ERIC EJ795571: Activity Determinants among Mexican American Women in a Border Setting

2008·0.13 MB·English

by  ERIC

Research Article
Activity Determinants among Mexican
American Women in a Border Setting
Bobby Guinn and Vern Vincent
ABSTRACT
Background: Mexican American women have the highest leisure-time physical inactivity prevalence of any ethnic
minority group. Purpose: This study examined a sample of Mexican American females living near the U.S.-Mexico
border to determine whether the variables of age, health status, educational level, marital status, and acculturation
distinguished between those who are physically active and those who are physically inactive. Methods: Participants
included 379 women ranging in age from 22 to 58 years. Data was gathered through a self-report survey instrument
with discriminant analysis used to test for variable differentiation between active and inactive subjects. Results:
Present activity was comparable to national representative samples, and the discriminant function indicated higher
acculturative status and better perceived health differentiated between those women reporting themselves to be physi-
cally inactive versus those reporting to be physically active. Discussion: Physical activity interventions targeting border
Mexican American women should account for varying acculturation levels. Translation to Health Education Practice:
To be effective, program strategies designed to promote physically active lifestyles among border Mexican American
women should be linguistically appropriate and culturally sensitive to optimize behavior change.
BACKGROUND physical activity.4 being overweight decreases life expectancy
Insuffi cient physical activity is an impor- An alarming issue attendant to this by one to three years and increases the risk
tant correlate of a number of health disor- problem is the very low level of physical from all-cause mortality from 50 to 100%.7
ders, including increased risk of coronary activity among minority ethnic groups. This Despite these health risks, U.S. overweight
heart disease, colon cancer, hypertension, is most evident in the high prevalence of and obesity estimates have dramatically in-
and osteoporosis.1,2 Crespo3 defi ned physical physical inactivity observed among Mexican creased in recent years, particularly among
inactivity as a lack of participation in any American women. The literature indicates Mexican Americans. While the prevalence of
type of leisure-time physical activity, viewing that Mexican American females, regardless overweight (i.e., body mass index [BMI] of
its measurement as less complicated than of occupational status, were least likely to at least 25.0) in the overall adult population
validly quantifying amounts and patterns of engage in moderate or vigorous physical is approximately 66.3%, among Mexican
physical activity. As a result of technologi- activity or to be physically active during Americans it is 75.8%.12 Additionally, obesity
cal advances engineering physical exertion leisure time when compared with Black and
out of daily routines, participation during non-Hispanic White females.5,6 Bobby Guinn is a professor in the Department of
leisure time has become the most widely Regular physical activity can help to Health and Kinesiology, University of Texas–Pan
studied form of activity assessment. Even control body weight, and measuring activ- American, 1201 W. University Dr., Edinburg, TX
though most people have greater amounts ity levels is of particular concern in view 78541; E-mail: [email protected]. Vern Vincent
of leisure time than in the past, our society of our nation’s overweight and obesity is a professor emeritus in the Department of
is becoming more sedentary; it is estimated prevalence. Healthy People 2010 placed over- Computer Information Systems and Quantita-
that only 32% of the U.S. population age weight and obesity among the country’s tive Methods, University of Texas–Pan Ameri-
18 and older regularly engages in moderate ten leading health indicators.7-11 Indeed, can; E-mail: [email protected].
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Bobby Guinn and Vern Vincent
(i.e., BMI of 30.0 to 39.9) is prevalent in activity than those with poorer health.23,24 and no effect.41 Lara and others34 attribute
40.0% of Mexican American women,13 and Education, as a criterion of socioeconomic this lack of a clear relationship to either an
morbid obesity (i.e., BMI of 40.0 or greater) status, exerts a powerful influence on insuffi cient number and/or quality of stud-
increased four- to fi vefold among this group health-related behavior.25 Persons of high ies or multiple studies that demonstrated
between 1990 and 2000.14 educational attainment are more physically opposite effects.
