The association of maternal country/region of origin and nativity with infant mortality rate among Hispanic preterm infants

OBJECTIVES

Among US-born preterm infants of Hispanic mothers, we analyzed the unadjusted and adjusted infant mortality rate (IMR) by country/region of origin and maternal nativity status.

STUDY DESIGN

Using linked national US birth and death certificate data (2005-2014), we examined preterm infants of Hispanic mothers by subgroup and nativity. Clinical and sociodemographic covariates were included and the main outcome was death in the first year of life.

RESULTS

In our cohort of 891,216 preterm Hispanic infants, we demonstrated different rates of infant mortality by country and region of origin, but no difference between infants of Hispanic mothers who were US vs. foreign-born.

CONCLUSION

These findings highlight the need to disaggregate the heterogenous Hispanic birthing population into regional and national origin groups to better understand unique factors associated with adverse perinatal outcomes in order to develop more targeted interventions for these subgroups.

Pregnancy-Related Deaths by Hispanic Origin, United States, 2009-2018

Objective: To describe pregnancy-related mortality among Hispanic people by place of origin (country or region of Hispanic ancestry), 2009-2018. Materials and Methods: We conducted a cross-sectional descriptive study of pregnancy-related deaths among Hispanic people, stratified by place of origin (Central or South America, Cuba, Dominican Republic, Mexico, Puerto Rico, Other and Unknown Hispanic), using Pregnancy Mortality Surveillance System data, 2009-2018. We describe distributions of pregnancy-related deaths and pregnancy-related mortality ratios (number of pregnancy-related deaths per 100,000 live births) overall and by place of origin for select demographic and clinical characteristics. Results: For 2009-2018, the overall pregnancy-related mortality ratio among Hispanic people was 11.5 pregnancy-related deaths per 100,000 live births (95% confidence intervals [CI]: 10.8-12.2). In general, pregnancy-related mortality ratios were higher among older age groups (i.e., 35 years and older) and lower among those with higher educational attainment (i.e., college degree or higher). Approximately two in five pregnancy-related deaths among Hispanic people occurred on the day of delivery through 6 days postpartum. Place of origin-specific pregnancy-related mortality ratios ranged from 9.6 (95% CI: 5.8-15.0) among people of Cuban origin to 15.3 (95% CI: 12.4-18.3) among people of Puerto Rican origin. Hemorrhage and infection were the most frequent causes of pregnancy-related deaths overall among Hispanic people. People of Puerto Rican origin had a higher proportion of deaths because of cardiomyopathy. Conclusions: We identified differences in pregnancy-related mortality by place of origin among Hispanic people that can help inform prevention of pregnancy-related deaths.

Geographic Origin may Affect Outcomes for Hispanic Patients with Non-Small Cell Lung Cancer in the United States

BACKGROUND

Social determinants of health thoroughly explored in the literature include insurance status, race, and ethnicity. There are over 50 million self-identifying Hispanics in the United States. This, however, represents a heterogeneous population. We used a national registry to investigate for significant differences in outcomes of Hispanic patients with non-small cell lung cancer (NSCLC) in the Unites states, by geographic region of origin.

MATERIALS AND METHODS

We identified a cohort of Hispanic patients in the Unites states with NSCLC for which region of origin was documented within the 2004 to 2016 National Cancer Database (NCDB) registry. This included patients from Cuba, Puerto Rico, Mexico, South and Central America, and the Dominican Republic. We performed multivariate logistic regression modeling to determine whether origin was a significant predictor of cancer staging at diagnosis, adjusting for age, sex, histology, grade, insurance status, and facility type. Race was not included due to a nonsignificant association with stage at diagnosis at the bivariate level in this cohort. Subsequently, we used Kaplan-Meier modeling to identify whether overall survival (OS) of Hispanic patients differed by origin.

RESULTS

A total of 12,557 Hispanic patients with NSCLC were included in this analysis. The breakdown by origin was as follows: n = 2071 (16.5%) Cuban, n = 2360 (18.8%) Puerto Rican, n = 4950 (39.4%) Mexican, n = 2329 (18.5%) from South or Central America, and n = 847 (6.7%) from the Dominican Republic. After controlling for age, sex, histology, grade, insurance status and treating facility type, we found that geographic origin was a significant predictor of advanced stage at diagnosis (P = .015). Compared to Cubans, patients of Puerto Rican origin were less likely to present with advanced disease (68.4% vs. 71.9%; OR: 0.82; 95%CI: 0.69-0.98; P = .026). We also identified a significant (log-rank P-value<.001) difference in OS by geographic origin, even at early-stages of diagnosis. Dominican patients with NSCLC exhibited the highest 5-year OS rate (63.3%), followed by patients from South/Central America (59.7%), Puerto Rico (52.3%), Mexico (45.9%), and Cuba (43.8%).

CONCLUSION

This study showed that for Hispanic individuals living in the Unites states, region/country of origin is significantly associated with outcomes, even after accounting for other known determinants of health. We suggest that region of origin should be studied further as a potential determinant of outcomes in patients with cancer.

Heterogeneity in Cardiovascular Disease Risk Factors Among Latino Immigrant Subgroups: Evidence From the 2010 to 2018 National Health Interview Survey

Background The Latino population is a growing and diverse share of the US population. Previous studies have examined Latino immigrants as a homogenous group. The authors hypothesized that there would be heterogeneity in cardiovascular disease risk factors among Latino immigrant subgroups (from Mexico, Puerto Rico, Cuba, Dominican Republic, Central America, or South America) compared with non-Latino White adults. Methods and Results A cross-sectional analysis of the 2010 to 2018 National Health Interview Survey (NHIS) among 548 739 individuals was performed. Generalized linear models with Poisson distribution were fitted to compare the prevalence of self-reported hypertension, overweight/obesity, diabetes, high cholesterol, physical inactivity, and current smoking, adjusting for known confounders. The authors included 474 968 non-Latino White adults and 73 771 Latino immigrants from Mexico (59%), Puerto Rico (7%), Cuba (6%), Dominican Republic (5%), Central America (15%), and South America (9%). Compared with White adults, Mexican immigrants had the highest prevalence of overweight/obesity (prevalence ratio [PR], 1.17 [95% CI, 1.15-1.19]); Puerto Rican individuals had the highest prevalence of diabetes (PR, 1.63 [95% CI, 1.45-1.83]); individuals from Central America had the highest prevalence of high cholesterol (PR, 1.16 [95% CI, 1.04-1.28]); and individuals from the Dominican Republic had the highest prevalence of physical inactivity (PR, 1.25 [95% CI, 1.18-1.32]). All Latino immigrant subgroups were less likely to be smokers than White adults. Conclusions The authors observed advantages and disparities in cardiovascular disease risk factors among Latino immigrants. Aggregating data on Latino individuals may mask differences in cardiovascular disease risk and hinder efforts to reduce health disparities in this population. Study findings provide Latino group-specific actionable information and targets for improving cardiovascular health.

