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1.  Experimenting with cigarettes and physical activity among Mexican origin youth: a cross sectional analysis of the interdependent associations among sensation seeking, acculturation, and gender 
BMC Public Health  2012;12:332.
Background
Sensation seeking tendencies tend to manifest during adolescence and are associated with both health-compromising behaviors and health-enhancing behaviors. The purpose of this study is to evaluate the relationship between sensation seeking and physical activity, a health-enhancing behavior, and between sensation seeking and experimenting with cigarettes, a health compromising-behavior, among a cohort of Mexican origin adolescents residing in the United States with different levels of acculturation.
Methods
In 2009, 1,154 Mexican origin youth (50.5% girls, mean age 14.3 years (SD = 1.04)) provided data on smoking behavior, physical activity, linguistic acculturation, and sensation seeking. We conducted Pearson’s χ2 tests to examine the associations between categorical demographic characteristics (i.e. gender, age, country of birth and parental educational attainment) and both cigarette experimentation and physical activity and Student’s t-tests to examine mean differences on the continuous variables (i.e. sensation seeking subscale) by the behaviors. We examined mean differences in the demographic characteristics, acculturation, and both behaviors for each of the sensation seeking subscales using analysis of variance (ANOVA). To examine relationships between the sensation seeking subscales, gender, and both behaviors, at different levels of acculturation we completed unconditional logistic regression analyses stratified by level of acculturation.
Results
Overall, 23.3% had experimented with cigarettes and 29.0% reported being physically active for at least 60 minutes/day on at least 5 days/week. Experimenting with cigarettes and being physically active were more prevalent among boys than girls. Among girls, higher levels of sensation seeking tendencies were associated with higher levels of acculturation and experimentation with cigarettes, but not with physical activity. Among boys, higher levels of sensation seeking tendencies were associated with higher levels of acculturation, experimenting with cigarettes and being physically active.
Conclusions
Our results suggest that interventions designed to prevent smoking among Mexican origin youth may need to address social aspects associated with acculturation, paying close attention to gendered manifestations of sensation seeking.
doi:10.1186/1471-2458-12-332
PMCID: PMC3441442  PMID: 22559717
Smoking behavior; Physical activity; Acculturation; Sensation seeking; Gender; Mexican origin youth
2.  The Effects of Parental Acculturation and Parenting Practices on the Substance Use of Mexican-Heritage Adolescents from Southwestern Mexican Neighborhoods 
A sample of 189 Mexican-heritage seventh grade adolescents reported their substance use, while one of the child’s parents reported parent’s acculturation and communication, involvement, and positive parenting with his or her child. Higher levels of parental acculturation predicted greater marijuana use, whereas parent communication predicted lower cigarette and marijuana use among girls. A significant parent acculturation by parent communication interaction for cigarette use was due to parent communication being highly negatively associated with marijuana use for high acculturated parents, with attenuated effects for low acculturated parents. A significant child gender by parent acculturation by parent positive parenting interaction was found. For girls, positive parenting had a stronger association with lower cigarette use for high acculturated parents. For boys, positive parenting had a stronger association with reduced cigarette use for low acculturated parents. Discussion focuses on how acculturation and gender impact family processes among Mexican-heritage adolescents.
doi:10.1080/15332640.2014.905215
PMCID: PMC4206522  PMID: 25176121
acculturation; Mexican American adolescents; parenting; substance use
3.  Acculturation, Social Self-Control, and Substance Use Among Hispanic Adolescents 
It is unclear how acculturation is related to self-control characteristics and whether part of the effect of acculturation on Hispanic adolescents’ substance use behavior is mediated through lower self-control. We tested social self-control, peer substance use, and baseline substance use as mediators of the effect of Hispanic (predominantly Mexican or Mexican American) adolescents’ level of U.S. acculturation on their substance use behavior 1 year later. In addition, we tested gender as a possible moderator of the pathways involved in the mediation model. Participants included 1,040 self-identified Hispanic/Latino adolescents (M = 14.7; SD = 0.90; 89% Mexican/Mexican American) recruited from nine public high schools. Acculturation was measured in terms of adolescents’ extent of English language use in general, at home, with friends, and their use of the English-language entertainment media. Analyses were conducted using structural equation modeling and controlled for potential confounders such as age and parental education. Results indicated a statistically significant three-path mediation in which poor social self-control and peer substance use mediated the effects of acculturation on prospective substance use. Paths in the mediation model were not found to differ by gender. Our findings suggest that acculturation may influence adolescents’ self-control characteristics related to interpersonal functioning, which may in turn influence their affiliation with substance-using friends and substance use behavior. Implications of the findings are discussed in terms of future research and prevention programming.
doi:10.1037/a0032836
PMCID: PMC4181571  PMID: 23772765
acculturation; social self-control; substance use
4.  Academic Success of Mexican Origin Adolescent Boys and Girls: The Role of Mothers’ and Fathers’ Parenting and Cultural Orientation 
Sex roles  2009;60(7-8):588-599.
To understand the role that Mexican origin parents play in their children’s academic success, this study used structural equation modeling to evaluate the associations of parents’ parenting practices (warmth, monitoring, harshness, and academic involvement) and cultural orientations (enculturation and acculturation) with their adolescents’ grades, classroom behavior, and association with peers who get into trouble at school. Data were obtained from teachers, mothers, fathers, and male and female adolescents in 560 Mexican origin families living in the southwest U.S. Results indicated that mothers’ and fathers’ parenting practices and cultural orientations were linked to adolescents’ academic outcomes. However, there were differences for boys and girls. Results are discussed in relation to parent and adolescent gender roles and implications for intervention.
doi:10.1007/s11199-008-9518-z
PMCID: PMC3128498  PMID: 21731172
Mexican American; parenting; adolescents; acculturation; enculturation; academic performance
5.  Ethnic Minority Children’s Active Commuting to School and Association with Physical Activity and Pedestrian Safety Behaviors* 
Background
Children’s active commuting to school, i.e. walking or cycling to school, was associated with greater moderate-to-vigorous physical activity, although studies among ethnic minorities are sparse.
