Parents' impressions of inappropriate television content for Hispanic preschool children

Rates of childhood obesity have increased three-fold in the last 20 years, and experts estimate that well over half of adolescents with a Body Mass Index at or above the 95th percentile become obese adults. These trends are even more pronounced in ethnic minority and lower income populations that are disproportionately impacted by obesity and its complications. It would be appropriate, then, to focus obesity interventions on Hispanic children. Television viewing, especially, has been shown to contribute to obesity by increasing caloric intake and decreasing physical activity. Parent involvement has proven to be a critical component in changing children’s health behaviors. In order to explore parents’ motivations for limiting their children’s television viewing, I qualitatively analyzed data from twenty-five interviews with Houston area Head Start parents. Using Grounded Theory, four main categories of concern emerged from the audio-recorded conversations: developmentally inappropriate content, the influence of television, poor health behaviors/outcomes, and general disapproval with television. Developmentally inappropriate content was the most frequently mentioned category with 119 mentions. This included violence, the most common sub-theme. In all, parents were more concerned with television content that produced proximate consequences such as modeling violent behavior or inappropriate language. Content that encouraged behaviors that led to obesity or other delayed consequences were of less concern to the parents. This suggests that future interventions aimed at encouraging Hispanic parents to reduce their children’s television viewing should draw motivation from parents’ concerns about developmentally inappropriate content, rather than focusing on deleterious health outcomes such as obesity. ^

Self-reported participation and perceived barriers to exercise in South Texas Hispanic adults

National data show that Hispanics report low levels of physical activity. Limited information on barriers to exercise in this population exists in the literature. Surveys were administered to 398 Hispanic participants from two colonias in South Texas to investigate self-reported levels of and perceived barriers to exercise. Results show that 67.6% of respondents did not meet physical activity recommendations of at least 150 minutes per week, as compared to 55.6% nationally. Overall, the most frequently reported barriers included “lack of time”, “very tired” and “lack of self-discipline” to exercise. An exploratory factor analysis of the barriers reported by participants not meeting physical activity recommendations resulted in a three-factor structure. A unidimensional scale was found for participants meeting recommendations. Findings suggest that future interventions should be specific to gender and exercise level to address the high prevalence of inactivity in this population. ^

Relationship between dietary patterns and body mass index in Hispanic children ages 4--19 years of age

Background. In over 30 years, the prevalence of overweight for children and adolescents has increased across the United States (Barlow et al., 2007; Ogden, Flegal, Carroll, & Johnson, 2002). Childhood obesity is linked with adverse physiological and psychological issues in youth and affects ethnic/minority populations in disproportionate rates (Barlow et al., 2007; Butte et al., 2006; Butte, Cai, Cole, Wilson, Fisher, Zakeri, Ellis, & Comuzzie, 2007). More importantly, overweight in children and youth tends to track into adulthood (McNaughton, Ball, Mishra, & Crawford, 2008; Ogden et al., 2002). Childhood obesity affects body functions such as the cardiovascular, respiratory, gastrointestinal, and endocrine systems, including emotional health (Barlow et al., 2007, Ogden et al., 2002). Several dietary factors have been associated with the development of obesity in children; however, these factors have not been fully elucidated, especially in ethnic/minority children. In particular, few studies have been done to determine the effects of different meal patterns on the development of obesity in children. Purpose. The purpose of the study is to examine the relationships between daily proportions of energy consumed and energy derived from fat across breakfast, lunch, dinner, and snack, and obesity among Hispanic children and adolescents. Methods. A cross-sectional design was used to evaluate the relationship between dietary patterns and overweight status in Hispanic children and adolescents 4-19 years of age who participated in the Viva La Familia Study. The goal of the Viva La Familia Study was to evaluate genetic and environmental factors affecting childhood obesity and its co-morbidities in the Hispanic population (Butte et al., 2006, 2007). The study enrolled 1030 Hispanic children and adolescents from 319 families and examined factors related to increased body weight by focusing on a multilevel analysis of extensive sociodemographic, genetic, metabolic, and behavioral data. Baseline dietary intakes of the children were collected using 24-hour recalls, and body mass index was calculated from measured height and weight, and classified using the CDC standards. Dietary data were analyzed using a GEE population-averaged panel-data model with a cluster variable family identifier to include possible correlations within related data sets. A linear regression model was used to analyze associations of dietary patterns using possible covariates, and to examine the percentage of daily energy coming from breakfast, lunch, dinner, and snack while adjusting for age, sex, and BMI z-score. Random-effects logistic regression models were used to determine the relationship of the dietary variables with obesity status and to understand if the percent energy intake (%EI) derived from fat from all meals (breakfast, lunch, dinner, and snacks) affected obesity. Results. Older children (age 4-19 years) consumed a higher percent of energy at lunch and dinner and less percent energy from snacks compared to younger children. Age was significantly associated with percentage of total energy intake (%TEI) for lunch, as well as dinner, while no association was found by gender. Percent of energy consumed from dinner significantly differed by obesity status, with obese children consuming more energy at dinner (p = 0.03), but no associations were found between percent energy from fat and obesity across all meals. Conclusions. Information from this study can be used to develop interventions that target dietary intake patterns in obesity prevention programs for Hispanic children and adolescents. In particular, intervention programs for children should target dietary patterns with energy intake that is spread throughout the day and earlier in the day. These results indicate that a longitudinal study should be used to further explore the relationship of dietary patterns and BMI in this and other populations (Dubois et al., 2008; Rodriquez & Moreno, 2006; Thompson et al., 2005; Wilson et al., in review, 2008). ^