Founder Effects of Spinocerebellar Ataxias in the American Continents and the Caribbean

Spinocerebellar ataxias (SCAs) comprise a heterogeneous group of autosomal dominant disorders. The relative frequency of the different SCA subtypes varies broadly among different geographical and ethnic groups as result of genetic drifts. This review aims to provide an update regarding SCA founders in the American continents and the Caribbean as well as to discuss characteristics of these populations. Clusters of SCAs were detected in Eastern regions of Cuba for SCA2, in South Brazil for SCA3/MJD, and in Southeast regions of Mexico for SCA7. Prevalence rates were obtained and reached 154 (municipality of Báguano, Cuba), 166 (General Câmara, Brazil), and 423 (Tlaltetela, Mexico) patients/100,000 for SCA2, SCA3/MJD, and SCA7, respectively. In contrast, the scattered families with spinocerebellar ataxia type 10 (SCA10) reported all over North and South Americas have been associated to a common Native American ancestry that may have risen in East Asia and migrated to Americas 10,000 to 20,000 years ago. The comprehensive review showed that for each of these SCAs corresponded at least the development of one study group with a large production of scientific evidence often generalizable to all carriers of these conditions. Clusters of SCA populations in the American continents and the Caribbean provide unusual opportunity to gain insights into clinical and genetic characteristics of these disorders. Furthermore, the presence of large populations of patients living close to study centers can favor the development of meaningful clinical trials, which will impact on therapies and on quality of life of SCA carriers worldwide.

Dengue fever complicated by liver dysfunction due to possible co-infection with hepatitis E in a returning traveller from Cuba

Dengue fever is a mosquito-borne infection that co-circulates with Chikungunya and Zika virus infection in many parts of the world. Dengue virus (DENV) is occasionally responsible for acute hepatitis and a few cases of acute hepatitis due to co-infection with DENV and hepatitis E virus have been described in India. A 37-year-old Cuban woman living in Italy was admitted to our hospital with a presumed arboviral infection upon her return to Italy short after a 15-day trip to her home-country to visit relatives. An acute infection due to DENV serotype 1 was initially diagnosed, following a clinical course characterized by signs of liver dysfunction that were possibly due to co-infection with hepatitis E virus.

Prescription Opioid Use Among Hispanics/Latinos With Arthritis Symptoms: Results From the Hispanic Community Health Study/Study of Latinos

INTRODUCTION

To determine the prevalence of prescription opioid (PO) use among Hispanics/Latinos with arthritis symptoms and to characterize how demographic and cultural factors are associated with PO use.

METHOD

Cross-sectional analysis of baseline visit data during 2008 to 2011 from the Hispanic Community Health Study/Study of Latinos, a population-based cohort study of 16,415 Hispanics/Latinos living in Chicago, Illinois, Miami, Florida, Bronx, New York, and San Diego, California. Included participants self-reported painful inflammation or swelling in one or more joints. Multivariate models controlling for physical and mental health scores were constructed to assess how demographic and cultural factors were associated with PO use.

RESULTS

A total of 9.3% were using POs at the time of the baseline visit. In multivariate models, persons of Cuban background (adjusted odds ratio [AOR] = 0.42, 95% confidence interval [CI; 0.21, 0.81]) and of Dominican background (AOR = 0.38, 95% CI [0.18, 0.80]) were significantly less likely to use POs compared with a reference group of persons of Mexican background. Greater language acculturation was also negatively associated with PO use (AOR = 0.68, 95% CI [0.53, 0.87]).

CONCLUSION

POs were used relatively uncommonly, and use showed marked variation between Hispanic/Latino groups. Future study should determine mechanisms for why greater use of English among Hispanics/Latinos might influence PO use.

Smoking expectancies and health perceptions: An analysis of Hispanic subgroups

Research suggests different patterns of cigarette smoking behaviors across Hispanic subgroups. However, research examining differences in known cognitive correlates of smoking behavior (e.g., beliefs about smoking and perceived consequences of smoking) is lacking. The purpose of this study was two-fold. First, given the dearth of research examining cigarette smoking across Hispanic subgroups, we sought to replicate previous findings related to disparities in smoking behavior across four subgroups (i.e., Mexican American, Puerto Rican, Cuban American, and Dominican American). Second, we sought to extend previous work by examining Hispanic subgroup differences across a range of smoking-related cognitive factors (i.e., positive and negative beliefs, perceived health risks, and perceived social consequences). This study used data from 1021 Hispanic individuals from four universities in the U.S. (i.e., Texas, California, New York, Florida) in a project funded by the American Legacy Foundation. Results indicated that Cuban Americans reported more current smoking than any other subgroup and the most positive beliefs about smoking, although Puerto Ricans endorsed the fewest negative beliefs about smoking out of all the groups. There were also differences across subgroups on some perceived health risks of smoking (e.g., Cubans were most likely to believe that smoking was a risk factor for diabetes) and perceived social consequences of smoking (e.g., Mexican Americans were less likely to perceive negative social consequences from not smoking). This study underscores the need to account for heterogeneity within the Hispanic population in tobacco research to more effectively inform future research and prevention practices.

The Influence of Ethnic Heterogeneity on Prostate Cancer Mortality After Radical Prostatectomy in Hispanic or Latino Men: A Population-based Analysis

OBJECTIVE

To determine if recently found disparities in prostate cancer-specific mortality (PCSM) among Mexican and Puerto Rican men remained true in patients undergoing radical prostatectomy (RP), where the true grade and extent of cancer are known and can be accounted for.

MATERIALS AND METHODS

Men diagnosed with localized-regional prostate cancer who had undergone RP as primary treatment were identified (N = 180,794). Patients were divided into the following racial and ethnic groups: non-Hispanic white (NHW) (n = 135,358), non-Hispanic black (NHB) (n = 21,882), Hispanic or Latino (n = 15,559), and Asian American or Pacific Islander (n = 7995). Hispanic or Latino men were further categorized into the following subgroups: Mexican (n = 3323) and South or Central American, excluding Brazilian (n = 1296), Puerto Rican (n = 409), and Cuban (n = 218). A multivariable analysis was conducted using competing risk regression in the prediction of PCSM.

RESULTS

This analysis revealed hidden disparities in surgical outcomes for prostate cancer. In the multivariable analysis, Hispanic or Latino men (hazard ratio [HR] = 0.88, P = .207) did not show a significant difference in PCSM compared with NHW men. When breaking Hispanic or Latino men into their country of origin or ancestry, Puerto Rican men were found to have significantly worse PCSM than NHW men (HR = 2.55, P = .004) and NHB men (HR = 2.33, P = .016).

CONCLUSION

Our findings reveal higher rates of PCSM for Puerto Rican men after RP than for both NHW and NHB men. At a minimum, these findings need further validation and should be considered in the screening and management of these men.

