Mexican Americans With Type 2 Diabetes: Perspectives on Definitions, Motivators, and Programs of Physical Activity

IntroductionResearch documents that Mexican Americans bear excess health risk because of physical inactivity and have higher morbidity and mortality rates from chronic diseases than do other ethnic groups. Factors influencing physical activity in this minority population, however, are not well understood. This study examines perceptions of physical activity in a population of Mexican Americans who have type 2 diabetes and live in the Texas-Mexico border region and identifies motivators and barriers to physical activity in this group.MethodsThis study used a qualitative research design and employed six focus groups comprising 39 Mexican Americans with type 2 diabetes who live in the Texas–Mexico border region. A team of bilingual Mexican American researchers systematically reviewed and analyzed focus group data by means of qualitative data analysis software. The study was conducted during 2005–2006.ResultsMost participants considered physical activity to be related not only to exercise but also to occupational and home activities. Walking was the preferred type of activity. Motivators to physical activity included family support and the sense of well-being derived from physical activity. Barriers to physical activity included individual and environmental factors, such as lack of time, physical pain, depression, being overweight, unsafe neighborhoods, and lack of facilities. Participants suggested that the ideal intervention would be low in cost, family-based, close to home, and led by bilingual instructors.ConclusionHealth promotion efforts to prevent or reduce the effects of chronic disease among Mexican Americans with type 2 diabetes in the Texas–Mexico border region should focus on implementing neighborhood-based, family-oriented walking interventions

Evidence-Based Program to Reduce Fall-Related Risk Among Older Adults: A Comparison of Program Efficacy by Ethnicity

Despite rapid growth among the Hispanic population in the United States, seniors within this ethnic group are typically underrepresented in evidence-based programs. The purpose of this study is to examine the relative efficacy of A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL), an eight session fall risk prevention program, for non-Hispanic White and English-speaking Hispanic participants on key study outcomes. Data were collected from 1,233 seniors enrolled in AMOB/VLL in Texas. Compared to non-Hispanic White participants, a significantly larger proportion of Hispanic participants were younger (?2=50.23, df=3, p<0.001), had less than a high school education (?2=200.31, df=2, p<0.001), and resided in less affluent areas. From baseline to post-intervention, significant improvements in falls efficacy (t=- 9.13, df=167, p<0.001), days limited from usual activity (t=1.99, df=164, p=0.049), and unhealthy mental days (t=2.51, p=0.013) were seen among Hispanic participants. Significant improvements among nonHispanic White participants were observed for falls efficacy (t=-15.90, df=868, p<0.001). Although significant improvements were found for each ethnic group, the magnitude of improvement among Hispanic participants exceeded that of non-Hispanic Whites in some aspects. Identifying participant characteristics and positive outcomes specific to Hispanics can inform strategies to maximize program reach and effectiveness among this vulnerable and underserved population

Finding Respondents from Minority Groups

The recruitment of respondents belonging to ethnic minorities poses important challenges in social and health research. This paper reflects on the enablers and barriers to recruitment that we encountered in our research work with persons belonging to ethnic minorities. Additionally, we applied the Matching Model of Recruitment, a theoretical framework concerning minority recruitment, to guide our reflection. We also explored its applicability as a research design tool. In assessing our research experience, we learned that minority recruitment in social and health research is influenced by the social context of all key players involved in the research. Also, there are enablers and barriers within that social context facilitating or delaying the recruitment process. The main enablers to recruit respondents belonging to ethnic minorities include working with community agencies and gatekeepers who share a common vision with researchers and the latter’s ability to gain the trust of potential respondents. The main barriers include demanding too much from these same community agencies and gatekeepers and ignoring factors that could delay the completion of the research. Although we found the Matching Model of Recruitment to be an effective tool in assessing the processes of recruiting respondents belonging to ethnic minorities, further empirical research is needed to explore its usefulness during the research planning phase

