Myriam E. Torres

Acculturation, physical activity, and obesity among Hispanic adolescents

Objective. Little is known about how acculturation may influence participation in leisure-time physical activity and obesity among adolescents. The objective of this study was to examine these associations among Hispanic adolescents. Design. Data were drawn from the 2003 National Survey of Childrens Health, restricted to Hispanic adolescents aged 10–17 (n=4704). Acculturation was assessed by proxy measures (generation status and language spoken at home). Adolescents who were not reported to engage in physical activity lasting at least 20 minutes, that was vigorous enough to cause sweating and hard breathing, for at least three days per week were defined as failing to meet physical activity requirements. Obesity was defined as gender and age-specific body mass index values at or above the 95th percentile of the reference population. Multiple logistic regressions were performed to adjust for confounders. Results. Of the Hispanic adolescents studied, 25.2%, 43.8%, and 31.1% were first, second, and third generation or more, respectively. English was the primary language in the home for 42.8% of these adolescents. Compared with adolescents in the third generation, adolescents from immigrant families had higher odds for not obtaining recommended physical activity (first generation: adjusted odds ratio [AOR] = 1.50, 95% conference intervals [CI]: 1.09, 2.05; second generation: AOR = 1.29, 95% CI: 0.99, 1.69). Living in homes where English was not the primary language, vs. English-speaking homes, was also associated with not obtaining recommended physical activity (AOR = 1.36, 95% CI: 1.06, 1.75). The unadjusted prevalence of obesity was higher in homes where English was not the primary language (22.5% vs. 16.1%; p<0.01), but this difference disappeared after adjusting for family socioeconomic status. Generational status was not a significant correlate of obesity. Conclusions. Findings suggest that future public health interventions that aim to increasing physical activity among Hispanic adolescents should be tailored based on generational status and English-language use.

Maternal obesity, folate intake, and neural tube defects in offspring

BACKGROUND We investigated the association between maternal obesity (body mass index [BMI] ≥ 30) and the risk of a neural tube defect affected pregnancy (NTD). We also studied relationships between perinatal folate intake from food and the NTD risk by maternal BMI. METHODS Data came from a state-wide case-control study conducted between 1992 and 1997 in South Carolina including 179 women with NTD-affected pregnancies and 288 women without NTD-affected births. A majority of case mothers (77%) and controls (86%) were interviewed within 6 months after delivery or pregnancy termination. Logistic regression models were used to examine the association between maternal obesity and the NTD risk after adjusting for maternal race, age, education, smoking, alcohol/drug use, chronic conditions, and multivitamin use within six periconceptional months. Stratified analysis by maternal BMI (≥25 vs. <25) was conducted for the association between food folate and the NTD risk. RESULTS After adjustment for confounders, obese women (BMI ≥ 30) had twice higher odds of having an NTD-affected pregnancy (odds ratios [OR] = 2.06, 95% confidence interval [CI] = 1.12, 3.81) than normal weight women (BMI: 18.0-24.9). Compared to the lowest quartile of average daily folate intake from food, the upper three quartiles had lower odds of NTDs in offspring. The NTD-protective association was stronger in overweight/obese women (BMI ≥ 25) than in normal/underweight women (BMI < 25). CONCLUSIONS These results support previous studies suggesting maternal obesity as a risk factor for NTDs. Higher intakes of dietary folate were associated with decreased NTD risk that was stronger in overweight and obese women.

Latina Voices in Childhood Obesity A Pilot Study Using Photovoice in South Carolina

BACKGROUND South Carolina has one of the highest rates of obesity in the nation and, proportionately, more Latino children aged 2-5 years are obese compared to black and white children in the state. PURPOSE Latina mothers will identify the barriers and opportunities for physical activity for Latino children in West Columbia SC and propose policy recommendations. METHODS This is a qualitative pilot study with 12 Latina mothers using Photovoice to identify barriers and opportunities for physical activity for their children. Community stakeholder and school staff interviews (eight) also were conducted. Latinas discussed the data collected and developed potential solutions to the problems. Data collection and analysis took place in the city of West Columbia during 2010-2011. Content analysis of focus groups and interview transcripts were conducted using descriptive qualitative coding techniques. RESULTS Latina mothers positively described their neighborhoods as their homes but also identified several environmental barriers to physical activity including lack of transportation, not being able to speak English, lack of knowledge of their childrens opportunities at school, and feelings of discrimination due to anti-immigration sentiments in the state. Mothers also proposed to improve their family diets, advocate for better equipment in public parks, building of community sidewalks, and increasing neighborhood police presence. CONCLUSIONS Latina mothers demonstrated knowledge about factors related to childhood obesity and proposed solutions to the problems and worked to organize their communities to present alternatives to policymakers. This study underscores the importance of including community input when planning programs addressing childhood obesity.