OSBPL10, RXRA and lipid metabolism confer African-ancestry protection against dengue haemorrhagic fever in admixed Cubans

Ethnic groups can display differential genetic susceptibility to infectious diseases. The arthropod-born viral dengue disease is one such disease, with empirical and limited genetic evidence showing that African ancestry may be protective against the haemorrhagic phenotype. Global ancestry analysis based on high-throughput genotyping in admixed populations can be used to test this hypothesis, while admixture mapping can map candidate protective genes. A Cuban dengue fever cohort was genotyped using a 2.5 million SNP chip. Global ancestry was ascertained through ADMIXTURE and used in a fine-matched corrected association study, while local ancestry was inferred by the RFMix algorithm. The expression of candidate genes was evaluated by RT-PCR in a Cuban dengue patient cohort and gene set enrichment analysis was performed in a Thai dengue transcriptome. OSBPL10 and RXRA candidate genes were identified, with most significant SNPs placed in inferred weak enhancers, promoters and lncRNAs. OSBPL10 had significantly lower expression in Africans than Europeans, while for RXRA several SNPs may differentially regulate its transcription between Africans and Europeans. Their expression was confirmed to change through dengue disease progression in Cuban patients and to vary with disease severity in a Thai transcriptome dataset. These genes interact in the LXR/RXR activation pathway that integrates lipid metabolism and immune functions, being a key player in dengue virus entrance into cells, its replication therein and in cytokine production. Knockdown of OSBPL10 expression in THP-1 cells by two shRNAs followed by DENV2 infection tests led to a significant reduction in DENV replication, being a direct functional proof that the lower OSBPL10 expression profile in Africans protects this ancestry against dengue disease.

Dengue is a concern of worldwide health authorities given the increase on virus and vector dispersions. So far only one traditional GWAS survey has been performed in Vietnamese children. This disease is also epidemic in tropical and subtropical regions of the Americas, where most populations descend from a dynamic admixture between African, European and Native American backgrounds. Empirical evidence claimed that African descent was protective against dengue haemorrhagic phenotype in the Cuban population, and this study is the first to apply admixture mapping to identify candidate genes that confer African protection. We also present evidence that two candidate genes, OSBPL10 and RXRA, are differentially expressed along dengue disease progression in Cuban patients and in a Thai dengue transcriptome dataset, and directly show that knockdown of OSBPL10 gene expression leads to a significant reduction in DENV2 replication. A very important overall result of our work is that it provides a unifying framework for many genes that have been said to be protective in dengue. Our evidence places the LXR/RXR activation pathway at the center of natural dengue protection, and supports pursuing therapeutic techniques involving synthetic ligands of nuclear receptor genes or kinases inhibitors that interact with proteins involved in lipid metabolism.

Acculturation dimensions and 12-month mood and anxiety disorders across US Latino subgroups in the National Epidemiologic Survey of Alcohol and Related Conditions

BACKGROUND

Individual-level measures of acculturation (e.g. age of immigration) have a complex relationship with psychiatric disorders. Fine-grained analyses that tap various acculturation dimensions and population subgroups are needed to generate hypotheses regarding the mechanisms of action for the association between acculturation and mental health.

METHOD

Study participants were US Latinos (N = 6359) from Wave 2 of the 2004-2005 National Epidemiologic Survey of Alcohol and Related Conditions (N = 34 653). We used linear χ2 tests and logistic regression models to analyze the association between five acculturation dimensions and presence of 12-month DSM-IV mood/anxiety disorders across Latino subgroups (Mexican, Puerto Rican, Cuban, 'Other Latinos').

RESULTS

Acculturation dimensions associated linearly with past-year presence of mood/anxiety disorders among Mexicans were: (1) younger age of immigration (linear χ2 1 = 11.04, p < 0.001), (2) longer time in the United States (linear χ2 1 = 10.52, p < 0.01), (3) greater English-language orientation (linear χ2 1 = 14.57, p < 0.001), (4) lower Latino composition of social network (linear χ2 1 = 15.03, p < 0.001), and (5) lower Latino ethnic identification (linear χ2 1 = 7.29, p < 0.01). However, the associations were less consistent among Cubans and Other Latinos, and no associations with acculturation were found among Puerto Ricans.

CONCLUSIONS

The relationship between different acculturation dimensions and 12-month mood/anxiety disorder varies across ethnic subgroups characterized by cultural and historical differences. The association between acculturation measures and disorder may depend on the extent to which they index protective or pathogenic adaptation pathways (e.g. loss of family support) across population subgroups preceding and/or following immigration. Future research should incorporate direct measures of maladaptive pathways and their relationship to various acculturation dimensions.

Not of African Descent: Dental Modification among Indigenous Caribbean People from Canímar Abajo, Cuba

Dental modifications in the Caribbean are considered to be an African practice introduced to the Caribbean archipelago by the influx of enslaved Africans during colonial times. Skeletal remains which exhibited dental modifications are by default considered to be Africans, African descendants, or post-contact indigenous people influenced by an African practice. Individual E-105 from the site of Canímar Abajo (Cuba), with a direct ¹⁴C AMS date of 990–800 cal BC, provides the first unequivocal evidence of dental modifications in the Antilles prior to contact with Europeans in AD 1492. Central incisors showing evidence of significant crown reduction (loss of crown volume regardless of its etiology) were examined macroscopically and with a scanning electron microscope (SEM) to determine if the observed alterations were due to deliberate modification or other (unintentional) factors considered: postmortem breakage, violent accidental breakage, non-dietary use of teeth, and wear caused by habitual or repeated actions. The pattern of crown reduction is consistent with deliberate dental modification of the type commonly encountered among African and African descendent communities in post-contact Caribbean archaeological assemblages. Six additional individuals show similar pattern of crown reduction of maxillary incisors with no analogous wear in corresponding mandibular dentition.

Disparities in colorectal cancer incidence among Latino subpopulations in California defined by country of origin

PURPOSE

In California, colorectal cancer (CRC) is the second most common cancer in Latinos. Using data from the California Cancer Registry, we investigated demographic and clinical characteristics of 36,133 Latinos with CRC living in California during 1995-2011 taking into account subpopulations defined by country of origin.

METHODS

Cases were defined as Latino according to the North American Association of Central Cancer Registries Hispanic Identification Algorithm, which was also used to group cases by country of origin: Mexico (9,678, 27 %), Central or South America (2,636, 7 %), Cuban (558, 2 %), Puerto Rico (295, 1 %), and other or unknown origin (22,966, 64 %; Other/NOS). 174,710 non-Hispanic white (NHW) CRC cases were included for comparison purposes. Annual age-adjusted incidence rates (AAIR) and proportional incidence ratios (PIRs) were calculated.

RESULTS

Differences were observed for age at diagnosis, sex distribution, socioeconomic status (SES), nativity (US born vs. foreign born), stage, and tumor localization across Latino subpopulations and compared to NHW. Mexican Latinos had the lowest AAIR and Cuban Latinos had the highest. PIRs adjusted for age, SES, and nativity showed an excess of CRC males and female cases from Cuba, female cases from Puerto Rico and reduced number of female cases from Mexico.

