This article presents an expanded model of acculturation among international migrants and their immediate descendants. Acculturation is proposed as a multidimensional process consisting of the confluence among heritage-cultural and receiving-cultural practices, values, and identifications. The implications of this reconceptualization for the acculturation construct, as well as for its relationship to psychosocial and health outcomes, are discussed. In particular, an expanded operationalization of acculturation is needed to address the “immigrant paradox,” whereby international migrants with more exposure to the receiving cultural context report poorer mental and physical health outcomes. We discuss the role of ethnicity, cultural similarity, and discrimination in the acculturation process, offer an operational definition for context of reception, and call for studies on the role that context of reception plays in the acculturation process. The new perspective on acculturation presented in this article is intended to yield a fuller understanding of complex acculturation processes and their relationships to contextual and individual functioning.
acculturation; immigrant; cultural practices; cultural values; cultural identifications
Despite their diverse cultural origins, Hispanics in the US are generally studied as a single ethnic group.
1) Assess demographic and disease-related differences among U.S. Hispanics by country of origin, and 2) Examine the mediating roles of socioeconomic status and acculturation on disease prevalence in these subgroups.
Design and Participants
Using data from the 2000-2005 National Health Interview Survey (NHIS), we compared characteristics of Mexican-Americans with Hispanics originally from: Mexico, Puerto Rico, Central/South America, Cuba, and Dominican Republic (n = 31,240). We stratified the analysis by foreign versus US-born Hispanic subgroups and modeled hypertension and diabetes prevalence, adjusting for demographic and acculturation differences.
The six Hispanic subgroups were significantly diverse in all measured variables. Prevalence of hypertension (32%) and diabetes (15%) was highest in foreign-born Puerto Ricans. After adjusting for age, BMI, smoking, socioeconomic status and acculturation in foreign-born Hispanics, Puerto Ricans (OR = 1.76 [95% CI: 1.23, 2.50], p = 0.002) and Dominicans (OR = 1.93 [1.24, 3.00], p = 0.004), had higher prevalence of hypertension relative to Mexican-Americans. Adjusted diabetes prevalence among foreign-born Hispanics was half or less in Cubans (OR = 0.42 [0.25, 0.68] p < 0.001), Dominicans (OR = 0.48 [0.26, 0.91], p = 0.02) and Central/South Americans (OR = 0.51 [0.33, 0.78], p = 0.002) relative to Mexican-Americans. Among US-born Hispanic subgroups, Cubans had lower hypertension (OR = 0.53, [0.33, 0.83], p = 0.006) and Mexicans (OR = 0.76 [0.60, 0.98], p = 0.03) had lower diabetes prevalence compared to Mexican-Americans in adjusted models.
The prevalence of hypertension and diabetes varies significantly among Hispanics by country of origin. Health disparities research should include representation from all Hispanic subgroups.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-010-1335-8) contains supplementary material, which is available to authorized users.
diabetes; health status; hypertension; immigrant health; vulnerable populations
We investigated ethnic differences in allostatic load in a population-based sample of adults living in Texas City, TX, and assessed the effects of nativity and acculturation status on allostatic load among people of Mexican origin.
We used logistic regression models to examine ethnic variations in allostatic load scores among non-Hispanic Whites, non-Hispanic Blacks, and people of Mexican origin. We also examined associations between measures of acculturation and allostatic load scores among people of Mexican origin only.
Foreign-born Mexicans were the least likely group to score in the higher allostatic load categories. Among individuals of Mexican origin, US-born Mexican Americans had higher allostatic load scores than foreign-born Mexicans, and acculturation measures did not account for the difference.
Our findings expand on recent research from the National Health and Nutrition Examination Survey with respect to ethnicity and allostatic load. Our results are consistent with the healthy immigrant hypothesis (i.e., newer immigrants are healthier) and the acculturation hypothesis, according to which the longer Mexican immigrants reside in the United States, the greater their likelihood of potentially losing culture-related health-protective effects.
Hispanics are the fasting growing population in the U.S. and disproportionately suffer from chronic diseases such as hypertension and diabetes. Little is known about the complex interplay between acculturation and chronic disease prevalence in the growing and increasingly diverse Hispanic population. We explored the association between diabetes and hypertension prevalence among distinct U.S. Hispanic subgroups by country of origin and by degree of acculturation.
