Toward a Theory-Driven Model of Acculturation in Public Health Research

Abraído-Lanza, Ana F.; Armbrister, Adria N.; Flórez, Karen R.; Aguirre, Alejandra N.

doi:10.2105/ajph.2005.064980

Cited by 600 publications

(585 citation statements)

References 42 publications

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“…Nevertheless, inclusion of additional variables such as income and health-care access serve to strengthen the proxy measures through contextualisation (62,63) .…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Predictors of trying to lose weight among overweight and obese Mexican-Americans: a signal detection analysis

Bersamin

Hanni

Winkleby

2009

Public Health Nutr.

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Objective: Signal detection analysis, a form of recursive partitioning, was used to identify combinations of sociodemographic and acculturation factors that predict trying to lose weight in a community-based sample of 957 overweight and obese Mexican-American adults (ages 18-69 years). Design: Data were pooled from the 2004 and 2006 Behavioral Risk Factor Surveillance System conducted in a low-income, semi-rural community in California. Results: Overall, 59 % of the population reported trying to lose weight. The proportion of adults who were trying to lose weight was highly variable across the seven mutually exclusive groups identified by signal detection (range 30-79 %). Significant predictors of trying to lose weight included BMI, gender, age and income. Women who were very overweight (BMI . 28?5 kg/m 2 ) were most likely to be trying to lose weight (79 %), followed by very overweight higher-income men and moderately overweight (BMI 5 25?0-28?5 kg/m 2 ) higher-income women (72 % and 70 %, respectively). Moderately overweight men, aged 28-69 years, were the least likely to be trying to lose weight (30 %), followed by moderately overweight lower-income women (47 %) and very overweight lower-income men (49 %). The latter group is of particular concern since they have characteristics associated with medical complications of obesity (low education and poor access to medical care). Conclusions: Our findings highlight opportunities and challenges for public health professionals working with overweight Mexican-American adults -particularly lower-income adults who were born in Mexico -who are not trying to lose weight and are therefore at high risk for obesity-related co-morbidities. Keywords Signal detection analysisMexican-Americans Weight lossThe high prevalence of obesity among Mexican-Americans is a major public health concern. Recent estimates indicate that more than 75 % of Mexican-American adults in the USA are overweight or obese -less than 25 % are at a healthy, normal weight (1) . These statistics may be a gauge of poor access to and/or lack of effective weightloss strategies and are a stark reminder of how much more progress is needed to reach the Healthy People 2010 target goal of increasing the proportion of adults at a healthy weight to 60 % (2) . Despite the well-recognised benefits of intentional weight loss among overweight and obese individuals (3)(4)(5)(6)(7) , less than 60 % of overweight and obese Latinos are currently trying to lose weight (8) ; this may be an indicator of a low level of readiness for weight loss and therefore has important implications for the success of weight-loss interventions. While previous studies have examined sociodemographic and acculturative correlates of obesity (9,10) and individual responses to weight-loss interventions (11) , few studies (8,12) have examined sociodemographic and acculturative factors in relation to trying to lose weight. To our knowledge none of these studies have examined interactions between these factors or focused on Latino populations,...

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“…Nevertheless, inclusion of additional variables such as income and health-care access serve to strengthen the proxy measures through contextualisation (62,63) .…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Predictors of trying to lose weight among overweight and obese Mexican-Americans: a signal detection analysis

Bersamin

Hanni

Winkleby

2009

Public Health Nutr.

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“…More than 40% are foreign born, and 75% are immigrants or children of immigrants (25). Acculturation, “the process by which individuals adopt the attitudes, values, customs, beliefs, and behaviors of another culture” (26), has been found to have mixed health, including mental health, effects for Latinos (27–29); Latinos who are less acculturated have lower prevalence rates of psychiatric disorders, but those with a disorder are less likely to receive mental health treatment (30, 31). Given these health and acculturation relationships, acculturation could potentially affect adherence via, for example, physician/patient communication or health literacy.…”

Section: Introductionmentioning

confidence: 99%

Psychotropic Medication Nonadherence Among United States Latinos: A Comprehensive Literature Review