The relationship between alcohol consumption and HDL cholesterol: A study of Hispanic drinking patterns

There has been very little research that has studied the effects of alcohol on biochemical markers in ethnic populations. This particular study is designed to identify the association, if any, between drinking patterns and high density lipoprotein cholesterol (HDL-C) levels in a Hispanic population. Most of what we know about the association between alcohol and HDL-C deals specifically with volume of alcohol consumed on a daily basis. Frequency, or how often alcohol consumption occurs within a given time period, is a variable that has rarely been studied. The results of this study showed how both volume and frequency of alcohol consumption affect HDL-C levels in a predominantly middle-aged Hispanic population. Ultimately, we will be able to apply these findings to future studies concerning risk of CHD in Hispanics. ^

Parenting practices, acculturation and Hispanic youth's sexual health

This dissertation examined the impact of acculturation and the influence of the family (specifically parenting practices) on Hispanic youth's sexual behavior and reproductive health and is presented in the form of three papers. In the first paper, we assessed the reliability and validity of the Bicultural Acculturation Scale/Language Proficiency (BAS/LP) subscale for use among Hispanic middle school-aged youth. The purpose of the second paper was to examine the associations between initiation of vaginal intercourse, parental monitoring, and parent-child communication while controlling for acculturation and other recognized covariates. Finally, the purpose of the third dissertation paper was to examine HPV vaccine knowledge, attitudes, and acceptability among Hispanic mothers and girls using strategic focus groups. The three papers will jointly extend the knowledge about Hispanic youth and their parents regarding both sexual initiation and uptake of the HPV vaccine. In addition, findings from the papers can inform the development of interventions for Hispanic youth and their parents to delay sexual initiation and increase HPV vaccine uptake.^

Fast food influences among Hispanic women

The purpose of this study was to evaluate the fast food influences such as restaurant frequency and restaurant choice among Hispanic women residing in Houston Texas. We also evaluated associations between BMI and frequency of fast food consumption. Methods: Data was obtained from the BOUNCE program and baseline data was evaluated from mothers enrolled in the study. Descriptive analysis and Fisher's exact test were conducted to evaluate patterns among fast food selection. Results: Nearly 88 percent of women were classified as overweight or obese, the population was predominately immigrants from Mexico with language preference of Spanish. Factors most influencing restaurant choice included quality of food, restaurant atmosphere, and healthy food availability. No associations were found between BMI and frequency of fast foods, however data show a slight association between duration in the U.S and increase in fast food frequency. Conclusion: Though statics are not statistically significant results demonstrate a possible trend in regards to length of stay and frequency eating out. This should be further explored. ^

A cross-sectional study of disparities in suicide ideation between Hispanic and non-Hispanic white female adolescents

