guided by the visualization of these ties to explore who was helpful or difficult in managing their health and health behaviors.

RESULTS

Individual-level indicators associated with lower HbA1c scores were body mass index (β = -0.07, p<0.05), and healthy eating index scores (β = -0.03, p<0.02). The network-level predictor associated with higher HbA1c levels was the percentage of diabetic alters in the network (β = 0.08, p <0.001, with a 25% increase in the percentages associated 2.0 change in HbA1c levels. The qualitative data highlighted that most of the diabetes-related information diffused through the social networks of our participants was related to dietary practices, such as reducing sugar and red meat consumption, eating out less, and reducing portion sizes. Notably, even among those with elevated levels and diabetes-related health complications, HbA1c was not considered a part of the lay descriptions of good health since they were not "suffering." Participants regarded doctors as the ultimate authority in diabetes care, even if they had supportive members in their personal networks.

CONCLUSION

Our study provides quantitative evidence for the significant role of diabetic network members in the etiology and management of T2DM among Mexican Americans. Our qualitative findings suggest important ley terms for T2DM management and the importance of physicians, which could be included in in future social networks studies seeking to diffuse diabetes-related health information for T2DM prevention and management efforts in this population.

The relation of acculturation to overweight, obesity, pre-diabetes and diabetes among U.S. Mexican-American women and men

OBJECTIVE

To estimate and compare the prevalences of overweight, obesity, pre-diabetes and diabetes among a nationally representative sample of Mexican-American, non-Latino white and black adults, and by acculturation for Mexican-Americans.

DESIGN, SETTINGS AND PARTICIPANTS

The NHANES 1999-2008 data sets were used. Binomial regression models were used to compute prevalence ratios and their respective 95% confidence intervals to assess the relationships of race/ethnicity and acculturation with obesity, overweight, pre-diabetes and diabetes.

MAIN OUTCOME MEASURES

Overweight, obesity, pre-diabetes, and diabetes.

RESULTS

Mexican Americans had a higher prevalence of overweight than white non-Latinos and Black non-Latinos. Obesity was significantly more prevalent among the most acculturated Mexican Americans but not the least acculturated. In contrast, the least acculturated Mexican Americans had the highest prevalence of overweight. The prevalence of pre-diabetes was higher among Mexican Americans than white non-Latinos and black non-Latinos. The most acculturated Mexican Americans had a higher prevalence of diabetes and the prevalence of pre-diabetes was elevated in less acculturated Mexican Americans. In both unadjusted and adjusted models, the less acculturated were significantly more likely to be overweight and significantly less likely to be obese, compared to more acculturated Mexican Americans, and acculturation was not associated with diabetes or prediabetes in adjusted models.

CONCLUSION

Our results suggest that obesity was less prevalent among the least acculturated Mexican-Americans but overweight was more prevalent.

Acculturation, nutrition, and health disparities in Latinos

BACKGROUND

Latinos have become the largest minority group in the United States and will represent 25% of the US population by 2050. Latinos experience a disproportionate burden of poverty and poor health outcomes.

OBJECTIVES

We critically examined the evidence for a link between acculturation and health disparities in Latinos with a focus on type 2 diabetes (T2D) and nutrition-related risk factors and illustrated how acculturation principles can help design a culturally appropriate T2D self-management intervention in Latinos.

DESIGN

Evidence presented in this article was drawn from 1) systematic reviews identified through PubMed searches, 2) backward searches that were based on articles cited, 3) experts in the field, and 4) the author's personal files.

RESULTS

The preponderance of the evidence supported an association of acculturation with poor dietary quality and obesity. These associations appeared to be modified by several socioeconomic and demographic factors and were not always linear. The association between acculturation and T2D is unclear.

CONCLUSIONS

Longitudinal studies and more sophisticated analytic approaches are needed to better understand if and how acculturation affects health-disparity outcomes in Latinos. Tailoring interventions to the acculturation level of individuals is likely to help reduce health disparities in Latinos.

