RESUMO
Family health history is an accessible, clinically-recommended genomic tool that improves health risk evaluation. It captures both genetic and modifiable risk factors that cluster within families. Thus, families represent a salient context for family health history-based interventions that motivate engagement in risk-reducing behaviors. While previous research has explored how individuals respond to their personal risk information, we extend this inquiry to consider how individuals respond to their spouse's risk information among a sample of Mexican-Americans. One hundred and sixty spouse-dyads within Mexican-heritage households received a pedigree or a pedigree and personalized risk assessments, with or without behavioral recommendations. Analyses of Covariance (ANCOVAs) were conducted to assess the relationship between risk feedback, both personal and spouse, and self-reported physical activity levels at 3-month and 10-month assessments, controlling for baseline levels. The effect of being identified as an encourager of spouse's healthy weight was also evaluated. Personal feedback had no effect on participants' physical activity at either 3- or 10-month assessments. However, husbands' risk information was associated with wives' physical activity levels at 3-month assessment, with women whose husbands received both increased risk feedback and behavioral recommendations engaging in significantly higher physical activity levels than all other women. At 10-month follow-up, physical activity levels for both husbands and wives differed depending on whether they encouraged their spouse's healthy weight. Spousal risk information may be a stronger source of motivation to improve physical activity patterns than personal risk information, particularly for women. Interventions that activate interpersonal encouragement among spouses may more successfully extend intervention effects.
Assuntos
Comportamentos Relacionados com a Saúde , Cardiopatias/prevenção & controle , Cardiopatias/psicologia , Americanos Mexicanos/psicologia , Cônjuges/psicologia , Exercício Físico , Retroalimentação Psicológica , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde/etnologia , Comunicação em Saúde , Promoção da Saúde , Cardiopatias/etnologia , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Cônjuges/etnologiaRESUMO
BACKGROUND: This study investigated diabetes and heart disease family health history (FHH) knowledge and changes after providing personalized disease risk feedback. METHODS: A total of 497 adults from 162 families of Mexican origin were randomized by household to conditions based on feedback recipient and content. Each provided personal and relatives' diabetes and heart disease diagnoses and received feedback materials following baseline assessment. Multivariate models were fitted to identify factors associated with the rate of 'don't know' FHH responses. RESULTS: At baseline, US nativity was associated with a higher 'don't know' response rate (p = 0.002). Though confounded by country of birth, younger age showed a trend toward higher 'don't know' response rates. Overall, average 'don't know' response rates dropped from 20 to 15% following receipt of feedback (p < 0.001). An intervention effect was noted, as 'don't know' response rates decreased more in households where one family member (vs. all) received supplementary risk assessments (without behavioral recommendations; p = 0.011). CONCLUSIONS: Limited FHH knowledge was noted among those born in the US and younger participants, representing a key population to reach with intervention efforts. The intervention effect suggests that 'less is more', indicating the potential for too much information to limit health education program effectiveness.
Assuntos
Diabetes Mellitus , Saúde da Família , Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Cardiopatias , Anamnese , Adulto , Idoso , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Anamnese/estatística & dados numéricos , México/etnologia , Pessoa de Meia-Idade , Análise Multivariada , Medição de Risco , Fatores de Risco , TexasRESUMO
The purpose of this study was to determine the association between income, insurance status, acculturation, and preventive screening for diabetes, high blood pressure, and cholesterol in Mexican American adults living in El Paso, Texas. This is a secondary data analysis using data from El Paso, Texas, that was collected between November 2007 and May 2009. Bivariate and stepwise regression analysis was used to determine the relationships between income, insurance, and acculturation factors on preventive screenings. Findings indicate that insurance status was associated with blood pressure check, blood sugar check, cholesterol screening, and any preventive screening. The association for income $40,000 + was explained by insurance. The only significant acculturation variable was language use for cholesterol. Disparities in preventive health screening in Mexican Americans were associated with primary insurance coverage in El Paso, Texas. With the border region being among the most medically underserved and underinsured areas in the United States, the results from this study suggest policy efforts are essential to ensure equal access to resources to maintain good health. Intervention efforts may include increasing awareness of enrollment information for insurance programs through the Affordable Care Act.