Suicide is recognized as a major public health and clinical problem in the United States. One fifth of adolescents in the United States seriously consider suicide each year, and about 8% of high school students attempt suicide at least once. Hispanic ethnicity constitutes a risk factor for suicidal ideation and suicide attempts, with Hispanic females at highest risk. Nevertheless, published studies on suicidal behavior in Hispanic female adolescents are extremely limited and focus on suicidal ideation in school samples. Given the severity of the problem and the paucity of information on this topic, more research on ethnic differences in suicidal ideation in community samples of high-risk children is urgently needed. This cross-sectional study delineated differences in suicide ideation between Hispanic female adolescents and non-Hispanic white female adolescents attending a mental health clinic and examined the association of ethnicity with suicide ideation independent of other known risk factors. Data were accrued between June 2004 and December 2008 in a Harris County Mental Health and Mental Retardation Association (MHMRA) clinic. Data were limited to adolescents who were Harris County Residents between the ages of 10 to 17 years when they were admitted to the clinic. The objective of this study was to determine whether differences in socio-demographic and clinical variables play a significant role in ethnic disparities in suicide ideation. A series of logistic regressions were performed to estimate the association between ethnicity and suicide ideation after controlling for potentially confounding factors. ^ Results showed an interaction between Hispanic ethnicity and having a history of treatment: Hispanic girls having history of treatment had lower odds of having suicide ideation than Hispanic girls without such a history. After adjusting for treatment history, family problems, substance use, juvenile justice involvement, current treatment, and age, Hispanic girls had 1.86 times the odds of having suicide ideation than non Hispanic girls (OR=1.86, 95% CI=0.88-1.46). Although additional studies on community samples of high risk adolescents are needed to verify these findings, our study highlights the fact that Hispanic girls are at significantly higher risk and need to be targeted for prevention and treatment efforts. ^

Factors influencing hurricane evacuation among Hispanic population

The recent hurricanes of Katrina, Rita, and Dolly have brought to light the precarious situation populations place themselves in when they are unprepared to face a storm, or do not follow official orders to evacuate when a destructive hurricane is poised to hit the area. Three counties in southern Texas lie within 60 miles of the Gulf of Mexico, and along the Mexican border. Determining the barriers to hurricane evacuation in this distinct and highly impoverished area of the United States would help aid local, state, and federal agencies to respond more effectively to persons living here.^ The aim of this study was to examine intention to comply with mandatory hurricane evacuation orders among persons living in three counties in South Texas by gender, income, education, acculturation and county of residence. A questionnaire was administered to 3,088 households across the three counties using a two-stage cluster sampling strategy, stratified by all three counties. The door-to-door survey was a 73-item instrument that included demographics, reasons for and against evacuation, and preparedness for a hurricane. Weighted data were used for the analyses.^ Chi-square tests were run to determine whether differences between observed and expected frequencies were statistically significant. A logistic regression model was developed based on that univariate analysis. Results from the logistic regression estimated odds ratios and their 95 percent confidence intervals for the independent variables.^ Logistic regression results indicate that females were less likely than men to follow an evacuation order. Having a higher education meant more likelihood of evacuating. Those respondents with a higher affiliation with Spanish than English were more likely to follow the evacuation orders. Hidalgo County residents were less likely to evacuate than Cameron or Willacy Counties' residents. Local officials need to implement communication efforts specifically tailored for females, residents with less of an affiliation with Spanish, and Hidalgo County residents to ensure their successful evacuation prior to a strong hurricane's landfall.^

A Su Salud Injury Prevention expansion: Analysis of injury prevention perceptions in a Hispanic community