We examined the adult participants in the 2001, 2003, 2005, and 2007 California Health Interview Survey (CHIS). Using weighted logistic regression stratified by nativity, we measured the association between country of origin and self-reported hypertension and diabetes adjusting for participants’ demographics, insurance status, socio-economic status and degree of acculturation measured by citizenship, English language proficiency and the number of years of residence in the U.S.
There were 33,633 self-identified Hispanics (foreign-born: 19,988; U.S.-born: 13,645). After multivariable adjustment, we found significant heterogeneity in self-reported hypertension and diabetes prevalence among Hispanic subgroups. Increasing years of U.S. residence was associated with increased disease prevalence. Among all foreign-born subgroups, only Mexicans reported lower odds of hypertension after adjustment for socioeconomic and acculturation factors. Both U.S.-born and foreign-born Mexicans had higher rates of diabetes as compared to non-Hispanic whites.
We found significant heterogeneity among Hispanics in self-reported rates of hypertension and diabetes by acculturation and country of origin. Our findings highlight the importance of disaggregation of Hispanics by country of origin and acculturation factors whenever possible.
Acculturation; Ethnicity; Hypertension; Diabetes; Hispanic
This study applies advanced conceptualization and measurement to an analysis of acculturation among 1,632 Mexican-heritage preadolescents. We assessed whether – and how – multiple measures combine to form a latent acculturation construct that groups individuals into classes; and determine how many and what classes (or types) of acculturation are experienced by this sample of 5th graders. Measures included attitudinal, behavioral, and linguistic acculturation, generation status, time in the U.S., ethnic identification, and contact with the culture of origin. The analysis identified five classes of acculturation, differing in size and characterized by specific measures of acculturation: less acculturated, moderately bicultural, strongly bicultural, highly acculturated, and marginalized. Although most youths fell into the first four classes, consonant with their exposure to American society, a small minority of youths fell into the last class. Despite substantial exposure to U.S. culture and recent exposure to Mexican culture, these youth showed little affinity for either culture.
acculturation; preadolescents; Mexican
In order to understand how culture influences Hispanic women's views about their health care provider (HCP), we examined the relationship between acculturation and fatalism in the HCP control expectations of Hispanic women. (A HCP control expectation is the extent to which an individual believes that her HCP has control over her health.) We predicted that acculturation would be negatively associated with HCP control expectations and fatalism would be positively associated with HCP control expectations. A group of 1,027 young Hispanic women (mean age 21.24 years; SD = 2.46) who were University of Texas Medical Branch clinic patients completed a comprehensive survey. Structural equation modeling was employed and as predicted, acculturation was negatively associated with HCP control expectations (p < .001) and fatalism was positively associated (p < .001). Understanding fatalism, acculturation, and their influence on HCP control expectations will help us understand this population's perceptions of their HCPs. This knowledge will assist HCPs in providing culturally competent care which will increase adherence to medical treatment and screening guidelines.
Health care provider control; fatalism; acculturation; Latina; Hispanic
Culturally valid measures of depression for Spanish-speaking Hispanic women are important for developing and implementing effective interventions to reduce health disparities. The Center for Epidemiological Studies--Depression Scale (CES-D) is a widely used measure of depression. Differential item functioning has been studied using language preference as a proxy for acculturation, but it is unknown if the results were due to acculturation or the language of administration.
To evaluate the relationship of acculturation, defined with a dimensional measure, to Spanish CES-D item responses.
Spanish-speaking Hispanic women (n = 504) were recruited for a randomized controlled trial of Salud, Educación, Prevención y Autocuidado (Health, Education, Prevention and Self-care). Acculturation, an important dimension of variation within the diverse United States Hispanic community, was defined by high or low scores on the Americanism subscale of the Bidimensional Acculturation Scale. Differential item functioning for each of the 20 CES-D items between more acculturated and less acculturated women was tested using ordinal logistic regression.
No items on the Depressed Affect, Somatic Activity, or Positive Affect subscales showed meaningful differential item functioning, but one item (“People were unfriendly”) on the Interpersonal subscale had small results (R2 = 1.1%).