The enormity of the physical inactivity active than those of lower educational level,
and overweight/obesity issue among Mexi- encountering fewer economic, physical, and PURPOSE
can American women is underscored by social constraints to leisure activity, and In view of the disturbing overweight and
their level of chronic disease risk and mor- responding more readily to appeals from obesity trend among Mexican American fe-
bidity. When compared with non-Hispanic health professionals to modify their lifestyles males and its potential impact on a number
Whites, Mexican American females have two related to physical activity.11,26,27 The effect of of co-morbidities, it is important that factors
to three times greater Type 2 diabetes rates, marital status on leisure activity participa- infl uencing physical activity among this sub-
are 6 times more likely to develop end-stage tion is generally a result of the orderly life group be investigated. These trends assume
renal disease, and are more subject to severe that marriage presents for a number of particular urgency given that Hispanics are
hyperglycemia and its related complications health-related behaviors. In addition to the largest and fastest growing ethnic minor-
of hypertension, hyperlipidemia, and ath- being more physically active, married per- ity in the United States and are projected to
erosclerotic vascular disease.15-19 sons generally enjoy better health and greater comprise 21% of the population by 2020.42
Energy imbalance resulting from a com- life expectancy than singles.25 Widowhood Therefore, the purpose of this study was to
bination of increased energy intake and and divorce, which can result in degrees of extend the research on factors infl uencing
decreased energy expenditure contributes social isolation as well as changes in eco- leisure-time physical activity participa-
to overweight and obesity. Interventions nomic status, are associated with decreased tion among Mexican American females.
designed to reduce energy imbalance must activity participation.28 Specifically, the influence of age, health,
include strategies that create increased Acculturation is the social process of be- education, marital status, and acculturation
expenditure and/or decrease intake. Moder- coming adapted to a new or different culture was assessed through identifi cation of which
ate and regular physical activity is a critical and is considered to be a prominent step variables distinguish between physically ac-
component of any weight-control program; toward assimilation.29 This process allows tive and physically inactive females.
however, studies on the topic report decreased persons to effectively function in a society by
METHODS
activity to be an independent predictor of distancing their culture of origin and accept-
obesity in female Mexican Americans.20,21 ing the host country’s mainstream beliefs Sample and Administration
Because of the extremely high prevalence of and customs.30 Landrine and Klonoff31 view The study sample was drawn from the
physical inactivity among this population, acculturation as a continuum from tradi- rural Lower Rio Grande Valley (LRGV)
identifi cation of factors associated with regu- tional to acculturated; traditional persons region of South Texas. The LRGV lies in
lar activity involvement must occur before remain immersed in many of the beliefs, the easternmost part of the U.S.-Mexico
effective interventions can be developed. practices, and values of their own culture border, with a population overwhelmingly
Studies of leisure-time physical activity whereas highly acculturated persons have of Mexican origin. Subjects were the parents
determinants in the general adult popula- rejected the beliefs and practices of their and adult relatives of students enrolled in
tion have reported age, health, education, own culture in favor of those of the main- three border-serving elementary schools
and marital status as factors infl uencing stream culture. The literature dealing with from a LRGV school district in which Mexi-
participation. Acculturation, because of the effects of acculturation on health-related can Americans comprise 97.2% of the total
its infl uence on the overall well-being of behaviors and outcomes among persons student body. A self-report questionnaire
an individual, has been widely investigated of Mexican origin indicates use of illicit instrument was distributed to all students
among foreign-born Mexican Americans drugs and alcohol and tobacco, patterns in three randomly selected fourth- and fi fth-
regarding relationships with selected health of unhealthy dietary practices, and obesity grade classes in each of the three schools.