Association of acculturation levels and prevalence of diabetes in the multi-ethnic study of atherosclerosis (MESA)

OBJECTIVE

The prevalence of type 2 diabetes among Hispanic and Asian Americans is increasing. These groups are largely comprised of immigrants who may be undergoing behavioral and lifestyle changes associated with development of diabetes. We studied the association between acculturation and diabetes in a population sample of 708 Mexican-origin Hispanics, 547 non-Mexican-origin Hispanics, and 737 Chinese participants in the Multi-Ethnic Study of Atherosclerosis (MESA).

RESEARCH DESIGN AND METHODS

Diabetes was defined as fasting glucose >/=126 mg/dl and/or use of antidiabetic medications. An acculturation score was calculated for all participants using nativity, years living in the U.S., and language spoken at home. The score ranged from 0 to 5 (0 = least acculturated and 5 = most acculturated). Relative risk regression was used to estimate the association between acculturation and diabetes.

RESULTS

For non-Mexican-origin Hispanics, the prevalence of diabetes was positively associated with acculturation score, after adjustment for sociodemographics. The prevalence of diabetes was significantly higher among the most acculturated versus the least acculturated non-Mexican-origin Hispanics (prevalence ratio 2.49 [95% CI 1.14-5.44]); the higher the acculturation score is, the higher the prevalence of diabetes (P for trend 0.059). This relationship between acculturation and diabetes was partly attenuated after adjustment for BMI or diet. Diabetes prevalence was not related to acculturation among Chinese or Mexican-origin Hispanics.

CONCLUSIONS

Among non-Mexican-origin Hispanics in MESA, greater acculturation is associated with higher diabetes prevalence. The relation is at least partly mediated by BMI and diet. Acculturation is a factor that should be considered when predictors of diabetes in racial/ethnic groups are examined.

Prevalence of self-reported diabetes and exposure to organochlorine pesticides among Mexican Americans: Hispanic health and nutrition examination survey, 1982-1984

BACKGROUND

The prevalence of diabetes is higher among Mexican Americans than among non-Hispanic whites. Higher serum levels of organochlorine pesticides in Mexican Americans have been reported. Few studies have explored the association between pesticide exposure and diabetes.

OBJECTIVES

We set out to examine the association between self-reported diabetes and serum concentrations of organochlorine pesticides among Mexican Americans residing in the southwestern United States from 1982 to 1984.

METHODS

This study was conducted among a sample of 1,303 Mexican Americans 20-74 years of age from the Hispanic Health and Nutrition Examination Survey. Serum concentrations were available for seven pesticides or pesticide metabolites at quantifiable levels in at least 1% of the study population: p,p'-DDT (dichlorodiphenyltrichloroethane), p,p'-DDE (dichlorodiphenyldichloro-ethylene), dieldrin, oxychlordane, beta-hexachlorocyclohexane, hexachlorobenzene, and trans-nonachlor. We used logistic regression to evaluate the association of self-reported diabetes with exposure to organochlorine pesticides, with and without adjustment for total serum lipids. Nonfasting serum glucose values were compared among exposure groups.

RESULTS

Self-reported diabetes was significantly associated with serum levels above the detectable limit for trans-nonachlor, oxychlordane, and beta-hexachlorocyclohexane and among those with the highest level of exposure to p,p'-DDT and p,p'-DDE. On adjustment for total serum lipids, the association with p,p'-DDT remained significant. Serum glucose levels were elevated among those exposed to trans-nonachlor and beta-hexachlorocyclohexane.

CONCLUSION

This study suggests that higher serum levels of certain organochlorine pesticides may be associated with increased prevalence of diabetes. Additional studies with more extensive clinical assessment are needed to confirm this association.

