Publications by authors named "Belinda M Reininger"

46 Publications

Examining the Validity, Reliability, and Measurement Invariance of the Social Support for Exercise Scale among Spanish- and English- language Hispanics.

Hisp J Behav Sci 2019 Aug 14;41(3):427-443. Epub 2019 Jun 14.

The University of Texas Health Science Center at Houston, School of Public Health, Brownsville Regional Campus, Department of Health Promotion and Behavioral Sciences, Brownsville TX.

The Social Support for Exercise Subscales are commonly used among Hispanic populations. The aims of this study were to test the validity and reliability of the Spanish-language version of the Social Support for Exercise Subscales, and test the invariance of the Spanish- and English-language versions. Data were from a subsample of Hispanic adults in the Cameron County Hispanic Cohort (n=1,447). A series of confirmatory factor analysis (CFA) models were used to assess the validity and reliability of the Spanish-language version of the subscales. A multi group CFA approach was used to test measurement invariance. Results indicated the Spanish-language versions of family and friend support subscales had good validity and reliability (RMSEA<.07, CFI>0.95, TLI>0.94, and SRMR<0.05). There was also evidence of measurement invariance between the Spanish- and English-language versions. These findings indicate the Spanish-language family and friend support subscales are valid and can be compared between Spanish- and English-language Hispanic respondents.
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http://dx.doi.org/10.1177/0739986319854144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291866PMC
August 2019

Improved diabetes control among low-income Mexican Americans through community-clinical interventions: results of an RCT.

BMJ Open Diabetes Res Care 2020 05;8(1)

Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.

Introduction: This randomized controlled trial investigated community-clinical intervention strategies for a Mexican American population who had not demonstrated control of their diabetes. We tested a control program (Salud y Vida 1.0) supporting diabetes management versus an enhanced version (Salud y Vida 2.0) for reductions in HbA1c at 12 months.

Research Design And Methods: Adults with uncontrolled diabetes (n=353) were enrolled if they had an HbA1c≥9.0% during a program or doctor's visit between 6 and 36 months of their receipt of SyV 1.0 services, were patients at one of two clinics in local counties, and had an HbA1c≥8.0% at SyV 2.0 baseline enrollment. The control and intervention arms were coordinated by community health workers and the intervention arm included the control program enhanced with medication therapy management; behavioral health services; peer-led support groups; and additional community-based lifestyle programs also open to the family.

Results: At 12 months, both study arms improved HbA1c (mean, (CI), Control (-0.47 (-0.74 to -0.20)) and intervention (-0.48 (-0.76 to -0.19)). The intervention group maintained HbA1c levels after month 6, whereas control group HbA1c levels slightly increased (adjusted mean from 9.83% at month 6%-9.90% at month 12). Also, HbA1c was examined by level of participant engagement. The high engagement group showed a decreasing trend over the study period, while control and lower engagement groups failed to maintain HbA1c levels at month 12.

Conclusions: Improved HbA1c was found among a population that had not demonstrated diabetes management prior; however, mean HbA1c values were above clinical guideline recommendations. The randomized control trial findings provide additional evidence that extended time and intervention supports may be needed for populations experiencing inequities in social determinants of health.

Trial Registration Number: NCT04035395.
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http://dx.doi.org/10.1136/bmjdrc-2019-000867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264997PMC
May 2020

Sex and age differences in prevalence and risk factors for prediabetes in Mexican-Americans.

Diabetes Res Clin Pract 2020 Jan 2;159:107950. Epub 2019 Dec 2.

School of Public Health, University of Texas Health Science Center at Houston, Brownsville Regional Campus, One West University Boulevard, Brownsville, TX 78520, USA.

Aims: Over 1/3 of Americans have prediabetes, while 9.4% have type 2 diabetes. The aim of our study was to estimate the prevalence of prediabetes in Mexican Americans, with known 28.2% prevalence of type 2 diabetes, by age and sex and to identify critical socio-demographic and clinical factors associated with prediabetes.

Methods: Data were collected between 2004 and 2017 from the Cameron County Hispanic Cohort in Texas. Weighted crude and sex- and age- stratified prevalences were calculated. Survey weighted logistic regression analyses were conducted to identify risk factors for prediabetes.

Results: The prevalence of prediabetes (32%) was slightly higher than the alarmingly high rate of type 2 diabetes (28.2%). Hispanic men had the highest overall (37.8%) and highest age stratified prevalence of prediabetes. Males had higher odds of prediabetes than females 1.56 (1.19, 2.06), controlling for the effect of family history of diabetes, age, BMI, and high-density lipoprotein. Family history of diabetes was a strong independent risk factor for prediabetes in all men, and in men and women in the age group 40-64 years. Elevated triglycerides (p = 0.003) was an independent risk factor for men and women in the age group 18-39 years.

Conclusions: Despite the very high prevalence of type 2 diabetes, prediabetes prevalence among Mexican Americans is only marginally less than national prediabetes rates. This suggests that progression to type 2 diabetes is more rapid and occurs earlier than nationally. Earlier screening and interventions for prediabetes, especially for men, are necessary to slow the transition to diabetes.
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http://dx.doi.org/10.1016/j.diabres.2019.107950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002264PMC
January 2020

Make Your Move Experience: A Worksite Wellness Pilot in South Texas.

Am J Health Promot 2020 02 14;34(2):161-168. Epub 2019 Nov 14.

UTHealth School of Public Health in Brownsville, TX, USA.

Purpose: To describe the implementation of Make Your Move Experience (MYME) between 2015 and 2017.

Design: Cross-sectional.

Setting: Make Your Move Experience is a culturally sensitive worksite wellness program in South Texas designed to encourage sedentary workers to engage in physical activity.

Participants: In total, 681 individuals from 19 different organizations.

Intervention: UTHealth School of Public Health in Brownsville staff recruited individuals within local organizations to join MYME. At the end of the 3 months, organizations in which employees met MYME goals earned an incentive-bike rack or hydration station-selected to be permanent features of the local environment and facilitate physical activity.

Measures: Participant self-reported gender, physical activity level prior to joining MYME (beginner or experienced), and weekly miles of biking, walking, or running completed.

Analysis: Mean number of miles biked, walked, and ran each month were compared between (1) beginners and experienced, (2) men and women, and (3) in fall 2016 and spring 2017 using tests.