Lanouette¹,

Folsom²,

Sciolla³

et al. 2009

Psychiatric Services

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Objective Psychotropic medication nonadherence is a major public health problem, but few studies have focused on Latinos. We systematically reviewed the literature on rates of and factors influencing antipsychotic, antidepressant, or mood stabilizer nonadherence among United States (US) Latinos. Methods Data Sources: MEDLINE and PsycINFO were searched using keywords adherence, compliance, Latino, Hispanic, psychotropic, and related terms, as well as bibliographies from relevant reviews and studies. Study Selection: 21 studies met inclusion criteria: published since 1980 in English or Spanish; measured psychotropic medication nonadherence rates among US Latino adults. Data Abstraction: We examined articles for study design and objective, location, population, medication type, participant demographics, adherence measure, adherence rates, and factors related to adherence. Results and Conclusions In studies including Latinos and other ethnic groups, mean nonadherence rates were 41%, 31%, and 43% among Latinos, Euro-Americans, and African Americans respectively, with an overall effect size of 0.64 between Latinos and Euro-Americans. In studies including only Latinos, the mean nonadherence rate was 44%. Ten of 16 studies found Latinos had significantly lower adherence rates than Euro-Americans. Risk factors for nonadherence included being monolingual Spanish speaking, lacking health insurance, experiencing barriers to quality care, and having lower socioeconomic status. Protective factors included family support and psychotherapy. Rates of nonadherence to psychotropic medications were higher for Latinos than for Euro-Americans. Further investigation is needed into the potentially modifiable individual and societal level mechanisms of this discrepancy. Clinical and research interventions to improve adherence should be culturally appropriate and incorporate identified factors.

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“…Acculturation is defined as a multidimensional process through which foreigners adapt to the customs, values, and traditions of a host country 17, 18. Of the limited available studies of diverse racial/ethnic groups, data suggest that increased acculturation is associated with greater risk of CVD 8, 19.…”

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confidence: 99%

Nativity Status and Cardiovascular Disease Mortality Among Hispanic Adults

Rodríguez

Hastings

et al. 2017

JAHA

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BackgroundHispanic persons represent a heterogeneous and growing population of any race with origins in Mexico, the Caribbean, Central America, South America, or other Spanish‐speaking countries. Previous studies have documented variation in cardiovascular risk and outcomes among Hispanic subgroups. Few studies have investigated whether these patterns vary by nativity status among Hispanic subgroups.Methods and ResultsWe used the National Center for Health Statistics mortality file to compare deaths of Hispanic (n=1 258 229) and non‐Hispanic white (n=18 149 774) adults (aged ≥25 years) from 2003 to 2012. We identified all deaths related to cardiovascular disease (CVD) and categorized them by subtype (all CVD, ischemic, or cerebrovascular) using the underlying cause of death (International Classification of Diseases, 10th Revision codes I00–I78, I20–I25, and I60–I69, respectively). Population estimates were calculated using linear interpolation from the 2000 and 2010 US censuses. CVD accounted for 31% of all deaths among Hispanic adults. Race/ethnicity and nativity status were recorded on death certificates by the funeral director using state guidelines. Nativity status was defined as foreign versus US born; 58% of Hispanic decedents were foreign born. Overall, Hispanic adults had lower age‐adjusted CVD mortality rates than non‐Hispanic white adults (296 versus 385 per 100 000). Foreign‐born Cubans, Mexicans, and Puerto Ricans had higher CVD mortality than their US‐born counterparts (rate ratio: 2.64 [95% confidence interval, 2.46–2.81], 1.17 [95% confidence interval, 1.15–1.21], and 1.91 [95% confidence interval, 1.83–1.99], respectively).ConclusionsMortality rates for total cardiovascular, ischemic, and cerebrovascular disease are higher among foreign‐ than US‐born Hispanic adults. These findings suggest the importance of disaggregating CVD mortality by disease subtype, Hispanic subgroup, and nativity status.

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Toward a Theory-Driven Model of Acculturation in Public Health Research

Cited by 600 publications

References 42 publications

Predictors of trying to lose weight among overweight and obese Mexican-Americans: a signal detection analysis

Predictors of trying to lose weight among overweight and obese Mexican-Americans: a signal detection analysis

Psychotropic Medication Nonadherence Among United States Latinos: A Comprehensive Literature Review

Nativity Status and Cardiovascular Disease Mortality Among Hispanic Adults

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