Objectives
Among a low-income, ethnic minority sample of fourth grade students from eight public schools, we examined (1) correlates of active commuting to school and (2) the relationship between active commuting to school and moderate-to-vigorous physical activity.
Methods
We conducted a cross-sectional analysis of baseline measurements from a sample of participants (n=149) aged 9–12 years from a walk to school intervention study in Houston, Texas. The primary outcome was the weekly rate of active commuting to school. Daily moderate-to-vigorous physical activity, measured by accelerometers, was a secondary outcome. Child self-efficacy (alpha=0.75), parent self-efficacy (alpha=0.88), and parent outcome expectations (alpha=0.78) were independent variables. Participant characteristics (age, gender, race/ethnicity, distance from home to school, acculturation, and BMI percentile) were independent sociodemographic variables. We used mixed-model regression analyses to account for clustering by school and a stepwise procedure with backward elimination of non-significant interactions and covariates to identify significant moderators and predictors. School-level observations of student pedestrians were assessed and compared using chi-square tests of independence.
Results
Among our sample, which was 61.7% Latino, the overall rate of active commuting to school was 43%. In the mixed model for active commuting to school, parent self-efficacy (std. beta = 0.18, p=0.018) and age (std. beta = 0.18, p=0.018) were positively related. Latino students had lower rates of active commuting to school than non-Latinos ( 16.5%, p=0.040). Distance from home to school was inversely related to active commuting to school (std. beta = 0.29, p<0.001). In the mixed model for moderate-to-vigorous physical activity, active commuting to school was positively associated (std. beta = 0.31, p <0.001). Among the Latino subsample, child acculturation was negatively associated with active commuting to school (std. beta = −0.23, p=0.01). With regard to school-level pedestrian safety observations, 37% of students stopped at the curb and 2.6% looked left-right-left before crossing the street.
Conclusion
Although still below national goals, the rate of active commuting was relatively high, while the rate of some pedestrian safety behaviors was low among this low-income, ethnic minority population. Programs and policies to encourage safe active commuting to school are warranted and should consider the influence of parents, acculturation, and ethnicity.
PMCID: PMC3160673  PMID: 21874160
Latino; ethnicity; active commuting to school; physical activity; pedestrian safety; safe routes to school
6.  The influence of linguistic acculturation and parental monitoring on the substance use of Mexican-heritage adolescents in predominantly Mexican enclaves of the Southwest US 
This study presents the results of an assessment of 377 Mexican heritage 7th grade adolescents attending middle school in Arizona. The students answered questions concerning personal substance use, linguistic acculturation and parental monitoring. Linguistic acculturation in general did not predict substance use, while greater perceived parental monitoring significantly predicted a lesser likelihood to use substances for both boys and girls. There was a significant acculturation by parental monitoring interaction for ever use of alcohol for boys, with parent monitoring effects being more pronounced in reducing alcohol use among highly acculturated boys. Results are discussed in terms of how acculturation impacts family processes and the drug use behaviors of Mexican heritage adolescents living in predominantly Mexican enclaves.
doi:10.1080/15332640.2012.701566
PMCID: PMC3477602  PMID: 22931157
7.  The Influence of Linguistic Acculturation and Gender on the Initiation of Substance Use Among Mexican Heritage Preadolescents in the Borderlands 
The Journal of early adolescence  2011;31(2):271-299.
This article examined the impact of linguistic acculturation and gender on the substance use initiation of a sample of 1,473 Mexican heritage preadolescents attending 30 public schools in Phoenix, Arizona. It was hypothesized that linguistic acculturation operates differently as a risk or protective factor for young children than for older youth. The study used discrete-time event history methods to model the rate at which nonusing children initiate substance use. Alcohol, cigarettes, marijuana, and inhalants were studied separately while inhalant use was examined more closely. Results suggested that while linguistic acculturation is a risk factor for Mexican heritage preadolescents, this association depended on gender, the linguistic acculturation context (family, friends, or media), and the type of substance. For inhalants, higher linguistic acculturation with friends was inversely associated with drug initiation both for boys and girls. Implications for preventive science and future intervention research are discussed.
doi:10.1177/0272431610363157
PMCID: PMC3108799  PMID: 21660121
acculturation; bilingual/bicultural; Hispanic/Latino/Latina; substance use/alcohol and drug use
8.  Adolescent body satisfaction: the role of perceived parental encouragement for physical activity 
Background
Parents play an important role in the development of children's health behaviors, but less is known about the role of parental encouragement for physical activity (PA) on youth PA behavior and body image satisfaction. The purposes of this study were to: (1) longitudinally assess whether adolescent PA at age 15 mediates the effect of perceived parental encouragement for PA at age 15 for predicting adolescent body satisfaction at age 16, while controlling for body mass index (BMI), and (2) examine the extent to which adolescent sex moderates this association.
Methods
Participants were 379 boys and girls assessed at 15 and 16 years of age, who completed surveys as part of a larger longitudinal study in their health/physical education classes in a school district in Central Pennsylvania. Participants completed measures of their perception of parental encouragement for PA, PA behavior, body satisfaction, and height and weight to calculate BMI at age 15 and 16 (i.e., 10th and 11th grades). Pearson correlations were used to examine the association among the study variables and hierarchical regression analyses were used to predict body satisfaction at age 16.