The majority of CES-D items performed similarly for Spanish-speaking Hispanic women with high and low acculturation. Less acculturated women responded more positively to “People were unfriendly,” despite having an equivalent level of depression, than more acculturated women. Possibilities for improving this item are proposed.
acculturation; depression; Hispanic; women; CES-D
Acculturation has been examined as a risk factor for eating disorders, but interpretation of findings has been limited by inconsistent operationalization of this construct across studies. The study aim was to develop and evaluate a population-specific measure of acculturation for ethnic Fijian adolescent schoolgirls, to use in future analyses related to eating disorders. Our findings suggest that acculturation is a multidimensional construct characterized by distinct, though related, dimensions of orientation to ethnic Fijian and/or western/global culture with respect to a range of behaviors and attitudes. In contrast to theoretical models positing uni-dimensional, orthogonal, or oblique relations between cultural identities in individuals undergoing acculturation, our study findings support a heterogeneous pattern among correlations of dimensions across contrasting cultural identities. We suggest multidimensional measures of acculturation are optimal — and socio-demographic proxies inadequate — for characterization of this complex process for health research.
acculturation; assessment; eating disorders; Fiji; global; western
The use of complementary and alternative medicine (CAM) in the United States has been rising steadily, especially among people with chronic conditions such as osteoarthritis. It has been suggested that ethnicity and acculturation may influence use of CAM. The purpose of this study was to assess the influence of ethnicity and acculturation on patterns of CAM use among Hispanic and non-Hispanic white adults with osteoarthritis.
We conducted interviews in person, in English or Spanish, using a 255-item survey. We randomly selected participants aged 18 to 84 years from patients at university-based primary care outpatient clinics who had been diagnosed with osteoarthritis during the previous year. Measures included prevalence and types of CAM use, sociodemographic factors, self-reported ethnicity, and degree of acculturation according to language use.
The Hispanic (n = 218) and non-Hispanic white (n = 204) populations showed similar rates of overall current CAM use (65.5% Hispanic vs 67.8% NHW) at time of interview. However, although more Hispanics used oral herbs (P = .03) and magnets or copper jewelry (P = .03), more non-Hispanic whites used nutritional supplements (P < .001). Hispanics speaking primarily English mirrored patterns of CAM use among non-Hispanic whites. These effects persisted after controlling for age, sex, income, education, degree of disability, and disease duration.
In this population, ethnicity was a significant influence on patterns of CAM use but did not affect overall rates of use. Some differences were more pronounced among Spanish-speaking Hispanics, reflecting the incorporation of folk or traditional remedies into their health care practices.
Acculturation may strongly influence use of or access to health services among Hispanics in the United States. We assessed the relationships between acculturation and use of oral health services among Hispanic adults in the United States.
Data were analyzed from Hispanic adults aged 18 years or older who participated in the 2006 Behavioral Risk Factor Surveillance System. Hispanics were defined by self-report of Spanish or Hispanic heritage. Preference to be interviewed in English or Spanish was used as a proxy for acculturation. Having had a dental visit in the previous 12 months was used as a proxy for use of oral health services.
English-speaking Hispanics were more likely to have had a dental visit in the previous 12 months compared with Spanish-speaking Hispanics (crude odds ratio [OR], 1.52; 95% confidence interval [CI], 1.36-1.71). After controlling for potential confounders, language was not significantly associated with having had a dental visit (OR, 1.05; 95% CI, 0.87-1.26; P = .61,). The most significant predictors for having had a dental visit in the previous 12 months were sex, education, income, and having health insurance.
Acculturation assessed by language spoken was not significantly associated with having had a dental visit in the previous 12 months among adult Hispanics in the United States. The common determinants of health care use, such as sex, income, level of education, and health insurance status, were the most significant predictors of use of oral health services among adult Hispanics.
Cultural beliefs and values influence treatment preferences for and experiences with end-of-life (EOL) care among racial and ethnic groups. Within-group variations, however, may exist based on level of acculturation.
To examine the extent to which EOL treatment factors (EOL treatment preferences and physician–caregiver communication) and select psychosocial factors (mental health, complementary therapies, and internal and external social support) differ based on the level of acculturation of caregivers of patients with advanced cancer.