CONCLUSIONS

Differences in cancer incidence patterns and tumor characteristics were observed among Latino subpopulations in California. These disparities may reflect differences in cancer determinants among Latinos; therefore, given that country of origin information is unavailable for a large proportion of these patients, greater efforts to collect these data are warranted.

Self-Reported Cancer Prevalence among Hispanics in the US: Results from the Hispanic Community Health Study/Study of Latinos

Cancer has surpassed heart disease as the leading cause of death among Hispanics in the U.S., yet data on cancer prevalence and risk factors in Hispanics in regard to ancestry remain scarce. This study sought to describe (a) the prevalence of cancer among Hispanics from four major U.S. metropolitan areas, (b) cancer prevalence across Hispanic ancestry, and (c) identify correlates of self-reported cancer prevalence. Participants were 16,415 individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), who self-identified as Cuban, Dominican, Mexican, Puerto Rican, Central or South American. All data were collected at a single time point during the HCHS/SOL baseline clinic visit. The overall self-reported prevalence rate of cancer for the population was 4%. The rates varied by Hispanic ancestry group, with individuals of Cuban and Puerto Rican ancestry reporting the highest cancer prevalence. For the entire population, older age (OR = 1.47, p < .001, 95% CI, 1.26-1.71) and having health insurance (OR = 1.93, p < .001, 95% CI, 1.42-2.62) were all significantly associated with greater prevalence, whereas male sex was associated with lower prevalence (OR = 0.56, p < .01, 95% CI, .40-.79). Associations between study covariates and cancer prevalence also varied by Hispanic ancestry. Findings underscore the importance of sociodemographic factors and health insurance in relation to cancer prevalence for Hispanics and highlight variations in cancer prevalence across Hispanic ancestry groups. Characterizing differences in cancer prevalence rates and their correlates is critical to the development and implementation of effective prevention strategies across distinct Hispanic ancestry groups.

Cuban Americans have the highest rates of peripheral arterial disease in diverse Hispanic/Latino communities

OBJECTIVE

Because Hispanic ethnicity in the United States is heterogeneous, the purpose of this study was to determine the epidemiology of peripheral arterial disease (PAD) within U.S. Hispanic/Latino groups defined by national background.

METHODS

This analysis included 9648 men and women older than 45 years enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The ankle-brachial index (ABI) was computed as the higher of the posterior tibial and dorsalis pedis systolic blood pressures for each leg divided by the higher brachial artery systolic blood pressure. The index ABI was the higher of the two. An ABI ≤0.90 was the criterion for the presence of PAD.

RESULTS

The mean age was 56 years, and 55% were female. Overall, the prevalence of an ABI ≤0.90 (PAD), 0.90 to 0.99 (borderline), 1.0 to 1.39 (normal), and ≥1.40 (high) was 5.7%, 19.3%, 72.5%, and 2.6%, respectively. After multivariable adjustment for PAD risk factors and compared with Mexicans, Cubans had a nearly threefold higher odds for PAD (odds ratio, 2.9; 95% confidence interval, 1.9-4.4). The odds of PAD for the other Hispanic/Latino groups ranged from 1.2 to 1.8. Although men had a more than threefold higher odds of an ABI ≥1.40 (3.6; 2.0-6.5), the odds did not differ significantly by Hispanic/Latino background.

CONCLUSIONS

Compared with Mexican Americans, all other Hispanic/Latino background groups have a significantly higher odds of having PAD, with the odds being nearly threefold higher among Cubans.

Changes in pre- to post-immigration HIV risk behaviors among recent Latino immigrants

This prospective longitudinal study examined pre- to post-immigration HIV risk behavior trajectories among recent Latino immigrants in Miami-Dade County (Florida). We identified socio-demographic factors associated with these trajectories and collected retrospective pre-immigration HIV risk behavior data at baseline from a sample of 527 Caribbean, South American, and Central American Latinos ages 18-34 who immigrated to the U.S. less than one year prior. Two follow-up assessments (12 months apart) reported on participants' post-immigration HIV risk behaviors. Results indicated overall decreases in pre- to post-immigration condom use. In the sample, recent Latino immigrants with lower education, younger age, and higher incomes had steeper decreases in pre- to post-immigration condom use. We also found differences in the risk behavior trajectories of males and females. Latino women reported significant increases in the number of sexual partners post immigration, while men reported decreases in the number of sexual partners after immigrating to the U.S.

Dyslipidemia patterns among Hispanics/Latinos of diverse background in the United States

BACKGROUND

The prevalence and determinants of dyslipidemia patterns among Hispanics/Latinos are not well known.

METHODS

Lipid and lipoprotein data were used from the Hispanic Community Health Study/Study of Latinos—a population-based cohort of 16,415 US Hispanic/Latinos ages 18-74 years. National Cholesterol Education Program cutoffs were employed. Differences in demographics, lifestyle factors, and biological and acculturation characteristics were compared among those with and without dyslipidemia.

RESULTS

Mean age was 41.1 years, and 47.9% were male. The overall prevalence of any dyslipidemia was 65.0%. The prevalence of elevated low-density lipoprotein cholesterol was 36.0%, and highest among Cubans (44.5%; P < .001). Low high-density lipoprotein cholesterol (HDL-C) was present in 41.4% and did not significantly differ across Hispanic background groups (P = .09). High triglycerides were seen in 14.8% of Hispanics/Latinos, most commonly among Central Americans (18.3%; P < .001). Elevated non-HDL-C was seen in 34.7%, with the highest prevalence among Cubans (43.3%; P < .001). Dominicans consistently had a lower prevalence of most types of dyslipidemia. In multivariate analyses, the presence of any dyslipidemia was associated with increasing age, body mass index, and low physical activity. Older age, female sex, diabetes, low physical activity, and alcohol use were associated with specific dyslipidemia types. Spanish-language preference and lower educational status were associated with higher dyslipidemia prevalence.

CONCLUSION

Dyslipidemia is highly prevalent among US Hispanics/Latinos; Cubans seem particularly at risk. Determinants of dyslipidemia varied across Hispanic backgrounds, with socioeconomic status and acculturation having a significant effect on dyslipidemia prevalence. This information can help guide public health measures to prevent disparities among the US Hispanic/Latino population.