Results
Perceived encouragement for PA from fathers, but not mothers, at age 15, was significantly associated with adolescent PA at age 15 and body satisfaction scores at age 16. Adolescents reporting higher PA behavior and perceived encouragement for PA from fathers at age 15 had higher body satisfaction scores at age 16. Moreover, adolescent PA at age 15 mediated the association between perceived fathers' encouragement for PA at age 15 and adolescent body satisfaction at age 16, when controlling for BMI. Examining the moderating effect of adolescent sex on this association revealed that adolescent PA no longer mediated the association between perceived encouragement for PA from fathers and adolescent body satisfaction, and sex moderated this association.
Discussion
These findings suggest that, regardless of adolescent BMI, fathers may play an instrumental role in adolescents' body image satisfaction by positively influencing PA behavior. However, the influence of perceived encouragement for PA from fathers on adolescent body satisfaction and PA behavior may differ for boys and girls.
doi:10.1186/1479-5868-6-90
PMCID: PMC2799384  PMID: 20003215
9.  Use and Appreciation of a Web-Based, Tailored Intervention (E-health4Uth) Combined With Counseling to Promote Adolescents’ Health in Preventive Youth Health Care: Survey and Log-File Analysis 
JMIR Research Protocols  2014;3(1):e3.
Background
Health promotion for adolescents is important in the prevention of mental health problems and health-risk behaviors. We implemented two interventions in a preventive youth health care setting. Adolescents in the E-health4Uth group received Web-based, tailored messages on their health behavior and well-being. Adolescents in the E-health4Uth and counseling group received the same tailored messages, but were subsequently referred to a school nurse for a consultation if they were at risk of mental health problems.
Objective
This study evaluated the use and appreciation of these Web-based, tailored messages and additional consultation with a school nurse. Differences in use and appreciation according to demographics (ie, gender, level of education, and ethnicity) of the adolescents were also assessed.
Methods
Two youth health care organizations participated in this study and conducted the interventions in 12 secondary schools. In total, 1702 adolescents participated; 533 in the E-health4Uth group, 554 in the E-health4Uth and counseling group, and 615 in the control group (ie, care as usual). Adolescents completed an evaluation questionnaire assessing the use and appreciation of the tailored messages immediately after receiving these messages and at a 4-month follow-up. After the consultation, adolescents and nurses completed an evaluation questionnaire on the use and appreciation of the consultation.
Results
The majority of the adolescents (845/1034, 81.72%) indicated they had read the tailored messages. Most items on the use and appreciation of the tailored messages and the program were scored positive (overall satisfaction on a scale from 1, most-negative, to 10, most-positive: mean 6.70, SD 1.60). In general, adolescents in vocational training, girls, and adolescents of non-Dutch ethnicity, indicated they used the tailored messages more often and appreciated the content of the messages better than adolescents receiving preuniversity education, boys, and adolescents of Dutch ethnicity, respectively (all P<.05). In the E-health4Uth and counseling group, 18.6% (103/553) of the adolescents were referred to a nurse. Adolescents in vocational training and girls were more often referred to a nurse than adolescents receiving preuniversity education (P=.007) and boys (P=.03), respectively. Adolescents and nurses positively evaluated the consultation (overall satisfaction of adolescents: mean 8.07, SD 1.21). Adolescents in vocational training attended the consultation more often (P=.047) and considered the consultation a more valuable addition to the tailored messages than adolescents receiving preuniversity education (P=.034).
Conclusions
The Web-based, tailored messages and additional consultation were used and appreciated positively by adolescents and nurses. The consultation seems a valuable addition to the tailored messages. However, the tailored messages might need further improvement since adolescents did not rate all evaluation items about these messages explicitly positive. As these interventions were already interweaved with the existing practice of the preventive youth health care, they are especially promising for future implementation.
Trial Registration
Netherlands Trial Register Number (NTR): NTR3596; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3596 (Archived by WebCite at http://www.webcitation.org/6LryL42zH).
doi:10.2196/resprot.2855
PMCID: PMC3906651  PMID: 24394676
adolescents; youth health care; Web-based tailoring; eHealth; Internet; counseling; health care evaluation; health promotion
10.  Adolescent Girls’ Weight-Related Family Environments, Minnesota 
Preventing Chronic Disease  2011;8(3):A68.
Significant sociodemographic disparities exist in the prevalence of obesity among adolescent girls, and in girls' participation in physical activity, sedentary activity, and healthful dietary intake. However, little is known of how factors in the family environment associated with weight and behavior vary by sociodemographic groups. We examined differences and similarities in the weight-related family environments of adolescent girls by race/ethnicity, parental educational attainment, and US nativity. Data are from the baseline assessment of 253 parent/daughter dyads. Parents completed survey items on the family environment; parents and girls reported their sociodemographic characteristics. Hierarchical regression models were used to test relationships between the family environment and sociodemographic characteristics. Parents of Asian girls reported qualities supportive of physical activity and healthy eating. Higher parental education was associated with more parental modeling of and support for physical activity and greater frequency of family meals. Parents of foreign-born girls reported having fewer televisions in the home, more frequent family meals, and fewer fast-food family meals. Understanding sociodemographic differences in the family environments of adolescent girls can inform the development of obesity prevention programs and reduce disparities in adolescents' weight status, physical activity, sedentary behavior, and healthful dietary intake.
