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2.  Sending-Country Violence & Receiving-Country Discrimination: Effects on the Health of Colombian Refugees in Ecuador 
This study explored factors affecting the health and well being of recent refugees from Colombia in Ecuador. Data collection focused on how sending-country violence and structural violence in a new environment affect immigrant health vulnerability and risk behaviors.
A qualitative approach included ethnographic observation, media content analysis, focus groups, and individual interviews with refugees (N=137). The focus groups (5) provided perspectives on the research domains by sex workers; drug users; male and female refugees; and service providers.
Social and economic marginalization are impacting the health and well being of this growing refugee population. Data illustrate how stigma and discrimination affect food and housing security, employment and health services, and shape vulnerabilities and health risks in a new receiving environment.
Widespread discrimination in Ecuador reflects fears, misunderstanding, and stereotypes about Colombian refugees. For this displaced population, the sequelae of violence, combined with survival needs and lack of support and protections, shape new risks to health and well-being.
PMCID: PMC4226797  PMID: 23377565
Violence; Discrimination; Refugees; Health; South America
3.  Lifestyle Physical Activity Behavior among South Asian Indian Immigrants 
Little is known of the physical activity behavior of South Asian Indian immigrants (SAIs), though they have more than twice the risk for cardiovascular disease (CVD) and diabetes than Whites.
A cross-sectional descriptive face-to-face survey design, comparing between men and women in leisure time (LTPA), household (HPA), and occupational physical activity (OPA). Participants also wore a Lifecorder EX (NL2200) accelerometer for seven days.
Just over half (51.8%) of the participants met the recommended PA guidelines (≥150 minutes moderate-intensity or ≥75 minutes vigorous-intensity) through LTPA. The average number of daily steps was 6904.3, which is in the “low active” classification.
Increasing lifestyle PA among SAIs is important; PA interventions appealing to gender and culture and with an aerobic component are needed.
PMCID: PMC4278962  PMID: 23686529
South Asian Indian immigrants; lifestyle physical activity; self-report measures; accelerometer
4.  Factors Associated with Breast Cancer Screening in Asian Indian Women in Metro-Detroit 
Few studies have examined social factors related to breast cancer screening in Asian Indian women in the Midwestern US. This cross-sectional, community-based survey utilized constructs of the Health Belief Model to examine factors associated with breast cancer screening among Asian Indian women in metropolitan Detroit, Michigan. Of the 160 participants, 63.8% reported receiving both a clinical breast exam and mammogram within the past 2 years. Women were more likely to screen for breast cancer if they had a college education, lived in the US for more years, perceived that breast cancer screening is useful in detecting breast cancer early, agreed that mammography was important, and received a recommendation by a healthcare provider to get a mammogram. These findings highlight the need for further research on regional differences in breast cancer screening knowledge, behaviors and predictors among Asian Pacific Islanders subgroups such as Asian Indian women who recently immigrated to the US.
PMCID: PMC4276127  PMID: 19629691
Asian Indian; Asian Pacific Islander; Breast cancer; Cancer screening; Health belief model
5.  A bi-national comparative study of health behaviors of Koreans in South Korea and Korean Americans in California 
Few studies have compared health behaviors of Koreans in their home country and Korean Americans.
Using 2009 data from the Community Health Survey (South Korea) and the California Health Interview Survey (USA), we compared native Koreans and Korean Americans, grouped by level of acculturation, on prevalence of specific health behaviors and self-rated health, and conducted multiple logistic regression comparing the odds of these behaviors among the groups adjusted for demographic variables.
While Korean Americans exhibit healthier behaviors than Koreans in some areas (e.g., reduced smoking and binge drinking in men, increased utilization of flu vaccinations), we also identified problem behaviors (e.g., increased body weight in Korean American men, uptake of alcohol drinking and smoking among Korean American women).
Findings support the critical need for health promotion programs addressing these health behaviors to prevent future health problems among Korean Americans.
PMCID: PMC3530654  PMID: 22918692
California Health Interview Survey; South Korea Community Health Survey; body mass index; smoking; alcohol intake; self-reported health; acculturation
Although family history of prostate cancer (PC) is an established risk factor for the disease, few studies have investigated this relationship among men with an African heritage.