Rural Hospitals and Spanish-Speaking Patients with Limited English Proficiency

Between 1990 and 2000, the Latino population in the United States increased by 61 percent, becoming the largest minority group. Language differences contribute to patient safety and access to healthcare concerns for limited English proficiency (LEP) Latinos. The objectives of this research were to determine the techniques rural hospitals use to accommodate Spanish-speaking LEP patients, to identify strengths and barriers to providing language services, and to describe local approaches to language assistance services. Surveys were mailed to 841 hospitals in 544 rural counties with moderate to high Latino growth rates between 1990 and 2000. A total of 319 rural hospitals responded. Nearly all rural hospitals reported having tools to help patients communicate language needs. The most commonly used tools include brochures, language identification posters, and language identification cards. Strengths were institutional support for language assistance services, staff willingness to use interpreters, and access to telephone language lines. Principal barriers included lack of funding for interpreters, lack of local language training programs, and lack of state agency support. Hospitals that serve counties with higher Latino population growth rates reported higher demand for services compared with those counties with smaller Latino population growth rates. Several innovative approaches were also identified. Various language accommodation resources, tools, and strategies are available for hospitals to help them serve LEP clientele. Hospitals should routinely review their policies and procedures for language assistance services to ensure compliance with federal and Joint Commission standards.

Periconceptional multivitamin folic acid use, dietary folate, total folate and risk of neural tube defects in South Carolina

Abstract PURPOSE: To investigate whether dietary folate or multivitamin folic acid taken 3 months before conception and during the first 3 months of pregnancy reduces the risk of isolated occurrent neural tube defect (NTD)-affected pregnancies. METHODS: This population-based case control study conducted between 1992 and 1997 included 179 women with NTD-affected pregnancies and 288 randomly selected controls. Women completed a food frequency questionnaire and were interviewed about lifestyle behaviors, pregnancy histories and use of multivitamins. RESULTS: Use of 0.4 mg or more of multivitamin folic acid at least 3 times per week during the periconceptional period showed no statistically significant reduction in NTD risk [adjusted odds ratio (AOR) = 0.55, 95% confidence interval (CI) = 025, 1.22]. After adjusting for covariates, protective effects for NTDs were observed at the highest quartiles of dietary folate and total folate (daily dietary folate plus daily multivitamin folic acid); the respective odds ratios were 0.40 (95% CI = 0.19, 0.84) and 0.35 (95% CI = 0.17, 0.72). CONCLUSIONS: This study illustrates some of the difficulties in determining effects of folic acid and dietary folate in a population where the consumption of foods rich in folate and the use of multivitamins are increasing and the rate of NTDs is declining. Studies are needed to monitor future changes in folate levels and their effect on health.

Written and spoken narratives about health and cancer decision making: a novel application of photovoice.

Photovoice is a community-based participatory research method that researchers have used to identify and address individual and community health needs. We developed an abbreviated photovoice project to serve as a supplement to a National Cancer Institute–funded pilot study focusing on prostate cancer (PrCA) that was set in a faith-based African American community in South Carolina. We used photovoice for three reasons: (a) to enhance communication between study participants and researchers, (b) to empower African American men and women to examine their health decisions through photographs, and (c) to better understand how participants from this community make health-related decisions. The 15 individuals participating in the photovoice project were asked to photograph aspects of their community that informed their health-related decisions. Participants provided written and oral narratives to describe the images in a small sample of photographs. Four primary themes emerged in participants’ photographs and narratives: (a) food choices, (b) physical activity practices, (c) community environment and access to care, and (d) influences of spirituality and nature on health. Although written and audio-recorded narratives were similar in content, the audio-recorded responses were more descriptive and emotional. Results suggest that incorporating audio-recorded narratives in community photovoice presentations may have a greater impact than written narratives on health promotion, decision making, and policy makers because of an increased level of detail and personalization. In conclusion, photovoice strengthened the parent study and empowered participants by making them more aware of factors influencing their health decisions.

