Julianna Deardorff

The Mexican American cultural values scale for adolescents and adults

This research evaluates the properties of a measure of culturally linked values of Mexican Americans in early adolescence and adulthood. The article discusses the items derived from qualitative data provided by focus groups in which Mexican Americans’ (adolescents, mothers, and fathers) perceptions of key values were discussed. The focus groups and a preliminary item refinement result in the 50-item Mexican American Cultural Values Scale (MACVS; identical for adolescents and adults) that includes 9 subscales. Analyses of data from two large previously published studies sampling Mexican American adolescents, mothers, and fathers provide evidence of the expected two correlated higher order factor structures, reliability, and construct validity of the subscales of the MACVS as indicators of values that are frequently associated with Mexican/Mexican American culture. The utility of this measure for use in longitudinal research and in resolving some important theoretical questions regarding dual cultural adaptation is discussed.

Onset of Breast Development in a Longitudinal Cohort

BACKGROUND AND OBJECTIVES: There is growing evidence of pubertal maturation occurring at earlier ages, with many studies based on cross-sectional observations. This study examined age at onset of breast development (thelarche), and the impact of BMI and race/ethnicity, in the 3 puberty study sites of the Breast Cancer and the Environment Research Program, a prospective cohort of >1200 girls. METHODS: Girls, 6 to 8 years at enrollment, were followed longitudinally at regular intervals from 2004 to 2011 in 3 geographic areas: the San Francisco Bay Area, Greater Cincinnati, and New York City. Sexual maturity assessment using Tanner staging was conducted by using standardized observation and palpation methods by trained and certified staff. Kaplan-Meier analyses were used to describe age at onset of breast maturation by covariates. RESULTS: The age at onset of breast stage 2 varied by race/ethnicity, BMI at baseline, and site. Median age at onset of breast stage 2 was 8.8, 9.3, 9.7, and 9.7 years for African American, Hispanic, white non-Hispanic, and Asian participants, respectively. Girls with greater BMI reached breast stage 2 at younger ages. Age-specific and standardized prevalence of breast maturation was contrasted to observations in 2 large cross-sectional studies conducted 10 to 20 years earlier (Pediatric Research in Office Settings and National Health and Nutrition Examination Survey III) and found to have occurred earlier among white, non-Hispanic, but not African American girls. CONCLUSIONS: We observed the onset of thelarche at younger ages than previously documented, with important differences associated with race/ethnicity and BMI, confirming and extending patterns seen previously. These findings are consistent with temporal changes in BMI.

Condom negotiation strategies and actual condom use among Latino youth.

PURPOSE To examine which condom negotiation strategies are effective in obtaining or avoiding condom use among Latino youth. METHOD Interviews were conducted with 694 Latino youth, 61% female, aged 16-22. Participants reported on their condom negotiation strategies, perceptions of whether their sexual partner wanted to use condoms, and actual condom use. Three strategies to obtain condom use (risk information, direct verbal/nonverbal communication, insist) and four strategies to avoid condom use (emotional coercion, ignore condom use, dislike condoms, seduction) were examined. Data were analyzed using multiple linear regression, and included youth (n = 574) who reported wanting to use or avoid condoms. RESULTS Almost 60% of participants reported wanting to use condoms, and nearly all of these used some strategy to obtain condom use. Young men who wanted to use condoms were more likely to do so, compared with young women. Risk information and direct verbal/nonverbal communication were effective strategies to obtain condom use, even among youth who perceived their sexual partners as not wanting to use condoms. Ignoring condom use was an effective condom avoidance strategy, even when youth thought their partners wanted to use condoms. Unexpectedly, young men who expressed dislike of condoms had higher rates of condom use than young men not using this condom avoidance strategy. CONCLUSIONS This research identified condom negotiation strategies that are effective among Latino youth, even when they believe their partners do not want to use condoms. Health care providers could encourage Latino youth to use such condom negotiation strategies.

Parental feeding practices in Mexican American families: initial test of an expanded measure.