The Prostate Cancer in a Black Population (PCBP) study is a large, nationwide case-control study conducted in Barbados, West Indies from 2002–2011.
In the PCBP study, a family history of PC in fathers or brothers was associated with a 3-fold increased risk of disease (OR=3.04, 95% CI (2.18, 4.22)) and a strong positive relationship was noted for the number of affected first degree relatives. Tumor grade did not generally influence the relationship between family history and PC.
The magnitude of risks associated with having a father affected with the disease was slightly higher in the PCBP study compared to other populations. It remains unclear whether this finding is the result of an increased genetic susceptibility in African-Barbadian men.
PMCID: PMC3551989  PMID: 22936456
Family history; prostate cancer; African ancestry; familial aggregation
7.  Osteoporosis and Milk Intake among Korean Women in California: Relationship with Acculturation to U.S. Lifestyle 
The Korean population in the U.S. increased by a third between 2000 and 2010. Korean women in the U.S. report low calcium intake and relatively high rate of fractures. However, little is known about the prevalence of osteoporosis among Korean American women. This paper examined the relationship between prevalence of osteoporosis and milk consumption, and their relationship with acculturation among a representative sample of immigrant California women of Korean descent.
Bilingual telephone surveys were conducted from a probability sample (N = 590) in 2007.
Lower acculturation significantly related to lower milk consumption for women during the age periods of 12-18 and 19-34 years. Acculturation was related to higher prevalence of osteoporosis among post-menopausal, but not pre-menopausal Korean women in California.
Future research should include larger cohorts, objective measures of osteoporosis, other sources of calcium specific to Korean cuisine, and assessment of bone-loading physical activity.
PMCID: PMC3654009  PMID: 23338905
osteoporosis; milk; acculturation; Asian; Korean; women’s health
9.  Incidence of Type 2 Diabetes by Place of Birth in the Multi-Ethnic Study of Atherosclerosis (MESA) 
Incidence of diabetes among US foreign-born individuals is not well studied. Data were from the Multi Ethnic Study of Atherosclerosis. Cox proportional hazards regression was used to examine diabetes risk by race/ethnicity, place of birth, and duration of residence among foreign-born. Foreign-born Latinos had a higher risk of incident diabetes compared to US-born Latinos (hazard ratio (HR) 1.79 [95 % confidence interval (CI) 1.00–3.21]). Latinos born in Mexico (HR, 2.26 [95 % CI, 1.18–4.33]) had higher risk of incident diabetes compared to US-born Latinos. Foreign-born living in the US ≥20 years had a higher adjusted risk of incident diabetes compared to those in the US for <20 years (HR, 1.60 [95 % CI, 1.05–2.55]). Incident diabetes may be higher among foreign-born compared to native born; incident diabetes may also be higher among those immigrants who have lived in the US for longer periods of time. Future studies should characterize individuals by race/ethnicity and place of birth to account for differences in biology and time spent in the US.
PMCID: PMC4039384  PMID: 22833256
Immigrant; Foreign-born; Diabetes incidence; Latino; Chinese
10.  Geopolitical and Cultural Factors Affecting ARV Adherence on the US-Mexico Border 
The data discussed represent the findings from a study by the NIH-funded Hispanic Health Disparities Research Center (UTEP), exploring the influence of institutional and psychosocial factors on adherence to antiretroviral medications (ARVs) by Mexican-origin persons living with AIDS on the US-Mexico Border.
A qualitative approach was utilized consisting of clinic observations, baseline and follow-up interviews with patients (N=113), key informant interviews (N=9) and focus groups (5) with patients and health providers.
Findings include the social-normative, institutional and geo-political factors affecting treatment and service delivery as well as individual variation and culturally patterned behaviors.
ARV adherence and retention were found to depend on complex interactions and negotiation of co-occurring factors including the experience of medications and side-effects, patient/provider relationships, cultural norms and the changing dynamics of international borders. We note effects of drug-related violence which created border-crossing obstacles influencing mobility, access to services and adherence.