and behavioral outcomes. Adult leisure-time prevalence are stronger among those who Students were given two copies of the ques-
physical activity is negatively related to age; are more acculturated than among those less tionnaire copies and asked to present them
as people grow older, the prevalence of activ- acculturated.20,32-35 However, no clear asso- to parents and/or adult family members in
ity participation decreases.2,6,22 Health status ciation has been demonstrated between ac- the household, returning them within three
is positively related to physical activity; per- culturation and physical activity prevalence days. Students were informed that taking
sons with better health have greater activity among this population. Results of studies the questionnaires home was voluntary
repertoire size and degree of involvement examining this relationship report negative and that their relatives’ participation was
as well as stronger likelihood of continuing associations,36-38 positive associations,39,40 both voluntary and anonymous. The study’s
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purpose and voluntary nature were also as moderate activities included bowling, Statistical Analysis
indicated on the instrument. All Human dancing, golf, yoga, walking at a moder- Two-group discriminant analysis with
Subjects Research Board stipulations were ate or vigorous pace, softball, and lifting stepwise procedure employing the Ma-
observed to protect the confi dentiality and weights. Vigorous activity examples included halanobis D2 method was used to determine
rights of the respondents. As an incentive to aerobics, jogging/running, basketball, tennis, which of the investigated variables made the
present the questionnaire to adult household soccer, riding a stationary bicycle or bicy- greatest contribution in discerning between
members, students were given a voucher for cling outside, swimming, and roller skating/ physically inactive and physically active
a fat-free frozen dessert for each returned rollerblading. Mexican American women.50 Pearson cor-
respondent-completed questionnaire. This Health status. Perceived health status was relation coeffi cients were computed to ascer-
incentive-by-extension procedure (i.e. the measured by the question, “In general, what tain degree of association between variables
adult’s incentive to participate is seeing the is your overall heath?” Possible responses as well as descriptive statistics determined
child rewarded) is a recognized method of (excellent, very good, good, fair, poor) were for all variables. All data analyses were con-
increasing response rate and data adequacy.43 scored on a scale of 5 to 1. For the purposes ducted using SPSS Version 13.0.
A total of 648 instruments were distributed of psychosocial research, this subjective
and 494 were returned. Deletion of errone- evaluation has been demonstrated to be RESULTS
ously marked instruments yielded 469 usable a valid indicator of wellness regardless of The study sample (N=379) ranged in
tests; of these, 379 respondents identifi ed ethnicity.45,46 age from 22 to 58 years, with a mean of 33.2
themselves as Mexican American females, Educational level. Educational attain- years. Participants’ present physical activity
and they comprised the study sample. ment was based on responses to the ques- level was low, with 21.4% indicating no
Instrumentation tion, “How much education have you had?” weekly participation and 37.2% reporting
Each item on the survey instrument used Possible responses, scored on a scale of 1 only one to two 10-minute leisure-time
to collect the data was dually printed in to 5, were “8th grade or less,” “some high sessions per week. These inactivity levels
both English and Spanish to accommodate school,” “high school or trade school gradu- are comparable with those reported by na-
non-English-speaking participants, with ate,” “some college,” or “college graduate or tional representative samplings of Mexican
items translated into Spanish and back- higher.” American women.39
translated to ensure accuracy, clarifi cation, Acculturation. English-language use, Self-reported health status indicated
and content preservation. For the purposes which measures functional integration the participants perceived themselves to
of the study, physical activity was defi ned on into the U.S. mainstream, is recognized be relatively healthy, with 68.1% reporting
the instrument as engagement in moderate as one of the most powerful indicators of overall health as very good to excellent. The
to vigorous activities during leisure and/or acculturation.47 Accordingly, participants’ majority, 74.5%, reported themselves as cur-
free time. Age, gender, ethnicity, and marital acculturative status was determined through rently married. Educational attainment was
status were appraised through single-item Marin et al.’s48 language-use acculturation relatively low; 39.3% did not graduate from
indices, while activity level, health status, scale. Developed specifi cally for Hispan- either high school or trade school, 25.0%
education, and acculturation were measured ics, this scale has correlated highly with were high school or trade school graduates,
as described below. the acculturation criteria of a respondent’s and 35.7% reported some college-level work
Present activity level. Current physical generation (r=0.69), length of residence in or higher. Acculturative status was moder-
activity level was assessed by the subject’s the United States (r=0.76), and age of ar- ate, with the sample’s mean acculturation
response to the statement, “The number of rival (r=-0.72).49 The scale consists of four score being 10.3 on a scale of 4 to 20. Table
times a week I participate in at least 10 min- statements: (1) In general, what language 1 presents a descriptive profi le of the par-
utes of moderate to vigorous leisure-time do you read and speak? (2) What language ticipants.