BackgroundAlthough obesity rates are high among Latino children, relatively few studies of parental feeding practices have examined Latino families as a separate group. Culturally-based approaches to measurement development can begin to identify parental feeding practices in specific cultural groups. This study used qualitative and quantitative methods to develop and test the Parental Feeding Practices (PFP) Questionnaire for use with Mexican American parents. Items reflected both parent’s use of control over child eating and child-centered feeding practices.MethodsIn the qualitative phase of the research, 35 Latino parents participated in focus groups. Items for the PFP were developed from focus group discussions, as well as adapted from existing parent feeding practice measures. Cognitive interviews were conducted with 37 adults to evaluate items. In the quantitative phase, mothers and fathers of 174 Mexican American children ages 8–10 completed the PFP and provided demographic information. Anthropometric measures were obtained on family members.ResultsConfirmatory factor analyses identified four parental feeding practice dimensions: positive involvement in child eating, pressure to eat, use of food to control behavior, and restriction of amount of food. Factorial invariance modeling suggested equivalent factor meaning and item response scaling across mothers and fathers. Mothers and fathers differed somewhat in their use of feeding practices. All four feeding practices were related to child body mass index (BMI) percentiles, for one or both parents. Mothers reporting more positive involvement had children with lower BMI percentiles. Parents using more pressure to eat had children with lower BMI percentiles, while parents using more restriction had children with higher BMI percentiles. Fathers using food to control behavior had children with lower BMI percentiles.ConclusionsResults indicate good initial validity and reliability for the PFP. It can be used to increase understanding of parental feeding practices, children’s eating, and obesity among Mexican Americans, a population at high risk of obesity.

Preventing Poor Mental Health and School Dropout of Mexican American Adolescents Following the Transition to Junior High School

This study provided an initial test of the Bridges to High School Program, an intervention designed to prevent school disengagement and negative mental health trajectories during the transition to junior high school. The intervention included an adolescent coping skills intervention, a parenting skills intervention, and a family strengthening intervention. The program was evaluated by examining pretest to posttest changes on targeted mediators and outcomes with a sample of 22 predominantlyMexican American families. Adolescents reported increased use of active and distraction coping strategies, and decreased depressive symptoms for themselves from pretest to posttest. They also reported significant changes in their mothers’parenting skills, including increased monitoring and a decrease in inconsistent discipline. Maternal caregivers reported an increase in supportive parenting and a decrease in inconsistent discipline for themselves and fewer adolescent problem behaviors. Process evaluations confirmed the attractiveness and perceived helpfulness of the program.

Identifying Opportunities for Cancer Prevention During Preadolescence and Adolescence: Puberty as a Window of Susceptibility

PURPOSE Early life exposures during times of rapid growth and development are recognized increasingly to impact later life. Epidemiologic studies document an association between exposures at critical windows of susceptibility with outcomes as diverse as childhood and adult obesity, timing of menarche, and risk for hypertension or breast cancer. METHODS This article briefly reviews the concept of windows of susceptibility for providers who care for adolescent patients. RESULTS The theoretical bases for windows of susceptibility is examined, evaluating the relationship between pubertal change and breast cancer as a paradigm, and reviewing the underlying mechanisms, such as epigenetic modification. CONCLUSIONS The long-term sequela of responses to early exposures may impact other adult morbidities; addressing these exposures represents an important challenge for contemporary medicine.

Sexual Abuse in Childhood and Adolescence and the Risk of Early Pregnancy Among Women Ages 18–22

PURPOSE This clinic- and community-based study of young women investigated the relationship between previous sexual abuse and early pregnancy, examining the effect of the developmental period in which sexual abuse occurred and type of sexual abuse, while also providing methodological advances in the assessment of distinctive sexual abuse and its sequelae. METHODS Secondary data analysis using Cox proportional hazards models was conducted to determine the association between sexual abuse in childhood, in adolescence, or both, and risk of early pregnancy among 1,790 young women. In addition, this study examined the type of sexual abuse that occurred during each period. RESULTS As compared with women with no history of sexual abuse, women who experienced sexual abuse only in childhood had a 20% greater hazard of pregnancy; women who experienced sexual abuse only in adolescence had a 30% greater hazard of pregnancy; and women who experienced sexual abuse in both childhood and adolescence had an 80% greater hazard of pregnancy. Across these periods, attempted rape and rape were associated with an increased hazard of pregnancy. The association between sexual abuse and pregnancy was mediated by age at first intercourse and moderated by a womans education level. CONCLUSION This study provides evidence that both the developmental timing and the type of sexual abuse contributes to an increased risk for early pregnancy. The study findings indicate that sexual abuse leads to an earlier age of first sexual intercourse, which in turn increases the likelihood of an early pregnancy. Women with higher educational attainment are less likely to experience early pregnancy as a result of abuse.