PMCID: PMC3488152  PMID: 22797951
ARV adherence; HIV/AIDS; Hispanic; US-Mexico border
11.  Influence of living arrangements on the management and control of hypertension: A mixed-methods study of Korean American elderly 
Elders living alone may experience worse health outcomes than do those living with spouse and/or children. Using baseline data from a randomized trial to promote high blood pressure (HBP) control in Korean elders (N=440), we examined the relationship between living arrangements and HBP control. We also interviewed a sub-sample to better understand the patterns of social interactions associated with different types of living arrangements. One in five reported living alone; this group tended to be older and female, and resided in senior group housing. Those living alone were twice as likely as those living with a spouse to have controlled BP (OR=2.08; 95% CI 1.09–3.97), even after controlling for study covariates. Those in senior group housing had frequent social interactions that involved conversations around health, encouragement concerning medication taking, and health information sharing. In conclusion, Korean elders living independently are neither socially-isolated nor at increased risk for poor BP control.
PMCID: PMC3494797  PMID: 22790881
living arrangements; elderly; hypertension
12.  Cancer Screening at a Federally Qualified Health Center: A qualitative study on organizational challenges in the era of health care reform 
Federally Qualified Health Centers (FQHCs) serve uninsured and minority populations, who have low cancer screening rates. The patient-centered medical home (PCMH) model aims to provide comprehensive preventive services, including cancer screening, to these populations. Little is known about organizational factors influencing the delivery of cancer screening in this context.
We conducted 18 semi-structured interviews with clinic personnel at four FQHC clinics in Washington State. All interviews were recorded and transcribed verbatim and analyzed by two bilingual coders to identify salient themes.
We found that screening on-site, scheduling separate visits for preventive care, and having non-provider staff recommend and schedule screening services facilitated the delivery of cancer screening. We found work overload to be a barrier to screening.
To successfully implement screening strategies within the PCMH model, FQHCs must enhance facilitators and address organizational gaps in their cancer screening processes.
PMCID: PMC3530661  PMID: 22878911
cancer prevention; cancer screening; Latinos; uninsured; primary care medical home; organizational change
14.  Festival Foods in the Immigrant Diet 
Dietary acculturation for immigrant groups has largely been attributed to the “Westernization” of indigenous diets, as characterized by an increased consumption of unhealthy American foods (i.e. fast foods, hamburgers). However, acculturation and adoption of western dietary habits may not fully explain new dietary patterns among racial/ethnic minority immigrants. The immigrant diet may change in such a way that it elaborates on specific ethnic traditions in addition to the incorporation of Western food habits. In this paper, we explore the role that festival foods, those foods that were once eaten a few times a year and on special occasions, play in the regular diet of immigrants to the U.S. This paper will focus on the overconsumption of ethnic festival foods, which are often high in carbohydrates, animal protein, sugar and fat, as opposed to Western “junk” food, as an explanation for the increased risk of cardiometabolic disorders among new immigrant groups.
PMCID: PMC3552147  PMID: 22968231
obesity; diet; dietary acculturation; behavior; health disparities
15.  Self-Reported Prior Lung Diseases as Risk Factors for Non-small Cell Lung Cancer in Mexican Americans 
This study was conducted to assess the association between prior history of respiratory disease and lung cancer among Mexican Americans using data from a multi-racial/ethnic lung cancer case–control study. Cases (n = 204) were patients with previously untreated lung cancer. Healthy control participants (n = 325) were recruited from a large physician group practice. Demographics, cigarette use, and history of respiratory disease were collected. Multivariable logistic regression models were used to estimate relative risk. Prior history of COPD (OR = 2.0; 95 % CI 1.2–3.3) and pneumonia (OR = 2.2; 95 % CI 1.3–3.6) were associated with an increased risk of lung cancer. These findings illustrate that prior COPD and pneumonia are associated with an increased risk of lung cancer among Mexican Americans. To our knowledge, this is one of largest case–control analyses assessing the role of respiratory disease and lung cancer risk specifically among Mexican-Americans.
PMCID: PMC3919532  PMID: 22847640
Lung diseases; Mexican Americans; Case–control studies; Epidemiology; Lung cancer
16.  Do Medical Homes Reduce Disparities in Receipt of Preventive Services Between Children Living in Immigrant and Non-immigrant Families? 