physical activity which causes an increase do you usually speak at home? (3) In which Correlation coeffi cients between activ-
in breathing or heart rate is....” Possible re- language do you think? (4) What language ity level and investigated variables revealed
sponses ranged from “none” to “5 or more do you usually speak with your friends? Each statistically signifi cant positive relationships
times.” This outcome measure was based on statement is rated on a fi ve-point response with acculturation (r=.252, p<.001) and
the National Center for Health Statistics14 option ranging from “Spanish only,” “Span- health status (r=.179, p<.01). The reason
method of appraisal and reporting leisure- ish better than English,” “both equally,” for these relatively modest correlations is
time physical activity among adults. To help “English better than Spanish,” “English only.” the large sample size, which tends to over-
clarify this item, activity examples based The instrument’s theoretical range is 4 to 20, power the test.50 Nevertheless, they indicate
on the Compendium of Physical Activity with a higher score indicating greater ac- physical activity levels were higher among
metabolic equivalent (MET) values were culturation. The scale’s internal consistency those more acculturated and reporting bet-
listed on the instrument.44 Examples given alpha for the present study was .96. ter health. This fi nding is consistent with
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Bobby Guinn and Vern Vincent
research suggesting that more acculturated
female Hispanics perceive themselves as be- Table 1. Description of the Sample
ing healthier than less acculturated female
Variable No. %
Hispanics.51
To achieve the study’s purpose of iden- Weekly activity sessions
tifying which factors influence physical None 81 (21.4)
activity participation, the polar-extremes One 60 (15.8)
approach was used to group subjects into Two 81 (21.4)
inactive and active categories.50 Those re- Three 76 (20.1)
Four 40 (10.6)
spondents indicating none or one activity
Five or more 41 (10.7)
session per week were placed in the physi-
cally inactive group, and those indicating Self-rated health
four or more sessions per week were placed Excellent 93 (24.5)
in the physically active group. This method Very good 169 (44.6)
yielded 141 physically inactive and 81 physi- Good 102 (26.9)
cally active respondents. Fair 10 (2.6)
Poor 5 (1.4)
A discriminant function model was
generated to determine what variable dif- Marital status
ferences existed between the inactive and Married now 282 (74.5)
active groups. The discriminant analysis Never married 48 (12.7)
produced a statistically signifi cant Wilks’ Divorced/separated 43 (11.3)
lambda, .91 (alpha=.001), indicating a dif- Widowed 6 (1.5)
ference between the groups. Additionally, Educational level
the discriminant function was evaluated 8th-grade or less 105 (27.7)
for predictive accuracy by means of a clas- Some high school 44 (11.6)
sification “hit” matrix. Cross-validation High school or trade school graduate 95 (25.0)
“leave-one-out” classifi cation analysis pro- Some college 84 (22.3)
duced a 53% hit ratio, which did not meet College graduate or higher 51 (13.4)
the 67% hit ratio necessary to be at least
one-fourth greater than that achieved by
chance.50 Therefore, whereas the function differentiating between border-area Mexican The literature is clear on the relationship
discriminates between inactive and active American women who were active and those between health and activity involvement. As
groups in statistical significance, it only who were not. In contrast, age, education, a direct result of impairment in function
marginally discriminated between groups and marital status showed no discriminating and physical disability produced by health
in practical signifi cance. The discriminant value between the two groups. conditions, physical activity levels decline
analysis retained acculturation and health The lack of infl uence shown by age and commensurately with poorer health.2 Al-
status as the only statistically signifi cant education on physical activity participation though previously mentioned studies have
(p<.05) predictors of membership in the may be explained by the Third National reported positive, negative, or no effects of
physically inactive or active groups. In other Health and Nutrition Examination Survey acculturation on leisure-time activity par-
words, among the border Mexican American (NHANES III) findings, which reported ticipation, this study indicates that it has a
women studied, only acculturative status that Mexican Americans are (1) inactive strong positive infl uence on such behavior.