Results: Beginners initiated physical activity by walking. Men biked more miles than women did ( < .05 all 3 years). Bike riders cycled fewer miles (20.2 miles vs 44.9 miles; = .03) and walkers covered fewer miles (195.4 miles vs 266.7 miles; = .04) in fall 2016 compared to spring 2017.

Conclusions: Participation in MYME, a culturally appropriate intervention delivered at the worksite, facilitated an increase in physical activity levels among sedentary individuals.
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http://dx.doi.org/10.1177/0890117119885874DOI Listing
February 2020

Coaction Between Physical Activity and Fruit and Vegetable Intake in Racially Diverse, Obese Adults.

Am J Health Promot 2020 03 13;34(3):238-246. Epub 2019 Nov 13.

Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Suite FCT9.6073, Houston, TX 77030, USA.

Purpose: There is minimal understanding of the potential for coaction, defined as action on one behavior increasing the likelihood of taking action on another behavior, between physical activity (PA) and fruit and vegetable (FV) intake. The purpose of this study was to assess the bidirectional coaction between FV intake and PA, as well as self-efficacy for these behaviors, in a racially diverse sample of obese adults.

Design: This is a secondary analysis using data collected from the Path to Health study, a randomized controlled trial. ClinicalTrials.gov Identifier: NCT03674229.

Sample: Obese adults who completed baseline and 6-month follow-up assessments.

Measures: For this study, data on FV intake, leisure time PA, and 7-day accelerometer data were analyzed at baseline and 6-month follow-up.

Analysis: We interchanged modeling the FV intake and PA change variables as the independent and dependent variables. We conducted multiple imputation and both linear and multinomial regression.

Results: The sample (n = 168) was 59% female and mainly split between white (42%) and African American (42%). Change in self-efficacy for PA was predictive of change in self-efficacy for FV intake and vice versa. When compared with participants with no change in FV intake, someone with a positive change in FV intake was more likely to have a positive change in self-reported PA (adjusted risk ratio [RR] = 6.72, 95% confidence interval [CI] = 1.69-26.68). Likewise, when compared with no change, participants with a positive change in self-reported PA were more likely to report a positive change in FV intake (adjusted RR = 6.79, 95% CI = 1.70-27.17).

Conclusion: Findings suggest coaction between self-efficacy for FV intake and PA as well as between FV intake and PA. Coaction could be capitalized on to more effectively promote both energy-balance behaviors.
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http://dx.doi.org/10.1177/0890117119884479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7033009PMC
March 2020

Home Visit Intervention Promotes Lifestyle Changes: Results of an RCT in Mexican Americans.

Am J Prev Med 2019 11 27;57(5):611-620. Epub 2019 Sep 27.

Health Promotion and Behavioral Sciences, Hispanic Health Research Center, University of Texas School of Public Health Brownsville Regional Campus, Brownsville, Texas. Electronic address:

Introduction: Hispanic populations are less likely that other ethnicities to meet physical activity guidelines. Community health worker (CHW) outreach is an effective delivery method for behavior change messages owing to shared culture, language, and life experience. This study examined the efficacy of a CHW-delivered intervention, Tu Salud ¡Si Cuenta! (Your Health Matters!) at Home Intervention, to promote physical activity among Mexican Americans.

Study Design: RCT.

Setting And Participants: Mexican Americans living along the Texas-Mexico border from June 2010 to April 2013.

Intervention: Eligible adults were randomized into intervention (n=250) or standard care (n=250). Intervention participants received 6 monthly CHW visits that included education, motivation, and support for lifestyle changes. Standard care was potentially exposed to a community-wide health promotion campaign. Data were collected at baseline and 6- and 12-month follow-ups.

Main Outcome Measures: Meeting physical activity guidelines was defined as ≥600 MET-adjusted minutes of moderate and vigorous exercise.

Results: Intervention participants were more likely to meet physical activity guidelines at 6 months (AOR=2.02, 95% CI=1.25, 3.26) than standard care, but the significance was not maintained at 12 months (AOR=1.53, 95% CI=0.92, 2.53). The results were similar in the as-treated and obesity-stratified analyses. The secondary analysis corroborated the primary results.

Conclusions: This study shows increases in physical activity among those exposed to a CHW intervention, including participants with obesity. It also indicates that the removal of CHW contact tapers the effect at 12 months.

Trial Registration: NCT01168765.
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http://dx.doi.org/10.1016/j.amepre.2019.06.020DOI Listing
November 2019

Health coaching to encourage obese adults to enroll in commercially-available weight management programs: The path to health study.

Contemp Clin Trials 2019 08 21;83:1-9. Epub 2019 Jun 21.

The University of Texas MD Anderson Cancer Center, Health Disparities Research, 1400 Pressler St, Houston, TX 77030, United States.

Physicians are recommended to screen and refer obese patients to weight management programs (WMPs). There are often limited referral options for physicians, though commercially-available WMPs could be a potential solution. The purpose of this study (Path to Health) was to evaluate the efficacy of health coaching to promote enrollment in commercially-available WMPs through a two-arm, RCT with obese patients (n = 168) randomly assigned to intervention (n = 84) or control groups (n = 84). Intervention participants received phone health coaching to help them select and enroll in WMPs. We collected data on program enrollment, weight, self-reported physical activity (PA), and fruit and vegetable (FV) intake at baseline, 3- and 6-months. We used logistic regression to assess the intervention effect on enrollment in WMPs and longitudinal regression models to evaluate the effect on weight change, PA and FV intake. The average age was 54.7 years, 59% were female and 43% were Black and 49% were White. At 6 months, 39% of the intervention group (vs. 29% of control) had enrolled in WMPs. We found no longitudinal intervention effect on weight, PA and FV intake. We found that there was more weight loss for those who completed ≥4 calls as compared to those who completed <4 calls. We also found significant dose response relationships for PA and FV intake at 3 months. In this study, we found that phone health coaching was successful in increasing obese adults' enrollment in commercially-available WMPs and that there was a dose response relationship for weight and behavioral outcomes.
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http://dx.doi.org/10.1016/j.cct.2019.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642849PMC
August 2019

Hispanic adults' physical activity and sedentary behavior profiles: examining existing data to drive prospective research.

J Public Health (Oxf) 2020 05;42(2):e120-e125

The University of Texas Health Science Center at Houston, School of Public Health, Brownsville Regional Campus, Department of Health Promotion and Behavioral Sciences; Brownsville, TX, USA.