PMCID: PMC3103573  PMID: 21477508
11.  Childhood and adolescent predictors of leisure time physical activity during the transition from adolescence to adulthood: a population based cohort study 
Background
Few studies have investigated factors that influence physical activity behavior during the transition from adolescence to adulthood. This study explores the associations of sociodemographic, behavioral, sociocultural, attitudinal and physical factors measured in childhood and adolescence with physical activity behavior during the transition from adolescence to adulthood.
Methods
Childhood and adolescent data (at ages 7-15 years) were collected as part of the 1985 Australian Health and Fitness Survey and subdivided into sociodemographics (socioeconomic status, parental education), behavioral (smoking, alcohol, sports diversity, outside school sports), sociocultural (active father, active mother, any older siblings, any younger siblings, language spoken at home), attitudinal (sports/recreational competency, self-rated health, enjoyment physical education/physical activity, not enjoying school sports) and physical (BMI, time taken to run 1.6 km, long jump) factors. Physical activity between the ages 15 and 29 years was reported retrospectively using the Historical Leisure Activity Questionnaire at follow-up in 2004-2006 by 2,048 participants in the Childhood Determinants of Adult Health Study (CDAH). Australia's physical activity recommendations for children and adults were used to categorize participants as persistently active, variably active or persistently inactive during the transition from adolescence to adulthood.
Results
For females, perceived sports competency in childhood and adolescence was significantly associated with being persistently active (RR = 1.88, 95% CI = 1.39, 2.55). Smoking (RR = 0.31 CI = 0.12, 0.82) and having younger siblings (RR = 0.69 CI = 0.52, 0.93) were inversely associated with being persistently active after taking physical and attitudinal factors into account. For males, playing sport outside school (RR = 1.47 CI = 1.05, 2.08), having active fathers (RR = 1.25 CI = 1.01, 1.54) and not enjoying school sport (RR = 4.07 CI = 2.31, 7.17) were associated with being persistently active into adulthood. Time taken to complete the 1.6 km run was inversely associated with being persistently active into adulthood (RR = 0.85 CI = 0.78, 0.93) after adjusting for recreational competency.
Conclusions
Perceived sports competency (females) and cardiorespiratory fitness, playing sport outside school and having active fathers (males) in childhood and adolescence were positively associated with being persistently active during the transition from adolescence to adulthood.
doi:10.1186/1479-5868-8-54
PMCID: PMC3129289  PMID: 21631921
12.  Association of Acculturation Levels and Prevalence of Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)  
Diabetes Care  2008;31(8):1621-1628.
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.
doi:10.2337/dc07-2182
PMCID: PMC2494621  PMID: 18458142
13.  Correlates of weight status among Norwegian 11-year-olds: The HEIA study 
BMC Public Health  2012;12:1053.
Background
The underlying mechanisms of overweight and obesity in adolescents are still not fully understood. The aim of this study was to investigate modifiable and non-modifiable correlates of weight status among 1103 Norwegian 11-year-old adolescents in the HEalth in Adolescents (HEIA) study, including demographic factors such as gender and parental education, and behavioral factors such as intake of sugar-sweetened beverages, snacks and breakfast consumption, watching TV and playing computer games, physical activity and sedentary time.
Methods
Weight and height were measured objectively, body mass index (BMI) was calculated and International Obesity Task Force cut-offs were used to define weight status. Physical activity and sedentary time were measured by accelerometers. Other behavioral correlates and pubertal status were self-reported by questionnaires. Parental education was reported by the parents on the consent form for their child. Associations were investigated using logistic regressions.
Results
There were gender differences in behavioral correlates of weight status but not for weight status itself. Adolescents with parents in the highest education category had a 46% reduced odds of being overweight compared to adolescents with parents in the lowest education category. Adolescents with parents with medium education had 42% lower odds of being overweight than adolescents with parents with the lowest education category. Level of parental education, breakfast consumption and moderate to vigorous physical activity were positively associated with being normal weight, and time watching TV was positively associated with being overweight for the total sample. Gender differences were detected; boys had a doubled risk of being overweight for every additional hour of watching TV per week, while for girls there was no association.
Conclusions
The present study showed a social gradient in weight status in 11-year-olds. Both breakfast consumption and moderate to vigorous physical activity were inversely associated with weight status. No associations were found between intake of sugar-sweetened beverages and snacks, playing computer games and weight status. Watching TV was positively associated with weight status for boys but not for girls. Interventions are needed to gain more insight into the correlates of change in weight status.
doi:10.1186/1471-2458-12-1053
PMCID: PMC3538064  PMID: 23216675
Overweight; Physical activity; Sedentary time; Parental education; Diet; Children; Adolescents
14.  Physical activity behavior and related characteristics of highly-active 8th grade girls 
Purpose
While girls are generally less physically active than boys, some girls regularly engage in high levels of physical activity (PA); however, very little is known about these girls and how they differ from those who are less physically active. This study examined the PA behavior and related characteristics of highly-active adolescent girls and compared them with those who are less active.
Methods
Data from 1,866 8th grade girls from 6 field centers across the U.S. participating in the Trial of Activity for Adolescent Girls (TAAG) were included in the present analysis. Mixed model ANOVAs examined differences in sociodemographic, anthropometric, psychosocial, and physical activity (accelerometry and self-report) variables between high- and low-active girls; effect sizes were calculated for the differences.
Results
High-active girls were taller, had lower BMIs and body fat, and were less sedentary. High-active girls scored higher on self-efficacy, enjoyment of PA, self-management strategies, outcome-expectancy value, and support from family and friends than low-active girls. Low-active girls participated in more leisure-time and educational sedentary activities than high-active girls. High-active girls participated in more PA classes/lessons outside of school, team sports, and individual sports. They were also more likely to participate in sports in an organized setting in the community or at school than low-active girls.