One hundred sixty-seven primary caregivers of patients with advanced cancer were interviewed as part of the multisite, prospective Coping with Cancer Study.
Caregivers who were less acculturated were more positively predisposed to use of a feeding tube at EOL (odds ratio [OR] 0.99 [p = 0.05]), were more likely to perceive that they received too much information from their doctors (OR 0.95 [p = 0.05]), were less likely to use mental health services (OR 1.03 [p = 0.003] and OR 1.02 [p = 0.02]), and desire additional services (OR 1.03 [p = 0.10] to 1.05 [p = 0.009]) than their more acculturated counterparts. Additionally, caregivers who were less acculturated cared for patients who were less likely to report having a living will (OR 1.03 [p = 0.0003]) or durable power of attorney for health care (OR 1.02 [p = 0.007]) than more acculturated caregivers. Caregivers who were less acculturated felt their religious and spiritual needs were supported by both the community (β −0.28 [p = 0.0003]) and medical system (β −0.38 [p < 0.0001]), had higher degrees of self-efficacy (β −0.22 [p = 0.005]), and had stronger family relationships and support (β −0.27 [p = 0.0004]).
The level of acculturation of caregivers of patients with advanced cancer does contribute to differences in EOL preferences and EOL medical decision-making.
Acculturation has been correlated with traditional cardiovascular disease risk factors. The purpose of this study was to examine the association between acculturation and health beliefs, barriers, and perceptions related to cardiovascular disease prevention. Racial/ethnic minority participants in the Family Intervention Trial for Heart Health were included in this analysis. Less acculturated minorities were more likely to have health beliefs that may impede prevention, have greater perceived susceptibility to disease, and believe in an external locus of control. Evaluating acculturation in clinical practice may be an opportunity to promote awareness, healthy behaviors, and prevention among immigrants.
acculturation; cardiovascular disease; prevention; minority; health beliefs; race; ethnicity
Hispanics with diabetes often have deficits in health literacy (HL). We examined the association among HL, psychosocial factors, and diabetes-related self-care activities.
Cross-sectional analysis of 149 patients. Data included patient demographics and validated measures of HL, physician trust, self-efficacy, acculturation, self-care behaviors, and A1c.
Participants (N=60) with limited HL were older and less educated, and had more years with diabetes compared with adequate HL participants (N=89). Limited HL participants reported greater trust in their physician, greater self-efficacy, and better diet, foot care, and medication adherence. Health literacy status was not associated with acculturation or A1c. In adjusted analyses, HL status remained associated with physician trust, and we observed a notable but nonsignificant trend between HL status and medication adherence.
Lower HL was associated with greater physician trust and better medication adherence. Further research is warranted to clarify the role of HL and physician trust in optimizing self-care for Hispanics.
Health literacy; Hispanics; diabetes; self-care; trust
To examine past year dental visits among underserved, Hispanic farmworker families using the Andersen Behavioral Model of Health Services Utilization (1968), which posits that predisposing, enabling, and need factors influence care-seeking behavior.
Oral health survey and clinical data were collected in 2006-7 from families in Mendota, California (Fresno County) as part of a larger, population-based study. Generalized estimating equation logit regression assessed effects of factors on having a dental visit among adults (N=326). Predisposing variables included socio-demographic characteristics, days worked in agriculture, self-rated health status, and dental beliefs. Enabling factors included resources to obtain services (dental insurance, income, acculturation level, regular dental care source). Need measures included perceived need for care and reported symptoms, along with clinically-determined untreated caries and bleeding on probing.
Only 34% of adults had a past year dental visit, despite 44% reporting a regular dental care source. Most (66%) lacked dental insurance, and nearly half (46%) had untreated caries. Most (86%) perceived having current needs, and on average, reported a mean of 4.2 dental symptoms (of 12 queried).
Regression analyses indicated those with more symptoms were less likely to have a past year dental visit. Those who would ask a dentist for advice and had a regular dental care source were more likely to have a past year dental visit.