The role of acculturation in nutrition, lifestyle, and incidence of type 2 diabetes among Latinos

Latinos have become the largest ethnic minority group in the U.S. and will become 25% of the population by 2050. The purpose of this critical review is to examine the influence of acculturation on type 2 diabetes and corresponding risk factors, including 1) dietary intake, 2) physical activity patterns, 3) smoking and alcohol consumption, and 4) obesity. Among Latinos, acculturation has been associated with obesity risk, suboptimal dietary choices including lack of breast-feeding, low intake of fruits and vegetables, a higher consumption of fats and artificial drinks containing high levels of refined sugar, smoking, and alcohol consumption. In contrast, acculturation has been positively associated with physical activity and a lower likelihood of type 2 diabetes among Latinos. However, findings have been inconsistent across acculturation indicators and appear to be strongly modified by Latino subethnicity and gender. It is important to improve existing acculturation measures available. Mexican Americans have been the target group in the majority of studies. Research in this group must continue but it is important to conduct additional research with other Latino subgroups that have been left out of most of the acculturation, lifestyles, and health outcomes research. Differences between acculturation and health-related outcomes may be confounded by socio-economic status, age, and movement from urban to rural areas. Longitudinal multivariate acculturation research is essential to disentangle these relations and to develop sound behavioral change theories that adequately predict behavioral change among Latinos.

Racial and ethnic differences in diabetes care and health care use and costs

INTRODUCTION

Previous studies have shown racial and ethnic differences in diabetes complication rates and diabetes control. The objective of this study was to examine racial and ethnic differences in diabetes care and health care use and costs for adults with diabetes using a nationally representative sample of the U.S. noninstitutionalized civilian population.

METHODS

We performed a cross-sectional analysis of the 2000 Medical Expenditure Panel Survey (MEPS) and its related Diabetes Care Survey. The respondents were adults (aged 18 years and older) with diabetes, including non-Hispanic whites, non-Hispanic African Americans, and Hispanics. Racial and ethnic differences were examined in diabetes process of care and health care use and costs using logistic regression, negative binomial regression, and ordinary least squares regression with log cost.

RESULTS

Most of the outcomes in diabetes care management, treatment, and complications were not significantly different among race groups. After adjusting for socioeconomic and demographic characteristics, Hispanics were more likely to have eye problems than whites (odds ratio, 1.56; 95% confidence interval, 1.03-2.56). African Americans and Hispanics had lower total health care costs, lower ambulatory care costs, and lower prescription drug costs than whites (P < .01 for all).

CONCLUSION

We found differences in ambulatory care and prescription drug fills among white, African American, and Hispanic adults with diabetes. However, most of the diabetes care measures were not significantly different among the three racial and ethnic groups. Understanding the reason outcomes do not differ when health care use and costs differ significantly should be a focus of future studies.

Racial differences in glycemic control in a well-functioning older diabetic population: findings from the Health, Aging and Body Composition Study

OBJECTIVE

To evaluate racial differences and factors associated with worse glycemic control in well-functioning older individuals with type 2 diabetes. Our hypothesis was that glycemic control would be worse among black than white diabetic individuals but that this association would be explained by differences in severity of diabetes, health status, health care indicators, and social, psychological, or behavioral factors. We further hypothesized that the association of race with poorer glycemic control would be limited to those with lower education or lower income.

RESEARCH DESIGN AND METHODS

Cross-sectional analysis of 468 diabetic participants among a cohort of 3,075 nondisabled blacks and whites aged 70-79 years living in the community enrolled in the Health, Aging and Body Composition Study. Glycemic control was measured by the level of HbA(1c).

RESULTS

A total of 58.5% of the diabetic individuals were black. Although control was poor in all diabetic participants (HbA(1c) > or =7% in 73.7%), blacks had worse glycemic control than whites (age- and sex-adjusted mean HbA(1c), 8.4% in blacks and 7.4% in whites; P < 0.01). Race differences in glycemic control remained significant, even after adjusting for current insulin therapy, cardiovascular disease, higher total cholesterol, and not receiving a flu shot in the previous year, all of which were associated with higher HbA(1c) concentrations. Controlling for these factors reduced the association by 27%. Race remained an important factor in glycemic control, even when results were stratified by education or income.

CONCLUSIONS

HbA(1c) concentrations were higher in older black diabetic individuals. Differences in glycemic control by race were associated with disease severity, health status, and poorer quality of care, but these factors did not fully explain the higher HbA(1c) levels in older black diabetic individuals.