Domains of acculturation and their effects on substance use and sexual behavior in recent Hispanic immigrant adolescents

This study evaluated the immigrant paradox by ascertaining the effects of multiple components of acculturation on substance use and sexual behavior among recently immigrated Hispanic adolescents primarily from Mexico (35 %) and Cuba (31 %). A sample of 302 adolescents (53 % boys; mean age 14.51 years) from Miami (n = 152) and Los Angeles (n = 150) provided data on Hispanic and US cultural practices, values, and identifications at baseline and provided reports of cigarette use, alcohol use, sexual activity, and unprotected sex approximately 1 year later. Results indicated strong gender differences, with the majority of significant findings emerging for boys. Supporting the immigrant paradox (i.e., that becoming oriented toward US culture is predictive of increased health risks), individualist values predicted greater numbers of oral sex partners and unprotected sex occasions for boys. However, contrary to the immigrant paradox, for boys, both US practices and US identification predicted less heavy drinking, fewer oral and vaginal/anal sex partners, and less unprotected vaginal/anal sex. Ethnic identity (identification with one's heritage culture) predicted greater numbers of sexual partners but negatively predicted unprotected sex. Results indicate a need for multidimensional, multi-domain models of acculturation and suggest that more work is needed to determine the most effective ways to culturally inform prevention programs.

Do post-migration perceptions of social mobility matter for Latino immigrant health?

Latino immigrants exhibit health declines with increasing duration in the United States, which some attribute to a loss in social status after migration or downward social mobility. Yet, research into the distribution of perceived social mobility and patterned associations to Latino health is sparse, despite extensive research to show that economic and social advancement is a key driver of voluntary migration. We investigated Latino immigrant sub-ethnic group variation in the distribution of perceived social mobility, defined as the difference between respondents' perceived social status of origin had they remained in their country of origin and their current social status in the U.S. We also examined the association between perceived social mobility and past-year major depressive episode (MDE) and self-rated fair/poor physical health, and whether Latino sub-ethnicity moderated these associations. We computed weighted logistic regression analyses using the Latino immigrant subsample (N=1561) of the National Latino and Asian American Study. Puerto Rican migrants were more likely to perceive downward social mobility relative to Mexican and Cuban immigrants who were more likely to perceive upward social mobility. Perceived downward social mobility was associated with increased odds of fair/poor physical health and MDE. Latino sub-ethnicity was a statistically significant moderator, such that perceived downward social mobility was associated with higher odds of MDE only among Puerto Rican and Other Latino immigrants. In contrast, perceived upward social mobility was not associated with self-rated fair/poor physical health. Our findings suggest that perceived downward social mobility might be an independent correlate of health among Latino immigrants, and might help explain Latino sub-ethnic group differences in mental health status. Future studies on Latino immigrant health should use prospective designs to examine the physiological and psychological costs associated with perceived changes in social status with integration into the U.S. mainland.

Perceived context of reception among recent Hispanic immigrants: conceptualization, instrument development, and preliminary validation

Context of reception has been discussed widely in the sociological and anthropological literature, but no measures of this construct exist. We designed a measure of perceived context of reception and provide initial support for the factorial validity, internal consistency reliability, and incremental and discriminant validity of scores generated by this measure. A sample of 302 recent-immigrant Hispanic parent-adolescent dyads from Miami and Los Angeles completed the new perceived context of reception measure, as well as measures of perceived discrimination; Hispanic/American cultural practices, values, and identifications; and depressive symptoms. In Phase 1, exploratory and confirmatory factor analyses extracted a factor for negative perceived context of reception. A subscale corresponding to this factor was used in Phase 2; for parents and adolescents, negative perceived context of reception and perceived discrimination were differentially associated with acculturation-related variables-suggesting discriminant validity between perceived discrimination and negative perceived context of reception. For adolescents at both sites and for parents in Los Angeles only, the negative perceived context of reception dimensions were significantly associated with depressive symptoms 6 months later, over and above the contribution made by perceived discrimination--suggesting incremental validity. Results are discussed in terms of perceived context of reception as a new and emerging construct.

Neighborhood effects on the self-rated health of older adults from four racial/ethnic groups

Building upon the sizable literature on individual-level predictors of self-rated health, this study examined the impact of neighborhood characteristics, using older adult samples of four racial/ethnic groups. The considered neighborhood characteristics include (a) the proportion of individuals age 65 and older, (b) the proportion of individuals below poverty, and (c) the proportion of individuals from the same racial/ethnic background in the Census-block group. The samples were drawn from the 2004-2005 Survey of Older Floridians, which includes Whites (n = 488), Blacks (n = 345), Cubans (n = 319), and non-Cuban Latinos (n = 230). Using the reported residential address, each participant was linked to the 2000 Census at block-group level to retrieve the above-mentioned neighborhood characteristics. Multilevel analysis of self-rated health was estimated for each racial/ethnic group, considering individual-level variables (e.g., age, gender, marital status, education, financial strain, and chronic conditions) and each of the neighborhood characteristics. Regardless of racial/ethnic groups, those living in the neighborhood with a higher proportion of residents below poverty were likely to report poorer health. The proportion of older adults in the neighborhood was significant only in Cubans, and the proportion of residents with the same ethnic background was only in Whites. The findings show the overall importance of neighborhood context in the health of older adults and indicate different implications of neighborhood characteristics for diverse racial/ethnic groups.

Migration circumstances, psychological distress, and self-rated physical health for Latino immigrants in the United States

OBJECTIVES

We determined the impact of premigration circumstances on postmigration psychological distress and self-rated physical health among Latino immigrants.

METHODS

We estimated ordinary least squares and logistic regression models for Latino immigrants in the 2002-2003 National Latino and Asian American Study (n = 1603).

RESULTS

Mean psychological distress scores (range = 10-50) were 14.8 for women and 12.7 for men; 35% of women and 27% of men reported fair or poor physical health. A third of the sample reported having to migrate; up to 46% reported unplanned migration. In multivariate analyses, immigration-related stress was significantly associated with psychological distress, but not with self-rated health, for both Latino men and women. Having to migrate was associated with increased psychological distress for Puerto Rican and Cuban women respondents and with poorer physical health for Puerto Rican migrant men. Unplanned migration was significantly associated with poorer physical health for all Latina women respondents.

CONCLUSIONS

The context of both pre- and postmigration has an impact on immigrant health. Those involved in public health research, policy, and practice should consider variation in immigrant health by migration circumstances, including the context of exit and other immigration-related stressors.

Acculturative stress and diminishing family cohesion among recent Latino immigrants

This study investigates a theorized link between Latino immigrants' experience of acculturative stress during their two initial years in the United States (US) and declines in family cohesion from pre- to post-immigration contexts. This retrospective cohort study included 405 adult participants. Baseline assessment occurred during participants' first 12 months in the US. Follow-up assessment occurred during participants' second year in the US. General linear mixed models were used to estimate change in family cohesion and sociocultural correlates of this change. Inverse associations were determined between acculturative stress during initial years in the US and declines in family cohesion from pre-immigration to post-immigration contexts. Participants with undocumented immigration status, those with lower education levels, and those without family in the US generally indicated lower family cohesion. Participants who experienced more acculturative stress and those without family in the US evidenced a greater decline in family cohesion. Results are promising in terms of implications for health services for recent Latino immigrants.

