RESUMEN
The Texas-Mexico border incidence rate of tuberculosis (TB) is 10 times the rate of TB in the United States. Additionally, this area is plagued by antibiotic-resistant TB at a rate that is 70% higher among those living along the border than among nonborder residents. Both the high rate of TB and the emergence of drug-resistant TB increases the importance of controlling TB along the U.S.-Mexico border. Men have higher rates of TB than women, which can be attributed to biological differences and increased environmental exposure. The purpose of this article is to describe the experience of TB for Mexican American men living on the Texas-Mexico border. This a qualitative descriptive study, using participants from a larger study. A purposeful sample was recruited through two south Texas TB clinics. Interviews were audio recorded, transcribed, and translated into English. Data analysis consisted of line-by-line coding, labeling, organizing, and discovering common codes to describe participants' experience of TB and TB treatment. The participants include 13 Mexican American men. Ages ranged from 22 to 76 years. Only one participant was employed during treatment. Years of education ranged from no school to an associate's degree. Five themes were discovered: misinformation, delayed diagnosis, stigma, depression, and loss of community. Participants without social support were further isolated and felt a greater burden of treatment. Two participants contemplated suicide and two others told their families to leave them because they were a burden and infectious. The burden of treatment on the patient is great, especially for Hispanic men.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud/etnología , Americanos Mexicanos/psicología , Determinantes Sociales de la Salud/etnología , Aislamiento Social/psicología , Estigma Social , Tuberculosis/etnología , Adulto , Anciano , Diagnóstico Tardío , Depresión/etiología , Humanos , Incidencia , Entrevistas como Asunto , Masculino , Americanos Mexicanos/estadística & datos numéricos , Persona de Mediana Edad , Investigación Cualitativa , Determinantes Sociales de la Salud/economía , Texas/epidemiología , Tiempo de Tratamiento , Tuberculosis/diagnóstico , Tuberculosis/psicología , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/etnología , Tuberculosis Resistente a Múltiples Medicamentos/psicología , Adulto JovenRESUMEN
PURPOSE: This study produced a rich description of the lived experiences of tuberculosis (TB) treatment among Mexican Americans living in the Lower Rio Grande Valley (LRGV) of Texas. DESIGN: This qualitative study used phenomenological methodology, guided by Merleau-Ponty's philosophical framework, particularly his theories on mind-body influence, fabric of relationships, importance of culture, and equilibrium. A purposive sample was recruited through TB clinics in four south Texas border counties: Hidalgo, Cameron, Starr, and Willacy, which make up the LRGV. Interviews from 18 participants-5 women and 13 men-were conducted in the participant's preferred language. Interviews were analyzed for common themes as described by Cohen Kahn and Steeves. FINDINGS: The majority of interviews were conducted in Spanish. Five themes were discovered: (a) day-to-day life during Directly Observed Therapy treatment, (b) signs and symptoms, (c) familismo, (d) living on the border, and (e) stigma. CONCLUSIONS: TB treatment can create a high level of patient burden. The participants in TB treatment in the LRGV on the Texas-Mexico border reported a high level of stigma. Due to this stigma, patients struggled to find a balance between exposure to stigma and the support from family that buoyed them through treatment. CLINICAL RELEVANCE: The findings support the importance of addressing stigma and the resulting sense of isolation in patients being treated for TB, perhaps through bolstering support from family and healthcare providers, which is relevant for public health professionals working in regions with high rates of TB.
Asunto(s)
Actitud Frente a la Salud/etnología , Americanos Mexicanos/psicología , Tuberculosis/etnología , Tuberculosis/terapia , Adulto , Anciano , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Americanos Mexicanos/estadística & datos numéricos , Persona de Mediana Edad , Investigación Metodológica en Enfermería , Investigación Cualitativa , Apoyo Social , Estereotipo , Texas , Tuberculosis/psicología , Adulto JovenRESUMEN
Folic acid can prevent neural tube defects (NTD). Hispanic women have a higher prevalence of NTD than non-Hispanic white (NHW) women and consume less folic acid. Among Hispanics, acculturation has been associated with lower intakes of natural folate. It is unknown if this same relationship is seen for fortified foods. This article describes the associations of acculturation factors with usual folate intakes from foods and supplements and compares the proportion that meets recommended intakes of folic acid of US Mexican American (MA) women with those of NHW women. For US NHW and MA women aged 15-44 y (n = 3167), usual folate intakes (i.e., natural food folate, folic acid from food, total folic acid [fortified foods plus supplements], and total folate) were estimated using measurement error models from NHANES 2001-2008. Compared with NHW women, MA women did not differ in their intake of natural food folate or folic acid from food. Similarly, compared with NHW women (332 ± 17.3 µg/d), the mean total usual folic acid intakes were lower among MA women who reported speaking Spanish (224 ± 24.9 µg/d) but not for MA women who reported speaking English (283 ± 36.2 µg/d). MA women were more likely than NHW women to consume a total folic acid intake <400 µg/d. MA women with lower acculturation factors were the most likely to have an intake <400 µg/d compared to NHW women. Public health efforts should focus on increasing total folic acid intake among MA women, emphasizing those with lower acculturation factors (e.g., MA women who report speaking Spanish).