The impact of diabetes on adult employment and earnings of Mexican Americans: findings from a community based study

Epidemiological studies indicate that minority populations in the US - including African Americans, Native Americans and Mexican Americans - are particularly at risk for diabetes and that their complications are more frequent and severe. Using microdata from a 1994-1999 population based study of middle aged and older Mexican Americans in the Southwest, this study analyzes the impact of diabetes on the employment and earnings outcomes of adults 45 years of age and older. The empirical results from estimating maximum likelihood employment and earnings models suggest that diabetes leads to lower productivity and earnings for women but has no statistically significant impact on their employment probability. In the case of men, however, diabetes leads to a lower employment propensity but has no effect on earnings. Thus, the problems associated with this condition could lead to potential future financial difficulties particularly for high-risk populations in their later years.

Effects of hyperinsulinemia and obesity on risk of neural tube defects among Mexican Americans

Although both maternal obesity and diabetes mellitus increase the risk for neural tube defects, it is unknown whether they are independent risk factors or manifestations of an underlying prediabetic state such as hyperinsulinemia. We investigated whether hyperinsulinemia was a risk factor for neural tube defects independent of obesity and hyperglycemia in Mexican-American women. We identified case and control women from residents delivering or terminating pregnancies in hospitals or birthing centers in any of the 14 Texas-Mexico border counties during 1995-2000. Case women had a pregnancy affected by anencephaly, spina bifida, or encephalocele; randomly selected control women had normal births, frequency matched by year and birth facility. Questionnaire and laboratory values obtained 5-6 weeks postpartum were available for 149 case and 178 control women. Both hyperinsulinemia and obesity were related to increased neural tube defect risk [odds ratio (OR) = 1.91, 95% confidence interval (CI) = 1.21-3.01 and OR = 1.73, 95% CI = 1.03-2.92, respectively]. Adjustment for obesity only slightly reduced the effect of hyperinsulinemia (OR = 1.75, 95% CI = 1.09-2.82). Alternatively, a modest effect remained for obesity after adjustment for hyperinsulinemia (OR = 1.45, 95% CI = 0.84-2.51). Hyperinsulinemia is a strong risk factor for neural tube defects and may be the driving force for the observed risk in obese women.

Correlates of self-efficacy in diabetes self-care among Hispanic adults with diabetes

PURPOSE

The purpose of this study was to examine factors associated with increased diabetes self-efficacy among insulin-requiring Hispanic adults with diabetes.

METHODS

A cross-sectional survey design was used to obtain self-reported data on a nonrandom sample of 97 insulin-requiring Hispanic adults with diabetes. The Insulin Management Diabetes Self-Efficacy Scale (IMDSES) was translated into Spanish and administered with a demographic questionnaire by trained bilingual/bicultural interviewers in each respondent's own home. Factor analysis of the IMDSES revealed 4 subscales that corresponded with major diabetes self-care management behaviors.

RESULTS

Respondents gave low to average self-efficacy ratings on their ability to manage all aspects of their disease. Behaviors that required problem solving in changing circumstances received the lowest scores. Attending diabetes classes and having home nursing visits were associated with an increased sense of self-efficacy, particularly as it related to diet and insulin. English-speaking ability was associated with a general sense of self-efficacy in managing diabetes care.

CONCLUSIONS

The model tested was able to explain modest levels of self-efficacy, particularly in 2 of the most important diabetes management areas, insulin and diet management.

Determinants of glaucoma awareness in a general eye clinic

PURPOSE

Heightened public awareness about glaucoma may increase the chance of identifying undetected cases. To ascertain determinants of glaucoma awareness, we surveyed a population visiting a general eye clinic.

DESIGN

Cross-sectional study.

PARTICIPANTS

1197 general eye clinic patients and their companions.

METHODS

We designed and administered a questionnaire about glaucoma to general eye clinic patients and their companions. We created multivariate logistic regression models to ascertain the effect of demographic and clinical features on the likelihood of being unaware of glaucoma.