The risk of developing invasive breast cancer in Hispanic women : a look across Hispanic subgroups

BACKGROUND

Current evidence on breast cancer among US Hispanic women indicates a significant public health threat, although few studies have assessed the heterogeneity in breast cancer risk among Hispanics of different origin.

METHODS

The 2000 and 2005 National Health Interview Survey Cancer Control Modules were used to examine the Breast Cancer Risk Assessment Tool (BCRAT) 5-year risk and lifetime risk of invasive breast cancer among Mexican/Mexican American, Puerto Rican, Cuban/Cuban American, Dominican (Republic), Central/South American, Other Hispanic, and non-Hispanic white (NHW) women ages 35 to 84 years. Multiple linear regression models were used to compare the BCRAT 5-year and lifetime breast cancer risk between 1) Hispanics and NHWs and 2) Hispanic subgroups.

RESULTS

Hispanic women had significantly lower mean BCRAT 5-year and lifetime breast cancer risk compared with NHW women (P < .001). Among Hispanic subgroups, Cuban/Cuban Americans had a higher BCRAT 5-year risk (P < .05), whereas Dominicans had a higher lifetime risk (P < .001) compared with Mexican/Mexican Americans. Approximately 2.6% of Hispanic women were at high risk for breast cancer (BCRAT 5-year risk ≥1.67%), ranging from 1% of Central/South Americans to 3.7% of Puerto Ricans; few Hispanics (0.2%) had a lifetime risk ≥20%.

CONCLUSIONS

The current findings indicate that Hispanic women have a significantly lower risk of breast cancer compared with NHW women, although the risk according to BCRAT differed significantly between specific Hispanic subgroups. We provide estimates of the number of US Hispanic women from six subgroups who may be eligible for prophylactic breast cancer chemoprevention. The authors concluded that future studies should further investigate the heterogeneity in breast cancer risk and risk factors between Hispanic women of different origins.

The dimensionality and measurement properties of alcohol outcome expectancies across Hispanic national groups

This study examines the psychometric properties of alcohol expectancies among Hispanic subgroups. Face-to-face interviews were conducted as part of the 2006 Hispanic Americans Baseline Alcohol Survey (HABLAS), which employed a multistage cluster sample design. A total of 5224 individuals (18+ years of age) representing four Hispanic national groups (Puerto Ricans, Cuban Americans, Mexican Americans, and South/Central Americans) were selected at random from the household population in five metropolitan areas (Miami, New York, Philadelphia, Houston, and Los Angeles). Alcohol expectancies included 18 items covering positive (e.g., laugh more, become more talkative) and negative dimensions (e.g., become aggressive, lose control) when alcohol is consumed. Confirmatory factor models replicated a previously proposed three-factor dimensional structure with a substantial majority of items exhibiting measurement invariance across Hispanic national group and gender. Items covering social extroversion were an exception, showing a lack of invariance for female Cuban and South/Central Americans. Latent mean differences across groups were detected for expectancies concerning emotional fluidity, and the pattern of differences largely mirrored known differences in alcohol consumption patterns. Results suggest that caution should be exercised in interpreting differences in expectancies concerning social extroversion across Hispanic groups, and additional work is needed to identify indices of this construct with invariant measurement properties. However, measures of emotional/behavioral impairment and emotional fluidity expectancies can be validly compared across gender and Hispanic national groups.

Do dietary factors contribute to medical cost for Cuban Americans with and without type 2 diabetes?

BACKGROUND

Cuban Americans have a high prevalence of type 2 diabetes, placing them at risk for cardiovascular disease (CVD) and increased medical costs. Little is known regarding the lifestyle risk factors of CVD among Cuban Americans. This study investigated modifiable CVD risk factors of Cuban Americans with and without type 2 diabetes.

METHODS

Sociodemographics, anthropometrics, blood pressure, physical activity, dietary intake, and biochemical parameters were collected and assessed for n=79 and n=80 Cuban Americans with and without type 2 diabetes.

RESULTS

Fourteen percent with diabetes and 24 percent without diabetes engaged in the recommended level of physical activity. Over 90 percent had over the recommended intake of saturated fats. Thirty-five percent were former or current smokers.

DISCUSSION

Cuban Americans had several lifestyle factors that are likely to increase the risk of CVD. Their dietary factors were associated with blood cholesterol and body weight, which has been shown to impact on medical expenses. These findings may be used for designing programs for the prevention of CVD as well as type 2 diabetes for Cuban Americans.

Application of the health literacy framework to diet-related cancer prevention conversations of older immigrant women to Canada

Health literacy, conceptualized as a framework involving basic (functional), interactive and critical skill sets, is a key determinant of health. Application of the health literacy framework (HLF) to immigrant populations has been limited. Our objective was to apply the HLF to discourses about diet-related colon cancer prevention among English-as-a-Second-Language (ESL) immigrant women. We also explored whether these discussions could inform the development of culturally appropriate information and potentially increase health literacy. Interviews were conducted with 64 older Spanish-speaking ESL immigrant women. Directed content analysis guided by the HLF was used to identify themes. Diet-related conversations were initiated by 43 (67%) participants. Four themes were identified: general information requests-low functional health literacy (FHL) (n = 23/43), specific nutrition inquiries-high FHL (n = 17/43), actions for healthy eating-low interactive health literacy (IHL) (n = 8/43) and community communication issues-high IHL (n = 3/43). No conversations representing critical health literacy were identified. Five women discussed both FHL and IHL themes. Women's diet-related conversations followed a continuum of increasing information needs supporting the HLF.

"Maricón," "pájaro," and "loca": Cuban and Puerto Rican linguistic practices, and sexual minority participation, in U.S. Santería

Lesbian, gay, bisexual, and transgender (LGBT) people in Cuba, Puerto Rico, and the United States are, to varying degrees, practitioners of the Afro-Cuban religion popularly known as Santería. Cuban and Puerto Rican forms of referencing LGBT populations are illustrated in this article, which is drawing from interviews and participant observation conducted in the United States, with close to 30 practitioners, many of whom were Cuban, Cuban American, and Puerto Rican. I discuss the ways in which Santería gatherings produce an alternative use of otherwise stigmatized language for "gay" practitioners. Through the use of distinctive language to reference all of these populations, we may rethink the relationship between identities and practices, and within that, gender presentations vis a vis identities.

Racial/ethnic disparities on self-reported hypertension in New York City: examining disparities among Hispanic subgroups

OBJECTIVES

To investigate differences in self-reported hypertension among Hispanic subgroups as they compare to Asian, non-Hispanic Black and non-Hispanic White groups; and whether these differences depend on nativity status in the New York City Community Health Survey 2006-2008.

DESIGN

Cross-sectional.

SETTING

New York City.

MAIN OUTCOME MEASURE

Self-reported hypertension.

METHODS

Log-binomial regression was used to estimate the strength of the association between race/ethnicity and self-reported hypertension before and after adjusting for selected covariates.