Conclusions
Health promotion efforts should focus on decreasing the amount of time girls spend in sedentary activities and replacing that time with organized PA opportunities; such efforts should seek to minimize perceived barriers and increase self-efficacy and support for PA.
doi:10.1016/j.jadohealth.2012.12.003
PMCID: PMC3654081  PMID: 23384978
physical activity; girls; psychosocial; sedentary behavior; sports participation
15.  Puerto Rican Early Adolescents’ Self-Esteem Patterns 
This study examines self-esteem as a multidimensional construct in 1 Latino subgroup, Puerto Rican girls and boys during early adolescence, using Harter’s (1985b) Self-Perception Profile for Children. The results show that in its English and Spanish versions—the latter developed by the present research team—the Self-Perception Profile for Children has adequate reliability for use with 13- to 14-year-old Puerto Rican youth living on the mainland. Results obtained in this study of Puerto Rican early adolescents, which contrasts with the results from the combined data of “Hispanics” in the American Association of University Women (1991) survey of 3,000 youth, strongly suggests that Latino subgroups need to be studied separately. The mean levels of self-esteem found among Puerto Rican girls and boys were generally similar to those found among Harter’s sample of predominantly Anglo middle school students from the suburbs of Denver except that Puerto Rican youth did not show gender differences in overall self-esteem. Gender differences in mean levels of self-esteem in different domains were similar to those of Anglo youth, regardless of the Puerto Rican youth’s individual level of psychological or behavioral acculturation. When differences by acculturation emerged, psychological acculturation appeared to play a more protective role for girls (Hispanic- or Latino-oriented girls reported being better behaved and having greater confidence in their scholastic abilities) and behavioral acculturation operated as a risk factor for boys (boys with preference for English reported low Behavioral Conduct and Scholastic Competence scores). On the other hand, greater acculturation (both psychological and behavioral) was associated with girls’ lower confidence in their physical attractiveness. Finally, the structure of self-esteem varied by gender, and psychological and behavioral acculturation.
doi:10.1207/SJRA1003_6
PMCID: PMC3066011  PMID: 21461183
16.  Substance Use and Sexual Behavior among Recent Hispanic Immigrant Adolescents: Effects of Parent-Adolescent Differential Acculturation and Communication* 
Drug and alcohol dependence  2012;125(Suppl 1):S26-S34.
Objectives
To ascertain the effects of parent-adolescent acculturation gaps, perceived discrimination, and perceived negative context of reception on adolescent cigarette smoking, alcohol use, sexual activity, and sexual risk taking. We used an expanded, multidimensional model of acculturation.
Method
A sample of 302 recently immigrated parent-adolescent dyads (152 from Miami and 150 from Los Angeles) completed measures of acculturation (Hispanic and American practices and identifications, and individualist and collectivist values) and parent-adolescent communication. Adolescents completed measures of recent cigarette smoking, alcohol use, sexual behavior, and sexual risk taking.
Results
Parent-adolescent gaps in American practices and ethnic identity, and perceptions of a negative context of reception, predicted compromised parent-adolescent communication. In Miami only, adolescent-reported communication negatively predicted odds of cigarette smoking, occasions of drunkenness, and number of sexual partners. Also in Miami only, parent-reported communication positively predicted these outcomes, as well as occasions of adolescent binge drinking, drunkenness, number of sexual partners, and odds of unprotected sex. The only significant findings in Los Angeles were protective effects of parent-reported communication on frequency of alcohol use and of binge drinking. Mediational effects emerged only in the Miami sample.
Conclusions
Effects of parent-adolescent acculturation gaps vary across Hispanic groups and receiving contexts. The especially strong parental control in many Mexican families may account for these differences. However, other important differences between Hispanic subgroups and communities of reception could also account for these differences. Prevention efforts might encourage Hispanic youth both to retain their culture of origin and to acquire American culture.
doi:10.1016/j.drugalcdep.2012.05.020
PMCID: PMC3435468  PMID: 22699094
Hispanic; acculturation; discrimination; alcohol use; recent immigrants
17.  Mothers of Adolescent Girls: Comparing HIV Positive and HIV Negative Women 
Ethnicity & disease  2010;20(1 0 1):S1-127-30.
Background
HIV+ mothers of adolescent girls can serve as agents of change, particularly when it comes to preventing patterns of behaviors that are inherently dangerous. In order to do so these women need to be able to communicate with their daughters and educate them about risk behaviors, especially those associated with HIV acquisition. The objective is to describe the sociodemographic and risk profile in a sample of mothers of adolescent girls who are HIV+ or HIV negative and analyze differences between them.
Methods
A convenience sample was recruited from three sites, the Universidad Central del Caribe School of Medicine, the UPR School of Medicine, and the Ponce School of Medicine. Six focus groups, two in each institution, were conducted following Krueger’s methodology with the objective of developing an educational intervention for mothers of adolescent girls. All participants completed two self-administered questionnaires prior to the focus group. A data analysis was performed - descriptive statistics for the sociodemographic measures included frequencies, percents, mean and SD. We used t test and the Fisher’s exact test to analyze differences between groups.
Results
A total of 44 participants were enrolled, with 50% being HIV positive mothers and 50% being HIV negative mothers. The mean age for both groups was similar (41 years). Statistically significant differences (P<.05) were observed among HIV diagnosis and for the following variables: education, working status, income, marital status, age at first intercourse, and illicit drug use.