and perceived health differentiated between beginning early in adult life rather than Attempts to explain what Williams52 referred
those who were inactive and those who were decreasing their activity levels with age, and to as an epidemiological paradox—i.e., poor
active. Table 2 presents the structure matrix (2) more inactive than non-Hispanic Whites socioeconomic status and favorable health
for the activity participation infl uences serv- regardless of educational attainment.6 As for indicators among border Hispanic popu-
ing as independent variables. marital status, its lack of effect on activity lations—have centered around the impact
participation was due to the statistically of acculturative status on health behavior.
DISCUSSION greater proportion of the sample reporting At the same time, the less acculturated an
As mentioned above, results indicated themselves as currently married versus those individual is, the less likely he or she is to
that acculturative level and, to a lesser who reported being unmarried, divorced/ engage in health-risking behaviors common
degree, health status were the key factors separated, or widowed. to the mainstream culture.
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further illustrate the problems in assessing disparities reported. More research is needed
Table 2. Discriminate Function physical activities outside of leisure time to explore the role that incidental, transpor-
Structure Matrix and may not take into account the cultural tational, and occupational activities play in
validity of these types of questions (e.g., Mexican American women’s reporting of
Variable Function Loadings
determining whether Mexican Americans physical activity engagement.
Acculturation* .857 interpret “leisure time” differently than the Despite its limitations, this study adds
rest of society). Additionally, Dixon et al.53 to the physical activity literature in an under-
Health status* .600 suggested the absence of a clear relationship reported and rapidly growing population
may be due to the diffi culties in differentiat- group. Many factors affect activity participa-
Educational level .526
ing populations based on only one charac- tion, and acculturation and health status are
teristic of acculturation, such as language but two considerations—albeit important
Age .161
use, without adjusting for non-language ones—in the design, planning, and imple-
domains such as values and attitudes. mentation of public health initiatives for
Marital status .024
Several limitations of this study should the Mexican American community. This
be acknowledged. The participants were a study’s fi ndings provide a starting point
*p<.05
convenience sample of Mexican American for the development of culturally sensitive
women residing in a rural southern Texas programs promoting leisure-time activ-
The fi nding that greater acculturation border area, and the results’ generalizability ity participation targeting border Mexican
is positively associated with leisure-time may therefore be limited geographically and Americans. Although it is promising from
physical activity may, in part, be the result of demographically. Moreover, data was gath- a statistical standpoint, the study also re-
accompanying English-language profi ciency. ered through the use of a self-report instru- veals the need for further investigation as
Conversely, the lack of English-language ment, and this methodological limitation to the role that other factors may play in
skills could serve as an obstacle to physical may not take into account (1) the respon- activity prevalence among an ethnic mi-
activity involvement as border Mexican dents’ interpretation of all items, or (2) the nority having the nation’s greatest physical
American women are exposed to English- possibility that some instruments may have inactivity disparity.
language messages regarding the health- been completed by persons other than those
promoting benefi ts of physical activity at from the intended study sample (though REFERENCES
work, in civic and social environments, and it should be emphasized that each instru- 1. Blair SN, Church TS. The fi tness, obesity, and
via mass media. English-language acquisi- ment was scrutinized to ascertain that it was health equation: is physical activity the common
tion, integral to assimilation, may therefore completed by an adult subject). In addition, denominator? JAMA. 2004;292:1232-1234.
allow such activity-promoting information data relating to occupation and income was 2. U.S. Department of Health and Human
to begin affecting these women’s beliefs not available. This information could help Services. Physical Activity and Health: A Report
and attitudes. explain variable implications more fully, as to the Surgeon General. Atlanta, GA: National
well as aid in identifying perceived socioeco- Center for Chronic Disease Prevention and
TRANSLATION TO HEALTH nomic barriers to participation. Health Promotion, Centers for Disease Control
EDUCATION PRACTICE Other limitations include the fact that and Prevention; 1996.