Background: Because physical activity (PA) and sedentary behavior (SB) are two distinct, interdependent behaviors, increases in PA may influence SB. As a limited number of SB interventions have been tested in Latino/Hispanic samples,. The purpose of this study is to assess if there was more PA and less SB in a Hispanic border community where there had been a PA-targeted community-wide campaign since 2005.

Methods: This cross-sectional study included Hispanic adults (N = 676) sampled from both intervention and comparison Texas-Mexico border communities in 2010. Our dependent variable was four-categories based on meeting PA guidelines and excessive SB (≥540 mins/day) cut-points. We conducted adjusted multivariable analysis to assess the association of intervention group with the PA/SB groupings.

Results: In 2010, most adults were in the Low PA/Low SB group. Compared to the comparison group, the intervention group had 6.45 (p < 0.001) times the adjusted odds of being in the High PA/Low SB vs. Low PA/High SB group.

Conclusions: Five years into the campaign, more PA and less SB were more likely in the intervention community, indicating the association of some PA interventions with SB. PA-targeted interventions should capture effects on SB to expand the literature on effective SB interventions for Hispanic adults.
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http://dx.doi.org/10.1093/pubmed/fdz065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251418PMC
May 2020

Fruit and Vegetable Intake is Inversely Associated with Cancer Risk in Mexican-Americans.

Nutr Cancer 2019 24;71(8):1254-1262. Epub 2019 Apr 24.

Department of Epidemiology, University of Texas Health Science Center-Houston, School of Public Health , Brownsville , Texas , USA.

: There is inconsistent evidence and limited data in the Hispanic population concerning fruit and vegetable intake and cancer risk. This study explored the effect of fruit and vegetable intake on cancer risk in Mexican-Americans. : Participants in this cross-sectional study were drawn from the Cameron County Hispanic Cohort. Consumption of fruits and vegetables were assessed using a validated questionnaire. Cancer was self-reported by the participants based on being told by a health care provider that they had cancer. : Among 2,381 participants with available dietary data, 82 reported a diagnosis of cancer. Participants who met recommendations of five or more servings of fruit and vegetable per day had a significantly 86% lower risk for reported cancer compared with those who did not meet recommendations, after adjusting for other covariates. Every portion increment of total fruit and vegetable intake was significantly associated with the reduced cancer risk by 11% with the adjustment of other covariates. : Fruit and vegetable intake was inversely associated with cancer risk in Mexican-Americans. Improving the consumption of fruit and vegetable might be an effective area for further research as part of a strategy for cancer prevention and control among Mexican-Americans independent of other factors.
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http://dx.doi.org/10.1080/01635581.2019.1603315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173711PMC
July 2020

The Emergence of Population Health in US Academic Medicine: A Qualitative Assessment.

JAMA Netw Open 2019 04 5;2(4):e192200. Epub 2019 Apr 5.

Department of Population Health, Dell Medical School, The University of Texas at Austin.

Importance: In response to rapidly growing interest in population health, academic medical centers are launching department-level initiatives that focus on this evolving discipline. This trend, with its potential to extend the scope of academic medicine, has not been well characterized.

Objective: To describe the emergence of departments of population health at academic medical centers in the United States, including shared areas of focus, opportunities, and challenges.

Design, Setting, And Participants: This qualitative study was based on a structured in-person convening of a working group of chairs of population health-oriented departments on November 13 and 14, 2017, complemented by a survey of core characteristics of these and additional departments identified through web-based review of US academic medical centers. United States medical school departments with the word population in their name were included. Centers, institutes, and schools were not included.

Main Outcomes And Measures: Departments were characterized by year of origin, areas of focus, organizational structure, faculty size, teaching programs, and service engagement. Opportunities and challenges faced by these emerging departments were grouped thematically and described.

Results: Eight of 9 population health-oriented departments in the working group were launched in the last 6 years. The 9 departments had 5 to 97 full-time faculty. Despite varied organizational structures, all addressed essential areas of focus spanning the missions of research, education, and service. Departments varied significantly in their relationships with the delivery of clinical care, but all engaged in practice-based and/or community collaboration. Common attributes include core attention to population health-oriented research methods across disciplines, emphasis on applied research in frontline settings, strong commitment to partnership, interest in engaging other sectors, and focus on improving health equity. Tensions included defining boundaries with other academic units with overlapping areas of focus, identifying sources of sustainable extramural funding, and facilitating the interface between research and health system operations.

Conclusions And Relevance: Departments addressing population health are emerging rapidly in academic medical centers. In supporting this new framing, academic medicine affirms and strengthens its commitment to advancing population health and health equity, to improving the quality and effectiveness of care, and to upholding the social mission of medicine.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.2200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481447PMC
April 2019

Weight loss and weight gain among participants in a community-based weight loss Challenge.

BMC Obes 2019 4;6. Epub 2019 Jan 4.

5The University of Texas School of Public Health, Health Science Center at Houston, Brownsville Regional Campus, Brownsville, TX USA.

Background: To describe the characteristics of participants who registered for multiple annual offerings of a community-based weight loss program called The Challenge, and to determine participant characteristics associated with weight change over multiple offerings of The Challenge occurring during the years 2010-2016.

Methods: Multivariable linear mixed effects analyses were conducted to describe percent weight change within and between offerings of The Challenge by participant characteristics.

Results: There were 669 and 575 participants included in the within and between analyses, respectively, for offerings of The Challenge. Among the 434 participants who lost weight in their first attempt at The Challenge and completed the initial weigh-in for a subsequent offering of The Challenge, 22.4% maintained their weight loss or had greater weight loss by the next Challenge, 40.3% gained back some weight, and 37.3% gained back all or more of the weight they lost during their first Challenge. Men had a significantly greater percent weight loss compared to women in their first and second Challenge and men were more likely to gain weight between Challenges. Participants who returned to more Challenges had a greater accumulated percent weight loss compared to those who returned to fewer Challenges.

Conclusions: The current weight loss Challenge appears to contribute to helping a percentage of participants lose weight and maintain some or all of the weight loss.
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http://dx.doi.org/10.1186/s40608-018-0225-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318905PMC
January 2019

The Longitudinal Relationship Between Social Support and Physical Activity in Hispanics.

Am J Health Promot 2019 07 7;33(6):921-924. Epub 2019 Feb 7.