The final model included predisposing, enabling and need factors. Despite low utilization and prevalent symptoms, having a regular source of care helps break this pattern and should be facilitated.
dental health services; Hispanic; agricultural workers
The authors reviewed the acculturation literature with the goal of identifying measures used to assess acculturation in Hispanic populations in the context of studies of health knowledge, attitudes, and behavior change. Twenty-six acculturation measures were identified and summarized. As the Hispanic population continues to grow in the United States, there is a need to develop rigorous acculturation measures that include health indicators. Findings suggest that multidimensional acculturation scales are robust measurement tools when assessing nationality, cultural awareness, media and language preferences, and health status. Furthermore, aspects of Hispanic cultural lifestyle, such as beliefs about nutrition and physical activity, affect health care utilization, treatment, and prevention. Health communication researchers should consider aspects of cultural values and beliefs, and their impact on health status, for future research and health promotion interventions.
acculturation; Hispanics; literature review; measurements; Latino health disparities
Determinants of physical activity in minority populations remain under-explored. Acculturation is one proposed mechanism for the disparities that exist between racial and ethnic groups in health outcomes.
This cross-sectional study evaluated the relation of language acculturation and generation in the US since migration with leisure-time and occupational activity. A low-income, multiethnic urban population was recruited from Massachusetts small businesses (SB) (n = 1725) and health centers (HC) (n = 2205). Baseline data were collected between May 2000 and February 2002.
Individuals with low acculturation reported leisure-time activity 3–5 MET hours/week lower than those who were highly acculturated (P < 0.05). Generation predicted leisure-time activity only in SB participants. In the HC, least acculturated participants reported occupational activity 10–12 MET hours/week higher than highly acculturated participants. In SB men, acculturation was inversely associated with occupational activity; in SB women, language acculturation was positively associated with occupational activity. Generation was not predictive of occupational activity.
Language acculturation and generation were positively associated with leisure-time activity. Language acculturation is also associated with occupational activity. Acculturation is important to consider when designing public health interventions.
Acculturation; Physical activity; Immigrant
The objective of this study is to examine the association between acculturation and BMI among Asian Americans using multiple measures of acculturation. Data of 847 Chinese, Korean and Vietnamese recruited for a health education program in Maryland during 2009 to 2010 were used. Acculturation was measured by the short version of Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA) and its individual components. Height and weight were measured by trained staff. Multiple linear regressions were used to estimate the association between acculturation and BMI. After adjusting for age, gender, education, income, marital status, and ethnicity, SL-ASIA (β = 0.71, SE = 0.28), having education in the US (β = 0.56, SE = 0.28), younger age of arrival (0–5 years: β = 3.32, SE = 0.76, 6–10 years: β = 1.55, SE = 0.78), self identified as Americans (β = 1.51, SE = 0.77) and equal preference of Asian/American food in restaurants (β = 0.92, SE = 0.28) were significantly associated with increased BMI. The association between acculturation and BMI was stronger among men than women, strongest among Chinese and weakest among Vietnamese. Acculturation was moderately associated with increased BMI among Asian Americans and this association varied by measures of acculturation. The association of acculturation and BMI was moderated by sex and ethnicity groups.
BMI; Obesity; Acculturation; Asian Americans
In this study, we employed structural equation modeling to test the degree to which racism-related stress, acculturative stress, and bicultural self-efficacy were predictive of mental health in a predominantly community-based sample of 367 Asian American adults. We also tested whether bicultural self-efficacy moderated the relationship between acculturative stress and mental health. Finally, we examined whether generational status moderated the impact of racial and cultural predictors of mental health by testing our model across immigrant and U.S.-born samples. Results indicated that our hypothesized structural model represented a good fit to the total sample data. While racism-related stress, acculturative stress, and bicultural self-efficacy were significant predictors of mental health in the total sample analyses, our generational analyses revealed a differential predictive pattern across generational status. Finally, we found that the buffering effect of bicultural self-efficacy on the relationship between acculturative stress and mental health was significant for U.S.-born individuals only. Implications for research and service delivery are explored.
Asian Americans; generational analyses; racism-related stress; acculturative stress; bicultural self-efficacy
There is insufficient empirical evidence which shows if and how there is an interrelation between acculturation and health care utilisation. The present study seeks to establish this evidence within first generation Turkish and Moroccan migrants, two of the largest migrant groups in present-day Western Europe.