MAIN OUTCOME MEASURES

Adjusted odds ratio (OR) with 95% confidence intervals of survey attributes associated with self-perceived unfamiliarity with glaucoma.

RESULTS

Glaucoma awareness overall (72%) approached that found in the subgroup self-reporting a diagnosis of glaucoma (80%). Survey attributes associated with an increased likelihood of being unaware of glaucoma were African American race (OR = 1.69 [1.28-2.20], Hispanic ethnicity (OR = 2.13 [1.46-3.02]), and less than a college education (OR = 1.67 [1.37-2.05]). Age was also a determinant of glaucoma awareness (for ages 50-64 years, OR = 0.60 [0.44-0.80] and for ages 65-79 years, OR = 0.56 [0.41-0.75] compared with ages less than 35 years). A self-report of glaucoma was not a determinant of glaucoma awareness (OR = 0.63 [0.33-1.17]), although there was a trend toward enhanced glaucoma awareness in this subgroup. Finally, respondents with a history of employment in the health field (OR = 0.63 [0.49-0.82]) myopia (OR = 0.68 [0.56-0.82]), glaucoma in a first-degree relative (OR = 0.68 [0.53-0.87]), and respondents who reported having a dilated eye examination (OR = 0.53 [0.42-0.66]) were less likely to be unaware of glaucoma than those who did not have these attributes.

CONCLUSIONS

Although glaucoma awareness in this population was high, Hispanics, African Americans, and those with less than a college education were more likely to be unfamiliar with the disease. Interestingly, a self-report of having glaucoma was not a statistically significant determinant of glaucoma awareness.

The prevalence and health burden of self-reported diabetes in older Mexican Americans: findings from the Hispanic established populations for epidemiologic studies of the elderly

OBJECTIVES

The prevalence and health burden of self-reported adult-onset diabetes mellitus were examined in older Mexican Americans.

METHODS

Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly were used to assess the prevalence of self-reported diabetes and its association with other chronic conditions, disability, sensory impairments, health behaviors, and health service use in 3050 community-dwelling Mexican Americans 65 years and older.

RESULTS

The prevalence of self-reported diabetes in this sample was 22%, and there were high rates of obesity, diabetes-related complications, and diabetic medication use. Myocardial infarction, stroke, hypertension, angina, and cancer were significantly more common in diabetics than in nondiabetics, as were high levels of depressive symptoms, low perceived health status, disability, incontinence, vision impairment, and health service use. Many of the rate differences found in this sample of older Mexican Americans were higher than those reported among other groups of older adults.

CONCLUSIONS

Our findings indicate that the prevalence and health burden of diabetes are greater in older Mexican Americans than in older non-Hispanic Whites and African Americans, particularly among elderly men.

Greater incidence of hospitalized myocardial infarction among Mexican Americans than non-Hispanic whites. The Corpus Christi Heart Project, 1988-1992

BACKGROUND

Since Mexican Americans have adverse patterns of risk factors for myocardial infarction relative to non-Hispanic whites, the incidence of myocardial infarction should be greater among Mexican Americans than among non-Hispanic whites. This expectation conflicts with reports generated from death certificate registries.

METHODS AND RESULTS

Data regarding myocardial infarction attacks and incident events were collected for a 4-year period in the Corpus Christi Heart Project, a population-based surveillance project for hospitalized coronary heart disease events. For both women and men, Mexican Americans experienced greater hospitalization rates for both attacks and incident events than non-Hispanic whites. Age-adjusted attack rate ratios comparing Mexican Americans with non-Hispanic whites were 1.59 (95% CI, 1.05 to 2.41) and 1.31 (95% CI, 1.18 to 1.45) among women and men, respectively. Corresponding incidence ratios were 1.52 (95% CI, 1.28 to 1.80) and 1.25 (95% CI, 1.10 to 1.42).

CONCLUSIONS

This is the first report documenting greater incidence of hospitalized myocardial infarction among Mexican Americans than among non-Hispanic whites, a biologically plausible finding given the risk factor patterns observed in the Mexican-American population. Public health planners and clinicians should be aware of the importance of myocardial infarction as a health problem in the Mexican-American population. Culturally appropriate prevention strategies should be developed for and tested in Mexican-American populations.

