RESUMEN
Disparities in health care access, including utilization of preventive health services, are well-documented among ethnic minority populations. This study examines factors associated with health care access and utilization among Hispanic manufacturing employees along the Texas-Mexico border. A cross-sectional survey was administered in 2010 to 228 mostly male (71%) workers. About half of participants (53%) lacked health insurance, which emerged as the most important variable related to health care access and utilization. In multivariate logistic regression analyses, relative to insured workers, uninsured workers were significantly more likely to delay getting medical care (p<.001) and to need medical services that they could not afford (p<.05). They were also less likely to receive a flu vaccine (p<.001). Additionally, uninsured women were less likely to receive screening for cervical cancer compared to insured women (p<.05). Findings support the promotion of employment-based health insurance and education programs stressing the importance of preventive health services.
Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Americanos Mexicanos/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Servicios Preventivos de Salud/estadística & datos numéricos , Factores Socioeconómicos , Texas , Adulto JovenRESUMEN
We examined the factors related to success in achieving weight reduction and glycemic control in Alliance for a Healthy Border (AHB), a chronic disease prevention program implemented from 2006 to 2009 through 12 federally qualified community health centers serving primarily Hispanics in communities located along the US-Mexico border region. We analyzed data from Phase I of AHB using logistic regression to examine the determinants of success in achieving weight reduction and glycemic control among the participants in AHB programs. Factors affecting weight reduction success were sex, age, employment status, income, insurance, diabetes, baseline body mass index (BMI), smoking status, family history of diabetes, session type, program duration, and physical activity changes. Factors affecting achievement of glycemic success included sex, age, employment status, diabetes, baseline BMI, family history of diabetes, program duration, and physical activity changes. We found that the AHB interventions were more successful in reducing participants' HbA1c level than BMI. In addition to sociodemographic factors, participants with better baseline health conditions (ie, participants without diabetes or family history of diabetes, normal BMI, former smokers) were more likely to achieve success after the interventions. Of the 4 key features defining each of the 12 interventions, session type and program duration were associated with success. Within a relatively short time period, physical activity improvements had a stronger effect on weight reduction and glycemic success than improvements in dietary habits. The effectiveness of diabetes and cardiovascular disease prevention programs can be improved substantially by considering these factors during program design and structure.
Asunto(s)
Centros Comunitarios de Salud/organización & administración , Diabetes Mellitus Tipo 2/prevención & control , Cooperación Internacional , Obesidad/prevención & control , Adulto , Factores de Edad , Anciano , Glucemia/análisis , Índice de Masa Corporal , Distribución de Chi-Cuadrado , Diabetes Mellitus Tipo 2/epidemiología , Empleo/estadística & datos numéricos , Femenino , Humanos , Renta/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Modelos Logísticos , Masculino , México/epidemiología , Persona de Mediana Edad , Actividad Motora , Obesidad/epidemiología , Evaluación de Programas y Proyectos de Salud , Factores de Riesgo , Factores Sexuales , Fumar/epidemiología , Estados Unidos/epidemiología , Pérdida de PesoRESUMEN
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.
Asunto(s)
Aculturación , Diabetes Mellitus Tipo 2/etnología , Etnicidad/estadística & datos numéricos , Hábitos , Estilo de Vida , Americanos Mexicanos/estadística & datos numéricos , Adulto , Estudios Transversales , Dieta , Ejercicio Físico , Conducta Alimentaria , Femenino , Promoción de la Salud , Encuestas Epidemiológicas , Humanos , Masculino , México/epidemiología , México/etnología , Pobreza , Factores Socioeconómicos , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
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.