Data were derived from the Amsterdam Health Monitor 2004, and were complete for 358 Turkish and 288 Moroccan foreign-born migrants. Use of health services (general practitioner, outpatient specialist and health care for mental health problems) was measured by means of self-report. Acculturation was measured by a structured questionnaire grading (i) ethnic self-identification, (ii) social interaction with ethnic Dutch, (iii) communication in Dutch within one's private social network, (iv) emancipation, and (v) cultural orientation towards the public domain.
Acculturation was hardly associated with the use of general practitioner care. However, in case of higher adaptation to the host culture there was less uptake of outpatient specialist care among Turkish respondents (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.82-0.99) and Moroccan male respondents (OR = 0.81, 95% CI = 0.71-0.93). Conversely, there was a higher uptake of mental health care among Turkish men (OR = 0.81, 95% CI = 0.71-0.93) and women (OR = 0.81, 95% CI = 0.71-0.93). Uptake of mental health care among Moroccan respondents again appeared lower (OR = 0.74, 95% CI = 0.55-0.99). Language ability appeared to play a central role in the uptake of health care.
Some results were in accordance with the popular view that an increased participation in the host society is concomitant to an increased use of health services. However, there was heterogeneity across ethnic and gender groups, and across the domains of acculturation. Language ability appeared to play a central role. Further research needs to explore this heterogeneity into more detail. Also, other cultural and/or contextual aspects that influence the use of health services require further identification.
Given the emphasis on modesty and self-effacement in Asian societies, the present study explored differential item responses for 2 positive affect items (5 = Hopeful and 8 = Happy) on a short form of the Center for Epidemiologic Studies-Depression scale. The samples consisted of elderly non-Hispanic Whites (n = 450), Korean Americans (n = 519), and Koreans (n = 2,030).
Multiple Indicator Multiple Cause models were estimated to identify the impact of group membership on responses to the positive affect items while controlling for the latent trait of depressive symptoms.
The data revealed that Koreans and Korean Americans were less likely than non-Hispanic Whites to endorse the positive affect items. Compared with Korean Americans who were more acculturated to mainstream American culture, those who were less acculturated were less likely to endorse the positive affect items.
Our findings support the notion that the way in which people endorse depressive symptoms is substantially influenced by cultural orientation. These findings call into question the common use of simple mean comparisons and a universal cutoff point across diverse cultural groups.
CES-D; Differential item function; Korean
OBJECTIVE—The prevalence of type 2 diabetes among Hispanic and Asian Americans is increasing. These groups are largely comprised of immigrants who may be undergoing behavioral and lifestyle changes associated with development of diabetes. We studied the association between acculturation and diabetes in a population sample of 708 Mexican-origin Hispanics, 547 non–Mexican-origin Hispanics, and 737 Chinese participants in the Multi-Ethnic Study of Atherosclerosis (MESA).
RESEARCH DESIGN AND METHODS—Diabetes was defined as fasting glucose ≥126 mg/dl and/or use of antidiabetic medications. An acculturation score was calculated for all participants using nativity, years living in the U.S., and language spoken at home. The score ranged from 0 to 5 (0 = least acculturated and 5 = most acculturated). Relative risk regression was used to estimate the association between acculturation and diabetes.
RESULTS—For non–Mexican-origin Hispanics, the prevalence of diabetes was positively associated with acculturation score, after adjustment for sociodemographics. The prevalence of diabetes was significantly higher among the most acculturated versus the least acculturated non–Mexican-origin Hispanics (prevalence ratio 2.49 [95% CI 1.14−5.44]); the higher the acculturation score is, the higher the prevalence of diabetes (P for trend 0.059). This relationship between acculturation and diabetes was partly attenuated after adjustment for BMI or diet. Diabetes prevalence was not related to acculturation among Chinese or Mexican-origin Hispanics.
CONCLUSIONS—Among non–Mexican-origin Hispanics in MESA, greater acculturation is associated with higher diabetes prevalence. The relation is at least partly mediated by BMI and diet. Acculturation is a factor that should be considered when predictors of diabetes in racial/ethnic groups are examined.