The patient-centered medical home model has the potential to reduce healthcare disparities among immigrant children. The purpose of this study is to examine the relationship between medical home (MH) participation and receipt of preventive services among immigrant children age 0–17. The study employed extant data from the National Survey of Children’s Health, 2007 (NSCH). Logistic regression analyses were employed to assess the relationship between receipt of preventive services and MH status among immigrant and non-immigrant children. Due to primarily the lack of family-centered care, only 40% of immigrant children met the medical home criteria versus approximately 62% of non-immigrant children. Immigrant children have decreased odds of receiving preventive care despite MH status. Improving the family-centered care aspect of the MH is necessary to increasing medical home access to immigrant children and the receipt of preventive services for immigrant children who meet the MH criteria.
PMCID: PMC4174363  PMID: 22052082
Medical home; Immigrant children; Preventive services; Disparities
17.  The Role of Social Support and Acculturative Stress in Health-Related Quality of Life Among Day Laborers in Northern San Diego 
There is evidence to suggest that Latino day laborers experience higher levels of acculturative stress than Latinos in employment sectors in the US. Given the stress-buffering role that social support plays in minimizing the negative physical and mental health outcomes of stress, this study examined this relationship in a sample of 70 Latino Day laborers in the northern San Diego area (100% male, mean age = 27.7, SD = 9.1). Results from multivariate regression analyses showed that there was a significant interaction effect between social support and acculturative stress (P = 0.025) on physical health, indicating that higher levels of social support buffered the negative effects of acculturative stress on physical health. Acculturative stress and social support were not associated with mental health status. Overall, these findings suggest that fostering social support may be an essential strategy for promoting health among Latino male day laborers.
PMCID: PMC4169889  PMID: 22286606
Latino; Day laborers; Social support; Migrants; Acculturative stress; Undocumented
18.  Clinical Profile, Quality of Care, and Recurrence in Arab-American and Caucasians Prostate Cancer Patients in Michigan 
Prostate cancer is the most common cancer among men in the United States with striking differences in incidence and mortality among ethnic groups. Michigan has one of the largest concentrations of Arab Americans (AAs) in the U.S. and little is known about this ethnic minority with respect to prostate cancer. This study investigated differences in clinical profile, quality of care, and recurrence among prostate cancer survivors comparing AAs and Caucasian Americans (CAs). Participants in this study included 2499 prostate cancer survivors from the Michigan Cancer Registry from 1985 to 2004. Participants completed surveys regarding health-seeking behavior, post-treatment symptoms, quality of care and recurrence. Ethnicity was self-reported and AAs and CAs were compared with respect to clinical profile, quality of care, and recurrence. There were 52 AAs and 1886 CAs patients with AAs being younger (x̄ age 68.3 ± SD 21.4 years, x̄ age 72.3 ± SD 14.1 years, for AAs and CAs, respectively) (P = 0.05). AAs had lower socioeconomic standard than CAs (34 vs. 10.6 %, <$20,000 yearly income/year; for AAs vs. CAs, respectively) (P < 0.0001). AAs reported poorer health than AAs (7.7 vs. 3.0 % for AAs vs. CAs, respectively) (P < 0.0001). AAs were more likely to visit specialists for prostate follow-up (44.5 vs. 19.7 % visited a specialist, for AAs vs. CAs respectively) (P < 0.0001) and received supplementary healthcare workers (13 % of AAs vs. 3.1 % CAs) (P = 0.032). In addition, AAs reported higher occurrence of urinary incontinence compared to CAs (67.4 vs. 60.4 %, for AAs vs. CAs, respectively) (P = 0.001). Ethnic background was not a predictor of recurrence [(Odds ratio (OR) = 1.1 (95 % confidence intervals CI = 0.40, 2.9)] (P = 0.873) even after adjusting for age, PSA levels within the last 2 years, metastasis and hormonal therapy. While AAs prostate cancer patients were different from CAs in age, income, seeking medical care, and health reporting, ethnic background was not a predictor of recurrence. Future studies of the impact of socioeconomic, demographic and cultural factors, and health care seeking behavior on long-term survival of prostate cancer in AAs and other ethnic minorities are warranted.