Epidemiology of stroke in Hispanic Americans

BACKGROUND AND PURPOSE

In 1990 cerebrovascular disease was the fourth leading cause of death in Hispanics in the United States. However, little information has been published about the epidemiology of stroke in US Hispanic populations.

METHODS

Data from the National Center for Health Statistics were examined to characterize the pattern of stroke occurrence and risk factors among Hispanics in the United States.

RESULTS

In 1989 through 1991, stroke death rates were similar in Hispanics and whites aged 45 to 64 years; at ages 65 and over, Hispanics had rates that were substantially lower than those of whites. Data from national surveys suggest that the ethic differences in stroke mortality may be due in part to lower blood pressure in Hispanics than non-Hispanics.

CONCLUSIONS

Cohort studies, well-designed case-control studies, and continued oversampling of Hispanics in national surveys are needed to further define the epidemiological patterns of stroke in US Hispanics and to guide stroke prevention efforts.

Mortality differences between elderly Mexican Americans and non-Hispanic whites in San Antonio, Texas

OBJECTIVE

To identify differences in causes of death between elderly Mexican Americans (MA) and non-Hispanic whites (NHW).

DESIGN

Retrospective death certificate review.

SUBJECTS

Elderly Mexican Americans and non-Hispanic Whites age 65 and over who died in Bexar County, Texas during 1989.

MEASURES

Data obtained from chart review included age, sex, race/ethnicity, and cause of death. Age-adjusted and cause-specific mortality rates, odds ratios (OR), and 95% confidence intervals (CI) were calculated.

RESULTS

Mexican Americans were at greater risk of dying in nine of the thirty causes of death examined. The mortality rates of MA subjects were higher than those of NHW from death caused by diabetes (OR = 3.19, CI = 2.27-4.49), renal failure (OR = 2.06, CI = 1.44-2.94), congestive heart failure (OR = 1.50, CI = 1.44-2.94), and multiple systemic diseases (OR = 2.59, CI = 1.89-3.57). Among the male subjects, MA had a greater risk than NHW of dying from myocardial infarction (OR = 1.83, CI = 1.15-2.90), coronary disease (OR = 1.37, CI = 1.07-1.75) and septicemia/pyuria (OR = 2.12, CI = 1.09-4.10). Among female subjects, MA had a greater likelihood of dying from cirrhosis (OR = 3.03, CI = 1.00-9.29). For only one of the causes of death was the risk lower among MA than NHW: MA female subjects had a lesser chance of dying from the chronic obstructive pulmonary disease (COPD) than NHW females (OR = 0.36, CI = 0.18-0.72).

CONCLUSION

Mexican American elders have a greater risk of dying from non-insulin dependent diabetes mellitus and renal failure than their NHW counterparts. Elderly MA men have a greater risk of dying from cardiovascular disease than their NHW counterparts. Mexican American women may have a greater risk of dying from cirrhosis, but a lower risk of dying from complications of COPD. Finally, death from ill defined causes, such as multiple systemic diseases, may be a major under-acknowledged cause of death among older MA.

Utilizing a 24-hour dietary recall and culturally specific diabetes education in Mexican Americans with diabetes

Two objectives were established for this study: 1) to assess the impact of a culturally specific, intensive diabetes education program on dietary patterns, and 2) to assess nutrient consumption relative to the Recommended Dietary Allowances. The study population consisted of elderly Mexican Americans with diabetes living in Harlingen and Brownsville, Texas. The experimental group (n = 78) participated in an intense, 2-hour nutrition education session, while the control group (n = 74) did not. The education session was conducted for groups of eight subjects via videotapes and interactive discussion. All groups experienced significant weight loss except the women in the experimental group. After the education program, however, the experimental women had increased the percentage of calories consumed daily from carbohydrate. Mean calcium consumption was substantially less than the RDA in all groups, and inadequate amounts of ascorbic acid and vitamin A often were consumed. Intensive, frequent, long-term follow-up appears essential for more sustained results.