Models that explain preventive behaviors, such as colorectal cancer (CRC) screening, do not account for social and cultural factors relevant to African Americans. This exploratory study examined the relationship between socio-cultural factors (e.g., traditional acculturative strategy, group-based medical mistrust, physician ethnicity, and group-level perceptions of susceptibility) and perceived benefits, perceived barriers, and CRC screening intentions among African Americans (N = 198; Age: M = 59.7, SD = 9.9; 65% female; 44% household income $50,000+).
Hierarchical multiple regression was used to test the following models: Traditional Acculturative Strategy × Medical Mistrust; b) Physician’s Ethnicity × Medical Mistrust; c) Group Susceptibility × Medical Mistrust; and d) Group Susceptibility × Traditional Acculturative Strategy.
Results revealed that perceiving high group susceptibility while being both more culturally traditional and less mistrustful was associated with more perception of screening benefits. Greater intention to be screened was associated with perceiving high group susceptibility while being more traditional and with low levels of mistrust in those with African American physicians.
These results suggest that it may be beneficial to include social and cultural factors in behavioral interventions to increase CRC screening among African Americans.
Colorectal cancer; screening; African American; culture
Hispanics bear a disproportionate burden of diabetes in the United States, yet relations of structural, socio-cultural and behavioral factors linked to diabetes are not fully understood across all of their communities. The current study examines disparities and factors associated with diabetes in adult Hispanics of Mexican-descent (N = 648) participating in a population survey of an underserved rural U.S.-Mexico border community. The overall rate of diabetes prevalence rate in the sample, based on self-report and a glucose testing, was 21%; much higher than rates reported for U.S. adults overall, for all Hispanic adults, or for Mexican American adults specifically. Acculturation markers and social determinants of health indicators were only significantly related to diabetes in models not accounting for age. Older age, greater BMI (>30), greater waist-to-hip ratio as well as lower fruit and vegetable consumption were significantly related to increased likelihood of diabetes when all structural, cultural, behavioral, and biological factors were considered. Models with sets of behavioral factors and biological factors each significantly improved explanation of diabetes relative to prior social ecological theory-guided models. The findings show a critical need for diabetes prevention efforts in this community and suggest that health promotion efforts should particularly focus on increasing fruit and vegetable consumption.
diabetes; hispanics; U.S.-Mexico border; obesity; underserved; socio-ecological model; health disparities; health behaviors
Culture may play an important role in contraceptive preference among young Hispanic women. We examined whether acculturation predicted the use of different contraceptives, grouped by level of efficacy in preventing pregnancy.
One-thousand seventeen sexually active Hispanic women between the ages of 16 and 24 (mean age = 20.69 ± 2.42) responded to a self-administered questionnaire. Data were analyzed using multinomial logistic regression.
Women low in acculturation (OR 1.79, CI 1.06 – 3.02) and bicultural (OR 2.66, CI 1.52 – 4.64) were more likely than women high in acculturation to have used no method of contraception than long-acting reversible contraception (LARC). Bicultural women were more likely to have used condoms that LARC (OR 2.51, CI 1.40 – 4.49) compared to women high in acculturation. Finally, women in low in acculturation (OR 1.98, CI 1.11 – 3.50) and bicultural (OR 1.88, CI 1.01 – 3.51) were more likely to have used cyclic hormonal contraception than LARC compared to women high in acculturation.
Educational efforts should focus on young Hispanic women who are bicultural and low in acculturation in order to increase their use of more effective contraceptive methods and reduce the number of unplanned pregnancies among this population.
Contraception; Birth Control; Acculturation; Hispanics; Latinas
Berry, Trimble, and Olmedo’s (1986) acculturation model was used to investigate the relationship among adolescents’ acculturation strategies, personal self-esteem, and collective self-esteem. Using data from 427 high school students, factor analysis results distinguished Collective Self-esteem Scale constructs (Luhtanen & Crocker, 1992) from both ethnic identity and outgroup orientation subscales of the Multigroup Ethnic Identity Measure (Phinney, 1992). Subsequent results showed that: 1) both acculturation dimensions were correlated with personal and collective self-esteems, 2) integrationists shared similar levels of personal and collective self-esteems with assimilationists and/or separationists, and 3) marginalizationists generally had the lowest levels of personal and collective self-esteems. Implications are drawn for understanding acculturation among adolescents and for the utility of group-level measures of self-esteem.
Acculturation; Collective Self-esteem; Personal Self-esteem