Conclusions
It is possible that the sociodemographic characteristics of HIV+ women affect their parenting and communication skills. The same factors that may have led to these women being infected by HIV in the first place might in addition be compromising their roles as effective parents.
PMCID: PMC3658465  PMID: 20521400
HIV+ Mothers; Adolescents; Sociodemographic Characteristics; Puerto Rican
18.  Association of breakfast intake with obesity, dietary and physical activity behavior among urban school-aged adolescents in Delhi, India: results of a cross-sectional study 
BMC Public Health  2012;12:881.
Background
In developed countries, regular breakfast consumption is inversely associated with excess weight and directly associated with better dietary and improved physical activity behaviors. Our objective was to describe the frequency of breakfast consumption among school-going adolescents in Delhi and evaluate its association with overweight and obesity as well as other dietary, physical activity, and sedentary behaviors.
Methods
Design: Cross-sectional study. Setting: Eight schools (Private and Government) of Delhi in the year 2006. Participants: 1814 students from 8th and 10th grades; response rate was 87.2%; 55% were 8th graders, 60% were boys and 52% attended Private schools. Main outcome measures: Body mass index, self-reported breakfast consumption, diet and physical activity related behaviors, and psychosocial factors. Data analysis: Mixed effects regression models were employed, adjusting for age, gender, grade level and school type (SES).
Results
Significantly more Government school (lower SES) students consumed breakfast daily as compared to Private school (higher SES) students (73.8% vs. 66.3%; p<0.01). More 8th graders consumed breakfast daily vs.10th graders (72.3% vs. 67.0%; p<0.05). A dose–response relationship was observed such that overall prevalence of overweight and obesity among adolescents who consumed breakfast daily (14.6%) was significantly lower vs. those who only sometimes (15.2%) or never (22.9%) consumed breakfast (p<0.05 for trend). This relationship was statistically significant for boys (15.4 % vs. 16.5% vs. 26.0; p<0.05 for trend) but not for girls. Intake of dairy products, fruits and vegetables was 5.5 (95% CI 2.4-12.5), 1.7 (95% CI 1.1-2.5) and 2.2 (95% CI 1.3-3.5) times higher among those who consumed breakfast daily vs. those who never consumed breakfast. Breakfast consumption was associated with greater physical activity vs. those who never consumed breakfast. Positive values and beliefs about healthy eating; body image satisfaction; and positive peer and parental influence were positively associated with daily breakfast consumption, while depression was negatively associated.
Conclusion
Daily breakfast consumption is associated with less overweight and obesity and with healthier dietary- and physical activity-related behaviors among urban Indian students. Although prospective studies should confirm the present results, intervention programs to prevent or treat childhood obesity in India should consider emphasizing regular breakfast consumption.
doi:10.1186/1471-2458-12-881
PMCID: PMC3549919  PMID: 23075030
Breakfast; Obesity; Adolescent; Diet; Physical activity; Behavior
19.  Gender Identity, Ethnicity, Acculturation, and Drug Use: Exploring Differences among Adolescents in the Southwest 
Journal of community psychology  2003;31(2):167-188.
This article presents the findings of a survey completed by 1351 predominantly Mexican American middle school students residing in a large urban center in the U.S. Southwest. The study explores possible associations between drug use attitudes and behaviors and gender (biological sex), gender identity, ethnicity, and acculturation status. Based on the concepts of “machismo” and “marianismo” that have been used to describe Mexican populations, four dimensions of gender identity were measured: aggressive masculinity, assertive masculinity, affective femininity, and submissive femininity. In explaining a variety of indicators of drug use behaviors and anti-drug norms, gender alone had limited explanatory power, while gender identity—often regardless of gender—was a better predictor. Aggressive masculinity was generally associated with higher risk of drug use, while the other three gender identity measures had selected protective effects. However, the impact of gender identity was strongly mediated by acculturation. Less acculturated Mexican American students reported lower aggressive masculinity scores than non-Latinos. Less acculturated Mexican American girls reported both the lowest aggressive masculinity scores and the highest submissive femininity scores. More acculturated Mexican American students, along with the less acculturated Mexican American boys, did not appear to be following a polarized approach to gender identity (machismo and marianismo) as was expected. The findings suggest that some aspects of culturally prescribed gender roles can have a protective effect against drug use behaviors and attitudes, possibly for both girls and boys.
doi:10.1002/jcop.10041
PMCID: PMC3045088  PMID: 21359134
20.  Intervention effects on physical activity: the HEIA study - a cluster randomized controlled trial 
Background
Although school-based interventions to promote physical activity in adolescents have been suggested in several recent reviews, questions have been raised regarding the effects of the strategies and the methodology applied and for whom the interventions are effective. The aim of the present study was to investigate effects of a school-based intervention program: the HEalth in Adolescents (HEIA) study, on change in physical activity, and furthermore, to explore whether potential effects varied by gender, weight status, initial physical activity level and parental education level.
Methods
This was a cluster randomized controlled 20 month intervention study which included 700 11-year-olds. Main outcome-variable was mean count per minute (cpm) derived from ActiGraph accelerometers (Model 7164/GT1M). Weight and height were measured objectively. Adolescents reported their pubertal status in a questionnaire and parents reported their education level on the consent form. Linear mixed models were used to test intervention effects and to account for the clustering effect of sampling by school.