Assuntos
Aculturação , Doença Crônica , Renda , Cobertura do Seguro , Idioma , Programas de Rastreamento , Americanos Mexicanos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Fatores Socioeconômicos , Texas , Adulto JovemRESUMO
Although prior research has shown that Community Health Workers/Promotores de Salud (CHW/PS) can facilitate access to care, little is known about how CHW/PS are perceived in their community. The current study reports the findings of a randomized telephone survey conducted in a high-risk urban community environment along the U.S.-Mexico border. In preparation for a community-based CHW/PS intervention called the HEART ecological study, the survey aimed to assess perceptions of CHW/PS, availability and utilization of community resources (recreational and nutrition related) and health behaviors and intentions. A total of 7,155 calls were placed to complete 444 surveys in three zip codes in El Paso, Texas. Results showed that participants felt that healthful community resources were available, but utilization was low and variable: 35% reported going to a park, 20% reported having taken a health class, few reported using a gym (12%), recreation center (8%), or YMCA/YWCA (0.9%). Awareness and utilization of CHW/PS services were low: 20% of respondents had heard of CHW/PS, with 8% reporting previous exposure to CHW/PS services. Upon review of a definition of CHW/PS, respondents expressed positive views of CHW/PS and their value in the healthcare system. Respondents who had previous contact with a CHW/PS reported a significantly more positive perception of the usefulness of CHW/PS (p = 0.006), were more likely to see CHW/PS as an important link between providers and patients (p = 0.008), and were more likely to ask a CHW/PS for help (p = 0.009). Participants who utilized CHW/PS services also had significantly healthier intentions to reduce fast food intake. Future research is needed to evaluate if CHW/PS can facilitate utilization of available community resources such as recreational facilities among Hispanic border residents at risk for CVD.
Assuntos
Doenças Cardiovasculares , Agentes Comunitários de Saúde/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Agentes Comunitários de Saúde/psicologia , Exercício Físico/fisiologia , Feminino , Alimentos , Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Masculino , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Logradouros Públicos/economia , Recreação/economia , Recreação/fisiologia , Comportamento de Redução do Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Adulto JovemRESUMO
Little is known about the effect of personalized risk information on risk perceptions over time, particularly among ethnically diverse subpopulations. The present study examines Mexican American's (MAs) risk perceptions for heart disease and diabetes at baseline and following receipt of risk feedback based on family health history. Participants comprising 162 households received a pedigree or personalized risk feedback, with or without behavioral risk reduction recommendations. Multiple logistic regression analyses were used to assess lifetime perceived risk (LPR) at baseline, 3 months and 10 months following the receipt of risk feedback. Having an elevated familial risk of heart disease or diabetes increased the odds of an elevated LPR for both diseases at baseline. At 3 months, compared with receipt of a pedigree only, MAs receiving elevated risk feedback for both diseases were more likely to have an elevated LPR for both diseases. At 10 months, participants receiving weak risk feedback for both diseases indicated an adjustment to a lower LPR for heart disease only. Results suggest that communicating risk for multiple diseases may be more effective than a single disease, with responses to increased risk feedback more immediate than to weak risk feedback.
Assuntos
Diabetes Mellitus/etnologia , Retroalimentação Psicológica , Educação em Saúde/métodos , Cardiopatias/etnologia , Americanos Mexicanos/psicologia , Adolescente , Adulto , Idoso , Diabetes Mellitus/etiologia , Diabetes Mellitus/psicologia , Família , Feminino , Cardiopatias/etiologia , Cardiopatias/psicologia , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Medição de Risco/métodos , Fatores de Risco , Comportamento de Redução do Risco , Adulto JovemRESUMO
OBJECTIVE: To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. METHODS: A stratified two-stage randomized cross-sectional health survey was conducted in 2009 - 2010 among 1 002 Mexican American households. RESULTS: Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$ 25 (P = 0.002) or US$ 100 (P = 0.016) for medical care, and experienced greater transportation and language barriers (P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 - 2.76). CONCLUSIONS: Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management.
Assuntos
Diabetes Mellitus/etnologia , Turismo Médico/estatística & dados numéricos , Americanos Mexicanos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adulto , Idoso , Barreiras de Comunicação , Comorbidade , Estudos Transversais , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Emigração e Imigração/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/economia , Inquéritos Epidemiológicos , Humanos , Renda/estatística & dados numéricos , Cobertura do Seguro , Idioma , Masculino , Indigência Médica/estatística & dados numéricos , Turismo Médico/economia , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Estudos de Amostragem , Texas/epidemiologia , Meios de Transporte/economia , Adulto JovemRESUMO
OBJECTIVE: To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. METHODS: A stratified two-stage randomized cross-sectional health survey was conducted in 2009 - 2010 among 1 002 Mexican American households. RESULTS: Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$ 25 (P = 0.002) or US$ 100 (P = 0.016) for medical care, and experienced greater transportation and language barriers (P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 - 2.76). CONCLUSIONS: Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management.