4 The University of Texas Health Science Center at Houston, School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA.

Purpose: Social support has been identified as a determinant of physical activity (PA), but research has been primarily cross-sectional, with mixed findings for different Hispanic subgroups and limited longitudinal research with Hispanics. The purpose of this study is to assess the longitudinal associations of social support with PA in Hispanics on the Texas-Mexico Border.

Design And Sample: We used 2 time points of data collected from Hispanic adults in the Cameron County Hispanic Cohort (N = 588).

Measures: We collected social support for PA and self-reported leisure-time PA.

Analysis: We used cross-lagged panel models to assess the association between friend support, family support, family punishment (criticizing or complaining) and PA over time.

Results: Although social support overall was low for PA, fully adjusted cross-lagged panel models indicated that time 1 friend support was associated with time 2 PA (adjusted rate ratio = 1.02, 95% confidence interval = 1.00 -1.04), though family support was not associated with time 2 PA. In males, time 1 friend support was inversely associated with time 2 family punishment.

Conclusion: As expected, the directionality of the relation appears to be from social support to PA. Friend support appears to be predictive of PA in Hispanics, whereas family support is not. This should be considered in intervention development, particularly because (commitment and mutual obligation to family) is considered to be a strong value in these communities.
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http://dx.doi.org/10.1177/0890117119828919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625903PMC
July 2019

The combined effect of physical activity and sedentary behavior on subclinical atherosclerosis: a cross-sectional study among Mexican Americans.

BMC Public Health 2019 Feb 6;19(1):161. Epub 2019 Feb 6.

Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Brownsville Regional Campus, 1 W University Blvd, Brownsville, TX, 78520, USA.

Background: Physical activity and sedentary behavior are considered independent risk factors for chronic disease. However, we do not fully understand their interrelation with key health outcomes such as subclinical atherosclerosis. This study examines the combined effects of sedentary behavior and physical activity on carotid intima-media thickness (cIMT) and presence of carotid plaque in a Mexican American population on the Texas-Mexico border.

Methods: This cross-sectional study was conducted using retrospective data from a sample (n = 612) of participants from the Cameron County Hispanic Cohort. Carotid ultrasound was used to measure cIMT and presence of carotid plaque. Self-reported questionnaires were used to assess leisure time physical activity and sedentary behavior (TV/movie sitting and total sitting). A series of multivariable regression models were used to assess study aims. An interaction term between physical activity and sedentary behavior was included in models for each respective outcome. Models were controlled for demographic and health-related variables.

Results: There were no significant associations found between physical activity, sedentary behavior and mean cIMT, or cIMT thickness ≥ 75th percentile for age and gender. However, there was a significant interaction between physical activity and TV/movie sitting with presence of carotid plaque. Participants who reported moderate levels of physical activity had significantly lower odds for presence of plaque compared to participants with no activity when TV/movie sitting time was ≤3 h per day. However, there was no significant difference in odds for presence of plaque between physical activity groups when TV/movie sitting exceeded 3 h/day. These results were consistent with models examining total sitting time.

Conclusions: Our results indicate that for Mexican Americans, there is a combined effect of sedentary behavior and physical activity on presence of carotid plaque. Participating in moderate physical activity is optimal for having lower levels of carotid plaque in addition to avoiding excessive levels of TV/movie sitting (≥3 h/day) and/or total sitting (≥8.5 h/day).
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http://dx.doi.org/10.1186/s12889-019-6439-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366018PMC
February 2019

Association between fruit and vegetable intake and symptoms of mental health conditions in Mexican Americans.

Health Psychol 2018 Nov 8;37(11):1059-1066. Epub 2018 Oct 8.

Division of Epidemiology.

Objective: No studies so far have shown the effect of fruit and vegetable intake on mental disorders in Mexican Americans, for whom mental illness is an important health issue. This study measured the association of fruit and vegetable intake with the symptoms of cognitive impairment, the indication of increased risk of dementia, anxiety, and depression in Mexican Americans.

Method: Participants were drawn from the Cameron County Hispanic Cohort ( = 3,943), a randomly selected Mexican American cohort in Texas on the United States-Mexico border. Consumption of fruit and vegetables and symptoms of four mental disorders were assessed using reliable and validated instruments.

Results: Among 2,702 participants (mean age = 50 years, 34% male) with available data, 213 had cognitive impairment, 61 had the indication of increased risk of dementia, 626 had depression, 196 had anxiety, and 787 (29.13%) had mental disorders (i.e., any symptoms of the above four disorders). Participants who met recommendations of 5 or more servings of fruits and vegetables per day were less likely to have anxiety = 0.22, 95% CI [0.08, 0.65], cognitive impairment = 0.16, 95% CI [0.05, 0.46]), and indication of increased risk of dementia ( = 0.16, 95% CI [0.03, 0.86]) compared with those who did not meet recommendations, after adjusting for covariates. Every portion increment of total fruit and vegetable intake was significantly associated with the reduced odds of mental disorders by 11% and the odds of cognitive impairment by 32%, with the adjustment of other covariates. No significant associations were found between fruit and vegetable intake and depression.

Conclusion: Fruit and vegetable intake was inversely associated with symptoms of cognitive impairment, the indication of increased risk of dementia, and anxiety in Mexican Americans. Improving consumption of fruit and vegetables may be a convenient target for mental disorder-symptoms prevention and control among Mexican Americans, independent of other factors. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188785PMC
November 2018

Participants' perceptions of interactions with community health workers who promote behavior change: a qualitative characterization from participants with normal, depressive and anxious mood states.

Int J Equity Health 2018 02 5;17(1):19. Epub 2018 Feb 5.

UT Health School of Public Health, Institute for Health Policy, Division of Management, Policy and Community Health, 6410 Fannin, Houston, TX, 77030, USA.

Background: Interventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). CHWs can effectively advocate for healthier lifestyles and may be pivotal in addressing such mental health conditions as depression and anxiety. The goal of this study was to characterize the relationship dynamics between Latino participants and CHWs, from the participant's perspective. We aimed to determine if CHW-delivered community interventions effected behavior change, especially among participants who reported anxiety and depression.

Methods: Semi-structured interviews were conducted with a purposive sample of 28 Latino participants that was based on a mental health scoring strata. Participants completed a lifestyle intervention that included multiple home visits from CHWs to promote physical activity and healthful food choice. Interviews were conducted in the participant's preferred language (English or Spanish). Transcribed interviews were analyzed using a grounded theory approach until concept saturation was achieved.