Leptin and its Association with Obesity among Mexican Adolescents

Purpose: To investigate the association between leptin concentrations and nutritional status among a Mexican adolescent population. Methods: Cross-sectional study with 448 adolescents attending five schools in Durango, Mexico. Serum leptin concentrations were measured by ELISA. Other measurements included height, weight, and waist and hip circumference. Body fat of participants was assessed with bio-electrical impedance using a body composition analyzer InBody-720. Sociodemographic information was also collected. Results: Based on IOTF BMI cut-off points, 34.1% of adolescents were overweight and obese and prevalence rates were higher among females (37.1%) than males (29.5%). In agreement with waist circumference, 22.5% of participants were overweight and had abdominal obesity; and based on waist-to-hip ratio 35.5% had truncal obesity. Leptin concentration levels among females (19.33 ng/dL) were two times higher than among males (40.07 ng/dL) with a statistical significant difference (p=0.000). Leptin levels among obese females (69.92 ng/dL) were three times higher than among underweight females (17.70 ng/dL). Conversely, leptin levels among males (43.52 ng/dL) were four times higher than among their underweight counterparts (10.08 ng/dL). Mean leptin levels among women with body fat greater than 28% (46.44 ng/dL) were statistically different and 1.7 times higher than those with lower body fat (25.96 ng/dL) (p=0.000). Mean leptin levels among males with body fat greater than 20% (30.17 ng/dL) were statistically different (p=0.000) and 2.4 times higher than among males with lower body fat (12.35 ng/dL). Among both females and males, leptin concentration levels were positively and significantly associated with visceral body fat (R2=0.344 females; R2=0.373 males; p=0.000). Conclusions: Significant correlations between leptin and BMI, body fat percentage, and visceral adipose tissue area indicate that this hormone can be used as a biomarker for obesity among adolescents

Diabetes Screening and Prevention in a High-Risk, Medically Isolated Border Community

Introduction: A project in a Texas border community setting, Prevention Organized against Diabetes and Dialysis with Education and Resources (POD2ER), offered diabetes prevention information, screening, and medical referrals. The setting was a large, longstanding flea market that functions as a shopping mall for low-income people. The priority population included medically underserved urban and rural Mexican Americans. Components of the program addressed those with diabetes, prediabetes, and accompanying relatives and friends. Background: People living in the Lower Rio Grande Valley (LRGV) face challenges of high rates of type 2 diabetes, lack of knowledge about prevention, and inadequate access to medical care. Recent statistics from actual community-wide screenings indicate a high diabetes prevalence, 30.7% among adults in the LRGV compared with 12.3% nationwide. Methods: A diverse team composed of public health faculty, students, a physician, a community health worker, and community volunteers conceived and developed the project with a focus on cultural and economic congruence and a user-friendly atmosphere. The program provided screening for prediabetes and diabetes with a hemoglobin A1c test. Screening was offered to those who were at least 25 years of age and not pregnant. When results indicated diabetes, a test for kidney damage was offered (urinary albumin-to-creatinine ratio). A medical appointment at a community clinic within a week was provided to those who tested positive for diabetes and lacked a medical home. Health education modules addressed all family members. Discussion: The project was successful in recruiting 2,332 high-risk people in 26 months in a community setting, providing clinic referrals to those without a doctor, introducing them to treatment, and providing diabetes prevention information to all project participants. Implications for research and practice are highlighted. Conclusion: This study shows that a regular access point in a place frequented by large numbers of medically marginalized people in a program designed to eliminate cultural and economic barriers can succeed in providing a hard-to-reach community with diabetes prevention services. Aspects of this program can serve as a model for other service provision for similar populations and settings

Establishing successful binational academic collaborations in minority health research

This article describes a continuing, successful binational collaborative effort between researchers from two academic institutions in the United States and Mexico addressing health issues on both sides of the Texas/Mexico border region. Researchers from the Texas A&M University System Health Science Center School of Rural Public Health (SRPH) and the Reynosa-Aztlán Multidisciplinary Academic Unit of Universidad Autónoma de Tamaulipas (UAT) partnered to conduct two research projects in the South Texas/Mexico border region. These binational research projects focus on obesity and diabetes, issues that seriously affect border residents. This article also highlights the challenges that must be addressed to sustain binational collaborative efforts and recommendations for successful partnership

Relationship Between Dyslipidemia and Obesity in Children

Purpose: Dyslipidemia is a general term that refers to abnormal levels of lipids. The purpose of this research was to determine the relationship among the nutritional state and the percentage of body fat with the levels of lipids in 10 to 13 year old children living in the city of Durango, Mexico. Method: The study was carried out with 823 elementary school children. The selection was done at random. The biochemical studies were done in a subpopulation of 425 children. Each child underwent the following studies: sociodemographic, anthropometric and corporal composition. After fasting overnight, a venous blood sample was obtained. lipid profile including cholesterol, LDL-C, HDL-C and triglycerides were determined in serum. In order to classify lipid levels we used the reference values suggested by the National Cholesterol Education Program (NCEP). The desirable values were: TC \u3c170 mg\u3e/dl, HDL -C \u3e45 mg/dl, LDL -C \u3c110 mg\u3e/dl and TG \u3c100 mg\u3e/dl. The nutritional state was calculated according the age and sex specific BMI values developed by the CDC. Fat mass content was determined using a bioelectrical impedance analyzer (Tanita TBF-215). Statistical analyses were performed using SPSS14. Results: This study included 428 (52%) boys and 395 (48%) girls. Mean age was 11.5 years. The prevalence of overweight and obesity was 36.7. In the population studied we found abnormal levels of lipids in: cholesterol (41.8%), HDL-C (55.8%), LDL-C (32.3%) and TG (38.5%). The girls showed lower levels of HDL-C than the boys (p \u3c 0.05), the other lipoproteins were not statistical different ( p \u3e 0.05). The lipids levels (TC, LDL-C and TG) were higher in those with a BMI greater than 85 th percentile of BMI, and DHL-C was lower. In those with a body fat greater than 20%, all the lipids levels resulted abnormal. Conclusions: A high risk of dislypidemia was associated with gender, BMI and body fat