OBJETIVO: Evaluar si las personas con diabetes que residen en la frontera mexicano-estadounidense 1) encuentran mayores barreras para obtener atención médica en los Estados Unidos de América que en México; y 2) acuden a México en busca de atención y medicación con mayor probabilidad que las personas no diabéticas que residen en la frontera. MÉTODOS: Durante el 2009 y el 2010, en una muestra de 1 002 hogares mexicano-estadounidenses, se llevó a cabo una encuesta transversal de salud en dos etapas, estratificada y aleatorizada. RESULTADOS: Las tasas de diabetes eran elevadas (15,4%). La mayor parte de las personas con diabetes (86%) notificaron comorbilidades. En comparación con los participantes no diabéticos, los afectados de diabetes experimentaban dificultades algo mayores para pagar US$ 25 (P = 0,002) o US$ 100 (P = 0,016) por recibir atención médica, y encontraban mayores barreras en materia de transporte e idioma (P = 0,011 y 0,014, respectivamente) para ser atendidos en los Estados Unidos, aunque era más probable que contaran con una persona o lugar adonde acudir en busca de atención médica y para ser sometidos a tamizaje. Una cuarta parte de los participantes acudían a México en busca de atención o medicamentos. Una edad menor y el haber vivido en México se asociaban con la búsqueda de atención en México, pero no el padecer diabetes. La presencia de múltiples barreras financieras se asociaba independientemente con una probabilidad aproximadamente tres veces mayor de acudir a México en busca de atención médica o medicación. Las barreras idiomáticas se asociaban con la búsqueda de atención en México. La confusión acerca de los trámites para recibir atención médica y la percepción de no recibir siempre un trato respetuoso por parte de los proveedores de atención médica en los Estados Unidos se asociaban con la búsqueda de atención y medicación en México (odds ratio, 1,70 - 2,76). CONCLUSIONES: La notificación de barreras modificables a la atención médica fue frecuente entre los participantes y algo más frecuente entre 1) las personas con diabetes; y 2) los que buscaban se atendidos en México. Sin embargo, estos fenómenos son estadísticamente independientes; no era más probable que las personas con diabetes utilizaran servicios en México. Ambos conjuntos de problemas (las barreras que deben afrontar las personas con diabetes, las barreras relacionadas con el uso de servicios en México) pueden coexistir, y proporcionan oportunidades para mejorar el acceso a la atención y el tratamiento de las enfermedades.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Diabetes Mellitus/etnologia , Turismo Médico/estatística & dados numéricos , Americanos Mexicanos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Barreiras de Comunicação , Comorbidade , Estudos Transversais , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Emigração e Imigração/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Inquéritos Epidemiológicos , Renda/estatística & dados numéricos , Cobertura do Seguro , Idioma , Indigência Médica/estatística & dados numéricos , Turismo Médico/economia , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , México/epidemiologia , México/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Estudos de Amostragem , Texas/epidemiologia , Meios de Transporte/economiaAssuntos
Hispânico ou Latino , Americanos Mexicanos , Diabetes Mellitus , Áreas de Fronteira , Saúde na Fronteira , Texas , México , Estados Unidos , Hispânico ou Latino , Americanos Mexicanos , Áreas de Fronteira , Saúde na Fronteira , Estados Unidos , Turismo Médico , Comorbidade , Inquéritos Epidemiológicos , Idioma , Indigência Médica , Pobreza , Estudos de Amostragem , Meios de Transporte , Aceitação pelo Paciente de Cuidados de Saúde , Barreiras de Comunicação , Estudos Transversais , Emigração e Imigração , Acessibilidade aos Serviços de Saúde , Renda , Cobertura do SeguroRESUMO
BACKGROUND: Sitting time and sedentary behaviors have been associated with adverse health outcomes including obesity, diabetes and cardiovascular disease (CVD) within non- Hispanic White populations. Similar associations have not been described within Hispanic populations despite their high CVD risk profile. This study aimed to assess the association between sitting time and obesity, self-reported diagnosed diabetes, hypertension and high cholesterol among a large cohort (N=11,268) of Mexican origin adults and to assess whether obesity mediated these associations. METHODS: Using a cross-sectional design, data collected between 2004 and 2010 were analyzed in late 2010. Regression analyses evaluated associations between self-reported daily sitting hours and disease outcomes, controlling for demographics, employment status, family disease history, and light, moderate and strenuous physical activity. RESULTS: Participants were mostly female (81.1%) Mexican origin adults. Sitting time was associated with increased odds of being obese, having diabetes and having hypertension, but not high cholesterol. Adjusted odds ratios of participants who reported sitting > 4 hours/day compared to those sitting 1-2 hours/day were for obesity OR=1.55 (95% CI 1.39, 1.73), p<.001, for diabetes OR=1.29 (95% CI, 1.09, 1.52), p=.003, for hypertension OR=1.17 (95% CI, 1.01, 1.37), p=.041. Associations controlled for physical activity and employment status. Effects on hypertension and diabetes were mediated by obesity. CONCLUSIONS: Sitting time was significantly associated with detrimental health outcomes, independent of physical activity. Obesity mediated these relationships for diabetes and hypertension. Future research should assess whether interventions addressing sitting time are feasible and effective among Mexican origin populations.