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Breast cancer is the main cause of cancer deaths for Hispanic women. This study analyzes the role of functional health literacy on mammography screening behavior and adherence of Hispanic women. Survey data from 722 Mexican American women age 40 and over residing in the Lower Rio Grande Valley of Texas in 2008 were used to estimate logistic regression models to assess the role of functional health literacy on mammography screening behavior and adherence. About 51% of survey respondents had a functional health literacy level deemed as inadequate or marginally functional. After adjusting for other factors, women with adequate health literacy levels were more likely to report to have ever had a mammogram (odds ratio [OR] = 2.92; 95% confidence interval [CI] = 1.62-5.28), to have had a mammogram within the last 2 years (OR = 1.70; 95% CI = 1.14-2.53) or to have had one within the last year (OR = 2.30; 95% CI = 1.54-3.43), compared to women with inadequate or marginally adequate functional health literacy levels. Inadequate/marginal functional health literacy is strongly associated with lower mammography screening. Large improvements in breast cancer control in this population may come from either basic advances in health literacy or by tailored approaches to help women with low literacy navigate local health care systems.

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OBJECTIVE: To explore the relationship between acculturation and healthy lifestyle habits in the largely Hispanic populations living in underserved communities in the United States of America along the U.S.-Mexico border. METHODS: A cross-sectional study was conducted from April 2006 to June 2008 using survey data from the Alliance for a Healthy Border, a program designed to reduce health disparities in the U.S.-Mexico border region by funding nutrition and physical activity education programs at 12 federally qualified community health centers in Arizona, California, New Mexico, and Texas. The survey included questions on acculturation, diet, exercise, and demographic factors and was completed by 2,381 Alliance program participants, of whom 95.3% were Hispanic and 45.4% were under the U.S. poverty level for 2007. Chi-square (χ2) and Student's t tests were used for bivariate comparisons between acculturation and dietary and physical activity measures. Linear regression and binary logistic regression were used to control for factors associated with nutrition and exercise. RESULTS: Based on univariate tests and confirmed by regression analysis controlling for sociodemographic and health variables, less acculturated survey respondents reported a significantly higher frequency of fruit and vegetable consumption and healthier dietary habits than those who were more acculturated. Adjusted binary logistic regression confirmed that individuals with low language acculturation were less likely to engage in physical activity than those with moderate to high acculturation (odds ratio 0.75, 95% confidence interval 0.59-0.95). CONCLUSIONS: Findings confirmed an association between acculturation and healthy lifestyle habits and supported the hypothesis that acculturation in border community populations tends to decrease the practice of some healthy dietary habits while increasing exposure to and awareness of the importance of other healthy behaviors.

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OBJECTIVE: To explore the relationship between acculturation and healthy lifestyle habits in the largely Hispanic populations living in underserved communities in the United States of America along the U.S.-Mexico border. METHODS: A cross-sectional study was conducted from April 2006 to June 2008 using survey data from the Alliance for a Healthy Border, a program designed to reduce health disparities in the U.S.-Mexico border region by funding nutrition and physical activity education programs at 12 federally qualified community health centers in Arizona, California, New Mexico, and Texas. The survey included questions on acculturation, diet, exercise, and demographic factors and was completed by 2 381 Alliance program participants, of whom 95.3 percent were Hispanic and 45.4 percent were under the U.S. poverty level for 2007. Chi-square (χ2) and Student's t tests were used for bivariate comparisons between acculturation and dietary and physical activity measures. Linear regression and binary logistic regression were used to control for factors associated with nutrition and exercise. RESULTS: Based on univariate tests and confirmed by regression analysis controlling for sociodemographic and health variables, less acculturated survey respondents reported a significantly higher frequency of fruit and vegetable consumption and healthier dietary habits than those who were more acculturated. Adjusted binary logistic regression confirmed that individuals with low language acculturation were less likely to engage in physical activity than those with moderate to high acculturation (odds ratio 0.75, 95 percent confidence interval 0.59-0.95). CONCLUSIONS: Findings confirmed an association between acculturation and healthy lifestyle habits and supported the hypothesis that acculturation in border community populations tends to decrease the practice of some healthy dietary habits while increasing exposure to and awareness of the importance of other healthy behaviors.

OBJETIVO: Explorar la relación entre la aculturación y los hábitos de vida saludables en las poblaciones en gran parte hispanas que residen en comunidades subatendidas de los Estados Unidos en la zona fronteriza con México. MÉTODOS: De abril del 2006 a junio del 2008, se llevó a cabo un estudio transversal a partir de los datos de la encuesta de la Alianza para una Frontera Saludable, un programa que se concibió para reducir las disparidades de salud en la zona fronteriza entre México y los Estados Unidos mediante el financiamiento de programas educativos en materia de nutrición y actividad física en 12 centros de salud comunitarios con calificación federal, en Arizona, California, Nuevo México y Texas. La encuesta incluyó preguntas sobre aculturación, régimen alimentario, ejercicio y factores demográficos, y fue respondida por 2 381 participantes del programa, de los que 95,3 por ciento eran hispanos y 45,4 por ciento estaban por debajo del nivel de pobreza del año 2007 en los Estados Unidos. Se utilizaron las pruebas de ji cuadrado (χ2) y t de Student para la comparación bifactorial entre la aculturación y las mediciones nutricionales y de actividad física. El control de los factores asociados con la nutrición y el ejercicio se llevó a cabo mediante métodos de regresión lineal y regresión logística binaria. RESULTADOS: Con base en pruebas unifactoriales, confirmadas mediante análisis de regresión con control de las variables sociodemográficas y de salud, los entrevistados menos aculturados notificaron una frecuencia significativamente mayor de consumo de frutas y verduras y hábitos alimentarios más saludables que los más aculturados. Mediante regresión logística binaria ajustada se confirmó que la probabilidad de que las personas con bajo nivel de aculturación idiomática realizaran algún tipo de actividad física era menor que la de los que tenían un grado de aculturación entre moderado y alto (razón de posibilidades 0,75; intervalo de confianza de 95 por ciento 0,59-0,95). CONCLUSIONES: Los resultados confirmaron una asociación entre la aculturación y los hábitos de vida saludables y apoyaron la hipótesis de que la aculturación en las comunidades de las poblaciones fronterizas tiende a reducir la práctica de algunos hábitos alimentarios saludables mientras que aumenta la exposición a otros comportamientos saludables, como la actividad física, y por tanto, la toma de conciencia de su importancia.

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Using individual-level data from the 2000 Mexican Survey of Satisfaction with Health Services we estimate a two-part negative binomial hurdle model to evaluate the decision-making process of health care utilization in Mexico. We find that there are income-related differences in utilization associated with the first visit to a physician, as well as substantial utilization differences by region, employment, insurance and financial status. There are also income-related differences in the first visit to a specialist but not in the number of days hospitalized. The results suggest that increasing initial access to services via income and insurance coverage and providing financial resources to underserved regions can substantially improve access to care and, ultimately, population health.

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