Asunto(s)
Aculturación , Dieta/etnología , Suplementos Dietéticos , Ácido Fólico/administración & dosificación , Americanos Mexicanos , Adolescente , Adulto , Estudios Transversales , Dieta/efectos adversos , Dieta/tendencias , Suplementos Dietéticos/análisis , Femenino , Deficiencia de Ácido Fólico/prevención & control , Alimentos Fortificados/análisis , Promoción de la Salud , Humanos , Defectos del Tubo Neural/epidemiología , Defectos del Tubo Neural/prevención & control , Política Nutricional , Encuestas Nutricionales , Necesidades Nutricionales , Valor Nutritivo , Cooperación del Paciente/etnología , Riesgo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Previous studies have shown that acculturation factors are associated with dietary patterns of older Mexican Americans (MAs), but the association of these factors with post-fortification folate intake is unknown. We estimated usual folate intakes for U.S. MAs aged ≥60 years (N = 712) by acculturation factors using data from the National Health and Nutrition Examination Survey 2001-2006. Mean total folic acid and total folate, but not natural folate intakes, were lower for MAs with lower acculturation factors, and 16% of MAs had total folate intakes less than the estimated average requirement (EAR) of 320 µg/day. Most older U.S. MAs did not meet requirements from natural food folate intake alone, regardless of acculturation status, but their intakes were adequate when fortified foods and supplement sources were taken into account. Logistic regression models including age, sex, education, poverty, and acculturation factors indicated that low income, not acculturation, was significantly associated with intake below the EAR. Thus our findings indicate that the association of low acculturation with folate intake below the EAR is not independent of poverty. [Supplementary materials are available for this article. Go to the publisher's online edition of the Journal of Nutrition in Gerontology and Geriatrics for the following free supplemental resource: a table of the distribution of usual folate intake among Mexican Americans aged ≥60 years by sex, age, education level, poverty income ratio, and acculturation factors, from the National Health and Nutrition Examination Survey 2001-2006.].
Asunto(s)
Aculturación , Suplementos Dietéticos , Ácido Fólico/administración & dosificación , Alimentos Fortificados , Americanos Mexicanos/estadística & datos numéricos , Encuestas Nutricionales , Anciano , Grano Comestible , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores SocioeconómicosRESUMEN
Acculturation factors have been found to affect dietary intakes of folate among older Mexican Americans (MAs) (≥60 years). The association of acculturation with folate biomarkers is unknown. We determined whether acculturation factors were associated with folate biomarkers (e.g., serum folate, red blood cell [RBC] folate, and total homocysteine concentrations) and whether this association could be explained by dietary folate. Using data from the National Health and Nutrition Examination Survey (NHANES) 2001-2006, we estimated that 42.8% and 40.1% of older MAs reported speaking Spanish all or most of the time or being born in Mexico, respectively (lower acculturation factors). Lower acculturation factors were not associated with total homocysteine concentrations but were, in general, associated with lower serum folate and RBC folate concentrations, but these associations were not always independent of factors such as sex, education, and poverty, and possibly were mediated by dietary and supplemental folate. Thus, the lower folate status observed among older MA with lower acculturation factors may be modifiable by changes in the intake of folic acid. [Supplementary materials are available for this article. Go to the publisher's online edition of the Journal of Nutrition in Gerontology and Geriatrics for the following free supplemental resource: a table of the predictors of serum folate or red blood cell folate concentrations among Mexican Americans 60 years of age or older using country of origin or language preference, respectively, as acculturation factors, from the National Health and Nutrition Examination Survey 2001-2006.].