Results: The sample was primarily female (82%), lower socioeconomic status (64%), and mean age of 50 years. Participants discussed the rapport building and professionalism of CHWs as a feature that facilitated strong, positive relationships and lifestyle behavior changes. Participants described how CHWs patterned their change approaches, which were similar to commonly used therapeutic techniques in the treatment of anxiety and depression. While anxiety and depression were described as having an impact on behavior change, most, but not all, participants who reported negative mood states said that the CHW relationship helped in changing that state to some extent.

Conclusions: Participants' perceptions indicated that positive personal changes were influenced by CHWs. Only participants who reported consistently poor scores for depression, anxiety or both reported negative or neutral experiences with the CHWs. This study lends qualitative support to the use of CHWs as extenders of care, particularly in areas that have a shortage of primary and mental health care providers.
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http://dx.doi.org/10.1186/s12939-018-0729-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800056PMC
February 2018

Correction to: Exposure to a community-wide campaign is associated with physical activity and sedentary behavior among Hispanic adults on the Texas-Mexico border.

BMC Public Health 2017 12 1;17(1):922. Epub 2017 Dec 1.

The University of Texas Health Science Center at Houston, School of Public Health, Brownsville Regional Campus, Houston, TX, USA.

Correction: After publication of the article [1], it has been brought to our attention that there is an acknowledgement missing. The authors would like to add the following - "The authors would like to thank the staff and community partners who work to implement the activities of the community wide campaign. In particular we would like to thank Lisa Mitchell-Bennett, Vanessa Saldana, Jennifer Mota, Sister Phylis Peters and the team of community health workers at UT Health and Proyecto Juan Diego who were involved in planning and gathering data."
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http://dx.doi.org/10.1186/s12889-017-4947-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712149PMC
December 2017

Exposure to a community-wide campaign is associated with physical activity and sedentary behavior among Hispanic adults on the Texas-Mexico border.

BMC Public Health 2017 Nov 16;17(1):883. Epub 2017 Nov 16.

The University of Texas Health Science Center at Houston, School of Public Health, Brownsville Regional Campus, Houston, Texas, USA.

Background: Despite evidence for the use of community-wide campaigns to promote physical activity, few evaluations of community-wide campaigns in Hispanic communities exist. This study assessed the associations of exposure to a community-wide campaign with physical activity and sedentary behavior among Hispanic adults living on the Texas-Mexico border.

Methods: The intervention, Tu Salud ¡Si Cuenta! (Your Health Matters!; TSSC), included a newsletter, community health worker discussion, TV and radio segments, which were conducted from 2005 to 2010. We matched an intervention (N = 399) and a control community (N = 400) on demographics and used a cross-sectional assessment in 2010 with randomly sampled adults from both communities. We collected exposure to the campaign, as well as physical activity and sedentary behavior with the International Physical Activity Questionnaire. We conducted bivariate analyses and multivariable logistic regression models to assess the association of TSSC exposure and its components with meeting moderate-to-vigorous intensity physical activity (MVPA) guidelines and exhibiting excessive sedentary behavior, controlling for covariates.

Results: As compared to the control community, the intervention community has 3 times the odds of meeting MVPA guidelines (Adjusted OR [AOR] = 3.01, 95% CI = 1.85-4.88, p < .05) and 2 times lower odds of excessive sedentary behavior ((AOR = 0.46, 95% CI = 0.30-0.70, p < .05). Exposure in the intervention group to any component was associated with five times the odds of meeting MVPA guidelines (AOR = 5.10, 95% CI 2.88-9.03, p < .001) and 3 times lower odds of excessive sedentary behavior (AOR = 0.32, 95% CI 0.17-0.60, p < .001), compared with those unexposed in the control community. Exposure to newsletters, CHW discussions and TV segments were associated with significantly lower odds of excessive sedentary behavior and higher odds of meeting MVPA guidelines. Exposure to radio segments was only associated with a significantly higher odds of meeting MVPA guidelines (AOR = 4.21, 95% CI = 1.17-15.09).

Conclusions: This study provides some evidence of the association of community-wide campaigns and its components in Hispanic communities with higher levels of MVPA and lower levels of excessive sedentary behavior.

Trial Registration Number: NCT00788879 Date: November 11, 2008.
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http://dx.doi.org/10.1186/s12889-017-4893-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689162PMC
November 2017

Tu Salud ¡Sí Cuenta! Your Health Matters! A Community-wide Campaign in a Hispanic Border Community in Texas.

J Nutr Educ Behav 2017 Nov - Dec;49(10):801-809.e1. Epub 2017 Aug 14.

Bownsville Regional Campus, UTHealth School of Public Health, Brownsville, TX.

Objective: To evaluate a community-wide campaign, Tu Salud ¡Si Cuenta! (TSSC), in improving eating behaviors and anthropometric outcomes in Hispanic border communities.

Design: A quasi-experimental study with matched intervention and comparison communities. Cross-sectional assessments with randomly sampled adults, examined by actual exposure and site (unexposed intervention, exposed intervention, and unexposed comparison).

Setting And Participants: Predominately Mexican Americans located in Brownsville, TX (intervention) and Laredo, TX (control).

Intervention: The TSSC campaign included television and radio segments, community health worker discussions, and newsletters delivered in Brownsville from 2005 to 2010.

Main Outcome Measures: Healthy and unhealthy eating indices and average hip and waist circumferences.

Analysis: Univariable and multivariable regression models.

Results: The sample (n = 799; 400 comparison and 399 intervention) was 98% of Mexican origin; 54% had completed grade 9 or higher. Exposure to any TSSC component was associated with a lower rate of unhealthy food consumption. Compared with the unexposed intervention group, the exposed intervention for the newsletter had a higher rate of healthy eating (adjusted rate ratio = 1.18; P < .01). Compared with the unexposed intervention, the exposed intervention for the community health worker discussion had a smaller hip circumference (adjusted mean difference = -5.77 cm; P < .05) and a smaller waist circumference (adjusted mean difference = -5.25 cm; P < .05).