PMCID: PMC4164151  PMID: 22763459
Prostate cancer; Arab-Americans; Ethnic minorities; Quality of care; Treatment; Survivorship
19.  Understanding the Barriers that Reduce the Effectiveness of HIV/AIDS Prevention Strategies for Puerto Rican Women Living in Low-income Households in Ponce, PR: A Qualitative Study 
The HIV/AIDS epidemic has been strongly felt in Hispanic/Latino communities. Estimates of AIDS prevalence among Latinos in the US reveal that just nine States and the Commonwealth of Puerto Rico account for 89% of the Latinos living with AIDS in 2004. Previous research reveals social and cultural factors play an important role in HIV prevention.
Four focus groups were conducted, with 39 women, ages 21–67, participating in the discussions. The objectives of this research were to assess knowledge regarding HIV transmission among women living in low-income households, to ascertain barriers to safe sex in this population, and to elicit opinions about effective prevention strategies.
Our results suggest that participants recognized HIV/AIDS modes of transmission and risk behaviors, as well as their barriers to practicing safe sex. They identified promiscuity, unprotected sex, infidelity, drug and alcohol use, and sharing syringes as behaviors which would place them at risk of HIV/AIDS transmission. They specifically identified lack of negotiating skills, fear of sexual violence, partner refusal to use condoms, and lack of control over their partner’s sexual behavior as barriers to practicing safe sex. Finally results also indicate that current HIV/AIDS prevention strategies in Puerto Rico are inadequate for these women.
To address these issues the authors suggest cultural and social factors to be considered for the development of more effective HIV/AIDS prevention programs.
PMCID: PMC4160146  PMID: 18712603
Culture; Women; HIV/AIDS prevention; Latino; Public housing
20.  Mortality Rates Among Arab Americans in Michigan 
The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population.
PMCID: PMC4149176  PMID: 21318619
Arab; Mortality rates; Surnames
21.  Comparison of Exposures Among Arab American and Non-Hispanic White Female Thyroid Cancer Cases in Metropolitan Detroit 
Arab American (ArA) women may be at greater risk for thyroid cancer (TC) than White women. This case-case comparison explored differences in known and proposed risk factors of TC among ArA and non-Hispanic White (NHW) female TC cases in metropolitan Detroit. Cases of invasive TC identified from a population-based registry responded to a telephone survey regarding potential TC risk factors. Thirty ArA women (response rate 52%) and 70 NHW women (67%) participated. NHW women reported significantly more prior thyroid disease (TD), family history of TD, hormone use, cumulative years of hormone use, cigarette and alcohol consumption. In adjusted logistic regression analysis, ArA women had significantly higher odds of exposure to dental x-rays (OR = 3.48, CI 1.01–12.00) and medical radiation (OR = 13.58, CI 1.49–124.04) than NHW women. Risk factors for TC may differ among ArA women and their NHW counterparts.
PMCID: PMC4149183  PMID: 21647624
Thyroid cancer; Risk factors; SEER; Ethnicity; Medical radiation
22.  HIV Sexual Risk Behaviors and Multi-Level Determinants Among Male Labor Migrants from Tajikistan 
The purpose of this study was to investigate HIV risk behaviors and their multilevel determinants in male labor migrants from Tajikistan to Moscow. In Russia and Central Asia, where AIDS rates are amongst the world’s highest, conditions in both sending and receiving countries pose serious challenges to HIV prevention. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method study. The quantitative results indicated that male labor migrants were at risk for HIV due to higher sexual behaviors including sexual relations with sex workers (92%), multiple partnering in the past month (86%), unprotected sex with sex workers (33%), and reduced frequency of condom use while drinking alcohol (57%). Multivariate tests indicated the multilevel factors that increased HIV sexual risks including: pre-migration factors (e.g. used sex workers in Tajikistan); migrant work and lifestyle factors (e.g. greater number of times visited Moscow); migrant sexual and relational factors (e.g. regular partner in Moscow); and migrant health and mental health factors (e.g. increased frequency of alcohol use). Qualitative findings from longitudinal ethnographic interviews and observations of a subset of 40 purposively sampled Tajik male migrants demonstrated how these multilevel pre-migration and migration factors account for HIV risk and protective behaviors in context. These findings underscore the seriousness of HIV risk for labor migrants and call both for multilevel approaches to prevention and for further study.