Based on these fi ndings, interventions only the language-use dimension was used 3. Crespo CJ. Physical activity in minority
promoting physical activity among border to assess acculturation. Future investiga- populations: overcoming a public health chal-
area Mexican American women should be tions including the dimensions of country lenge. Res Digest. 2005;2:1-6.
directed toward those who are less accultur- of origin, age of arrival, and length of 4. National Center for Health Statistics. Health
ated. This would necessitate development residence in the United States could help to Behaviors of Adults: United States, 2000–2001.
of culturally relevant forms of physical more adequately explain the complexity of Vital and Health Statistics. Hyattsville, MD: U.S.
activity and promotion of active lifestyles this construct. Additionally, the results were Government Printing Offi ce; 2004.
in ethnic-specifi c formats. Programming based on leisure-time activities only and did 5. Ford ES, Ford MA, Will JC, Galuska DA,
features should include Spanish-language not include work-related physical activity. Ballew C. Achieving a healthy lifestyle among
presentation and materials emphasizing Although Mexican Americans’ leisure-time United States adults: a long way to go. Ethn Dis.
family engagement, appropriate role model- inactivity has been reported to be higher 2001;11:224-231.
ing, and long-term health benefi ts. than that of non-Hispanic Whites, they 6. Crespo CJ, Smit E, Carter-Pokras O, Ains-
As to the issue of confl icting reports on engage more frequently in physically active worth BE. Race/ethnicity, social class and their
the acculturation/activity association, Cre- jobs than non-Hispanic Whites.6,54 This may relation to physical inactivity during leisure
spo et al.39 indicated that these mixed results help explain some of the physical inactivity time: results from the Third National Health and
152 American Journal of Health Education — May/June 2008, Volume 39, No. 3
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PPrroocceessss BBllaacckk
Bobby Guinn and Vern Vincent
Nutrition Examination Survey, 1988–1994. Am J can population: Proyecto VER. Diabetes Care. 2000;100:665-673.
Prev Med. 2000;18:46-53. 2001;24:1204-1209. 33. Chamorro R, Flores-Ortiz Y. Accul-
7. Allison DB, Fontaine KR, Manson JE, 20. Hubert HB, Snider J, Winkelby MA. turation and disordered eating patterns among
Stevens J, Vanitalle TB. Annual deaths attrib- Health status, health behaviors, and acculturation Mexican American women. Int J Eating Disord.
utable to obesity in the United States. JAMA. factors associated with overweight and obesity in 2000;28:125-129.
1999;282:1530-1538. Latinos from a community and agricultural camp 34. Lara M, Gamboa C, Kahramanian MI,
8. Calle EE, Rodriguez C, Walker-Thurmond survey. Prev Med. 2005;40:642-651. Marales LS, Bautista DE. Acculturation and
K, Thun MJ. Overweight, obesity, and mortality 21. Rutt CD, Coleman KJ. Examining the Latino Health in the United States: a review of
from cancer in a prospectively studied cohort of relationships among built environment, physical the literature and its sociopolitical context. Annu
U.S. adults. N Engl J Med. 2003;348:1625-1628. activity, and body mass index in El Paso, TX. Prev Rev Public Health. 2005;26:367-397.