Conclusions And Implications: This study provides evidence for the use of community-wide campaigns for nutrition and obesity-related outcomes in Hispanic communities.
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http://dx.doi.org/10.1016/j.jneb.2017.06.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682211PMC
May 2018

Community Perceptions of Biobanking Participation: A Qualitative Study among Mexican-Americans in Three Texas Cities.

Public Health Genomics 2017 8;20(1):46-57. Epub 2016 Dec 8.

School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.

Background: Most biospecimens in the US are collected from non-Hispanic Whites, limiting the generalizability of findings. There is a need to increase participation in biobanking among ethnic and racial minorities. The purpose of this study was to use qualitative methods to identify factors that may influence Mexican-American individuals' willingness to participate in biobanking.

Methods: We conducted 15 focus groups in three Texas cities with Mexican-American individuals, in both Spanish and English.

Results: Lack of knowledge about medical research and biobanks, lack of information about the specifics of biobanking participation, lack of communication of the results, fear of pain or harm, and distrust of the healthcare system or health research were identified as barriers to biobanking participation. Facilitators to participation were altruism, safety, understanding biobanking procedures and purposes, perceived benefits to participation, and culturally appropriate recruitment strategies. Although Mexican-Americans living in Texas are willing to donate biospecimens for altruistic reasons, such as helping society or advancing science, they want more information about what biobanking entails. They want to be assured that participation will not cause them harm and that the research is conducted with good intentions.

Conclusion: Results from this study can inform educational materials or interventions to increase Hispanic participation in biobanking.
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http://dx.doi.org/10.1159/000452093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453816PMC
January 2018

The Precarious Health of Young Mexican American Men in South Texas, Cameron County Hispanic Cohort, 2004-2015.

Prev Chronic Dis 2016 08 25;13:E113. Epub 2016 Aug 25.

University of Texas School of Public Health, Brownsville Regional Campus, Brownsville, Texas.

Introduction: Hispanic men have higher rates of illness and death from various chronic conditions than do non-Hispanic men. We aimed to characterize the health of Mexican American men living on the US-Mexico border in South Texas and elucidate indications of chronic disease in young men.

Methods: We sampled all male participants from the Cameron County Hispanic Cohort, an ongoing population-based cohort of Mexican Americans in Brownsville, Texas. We calculated descriptive statistics and stratified the sample into 3 age groups to estimate the prevalence of sociodemographic, behavioral, and clinical factors by age group and evaluated differences between age groups.

Results: Obesity prevalence was approximately 50% across all age groups (P = .83). Diabetes prevalence was high overall (26.8%), and 16.9% (95% confidence interval [CI], 10.1%-23.8%) of men younger than 35 had diabetes. More than 70% of these young men had elevated liver enzymes, and mean values of aspartate aminotransferase were significantly higher in younger men (45.0 u/L; 95% CI, 39.5-50.6 u/L) than in both older age groups. Less than 20% of young men had any form of health insurance. Current smoking was higher in young men than in men in the other groups, and the rate was higher than the national prevalence of current smoking among Hispanic men.

Conclusions: We suggest a need for obesity and diabetes prevention programs and smoking cessation programs for men in this region. Opportunities exist to expand current intervention programs and tailor them to better reach this vulnerable population of young Hispanic men. Elevated liver enzymes in men younger than 35 suggest a substantial burden of liver abnormalities, a finding that warrants further study.
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http://dx.doi.org/10.5888/pcd13.160020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003530PMC
August 2016

Tu Salud, ¡Si Cuenta!: Exposure to a community-wide campaign and its associations with physical activity and fruit and vegetable consumption among individuals of Mexican descent.

Soc Sci Med 2015 Oct 17;143:98-106. Epub 2015 Aug 17.

University of Texas Health Science Center, School of Public Health, Brownsville Regional Campus, Hispanic Health Research Center, One West University Blvd, Brownsville, TX 78520, USA.

Mexican Americans along the US-Mexico border have been found to be disproportionately affected by chronic diseases particularly related to lack of physical activity and healthful food choices. A community-wide campaign (CWC) is an evidence-based strategy to address these behaviors but with few examples of implementation in Mexican descent populations facing profound health disparities. We examined exposure to a CWC, titled Tu Salud ¡Sí Cuenta!, and its association with meeting the recommended minutes of moderate and vigorous physical activity weekly and consuming more portions of fruits and vegetables daily. A cross-sectional sample of 1438 Mexican descent participants was drawn from a city-wide, randomly-selected cohort interviewed between the years 2008 and 2012. Multivariable comparisons of participants exposed and not exposed to the CWC and meeting physical activity guidelines or their fruit and vegetable consumptions using mixed effects models were conducted. The community-wide campaign components included different forms of mass media and individually-focused components such as community health worker (CHW) home visits. After adjusting for gender, age, marital status, educational attainment, language preference, health insurance, and diabetes diagnosis, the strongest association was found between meeting physical activity guidelines and exposure to both CHW discussions and radio messages (adjusted OR = 3.83; 95% CI = [1.28, 6.21]; p = 0.0099). Participants who reported exposure to both radio and TV messages consumed more portions of fruits and vegetables than those who reported no exposure (adjusted RR = 1.30; 95% CI = [1.02, 1.66]; p = 0.0338). This study provides insights into the implementation and behavioral outcomes associated with exposure to a community-wide campaign, a potential model for addressing lifestyle modifications in populations affected by health disparities.
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http://dx.doi.org/10.1016/j.socscimed.2015.08.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642277PMC
October 2015

Anxiety, depression and smoking status among adults of Mexican heritage on the Texas-Mexico Border.

Hisp J Behav Sci 2014 Aug;36(3):316-328

University of Texas Health Science at Houston, Center School of Public Health, Brownsville Regional Campus.

The goal of the current analysis is to examine relationships between smoking status and anxiety and depression among adults of Mexican heritage to inform the development of culturally relevant smoking cessations efforts. Mexican heritage residents (N=1,791) of the city of Brownsville, TX, aged 18 years or older, enrolled in the Cameron County Hispanic Cohort, were selected through two stage cluster sampling of randomly selected census tracts from the first and third quartile of SES using Census 2000. Among current smokers, anxiety and depression scores were highest among women who had not completed high school (p<0.05). Former smoking women, but not men, with at least a high school education and former smoking women born in the United States reported higher levels of anxiety and depression than never smoking women. Negative affective states may represent a greater barrier to smoking cessation among women than men.
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http://dx.doi.org/10.1177/0739986314540455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479298PMC
August 2014

Non-communicable diseases and preventive health behaviors: a comparison of Hispanics nationally and those living along the US-Mexico border.