Maternal Hyperglycemia During Pregnancy Predicts Adiposity of the Offspring

OBJECTIVE To investigate associations between maternal pregnancy hyperglycemia, gestational diabetes mellitus (GDM), and offspring adiposity. RESEARCH DESIGN AND METHODS We evaluated these associations in a longitudinal study of 421 mother-daughter pairs at Kaiser Permanente Northern California. Maternal pregnancy glucose values were obtained from maternal medical records. Outcomes included three measures of girls’ adiposity, measured annually: 1) ≥85th age-specific percentile for BMI; 2) percent body fat (%BF); and 3) waist-to-height ratio (WHR). RESULTS Adjusting for maternal age at delivery, race/ethnicity, pregravid BMI, girl’s age, and girl’s age at onset of puberty, having a mother with GDM increased a girl’s risk of having a BMI ≥85th percentile or having %BF or WHR in the highest quartile (Q4), compared with those in the lowest quintile of blood glucose (odds ratio [OR] 3.56 [95% CI 1.28–9.92]; OR 3.13 [95% CI 1.08–9.09]; and OR 2.80 [95% CI 1.00–7.84], respectively). There was a significant interaction between the presence of GDM and pregravid BMI; girls whose mothers had both risk factors had the highest odds of having a BMI ≥85th percentile (OR 5.56 [95%CI 1.70–18.2]; Q4 %BF, OR 6.04 [95%CI 1.76–20.7]; and Q4 WHR, OR 3.60 [95%CI 1.35–9.58]). Similar, although weaker, associations were found in the association between hyperglycemia and offspring adiposity. CONCLUSIONS Girls who were exposed to maternal GDM or hyperglycemia in utero are at higher risk of childhood adiposity; risk increases if the mother is overweight or obese. Screening and intervention for this high-risk group is warranted to slow the intergenerational transmission of obesity and its sequelae.

Education and obesity at age 40 among American adults.

Although many have studied the association between educational attainment and obesity, studies to date have not fully examined prior common causes and possible interactions by race/ethnicity or gender. It is also not clear if the relationship between actual educational attainment and obesity is independent of the role of aspired educational attainment or expected educational attainment. The authors use generalized linear log link models to examine the association between educational attainment at age 25 and obesity (BMI≥30) at age 40 in the USAs National Longitudinal Survey of Youth 1979 cohort, adjusting for demographics, confounders, and mediators. Race/ethnicity but not gender interacted with educational attainment. In a complete case analysis, after adjusting for socioeconomic covariates from childhood, adolescence, and adulthood, among whites only, college graduates were less likely than high school graduates to be obese (RR = 0.69, 95%CI: 0.57, 0.83). The risk ratio remained similar in two sensitivity analyses when the authors adjusted for educational aspirations and educational expectations and analyzed a multiply imputed dataset to address missingness. This more nuanced understanding of the role of education after controlling for a thorough set of confounders and mediators helps advance the study of social determinants of health and risk factors for obesity.

Is it time for bed? Short sleep duration increases risk of obesity in Mexican American children

OBJECTIVE Cross-sectional studies show that sleep is related to childhood obesity. We aimed to examine the longitudinal impact of sleep on the risk of obesity in Mexican American children. DESIGN AND METHODS We evaluated 229 Mexican American 8-10-year-olds and their mothers at baseline and at 12- and 24-month follow-ups. Sleep duration and anthropometrics were collected. Age- and gender-specific body mass index (BMI) z-scores (BMIz) were calculated based on Centers for Disease Control and Prevention guidelines. Sleep duration was estimated using accelerometry. Children were also categorized as long or short sleepers, using the National Sleep Foundations recommendation to define adequate sleep duration (10-11 h for 5-12-year-olds). Using linear regressions, we examined whether sleep duration predicted BMIz, waist-to-height ratio (WHtR), and weight gain at 24 months. RESULTS Children were mostly short sleepers (82%). Children who slept less were more likely to have a higher BMIz, WHtR, and weight gain at the 24-month follow-up (β = -0.07, P = 0.01; β = -0.11, P <0.01; and β = -0.14, P = 0.02, respectively), after controlling for baseline weight status, child gender, maternal BMI, and occupation. CONCLUSION In Mexican American children, shorter sleep duration at baseline was associated with increased weight status over 24 months.