PMCID: PMC3789367  PMID: 23054537
HIV risk; labor migrants; Central Asia
23.  Influence of Information Sources on Hepatitis B Screening Behavior and Relevant Psychosocial Factors Among Asian Immigrants 
This study examines how different information sources relate to Health Belief Model (HBM) constructs, hepatitis B virus (HBV) knowledge, and HBV screening. The Maryland Asian American Liver Cancer Education Program administered a survey of 877 Asian immigrants. The most common sources of information identified by the multiple-answer questions were newspapers (39.8%), physicians (39.3%), friends (33.8%), TV (31.7%), and the Internet (29.5%). Path analyses—controlling for age, sex, educational level, English proficiency, proportion of life in U.S., health insurance coverage, and family history of HBV infection—showed that learning about HBV from physicians had the strongest direct effect; friends had a marginal indirect effect. Perceived risk, benefits, and severity played limited roles in mediation effects. Path analysis results differed by ethnicity. Physician-based HBV screening intervention would be effective, but should be complemented with community health campaigns through popular information sources for the uninsured.
PMCID: PMC3615083  PMID: 23238580
Hepatitis B; Asian American; health information; screening; Health Belief Model
24.  Intensified Case-Finding for Latent Tuberculosis Infection among the Baltimore City Hispanic Population 
Foreign-born immigrants are at high risk for latent TB infection (LTBI). In conjunction with the Baltimore City Health Department (BCHD), student volunteers conducted intensified LTBI case-finding (ICF) using tuberculin skin testing (TST) in the Hispanic community from 2006-10. We sought to determine the yield of ICF and estimate the LTBI prevalence.
retrospective cross-sectional study
Among 478 individuals screened, 164 (34.3%) had a positive TST, 227 (47.5%) had a negative TST, and 87 (18.2%) did not return. Among those who completed screening, the prevalence of LTBI was 164/391 (41.9%, 95% CI 0.37-0.47). ICF referrals accounted for 4.4% of all LTBI referrals to BCHD and for 41% of referrals among Hispanics.
We found a high rate of undiagnosed LTBI within the Hispanic community. This student-run ICF program accounted for almost half of all LTBI cases among Hispanics. Community resources are needed to target this high-risk population.
PMCID: PMC3521081  PMID: 22825465
25.  Association of Cigarette Smoking and Metabolic Syndrome in a Puerto Rican Adult Population 
Metabolic syndrome (MetSyn) is related to an increased risk for type 2 diabetes and cardiovascular disease. Smokers are at greater risk than nonsmokers of becoming insulin resistant and to develop cardiovascular disease. This study aimed to explore the association between cigarette smoking, MetSyn and its components among Puerto Rican adults.
A representative sample of 856 persons aged 21–79 years from the San Juan Metropolitan area participated in this study. Demographic and lifestyle characteristics, including smoking habits, were gathered from a self-reported questionnaire. MetSyn was defined according to the revised NCEP-ATP III criteria and measured using biochemical measurements and anthropometric indices. Logistic regression models were used to estimate prevalence odds ratios (POR) and its 95% confidence intervals (CI).
MetSyn was significantly (p<0.001) more prevalent in former smokers (48.4%) as compared to current (42.7%) and never smokers (40.0%). However, after adjusting for possible confounders, current smokers who used more than 20 cigarettes per day were 2.24 (95% CI= 1.00–4.99) times more likely to have MetSyn as compared to never smokers. Heavy smokers were also more likely to have high triglyceride levels (POR=2.22, 95% CI=1.12–4.38) and low HDL-cholesterol levels (POR=2.49, 95% CI= 1.28–4.86) as compared to never smokers.
This study supports previous reports of an increased risk of MetSyn among current smokers, particularly those with a heavier consumption. Tobacco control strategies, such as preventing smoking initiation and disseminating evidence-based cessation programs, are necessary to reduce the burden of MetSyn in Puerto Rico.
PMCID: PMC3502663  PMID: 22729380
Metabolic syndrome; Smoking; Puerto Rico; Hispanics

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