RESULTS

In adjusted analyses, Puerto Ricans, Dominicans and Blacks had 17%, 28% and 34% greater probability of reporting hypertension than Whites. The association between race/ethnicity and self-reported hypertension appears to vary with nativity status/length of stay in the United States. (P=.08).

CONCLUSIONS

These findings underscore the need to investigate the prevalence of hypertension among subgroups of the Hispanic population. This issue is also relevant to Asians and Blacks, who are very heterogeneous populations regarding subgroups and nativity status.

The Campesino-to-Campesino agroecology movement of ANAP in Cuba: social process methodology in the construction of sustainable peasant agriculture and food sovereignty

Agroecology has played a key role in helping Cuba survive the crisis caused by the collapse of the socialist bloc in Europe and the tightening of the US trade embargo. Cuban peasants have been able to boost food production without scarce and expensive imported agricultural chemicals by first substituting more ecological inputs for the no longer available imports, and then by making a transition to more agroecologically integrated and diverse farming systems. This was possible not so much because appropriate alternatives were made available, but rather because of the Campesino-a-Campesino (CAC) social process methodology that the National Association of Small Farmers (ANAP) used to build a grassroots agroecology movement. This paper was produced in a 'self-study' process spearheaded by ANAP and La Via Campesina, the international agrarian movement of which ANAP is a member. In it we document and analyze the history of the Campesino-to-Campesino Agroecology Movement (MACAC), and the significantly increased contribution of peasants to national food production in Cuba that was brought about, at least in part, due to this movement. Our key findings are (i) the spread of agroecology was rapid and successful largely due to the social process methodology and social movement dynamics, (ii) farming practices evolved over time and contributed to significantly increased relative and absolute production by the peasant sector, and (iii) those practices resulted in additional benefits including resilience to climate change.

Social status, race, and the timing of marriage in Cuba's first constitutional era, 1902-1940

This article examines the practice of marriage among whites, "mestizos," blacks, Cubans, and Spaniards during the first constitutional era, focusing upon the reported ages of brides and grooms. The study consists of a quantitative examination of trends found in the records of 900 Catholic marriages celebrated in Havana during the opening decades of independence. The first major finding of the research is that according to most major indicators of status, age was negatively correlated with rank. Thus, contrary to the conclusions of studies conducted in many other contexts, those in the highest strata of society married young. Furthermore, very significant differences were detected in the marital patterns of those identified as mixed-race and those labeled as black. This finding offers empirical weight to the notion that the early-mid twentieth-century Cuban racial structure would best be characterized as tripartite, rather than binary in nature.

Waist circumference and BMI in relation to serum high sensitivity C-reactive protein (hs-CRP) in Cuban Americans with and without type 2 diabetes

Relationship between high-sensitivity C-reactive protein (hs-CRP) and adiposity by diabetes status and gender in Cuban-Americans with and without type 2 diabetes (T2D) was studied. Adult subjects, 226 females, 129 males participated in a case control, single time point study. Subjects with T2D were older, had higher waist circumference (WC) and body mass index (BMI). WC and BMI were associated with ln hs-CRP (P < 0.001). An interaction with diabetes status was found for BMI (P = 0.037). Gender showed a strong relationship with ln hs-CRP (P < 0.001), which was moderated by diabetes status. Only males without diabetes exhibited a significant relationship for both WC and BMI with ln hs-CRP. In this sample of Cuban-Americans, WC and BMI had stronger associations with ln hs-CRP but not with diabetes status. Obesity prevention and controlling for CRP levels may be necessary to eliminate its contributions to develop diabetes and cardiovascular disease (CVD).

Sex and sentiment in Cuban tourism

Helen Safa has been a leading program builder and pioneer in research that examines the complex intersections of gender, race, class, and nation in Latin America and the Caribbean. Her comparative research culminated in her influential book, The Myth of the Male Breadwinner: Women and Industrialization in the Caribbean (1995), which examined gender, family, and employment across three Caribbean societies. Over several decades Safa has inspired scholarship throughout the Caribbean and the Americas and her work is exemplary of engaged anthropology in the region. Here I present work I conducted in Cuba that was guided, like my work in Peru, Nicaragua, and southern Mexico by the writings of Safa and others who saw the critical need to bring gender into meaningful discussion in the field of Latin American and Caribbean studies. In what follows, drawn from my broader research on tourism in four nations, I explore and reflect on the contemporary dynamics of sex and romance tourism in Cuba. I suggest that the allure of this domain of tourism may be enhanced by Cuba's global political identity, and that Cuban women participating in commodified and intimate exchanges reveal an ability to get along in a market economy that generally excludes them.

Cardiovascular risk factor variation within a Hispanic cohort: SWAN, the Study of Women's Health Across the Nation

OBJECTIVES

Hispanics have less favorable cardiovascular risk profiles relative to other groups, although little is known regarding variability in risk profiles according to country of origin. Our goal was to examine the association of cardiovascular risk factors with country of origin and acculturation in a cohort of middle-aged Hispanic women.

SETTING

Baseline data for participants at the New Jersey Site of the Study of Women's Health Across the Nation (SWAN).

PARTICIPANTS

419 women, aged 42-52 years, comprising 142 non-Hispanic Whites and 277 Hispanic: Central American (n = 29), South American (n = 106), Puerto Rican (n = 56), Dominican (n = 42) and Cuban (n = 44).

MAIN OUTCOME MEASURES

BMI, smoking, blood pressure, lipid profiles, and presence of hypertension, hyperlipidemia, diabetes and metabolic syndrome were compared using univariate and multivariable models.

RESULTS

LDL and HDL varied significantly across Hispanic subgroups (overall P < or = .05). Prevalence of metabolic syndrome was greatest in Puerto Rican women (48.2% vs 40.0%, 35.0%, 13.9% and 29.3% in Central American, South American, Dominican and Cuban women, respectively, P = .016). Central American women were least likely to smoke (P < .05 vs Puerto Rican, Cuban and South American). Prevalence of hypertension and diabetes were similar across groups. Differences in lipids and metabolic syndrome were not explained by acculturation, financial strain, education, physical activity, smoking or dietary fat intake.

CONCLUSIONS

There is significant heterogeneity in cardiovascular risk status among middle-aged Puerto Rican, Cuban, Dominican, Central American and South American women, not explained by acculturation or socioeconomic indicators. These differences may be important for targeting screening and preventive interventions.

Cubans abroad: a gendered case study on international migrations

Cubans who have migrated since the 1990s after living for two decades or more in their country of origin left with an embedded gender ideology that they acquired in a society where gender relations were undergoing radical transformations. As a result, Cuban feminization of migrations has its peculiarities. In this context, there are three issues to consider: explaining how gender relations attained in Cuba, as part of the overall attitudes gained since childhood, influenced Cuban migrants who have left the island permanently since 1990, introduced uniqueness in their migration processes, and made up a different feminization of migration; identifying the features of Cuban social structure that shaped the gender ideology of Cuban migrants; and producing new knowledge about Cuban international migration processes by using a gender perspective and by analyzing the gender relations prevailing in the years before the crisis of the 1990s, as well as since the beginning of the twenty-first century. The first part of this article focuses on gender distinctiveness of recent Cuban migrants, and the second summarizes some traits of the Cuban social structure—mainly referred to female employment—that could explain the gender training of the migrants.