Results
The present study showed an intervention effect on overall physical activity at the level of p = 0.05 with a net effect of 50 cpm increase from baseline to post intervention in favour of the intervention group (95% CI −0.4, 100). Subgroup analyses showed that the effect appeared to be more profound among girls (Est 65 cpm, CI 5, 124, p = 0.03) and among participants in the low-activity group (Est 92 cpm, CI 41, 142, p < 0.001), as compared to boys and participants in the high-activity group, respectively. Furthermore, the intervention affected physical activity among the normal weight group more positively than among the overweight, and participants with parents having 13–16 years of education more positively than participants with parents having either a lower or higher number of years of education. The intervention seemed to succeed in reducing time spent sedentary among girls but not among boys.
Conclusions
A comprehensive but feasible, multi-component school-based intervention can affect physical activity patterns in adolescents by increasing overall physical activity. This intervention effect seemed to be more profound in girls than boys, low-active adolescents compared to high-active adolescents, participants with normal weight compared to the overweight, and for participants with parents of middle education level as opposed to those with high and low education levels, respectively. An implementation of the HEIA intervention components in the school system may have a beneficial effect on public health by increasing overall physical activity among adolescents and possibly among girls and low-active adolescents in particular.
doi:10.1186/1479-5868-10-17
PMCID: PMC3598379  PMID: 23379535
Obesity prevention; Overweight; Accelerometers; Intervention; Children; Adolescents
21.  Gender Related Differences in Response to “In Favor of Myself” Wellness Program to Enhance Positive Self & Body Image among Adolescents 
PLoS ONE  2014;9(3):e91778.
Background
Physical, neurological and psychological changes are often experienced differently by male and female adolescents. Positive self-esteem, emotional well-being, school achievements, and family connectedness are considered as protective factors against health-compromising behaviors. This study examines the gender differences in respect to the effect of a school-based interactive wellness program – “In Favor of Myself” – on self-image, body image, eating attitudes and behaviors of young adolescents.
Methods
Two hundred and ten adolescents (mean age 13.5) participated in the intervention group, 55% were girls and 45% boys. Program consisted of eight 90-minutes structured sessions integrated into a regular school coping skills curriculum. The program focused on self-esteem, self-image, body image, media literacy and cognitive dissonance. The overall impact of the program and the study protocol were previously published.
Results
Overall, there are gender related differences in respect to body image and self-image in young adolescents in response to “In Favor of Myself”. Compared to boys, girls reported at baseline higher self-esteem, being more contingent by appearance, and their self-image was more influenced by popularity, appearance, interpersonal communication and admired people. Furthermore girls presented greater gap between current body figure and perceived ideal figure. Not only were girls more dissatisfied with their body, but they were more active in attempts to become and/or remain “thin”. At program termination, gender × time effect was detected in reduction of self-worth contingent by others, change in importance given to achievements at schools, parents' perceptions, as well as the impact of comparisons to friends and family members on self-image.
Conclusions
Girls exhibited more gains than boys from ‘In Favor of Myself’ which raise the questions about how effective would be the program when delivered in mixed gender groups vs. mono-gender groups.
doi:10.1371/journal.pone.0091778
PMCID: PMC3950257  PMID: 24618996
22.  The influence of subjective social status on the relationship between positive outcome expectations and experimentation with cigarettes 
Purpose
In Texas, Mexican American (MA) adolescents, and in particular boys, are at increased risk of experimenting with cigarettes compared to their black or white counterparts. Positive outcome expectations (POE), the functional social significance ascribed to cigarettes, and subjective social status (SSS), the adolescents’ subjective views of where they lie in the school-based social hierarchy, are independent predictors of smoking. The goal of this study was to test the hypothesis that SSS moderates the relationship between POE and experimentation with cigarettes.
Methods
Moderating effects of SSS were examined using a between-subjects 2 by 2 ANOVA and unconditional logistic regression analyses. Using a prospective study design, we followed 1,142 MA adolescents aged 11 to 13. Participants completed a baseline survey at home, which assessed POE, SSS, and smoking and were followed via telephone at 6 monthly intervals over a 12 month period to assess changes in smoking behavior.
Results
At follow-up, there were 99 new experimenters. Consistent with our hypothesis, adolescents who reported moderate-low SSS and who held POE at baseline were more likely to have experimented with cigarettes at either follow-up than their peers with moderate-low SSS who held less POE (OR=1.92, CI: 1.02–3.58). There was no association between outcome expectations and experimenting among adolescents with high SSS (OR=1.79, CI: 0.73–4.36). Low SSS boys were more likely to experiment than girls and high SSS boys.
Conclusions
The results of this study indicate that adolescents with moderate-low SSS hold different outcome expectations about smoking than their higher SSS peers. The results underscore the possibility that moderate-low SSS adolescents view behaviors such as smoking as a way to achieve higher SSS and thereby increase their peer social standing. Our results suggest that, in addition to tailoring intervention efforts by gender, placing adolescents of similar social standing to one another within the school into intervention groups that are led by a peer-nominated peer may increase the overall effectiveness of these peer-led prevention efforts.
doi:10.1016/j.jadohealth.2008.08.003
PMCID: PMC2705959  PMID: 19306792
23.  But I Like PE: Factors Associated With Enjoyment of Physical Education Class in Middle School Girls 
The current study examined associations between physical education (PE) class enjoyment and sociodemographic, personal, and perceived school environment factors among early adolescent girls. Participants included 1,511 sixth-grade girls who completed baseline assessments for the Trial of Activity in Adolescent Girls, with 50% indicating they enjoyed PE class a lot. Variables positively associated with PE class enjoyment included physical activity level, perceived benefits of physical activity, self-efficacy for leisure time physical activity, and perceived school climate for girls' physical activity as influenced by teachers, while body mass index was inversely associated with PE class enjoyment. After adjusting for all variables in the model, PE class enjoyment was significantly greater in Blacks than in Whites. In model testing, with mutual adjustment for all variables, self-efficacy was the strongest correlate of PE class enjoyment, followed by perceived benefits, race/ethnicity, and teacher's support for girls' physical activity, as compared to boys, at school. The overall model explained 11% of the variance in PE class enjoyment. Findings suggest that efforts to enhance girls' self-efficacy and perceived benefits and to provide a supportive PE class environment that promotes gender equality can potentially increase PE class enjoyment among young girls.