Unintentional injury is the leading cause of death for American ages one to 44 and is ranked in the top ten causes of death for all age groups (CDC, 2006a). A Su Salud Injury Prevention was developed to address injury prevention awareness and education. The program is a mass media education campaign that uses role models, mass media, and community outreach to prevent injury. In 2009, University Health System (UHS) expanded the program. Baseline data were collected from 426 residents in targeted neighborhoods northwest of downtown San Antonio to support the expansion. The purpose of this study was to explore injury perceptions, knowledge, and behaviors of adults living in the expansion area, and define the predominant factors associated with these perceptions. A secondary aim was to assess community awareness and willingness to participate in the program.^ Survey results showed motor vehicle crashes (MVC), falls, drinking and driving, and guns and assaults were considered the most serious injures for adults. The most serious child injuries were MVC, abuse and neglect, falls, and head injuries. Residents were knowledgeable of state seatbelt policy, and over 90% responded as compliant for seatbelt and child car seat use. Most were knowledgeable about drinking and driving state policy and negative outcomes. However, 70% of those reporting driving under the influence of alcohol within the last year engaged in repeat high risk behavior. Men and residents under the age of 55 were more likely to engage in repeat drinking and driving (OR= 3.6, 7.0 respectively). Residents consider injury prevention an important issue, and have interest in a local injury prevention program. Younger women are the most likely to participate in a local program as potential role models and volunteers.^ Results from the study are summarized into an injury prevention and demographic profile of the community that will be used to develop tailored injury prevention messages to create a more effective program, and support program coordinators in effective community engagement. Results will also be used as a comparative basis for future evaluation of a behavioral injury prevention program focused on a predominantly Mexican-American community.^

Examining seasonal variations in physical activity among low-income Hispanic walk-trail users living in the Cameron Park Colonia

This study examines variations in physical activity by season, and within seasons by age and gender among park users living in the Cameron Park Colonia, a low-income Hispanic community along the Texas-Mexico border. This is the first study of its kind to evaluate seasonal variations by physical activity among a Hispanic population. We hypothesized that (1) there are no differences in overall physical activity by season; (2) youth engage in more sport-related physical activity compared to adults, (3) males engage in more physical activity than females, and (4) there are differences in physical activity between walk-trail users compared to non walk-trail users in the park.^ Physical activity behavioral data was collected (males n=2,093; females n=1,014) at two time periods (winter 2007; summer 2007) via direct observations and assessed park use, walking trail use, and physical activity (moderate-to-vigorous physical activity (MVPA) by seasons. Frequencies for physical activities were calculated for gender, age groups, and season. Separate Pearson's chi-square analyses were used to address variations in physical activity, age, gender, intensity level of physical activity by season, between walk-trails users and non walk-trail users.^ People visiting the park engaged in more sedentary behavior in winter than summer and a higher percentage engaged in MVPA in the summer than winter (p<.05). More females engaged in light activity compared to males (p<.05). Walk-trail users consisted mostly of females and engaged in more light activity than non walk-trail users (p<.05) who participated in more MVPA.^ Increasing access to parks and walk-trails may be an intervention strategy to increase physical activity among Hispanics. More research is needed to assess promoting trail use and determining long-term effects on physical activity among minority/ethnic groups at greater risk of a sedentary lifestyle and reasons for trail use and non-use. Future studies should focus on the types of activities Hispanics engage in at different parks particularly between men and women. As a result of this study city officials and planners may use this information to build and design parks that cater to the types of activities that Hispanics engage in and may use to meet physical activity guidelines.^

Process evaluation of intervention program for prevention of early sexual activity and alcohol use among Hispanic teenagers

Hispanic teens are a high-risk population for initiation of early sexual activity and alcohol use which in turn has numerous social and health consequences. One strategy to address prevention of these behaviors is to implement a capacity building intervention that promotes parent child communication, encompasses their cultural values and community participation. This study describes the process evaluation of a pilot intervention program amongst Hispanic teens and their families living along the Texas-Mexico border. “Girls Lets Talk” is a small group intervention with 10-14 year old teens and their female adult family members that involves education regarding effects of alcohol use and sexual activity as well as activities for monitoring and refusal skills to prevent risky behaviors. Two waves of the program each consisting of at least seven mother daughter dyads were conducted. During the designing process, community advisory board meetings and focus groups were held to review course materials and ensure they were appropriate to the Mexican American culture. Parent and adolescent surveys were administered at the beginning and end of the intervention to assess for psychosocial outcome variables. All sessions received high mean satisfactory scores (mean of 4.00 or better on a five point scale) for both adult and adolescent participants. Qualitative feedback was obtained via debriefing sessions to evaluate experience as well as alter recruitment strategies. A Wilcoxon Sign Rank analysis of the pre and post intervention surveys was done that showed significant changes in some outcome variables such as intentions and confidence for monitoring behaviors for adults and beliefs regarding sexual activity. “Girls Lets Talk” is a promising example of how a process evaluation plan can help develop a theory based health promotion program using the community based participatory research approach. The intervention may also be effective in altering intentions and enhancing self-efficacy among parents and teens in order to decrease risky behaviors such as early sexual activity and alcohol use.^