Overweight among Mexican Americans and its relationship to life style behavioral risk factors

The hypothesis positing differences between Mexican Americans and whites regarding attitudes and behaviors concerning obesity and other health issues was tested. A random sample of 1171 whites and 155 Mexican Americans aged 18 to 65 was selected. Two analyses were carried out. First, overweight Mexican Americans were compared with overweight whites. Second, overweight individuals were compared with normal weight counterparts within each ethnic group. Differences between overweight Mexican Americans and overweight whites disappeared after adjusting for the effects of sex, income, educational status, and marital status. Among whites, several factors remained significantly different when comparing overweight with normal weight individuals. Among Mexican Americans, however, all but one of the significant differences between overweight and normal weight individuals disappeared after adjusting for other variables. The implications of these results as they relate to the implementation of public health programs to deal with the prevention and treatment of obesity among Mexican Americans are discussed.

Hospitalization rates for myocardial infarction among Mexican-Americans and non-Hispanic whites. The Corpus Christi Heart Project

The rate of hospitalization for myocardial infarction was examined in the Corpus Christi Heart Project (CCHP), a prospective population-based surveillance program in a biethnic community of Mexican-Americans and non-Hispanic whites. During 12 months of ascertainment, a total of 740 patients hospitalized with definite (217) or possible (523) myocardial infarction were identified. Of the 740 subjects, 334 were Mexican-Americans (150 females and 184 males), 348 were non-Hispanic whites (138 females and 210 males), and 58 were of other ethnic backgrounds. The 1-year age-adjusted rates of hospitalization per 100,000 population were 427.4 and 276.9 among Mexican-American and non-Hispanic white females, respectively, and 721.4 and 502.6 among Mexican-American and non-Hispanic white males, respectively. The age-adjusted hospitalization rate ratios for Mexican-Americans in relation to non-Hispanic whites were 1.55 (95% confidence interval [CI]: 1.23 to 1.95) and 1.40 (95% CI: 1.15 to 1.70) for females and males, respectively. These results suggest that Mexican-Americans may have a greater burden of coronary disease than non-Hispanic whites.

Getting by at home. Community-based long-term care of Latino elders

Although evidence suggests that the morbidity and mortality of Latino elders (of any Hispanic ancestry) are similar to those of non-Latino whites, Latinos have higher rates of disability. Little is known about influences on the use of in-home health services designed to assist disabled Latino elders. We examine the effects of various cultural and structural factors on the use of visiting nurse, home health aide, and homemaker services. Data are from the Commonwealth Fund Commission's 1988 national survey of 2,299 Latinos aged 65 and older. Mexican-American elders are less likely than the average Latino to use in-home health services despite similar levels of need. Structural factors including insurance status are important reasons, but acculturation is not pertinent. Physicians should not assume that Latino families are taking care of their disabled elders simply because of a cultural preference. They should provide information and advice on the use of in-home health services when an older Latino patient is physically disabled.

Diabetes and disability among Mexican Americans: the effect of different measures of diabetes on its association with disability

The association of non-insulin-dependent diabetes mellitus and disability was evaluated in a population of Mexican Americans from the southwest U.S. using data from the Hispanic Health and Nutrition Examination Survey. Among the total sample of persons who completed a clinical examination, 14.6% reported a limitation of job performance, the inability to complete housework, or the inability to perform activities of daily living. Among the subsample who completed the clinical examination and reported having diabetes, 31.6% claimed similar disability. In those respondents who also completed an oral glucose tolerance test (OGTT) or who were currently receiving insulin, the prevalence of disability was 25% in persons with an abnormal OGTT and 40.2% in those who were receiving insulin compared with 14.9% in those with a normal OGTT. Self-reported diabetes was positively associated with functional impairment in the examined population after adjusting for demographic variables and comorbidity; however, diabetes confirmed by OGTT was not significantly associated with disability after adjustment for other factors. Differences in pre-existing health status between persons who completed the OGTT and those who did not are discussed in relation to these results.