PMCID: PMC2430627  PMID: 18431947
adolescents; physical activity; school climate; self-efficacy
24.  Psychometric properties of a culture-adapted Spanish version of AIDA (Assessment of Identity Development in Adolescence) in Mexico 
Background
The construct “identity” was discussed to be integrated as an important criterion for diagnosing personality disorders in DSM-5. According to Kernberg, identity diffusion is one of the relevant underlying structures in terms of personality organization for developing psychopathology, especially borderline personality disorder. Therefore, it would be important to differentiate healthy from pathological development already in adolescence. With the questionnaire termed AIDA (Assessment of Identity Development in Adolescence), a reliable and valid self-rating inventory was introduced by Goth, Foelsch, Schlueter-Mueller, & Schmeck (2012) to assess pathology-related identity development in healthy and disturbed adolescents. To test the usefulness of the questionnaire in Mexico, we contributed to the development of a culture-specific Spanish translation of AIDA and tested the reliability and aspects of validity of the questionnaire in a juvenile Mexican sample.
Methods
An adapted Spanish translation of AIDA was developed by an expert panel from Chile, Mexico, and Spain in cooperation with the original authors, focusing on content equivalence and comprehensibility by considering specific idioms, life circumstances, and culture-specific aspects. The psychometric properties of the Spanish version were first tested in Mexico. Participants were 265 students from a state school (N = 110) and private school (N = 155), aged between 12 and 19 years (mean 14.15 years). Of these, 44.9% were boys and 55.1% were girls. Item characteristics were analyzed by several parameters, scale reliability by Cronbach’s Alpha, and systematic effects of gender, age, and socioeconomics by an analysis of variance (ANOVA). We evaluated aspects of criterion validity in a juvenile justice system sample (N = 41) of adolescent boys in conflict with the law who displayed various types of behavioral problems by comparing the AIDA scores of a subgroup with signs for borderline pathology (N = 14) with the scores obtained in the student sample using T-tests.
Results
The psychometric properties of the Spanish version of AIDA proved satisfactory in the Mexican sample for items as well as scales. The reliability coefficients were α = .94 for the total scale “Identity Diffusion”, α = .85 and .92 for the two primary scales “Discontinuity” and “Incoherence”, and between α = .70 and .83 for the subscales. However, some items of the item pool in the Spanish version of AIDA did not meet all criteria for test equivalence and should thus be reformulated, taking the Mexican culture into account. Significant effects for gender and age were found. In line with our theory, the AIDA scores in the domains “Discontinuity” (high effect size) and “Incoherence” (medium effect size) were markedly higher in the delinquent boys than in the student group.
Conclusion
The Spanish version of AIDA can be used in Mexico with satisfying psychometric properties, with only minor adaptions required. Our study contributes to the intercultural applicability of the AIDA instrument using the construct “identity integration vs. diffusion” as it was defined in the AIDA model for diagnostic purposes. Cultural differences, even those present in the various Spanish-speaking countries, should be modeled carefully.
doi:10.1186/1753-2000-7-25
PMCID: PMC3765088  PMID: 23899385
Identity; Questionnaire; Psychometrics; Adolescence; Cultural test adaption; Cross-cultural
25.  Correlates of susceptibility to smoking among Mexican origin youth residing in Houston, Texas: A cross-sectional analysis 
BMC Public Health  2008;8:337.
Background
Survey data suggest that in Texas Latino youth exhibit higher rates of susceptibility to smoking than youth from other ethnic groups. In this analysis we examined the relationship between susceptibility to smoking and well-known risk factors associated with smoking initiation among a cohort of 11 to 13 year old Mexican origin youth residing in Houston, Texas.
Methods
We analyzed cross-sectional survey data from 1,187 participants who reported they had never smoked, even a puff of a cigarette. The survey assessed peer and family social influence, school and neighborhood characteristics, level of family acculturation and socioeconomic status, and attitudes toward smoking. Bivariate associations, Student's t-tests, and logistic regression analysis were used to examine predictors of susceptibility.
Results
Overall, 22.1% of the never-smokers were susceptible to smoking. Boys were more likely to be susceptible than girls (25.6% vs. 18.9%), and susceptible children were slightly older than non-susceptible children (12.1 vs. 11.8 years). In addition, multivariate analyses revealed that positive expectations about smoking exerted the strongest influence on susceptibility status (odds ratio = 4.85). Multivariate analyses further revealed that compared to non-susceptible participants, susceptibles were more likely to report peer influences supportive of smoking, lower subjective social status and more detentions at school, more temptations to try smoking and to have a mother and a brother who smokes.
Conclusion
Our findings suggest that interventions that target positive expectations about smoking may be useful in this population. Furthermore, because youth encounter smoking-initiation risk factors in different social environments, our results underscore the continued need for both family- and school-based primary prevention programs to adequately combat their influence. The results also can be used to inform the development of culturally sensitive programs for Mexican origin youth.
doi:10.1186/1471-2458-8-337
PMCID: PMC2569937  PMID: 18822130

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