BMC Public Health 2015 Jun 19;15:564. Epub 2015 Jun 19.

University of Texas Health Science Center - School of Public Health, Brownsville Regional Campus, One West University Blvd, RAHC, Brownsville, TX, 78520, USA.

Background: Non-communicable diseases (NCDs) are rising among US Hispanics, but few studies have examined the preventive health behaviors for these NCDs among Hispanics. This study compared the preventive health behaviors of smoke-free living, physical activity, fruit and vegetable consumption, and avoidance of heavy alcohol use in Hispanics in the United States and Hispanics living along the US-Mexico border.

Methods: Two weighted data sets with information on Hispanic populations were analyzed: 1) the national Behavioral Risk Factor Surveillance Survey (n = 29,942) from 2009; and 2) the Cameron County Hispanic Cohort (n = 1,439) recruited from the US-Mexico border between 2008-2011. To compare the preventive health behaviors of the samples, within a generalized estimating equation framework, weighted univariate and multivariate logistic regression analyses were conducted controlling for age, educational attainment, employment, language, and insurance status. Statistical tests were two-sided with a significance level set at 0.05.

Results: Both samples reported low engagement in preventive behaviors. However, Hispanic males and females from the US-Mexico border were significantly less likely than the national sample to meet physical activity and fruit and vegetable consumption guidelines. Also, Hispanic males from the US-Mexico border were more likely to engage in heavy alcohol use.

Conclusion: The lack of preventive health behaviors among Hispanics living along the US-Mexico border presents a dire prospect for NCD control in the region. Multipronged approaches to address multiple behaviors should be considered.
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http://dx.doi.org/10.1186/s12889-015-1850-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4474463PMC
June 2015

The association of depression and anxiety with glycemic control among Mexican Americans with diabetes living near the U.S.-Mexico border.

BMC Public Health 2014 Feb 18;14:176. Epub 2014 Feb 18.

School of Public Health, The University of Texas Health Science Center, Dallas, TX, USA.

Background: The prevalence of diabetes is alarmingly high among Mexican American adults residing near the U.S.-Mexico border. Depression is also common among Mexican Americans with diabetes, and may have a negative influence on diabetes management. Thus, the purpose of the current study was to evaluate the associations of depression and anxiety with the behavioral management of diabetes and glycemic control among Mexican American adults living near the border.

Methods: The characteristics of Mexican Americans with diabetes living in Brownsville, TX (N = 492) were compared by depression/anxiety status. Linear regression models were conducted to evaluate the associations of depression and anxiety with BMI, waist circumference, physical activity, fasting glucose, and glycated hemoglobin (HbA1c).

Results: Participants with clinically significant depression and/or anxiety were of greater age, predominantly female, less educated, more likely to have been diagnosed with diabetes, and more likely to be taking diabetes medications than those without depression or anxiety. In addition, anxious participants were more likely than those without anxiety to have been born in Mexico and to prefer study assessments in Spanish rather than English. Greater depression and anxiety were associated with poorer behavioral management of diabetes (i.e., greater BMI and waist circumference; engaging in less physical activity) and poorer glycemic control (i.e., higher fasting glucose, HbA1c).

Conclusions: Overall, depression and anxiety appear to be linked with poorer behavioral management of diabetes and glycemic control. Findings highlight the need for comprehensive interventions along the border which target depression and anxiety in conjunction with diabetes management.
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http://dx.doi.org/10.1186/1471-2458-14-176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929559PMC
February 2014

Social capital and disaster preparedness among low income Mexican Americans in a disaster prone area.

Soc Sci Med 2013 Apr 11;83:50-60. Epub 2013 Feb 11.

Health Promotion & Behavioral Sciences, UT School of Public Health-Brownsville, 80 Fort Brown, Brownsville, TX 78520, USA.

Examination of social capital and its relationship to disaster preparedness has grown in prominence partially due to world-wide need to effectively respond to terrorist attacks, viral epidemics, or natural disasters. Recent studies suggested that social capital may be related to a community's ability to plan for and respond to such disasters. Few studies, however, have examined social capital constructs among low income populations living in disaster prone areas and accounted for the influence of social capital at the individual and community level. We examined social capital as measured by perceived fairness, perceived civic trust, perceived reciprocity and group membership. We undertook a multistage random cluster survey in three coastal counties in Texas (U.S.) noted for their high levels of poverty. Individuals from 3088 households provided data on social capital, socioeconomic and demographic characteristics, and self-reported level of preparedness for a hurricane. We used multivariable logistic regression to test potential associations between social capital measures and disaster preparedness. After adjusting for age, gender, marital status, ethnicity, education, employment, household income, acculturation, self-reported health, special needs persons in household, household size, and distance to the shore we found a higher prevalence of preparedness among individuals who reported the highest perception of fairness [AOR = 3.12, 95% CI: (1.86, 5.21)] compared to those individuals who reported lowest perceptions of fairness. We also found a higher prevalence of preparedness [AOR = 2.06; 95% CI: (1.17, 3.62)] among individuals who reported highest perceptions of trust compared to individuals who reported lowest perceptions of trust. Perceived reciprocity and group membership were not associated with preparedness. These results extend previous findings on social capital and disaster preparedness and further characterize social capital's presence among a low income population living in a hurricane prone area.
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http://dx.doi.org/10.1016/j.socscimed.2013.01.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899973PMC
April 2013

The burden of non-communicable disease in transition communities in an Asian megacity: baseline findings from a cohort study in Karachi, Pakistan.

PLoS One 2013 13;8(2):e56008. Epub 2013 Feb 13.

Indus Hospital Research Center, Korangi Crossing, Karachi, Pakistan.

Background: The demographic transition in South Asia coupled with unplanned urbanization and lifestyle changes are increasing the burden of non-communicable disease (NCD) where infectious diseases are still highly prevalent. The true magnitude and impact of this double burden of disease, although predicted to be immense, is largely unknown due to the absence of recent, population-based longitudinal data. The present study was designed as a unique 'Framingham-like' Pakistan cohort with the objective of measuring the prevalence and risk factors for hypertension, obesity, diabetes, coronary artery disease and hepatitis B and C infection in a multi-ethnic, middle to low income population of Karachi, Pakistan.