A comparison of healthcare access, healthcare utilization and asthma self-management for Hispanic children in border and non-border regions of Texas

The purpose of this culminating experience was to investigate the relationships between healthcare utilization, insurance coverage, and socioeconomic characteristics of children with asthma along the Texas-Mexico Border. A secondary data analysis was conducted on cross-sectional data from the Texas Child Asthma Call-back Survey, a follow-up survey to the random digit dialed Behavior Risk Factor Surveillance Study (BRFSS) conducted between 2006-2009 ( n = 556 adults living in households with a child with asthma).^ The proportion of Hispanic children with asthma in Border areas of Texas was more than twice that of non-Border areas (84.8% vs. 28.8%). Parents in Border areas were less likely to have their own health insurance (OR = 0.251, 95% C.I. = 0.117-0.540) and less likely to complete the survey in English than Spanish (OR = 0.251 95% C.I. = 0.117-0.540) than parents in non-Border areas. No significant socio-economic or health care utilization differences were noted between Hispanic children living in Border areas compared to Hispanic children living in non-Border areas. Children with asthma along the Texas-Mexico Border, regardless of ethnicity and language, have insurance coverage rates, reported cost barriers to care, symptom management, and medication usage patterns similar to those in non-Border areas. When compared to English-speakers, Spanish-speaking parents in Texas as a whole are far less likely to be taught what to do during an asthma attack (50.2% vs. 78.6%).^ Language preference, rather than ethnicity or geographical residence, played a larger role on childhood asthma-related health disparities for children in Texas. Spanish-speaking parents in are less likely to receive adequate asthma self-management education. Investigating the effects of Hispanic acculturation rates and incongruent parent-child health insurance coverage may provide better insight into the health disparities of children along the Texas-Mexico Border.^

African American and Hispanic adolescent STI and pregnancy prevention: Whose responsibility is it, anyway?

This dissertation utilized quantitative and qualitative methods to examine the role of responsibility in the prevention of sexually transmitted infections (STIs) and pregnancy through condom use and other sexual behaviors among young adolescents. Data were analyzed across race and gender and three papers were developed. The quantitative portion used logistic regression to assess associations between personal responsibility, as well as other know correlates, and reported condom use and condom use intentions as a means of STI and pregnancy prevention among 445 inner-city, high school adolescents. Responsibility to prevent pregnancy by providing the condom was associated with condom use at last sex and consistent condom use. Responsibility to prevent acquiring a STI by using a condom was significantly associated with consistent condom use. No significant associations were found between responsibility and condom use intentions. ^ The qualitative section of the dissertation project involved conducting 28 in-depth interviews among 9th and 10th grade, African American and Hispanic students who attended a large urban school district in South Central Texas. Perceptions of responsibility for preventing STIs and unintended pregnancy, as well as for condom use, were explored. Male and female adolescents expressed joint responsibility to prevent a STI or pregnancy. Perceptions of responsibility for providing and using the condoms were mixed. Despite the indication of both partners, mostly all participants implied that females, more so than the males, had the final responsibility to prevent contracting a STI, a pregnancy, to provide a condom, and to make sure a condom was used. Participants expressed the role of parents' involvement for preventing these outcomes as well as the need for more sexual health education and access to preventative methods. ^ The last section of this dissertation involved qualitative inquiry to ascertain perceptions of reasons why adolescents engage in anal and oral (non-coital) sex. Pleasure-seeking and giving as well social influence and pressure were described as the main reasons why teenagers have non-coital sex. Other reasons included conveniences of participating in these behaviors such as ease of performing oral sex and anal sex as a convenient alternative to vaginal sex. Sexual inexperience was an indicator for why anal sex occurs. Many of the reasons involved misperceptions and adolescents who practice these sexual behaviors place themselves at-risk for contracting a STI. ^ This dissertation increased the current knowledge base about adolescent sexual responsibility and non-coital behaviors. Future studies should explore perceptions of responsibility and actual sexual activity practices among adolescents to reduce the burden of STIs and pregnancy as well as help public health professionals develop programs for adolescent populations, schools, and communities where these issues persist.^