Study of the food habits of 4- to 6-year-old children in Reynosa, Tamaulipas (Mexico)

Se estudiaron los hábitos alimentarios de niños de 4 a 6 años en Reynosa, Tamaulipas (México) para determinar el riesgo de problemas nutricionales derivados del sobrepeso y obesidad. Se estudiaron las dietas de 999 niños. La ingesta de calorías en los niños (1457,10 ± 22,30 kcal) fue significativamente mayor que en las niñas (1345,69 ± 20,58 kcal). Un comportamiento similar se observó para la mayoría de los macronutrientes. El porcentaje de niños con sobrepeso (13,9%) coincidió con el porcentaje de la población (13,1%) que consumió una cantidad de calorías mayor al 150% de la recomendación para la población mexicana, también con ingesta excesiva de carbohidratos (51,6%), proteínas (87%) y colesterol (45%). En micronutrientes, 49,1% de los niños mostraron un consumo menor al 50% de la recomendación para vitamina A, 32,3% para calcio, 23% para hierro y 17,1% para zinc. Los resultados mostraron un desequilibrio alimentario por exceso de proteínas, carbohidratos, colesterol y déficit en la ingesta de micronutrientesA study of the food intake habits of 4- to 6‐year-old children in Reynosa, Tamaulipas, Mexico was carried out to determine the risk of nutritional problems related to being overweight and obesity. The diet of 999 children was studied. The energy intake in males (1457.10 ± 22.30 kcal) was statistically higher than the female intake (1345.69 ± 20.58 kcal). Similar behavior was observed for the majority of the macronutrients. The percentage of overweight children (13.9%) coincided with the percentage of the population who consumed greater than 150% of the calorie recommendation for adults (13.1%), with an excessive intake of carbohydrates (51.6%), proteins (87%), and cholesterol (45%). Nevertheless, the consumption was smaller than 50% of the daily-recommended intake (DRI) for vitamins in 49.1% of the children, calcium in 32.3%, iron in 23%, and zinc in the 17.1% of the population. The results suggest a food intake imbalance due to the excess of macronutrients (proteins, carbohydrates, and cholesterol) in combination with a deficit in micronutrient intakeS

Insulin Resistance and Obesity in Mexican Youth

Purpose: Although research shows that prevalence rates of insulin resistance (IR) is increasing in children, little is known about the impact of obesity in IR in Mexican youth. This study investigated the association between overweight, obesity, and insulin resistance in Mexican adolescents. Methods: Data were collected from 448 adolescents aged 12 to 18 years from a random sample of a high school student population in Durango, Mexico. After fasting overnight, blood samples were obtained from participants. Glucose, insulin, lipid profile, leptin, insulin growth factor, growth hormone, cortisol, TNF-alpha, and C-reactive protein were determined in serum. Body Mass Index (BMI) was calculated using CDC parameters. Fat mass was determined using a bioelectrical impedance analyzer. THE HOMA index was used to calculate IR and a Keskin diagnosis value of 3.1 was considered. Statistical analyses were conducted. Results: The mean age of the sample was 15.44 years and a majority was female (61.4%). Prevalence of overweight and obesity was 31.9%. The BMI mean was slightly higher in females (65.5) than in males (61.1) (p \u3e0.05). Females had a greater mean of body fat percentage (31.9) than males (20.2) (p\u3c 0.05). Prevalence of resistance to insulin by HOMA-IR was 14.4% with no statistically significant gender differences. The IR mean was higher in adolescents with greater BMI (≥85th percentile) than those with low and normal BMI (\u3c85th percentile) (p \u3c0.05). Adolescents with high IR levels (≥3.1) had higher mean values of corporal fat (37.69%) and BMI (89.76) than those with lower IR levels (\u3c3.1) and lower corporal fat and BMI values (26.4%3 and 61.67, respectively). Conclusions: The significant association found between obesity and insulin resistance in Mexican adolescents suggests a greater risk for the development of degenerative disease in this young population during adulthood. Public health programs among Mexican adolescents are essential to prevent obesity and IR related consequences