9. Mokdad AH, Ford ES, Bowman BA, Dietz Med. 2005;40:831-841. 35. Vega WA, Scribney WM. Co-occurring
WH, Vinicor F, et al. Prevalence of obesity, diabe- 22. Wiest J, Lyle RM. Physical activity and alcohol, drug and other psychiatric disorders
tes, and obesity-related health risk factors, 2001. exercise: a fi rst step to health promotion and among Mexican-origin people in the United
JAMA. 2003;289:76-79. disease prevention in women of all ages. Womens States. Am J Public Health. 2003;93:1057-1064.
10. Must A, Spadano J, Coakley EH, Field Health Issues. 1997;7:10-16. 36. Esparza J, Harper IT, Bennett PH, Schultz
AE, Colditz G, et al. The disease burden as- 23. Strain LA, Grabusic CC, Searle MS, Dunn LO, Valencia ME, et al. Daily energy expenditure
sociated with overweight and obesity. JAMA. NJ. Continuing and ceasing leisure activities in Mexican and U. S. Pima Indians: low physical
1999;282:1523-1529. in later life: a longitudinal study. Gerontologist. activity as a possible cause of obesity. Int J Obes
11. U.S. Department of Health and Human 2002;42:217-223. Relat Metab Disord. 2000;24:55-59.
Services. Healthy People 2010. Washington, DC: 24. Verbrugge LM, Gruber-Baldini AL, Fozard 37. Gordon-Larson P, Harris KM, Ward DS,
Public Health Service; 2000. JL. Age differences and age changes in activities: Popkin BM. Acculturation and overweight related
12. Ogden CL, Carroll MD, Curtin LR, Baltimore Longitudinal Study on Aging. J Geron- behaviors among Hispanic immigrants to the US:
McDowell MA, Tabak CJ, et al. Prevalence of tol. 1996;51:31-41. the National Longitudinal Study of Adolescent
overweight and obesity in the United States, 25. Green LW, Ottoson JM. Community and Health. Soc Sci Med. 2003;57:2023-2034.
1999–2004. JAMA. 2006:295:1549-1555. Population Health. New York: McGraw-Hill; 1999. 38. Stern MP, Gonzales C, Mitchell BD,
13. National Center for Health Statistics. 26. Lanz PM, House JS, Lepkowski JM, Wil- Villapando E, Haffner SM, et al. Genetic and
Health, United States, 2006, with Chartbook on liams DR. Socioeconomic factors, health behav- environmental determinants of type II diabe-
Trends in the Health of Americans. Hyattsville, iors, and mortality. Results from a nationally tes in Mexico City and San Antonio. Diabetes.
MD: U.S. Government Printing Offi ce; 2006. representative prospective study of U.S. adults. 1992;41:484-492.
14. Freedman DS, Knan LK, Serdula MK, Ga- JAMA. 1998;279:1703-1708. 39. Crespo CJ, Smit E, Carter-Pokras O,
luska DA, Dietz WH. Trends and correlates of class 27. Liberatos P, Link BG, Kelsey JL. The Anderson RE. Acculturation and leisure-time
3 obesity epidemic in the United States from 1990 measurement of social class in epidemiology. physical inactivity in Mexican American adults:
through 2000. JAMA. 2002;288:1758-1761. Epidemiol Rev. 1988;10:87-121. results from NHANES III, 1988–1994. Am J
15. Haffner SM, Morales PA, Hazuda HP. 28. Centers for Disease Control and Preven- Public Health. 2001;91:1254-1257.
Level of control of hypertension in Mexican tion. Marital Status and Health: United States, 40. Everson,KR, Sarmiento OL, Ayala GX.
American and non-Hispanic whites. Hyperten- 1999–2002. Advance Data from Vital and Health Acculturation and physical activity among
sion. 1993;21:83-88. Statistics. Hyattsville, MD: U.S. Government North Carolina Latina immigrants. Soc Sci Med.