Factors affecting prenatal care use and pregnancy outcome in Texas: A comparative study among and within Black, Anglo, and Hispanic populations

This research project is a study in the field of public health to test the relationships of demographic, socioeconomic, behavioral, and biological factors with (1) prenatal care use and (2) pregnancy outcome, measured by birth weight. It has been postulated that demographic, socioeconomic, and behavioral factors are associated with differences in the use of prenatal care services. It has also been postulated that differences in demographic, socioeconomic, behavioral, and biological factors result in differences in birth weight. This research attempts to test these two basic conceptual frameworks. At the same time, an attempt is made to determine the population groups and subgroups that are at increased risk (1) of using fewer prenatal care visits, and (2) of displaying a higher incidence of low birth weight babies. An understanding of these relationships of the demographic, socioeconomic, behavioral, and biological factors in the use of prenatal care visits and pregnancy outcome, measured by birth weight, will potentially offer guidance in the planning and policy development of maternal and child health services. The research considers four major components of maternal characteristics: (1) Demographic factors. Ethnicity, household size, maternal parity, and maternal age; (2) Socioeconomic factors. Maternal education, family income, maternal employment, health insurance coverage, and household dwelling; (3) Behavioral factors. Maternal smoking, attendance at child development classes, mother's first prenatal care visit, total number of prenatal care visits, and adequacy of care; and, (4) Biological factors. Maternal weight gain during pregnancy.^ The research considers 16 independent variables and two dependent variables.^ It was concluded that: (1) Generally, differences in demographic, socioeconomic, and behavioral factors were associated with differences in the average number of prenatal care visits between and within population groups and subgroups. The Hispanic mothers were the lowest users of prenatal care services. (2) In some cases, differences in demographic, socioeconomic, behavioral, and biological factors demonstrated differences in the average birth weight of infants between and within population groups and subgroups. (3) Differences in demographic, socioeconomic, behavioral, and biological factors resulted in differences in the rates of low birth weight babies between and within population groups and subgroups. The Black mothers delivered the highest incidence of low birth weight infants.^ These findings could provide guidance in the formulation of public health policies such as MCH services, an increase in the use of prenatal care services by prospective mothers, resulting in reduction of the incidence of low birth weight babies, and consequently aid in reducing the rates of infant mortality. ^

A methodologic study of pain assessment in Anglo and Hispanic children with cancer

There is growing clinical evidence that even young children experience pain and accompanying anxiety. Few instruments have been validated to assess pain characteristics in children. The study of related demographic, illness, psychologic and parental factors in children has also been limited. This study examines the reliability and validity of pain assessment tools in an outpatient pediatric cancer population. A total of 78 children from three to fifteen years of age were observed and interviewed about the pain of invasive procedures. The effect of cultural factors and the stress of acculturation were examined by comparing data from two cultural groups, Anglo and Hispanic.^ Spielberger State-Trait Anxiety Scales were administered to children and parents prior to an invasive procedure. The Procedure Behavioral Checklist (PBCL) was used for observation of the child's response during the procedure. The Children's Procedural Interview (CPI) which contains items on the PBCL and visual analogues (scales of faces indicating varying degrees of pain and anxiety) was administered following the procedure.^ Reliability coefficients for Anglos were.78 on the PBCL,.79 on the CPI and.85 on the visual analogue scales. For Hispanics, the reliability for the PBCL was.54, while the CPI had a reliability of.72 and the visual analogue scales,.87. Construct validity was demonstrated by high correlations between the PBCL and CPI scores for both ethnic groups (.66 for Anglos and.64 for Hispanics) and by the significant correlation of State anxiety scores with both PBCL and CPI scores. Age was inversely correlated with PBCL and CPI scores for both ethnic groups. Hispanic parents' anxiety scores were higher than Anglo parents, but were not highly correlated with their child's PBCL, CPI or State-Trait anxiety scores. Caregivers' ratings were correlated with the PBCL scores for Anglos but not for Hispanics.^ The findings of this study indicate that pain responses may be reliably assessed using both observational and self-report methods in children, though differences in Anglo and Hispanic cultures exist. Differences in pain symptomatology and assessment in the two cultural groups warrant further study. ^