Periconceptional vitamin use, dietary folate and occurrent neural tube defected pregnancies in a high risk population

PURPOSE: This 5 year (1992-1997) population-based case control study was conducted to determine if supplemental or dietary folate taken during the periconceptional period reduces the risk of occurrent neural tube defect (NTD) affected pregnancies in a high risk population.METHODS: Cases were all NTD pregnancies including elective terminations, fetal deaths and live births in South Carolina. Only isolated, occurrent NTD affected pregnancies were included (N = 179). Controls (N = 288) were randomly selected from each hospital in proportion to the hospitals contribution to the total live births in the state for the previous year. All mothers were interviewed in person using a modified Centers for Disease Control and Prevention Birth Defect Risk Factor Surveillance Mothers Questionnaire and the Harvard Food Frequency Questionnaire.RESULTS: Women who used a vitamin with 0.4 mg or more of folate at least 3 times per week during the 3 months before and 3 months after conception had a lower risk of having an NTD affected pregnancy than women who took no folate supplementation at any time during pregnancy [adjusted odds ratio (AOR) = 0.42; 95% confidence interval (CI) = 0.19-0.94]; women who used a vitamin with 0.4 mg or more of folic acid for less than 3 times per week or in partial months during the 6 month periconceptional period also had a slightly lower risk of having an NTD affected pregnancy relative to women who used no folate supplementation at any time during pregnancy [AOR =.72; 95% CI = 0.41-1.30]. The risk of NTD affected pregnancy was also lower for women who daily consumed foods containing higher levels of folate: AORs were 0.36 (95% CI = 0.18-0.73), 0.72 (95% CI = 0.42-1.22), and 0.61 (95% CI 0.36-1.04) from the highest to lowest quartile of dietary folate which were 0.457-3.12 mg, 0.322-0.457 mg, and 0.236-0.322 mg respectively.CONCLUSIONS: A reduction in occurrent NTD risk associated with folate supplementation and dietary intake was observed.

Gender-specific association between iron status and the history of attempted suicide: Implications for gender paradox of suicide behaviors

PURPOSE Iron deficiency (ID) has been linked with high impulsivity, and an increased risk of ID was reported among suicide attempters. We hypothesized that poor iron status might be prevalent among suicide attempters, who have high impulsivity. METHODS As a part of the third National Health and Nutrition Examination Survey (1988-1994), a set of iron indices were measured in 2598 men and 2975 women aged 17-39 years, who completed a mental disorder diagnostic interview. RESULTS Using non-attempters as reference within each gender, we observed a gender-dependent association between poor iron status and the history of attempted suicide. For male attempters (n=74), the prevalence ratios (PR) of abnormal serum ferritin, serum iron and protoporphyrin were 18.3 (95%CI=3.3-101.7), 3.2 (1.1-9.4) and 5.4(1.8-15.6). In contrast, the PR of abnormal serum ferritin for female attempters (n=217) was 0.3 (0.1-0.6). The hematological indices did not differ significantly between attempters and non-attempters among either men or women. Compared with non-attempters, male attempters were prone to a higher odds [17.5 (4.2-72.4)] while female attempters to a lower odds [0.6 (0.3-1.1)] of ID. CONCLUSION These data suggest new opportunities for exploring biological bases of gender paradox of suicidal behaviors and a novel way to enhance therapeutic and preventive interventions against suicide.

Developing a Culturally Appropriate Preconception Health Promotion Strategy for Newly Immigrated Latinos through a Community-Based Program in South Carolina

Maternal and Child Health (MCH) experts emphasize the importance of preconception health (PCH) in achieving healthy pregnancies and positive birth outcomes. Research demonstrates that Latinas face significant PCH disparities, yet no comprehensive PCH promotion strategy exists to reach them. As a trusted community-based organization that uses culturally competent strategies to promote MCH in the Latino community, PASOs is well-positioned to address PCH among Latinos in South Carolina. With the input and support of Latino community members, PASOs is pioneering a PCH strategy using its successful model of education, outreach, partnerships and resource navigation.

Associations Between School Perceptions and Tobacco Use in a Sample of Southern Middle School Students

Cigarettes are responsible for nearly 443,000 deaths per year in the United States. Eighty percent of adult smokers began smoking before the age of 18. In 2009, 17.2% of high school and 5.2% of middle school youths reported being a smoker. Research on school perceptions suggests that “engaged” students get more from school on all levels, including reduced health risk behaviors. The purpose of this study was to identify which school perceptions are protective against tobacco use in a sample of middle school youths. Results conclude that high levels of educational attachment are significantly associated with low levels of tobacco use.