16. Hunt KJ, Williams R, Resendez RG. All- Printing Offi ce; 2004. 2004;59:2509-2522.
cause cardiovascular mortality among diabetic 29. Gordon MM. Assimilation in American 41. Cantero PJ, Richardson JL, Baezconde-
participants in the San Antonio Heart Study: Life. London: Oxford University Press; 1964. Garbanati L, Mark G. The association between
evidence against the “Hispanic paradox.” Diabetes 30. Mungia E. Assimilation, Colonialism and acculturation and health practices among middle-
Care. 2002;25:1557-1563. the Mexican American People. Austin, TX: Uni- aged elderly Latinas. Ethn Dis. 1999;9:166-180.
17. Nakamora RM. Health in America: A versity of Texas Printing Division; 1975. 42. U.S. Census Bureau. Current Population
Multicultural Perspective. Boston, MA: Allyn and 31. Landrine H, Klonoff E. African American Reports: The Hispanic Population in the United
Bacon; 1999. Acculturation. Thousand Oaks, CA: Sage Publi- States. Washington, DC: U.S. Government Print-
18. Sundquist J, Winkelby MA. Cardiovascular cations; 1996. ing Offi ce; 2000.
risk factors in Mexican American adults: a tran- 32. Bermudez OL, Falcon LM, Tucker KL. 43. Neutins JJ, Rubinson L. Research Tech-
scultural analysis of NHANES III, 1988–1994. Intake and food sources of macronutrients niques for the Health Sciences. San Francisco, CA:
Am J Public Health. 1999;89:723-730. among older Hispanic adults: association Benjamin Cummings; 2002.
19. West SK, Klein R, Rodriguez J. Diabetes with ethnicity, acculturation, and length of 44. Ainsworth BE, Haskell WL, Whitt MC,
and diabetic retinopathy in a Mexican Ameri- residence in the United States. J Am Diet Assoc. Sallis JF, Paffenberger RS, et al. Compendium
American Journal of Health Education — May/June 2008, Volume 39, No. 3 153
AAJJOOHHEE MMaayy--JJuunnee 0088 IIPPCC..iinndddd 115533 44//3300//0088 66::2266::5555 PPMM
PPrroocceessss BBllaacckk
Bobby Guinn and Vern Vincent
of physical activities: an update of activity codes Otero-Sabogal R, et al. Development of a short Mexico border. Texas Journal of Rural Health.
and MET intensities. Med Sci Sports Exerc. acculturation scale for Hispanics. Hisp J Behav 2002;20:42-60.
2000;32(Suppl):S498-S504. Sci. 1987;9:183-205. 53. Dixon LB, Sundquist J, Winkelby M. Dif-
45. Idler EL, Benyamini Y. Self-rated health 49. Marin G, VanOss-Marin B. Research with ferences in energy, nutrient, and food intakes in
and mortality: a review of twenty-seven commu- Hispanic Populations. Newbury Park, CA: Sage a US sample of Mexican American women and
nity studies. J Health Soc Behav. 1997;38:21-37. Publications; 1991. men: fi ndings from the Third National Health
46. McGee DL, Liao Y, Cao G, Cooper RS. 50. Hair JS, Anderson R, Tatham R, Black W. and Nutrition Examination Survey, 1988–1994.
Self-reported health status and mortality in Multivariate Data Analysis. Upper Saddle River, Am J Epidemiol. 2000;152:548-557.
a multiethnic U.S. cohort. Am J Epidemiol. NJ: Prentice Hall; 1998. 54. He ZX, Baker DW. Differences in leisure-
1999;149:41-46. 51. Finch BK, Hummer RA, Reindl M, Vega time, household, and work-related physical
47. Betancourt H, Lopez SC. The study of WA. Validity of self-rated health among Latinos. activities by race, ethnicity, and education. J Gen
culture, ethnicity, and race in American psychol- Am J Epidemiol. 2002;155:755-759. Intern Med. 2005;20:259-266.
ogy. Am Psychologist. 1993;48:629-637. 52. Williams DM. The “epidemiological
48. Marin G, Sabogal F, VanOss-Marin B, paradox” of health indicators and the Texas-
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