Methods: We selected two administrative areas from a private charitable hospital's catchment population for enrolment of a random selection of cohort households in Karachi, Pakistan. A baseline survey measured the prevalence and risk factors for hypertension, obesity, diabetes, coronary artery disease and hepatitis B and C infection.

Results: Six hundred and sixty-seven households were enrolled between March 2010 and August 2011. A majority of households lived in permanent structures (85%) with access to basic utilities (77%) and sanitation facilities (98%) but limited access to clean drinking water (68%). Households had high ownership of communication technologies in the form of cable television (69%) and mobile phones (83%). Risk factors for NCD, such as tobacco use (45%), overweight (20%), abdominal obesity (53%), hypertension (18%), diabetes (8%) and pre-diabetes (40%) were high. At the same time, infectious diseases such as hepatitis B (24%) and hepatitis C (8%) were prevalent in this population.

Conclusion: Our findings highlight the need to monitor risk factors and disease trends through longitudinal research in high-burden transition communities in the context of rapid urbanization and changing lifestyles. They also demonstrate the urgency of public health intervention programs tailored for these transition communities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0056008PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572147PMC
August 2013

Intention to comply with mandatory hurricane evacuation orders among persons living along a coastal area.

Disaster Med Public Health Prep 2013 Feb;7(1):46-54

Objectives: We examined the intention to comply with mandatory hurricane evacuation orders among respondents living in coastal areas with pronounced poverty by demographic and location characteristics.

Methods: A 3-county door-to-door survey was conducted with 1 randomly selected resident per household. Households were selected using a 2-stage cluster sampling strategy and stratified by county. The final sample included 3088 households in 100 census tracts across 3 counties.

Results: Findings suggest that the majority of residents living in areas prone to hurricanes intend to comply with mandatory evacuation orders regardless of income level. Variation in intention to comply with mandatory evacuation orders is shown by age, gender, ethnicity, education, acculturation, county, and distance from shoreline.

Conclusions: The demonstrated high intention to comply with evacuation orders in impoverished areas suggests a need for improved planning to evacuate the most vulnerable residents. Demographic and location characteristics associated with decreased intention to comply may be considered for targeting messages and education before disasters to modifying intentions and plans to evacuate.
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http://dx.doi.org/10.1001/dmp.2012.57DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910157PMC
February 2013

Socio-ecological influences on health-care access and navigation among persons of Mexican descent living on the U.S./Mexico border.

J Immigr Minor Health 2014 Apr;16(2):218-28

Health Promotion and Behavioral Science, University of Texas Health Science Center, School of Public Health, Brownsville Regional Campus, 80 Fort Brown, Brownsville, TX, 78520, USA,

The study reported here examines factors influencing decision-making concerning health care access and navigation among persons of Mexican origin living along the U.S./Mexico border. Specifically, the study examined how persons with limited financial resources accessed these two systems. Seven focus groups were held with 52 low income Mexican American people aged 18-65 years. Transcripts were analyzed to identify themes in Atlasti 5.0 software and the theory used included a socio-ecological framework and complemented by constructed from the Social Cognitive Theory. We found that in addition to a lack of insurance and financial resources to pay for health care; fear, embarrassment and denial associated with a diagnosis of illness; poor medical personnel interactions, and desire for quality but streamlined health care also influenced decision making. This theory-based study raises important issues if health care is to improve the health and welfare of disadvantaged populations and points to the need for greater focus on medical homes and prevention and early intervention approaches.
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http://dx.doi.org/10.1007/s10903-012-9714-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377819PMC
April 2014

Missed opportunities for diagnosis and treatment of diabetes, hypertension, and hypercholesterolemia in a Mexican American population, Cameron County Hispanic Cohort, 2003-2008.

Prev Chronic Dis 2012 ;9:110298

University of Texas School of Public Health, 80 Fort Brown, Brownsville, TX 78597, USA.

Introduction: Diabetes, hypertension, and hypercholesterolemia are common chronic diseases among Hispanics, a group projected to comprise 30% of the US population by 2050. Mexican Americans are the largest ethnically distinct subgroup among Hispanics. We assessed the prevalence of and risk factors for undiagnosed and untreated diabetes, hypertension, and hypercholesterolemia among Mexican Americans in Cameron County, Texas.

Methods: We analyzed cross-sectional baseline data collected from 2003 to 2008 in the Cameron County Hispanic Cohort, a randomly selected, community-recruited cohort of 2,000 Mexican American adults aged 18 or older, to assess prevalence of diabetes, hypertension, and hypercholesterolemia; to assess the extent to which these diseases had been previously diagnosed based on self-report; and to determine whether participants who self-reported having these diseases were receiving treatment. We also assessed social and economic factors associated with prevalence, diagnosis, and treatment.

Results: Approximately 70% of participants had 1 or more of the 3 chronic diseases studied. Of these, at least half had had 1 of these 3 diagnosed, and at least half of those who had had a disease diagnosed were not being treated. Having insurance coverage was positively associated with having the 3 diseases diagnosed and treated, as were higher income and education level.

Conclusions: Although having insurance coverage is associated with receiving treatment, important social and cultural barriers remain. Failure to provide widespread preventive medicine at the primary care level will have costly consequences.
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http://dx.doi.org/10.5888/pcd9.110298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475522PMC
November 2012

Perceptions of social support, empowerment and youth risk behaviors.

J Prim Prev 2012 Feb;33(1):33-46

Division of Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Brownsville Regional Campus, Brownsville, TX, USA.

This study examined the association of perceived social support and community empowerment among urban middle-school students living in Matamoros, Mexico and the risk behaviors of fighting, alcohol and tobacco use, and sexual activity. Middle school students (n = 1,181) from 32 public and private Mexican schools were surveyed. Weighted multiple logistic regression analyses were conducted. Among girls, lack of parent/teacher interactions regarding school increased odds for fighting, alcohol and tobacco use. Among boys, lack of empowerment increased odds of alcohol and tobacco use and lack of parent/teacher interactions regarding school increased odds for sexual activity. Community empowerment and perceived social support are uniquely associated with risk behaviors for girls and boys. Additionally, perceived social support from individuals most immediate to the youth are associated with protection against risk for some behaviors, while perceived social support from individuals more removed from youth have mixed association with risk behaviors.
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http://dx.doi.org/10.1007/s10935-012-0260-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899967PMC
February 2012