Cuban medical cooperation in Haiti: one of the world's best-kept secrets

This article analyzes Cuba's medical role in Haiti since Hurricane Georges in 1998, with particular emphasis on the Cuban government's response to the 2010 earthquake. The article examines two central themes. First, it assesses the enormous impact on public health that Cuba has made since 1998, and second, it provides a comparative analysis of Cuba's medical role since the earthquake.

Fifty years of Cuba's medical diplomacy: from idealism to pragmatism

Medical diplomacy, the collaboration between countries to simultaneously produce health benefits and improve relations, has been a cornerstone of Cuban foreign policy since the outset of the revolution fifty years ago. It has helped Cuba garner symbolic capital (goodwill, influence, and prestige) well beyond what would have been possible for a small, developing country, and it has contributed to making Cuba a player on the world stage. In recent years, medical diplomacy has been instrumental in providing considerable material capital (aid, credit, and trade), as the oil-for-doctors deals with Venezuela demonstrates. This has helped keep the revolution afloat in trying economic times. What began as the implementation of the one of the core values of the revolution, namely health as a basic human right for all peoples, has continued as both an idealistic and a pragmatic pursuit. This article examines the factors that enabled Cuba to conduct medical diplomacy over the past fifty years, the rationale behind the conduct of this type of soft power politics, the results of that effort, and the mix of idealism and pragmatism that has characterized the experience. Moreover, it presents a typology of medical diplomacy that Cuba has used over the past fifty years.

El Habano and the world it has shaped: Cuba, Connecticut, and Indonesia

In the half century since the 1959 Cuban Revolution, El Habano remains the premium cigar the world over; but both before and since 1959, the seed, agricultural and industrial know-how, and human capital have been transplanted to replicate that cigar in a process accentuated by upheavals and out-migration. The focus here is on a little-known facet of the interconnected island and offshore Havana cigar history, linking Cuba with Connecticut and Indonesia: from when tobacco was taken from the Americas to Indonesia and gave rise to the famed Sumatra cigar wrapper leaf; through the rise and demise of its sister shade wrapper in Connecticut, with Cuban and Sumatra seed, ultimately overshadowed by Indonesia; and the resulting challenges facing Cuba today. The article highlights the role of Dutch, U.S., British, and Swedish capital to explain why in 2009 the two major global cigar corporations, British Imperial Tobacco and Swedish Match, were lobbying Washington, respectively, for and against the embargo on Cuba. As the antismoking, antitobacco lobby gains ground internationally, the intriguing final question is whether the future lies with El Habano or smokeless Swedish snus.

Cancer incidence in first generation U.S. Hispanics: Cubans, Mexicans, Puerto Ricans, and new Latinos

BACKGROUND

The diversity among Hispanics/Latinos, defined by geographic origin (e.g., Mexico, Puerto Rico, Cuba), has been neglected when assessing cancer morbidity. For the first time in the United States, we estimated cancer rates for Cubans, Mexicans, Puerto Ricans, and other Latinos, and analyzed changes in cancer risk between Hispanics in their countries of origin, U.S. Hispanics in Florida, and non-Hispanic Whites in Florida.

METHODS

Florida cancer registry (1999-2001) and the 2000 U.S. Census population data were used. The Hispanic Origin Identification Algorithm was applied to establish Hispanic ethnicity and subpopulation.

RESULTS

The cancer rate of 537/100,000 person-years (95% confidence interval, 522.5-552.5) for Hispanic males in Florida was lower than Whites (601; 595.4-606.9). Among women, these rates were 376 (365.6-387.1) and 460 (455.6-465.4), respectively. Among Florida Hispanics, Puerto Ricans had the highest rates, followed by Cubans. Mexicans had the lowest rates. Rates for Hispanics in Florida were at least 40% higher than Hispanics in their countries of origin, as reported by the IARC.

CONCLUSION

Substantial variability in cancer rates occurs among Hispanic subpopulations. Cubans, unlike other Hispanics, were comparable with Whites, especially for low rates of cervical and stomach cancers. Despite being overwhelmingly first generation in the U.S. mainland, Puerto Ricans and Cubans in Florida showed rates of colorectal, endometrial, and prostate cancers similar to Whites in Florida. Because rates are markedly lower in their countries of origin, the increased risk for cancer among Cubans, Mexicans, and Puerto Ricans who move to the United States should be further studied.

Looking under the Hispanic umbrella: cancer mortality among Cubans, Mexicans, Puerto Ricans and other Hispanics in Florida

Cancer is the second leading cause of death among Hispanics. Most of the cancer statistics available both at the state and national levels report cancer statistics for all Hispanics as an aggregate group. The goal of this paper is to provide a population-based overview of cancer mortality among Hispanics (Cubans, Mexicans, Puerto Ricans and other Hispanics) in Florida from 1990 to 2000 and to explore the demographic diversity of this growing ethnic group. The study population consisted of Hispanics and White non-Hispanics who died from cancer. Cancer mortality rates and proportion of cancer deaths by type and age at death for the selected racial/ethnic groups were calculated. Our findings indicate that the cancer death rates of the Hispanic subgroups compared favorably with those of White non-Hispanics and that cancer rates often presented for all Hispanics mask important differences between the different ethnic subgroups that fall under the Hispanic umbrella.

Validation of a semiquantitative food frequency questionnaire to assess energy and macronutrient intakes of Cuban Americans

OBJECTIVE

To assess the validity of a 131-item semiquantative food frequency questionnaire (FFQ) by comparison with multiple food records in Cuban Americans.

DESIGN

The Willet FFQ was administered and food consumptions of three random days (two weekdays and one weekend day) were collected.

SETTING

Cuban Americans residing in Miami.

PARTICIPANTS

Twenty adult Cuban American volunteers who participated in a larger epidemiological study to evaluate the dietary risk of type 2 diabetes and cardiovascular disease.

RESULTS

There were no significant differences in the mean intakes of energy, macronutrients, cholesterol and alcohol estimated by the Willett FFQ and the 3-day food records. For most of the macronutrients the correlation coefficients ranged from 0.14 to 0.71. The correlation coefficient was highest for polyunsaturated fatty acid (r = 0.71, P<0.001) and lowest for protein (r = 0.14, P=0.56). Correlation coefficients for carbohydrate (r = 0.42) and monounsaturated fatty acid (r = 0.43) were only marginally significant (P=0.06).

CONCLUSION

Compared with 3-day food records, the Willett FFQ is a reasonable instrument to assess the intakes of most macronutrients and alcohol among Cuban Americans. Further studies should be conducted to validate the usefulness of the Willett FFQ in Cuban Americans for other nutrients.