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1.  Prevalence of Eating Disorder Risk and Body Image Distortion Among National Collegiate Athletic Association Division I Varsity Equestrian Athletes 
Journal of Athletic Training  2011;46(4):431-437.
Participation in appearance-based sports, particularly at the collegiate level, may place additional pressures on female athletes to be thin, which may increase the likelihood of their resorting to drastic weight control measures, such as disordered eating behaviors.
(1) To estimate the prevalence and sources of eating disorder risk classification by academic status (freshman, sophomore, junior, or senior) and riding discipline (English and Western), (2) to examine riding style and academic status variations in body mass index (BMI) and silhouette type, and (3) to examine these variations across eating disorder risk classification type (eg, body image disturbances).
Cross-sectional study.
Seven universities throughout the United States.
Patients or Other Participants:
A total of 138 participants volunteered (mean age = 19.88 ± 1.29 years). They represented 2 equestrian disciplines: English riding (n = 91) and Western riding (n = 47).
Main Outcome Measure(s):
Participants self-reported menstrual cycle history, height, and weight. We screened for eating disorder risk behaviors with the Eating Attitudes Test and for body disturbance with sex-specific BMI silhouettes.
Based on the Eating Attitudes Test, estimated eating disorder prevalence was 42.0% in the total sample, 38.5% among English riders, and 48.9% among Western riders. No BMI or silhouette differences were found across academic status or discipline in disordered eating risk. Overall, participants perceived their body images as significantly larger than their actual physical sizes (self-reported BMI) and wanted to be significantly smaller in both normal clothing and competitive uniforms.
Disordered eating risk prevalence among equestrian athletes was similar to that reported in other aesthetic sports and lower than that in nonaesthetic sports. Athletic trainers working with these athletes should be sensitive to these risks and refer athletes as needed to clinicians knowledgeable about disordered eating. Professionals working with this population should avoid making negative comments about physical size and appearance.
PMCID: PMC3419156  PMID: 21944076
disordered eating behaviors; riding disciplines; aesthetic sports
2.  Application of a Novel Method for Assessing Cumulative Risk Burden by County 
The purpose of this study is to apply the Human Security Index (HSI) as a tool to detect social and economic cumulative risk burden at a county-level in the state of Texas. The HSI is an index comprising a network of three sub-components or “fabrics”; the Economic, Environmental, and Social Fabrics. We hypothesized that the HSI will be a useful instrument for identifying and analyzing socioeconomic conditions that contribute to cumulative risk burden in vulnerable counties. We expected to identify statistical associations between cumulative risk burden and (a) ethnic concentration and (b) geographic proximity to the Texas-Mexico border. Findings from this study indicate that the Texas-Mexico border region did not have consistently higher total or individual fabric scores as would be suggested by the high disease burden and low income in this region. While the Economic, Environmental, Social Fabrics (including the Health subfabric) were highly associated with Hispanic ethnic concentration, the overall HSI and the Crime subfabric were not. In addition, the Education, Health and Crime subfabrics were associated with African American racial composition, while Environment, Economic and Social Fabrics were not. Application of the HSI to Texas counties provides a fuller and more nuanced understanding of socioeconomic and environmental conditions, and increases awareness of the role played by environmental, economic, and social factors in observed health disparities by race/ethnicity and geographic region.
PMCID: PMC3382739  PMID: 22754475
cumulative risk burden; socioeconomics; race/ethnicity; Texas-Mexico border; Texas
3.  Impact of Hispanic Ethnic Concentration and Socioeconomic Status on Obesity Prevalence in Texas Countie 
The purpose of this study is to determine whether Hispanic ethnic concentration is associated with a higher prevalence of obesity and, if this relationship exists, whether it is affected by the socioeconomic environment. The study uses the Texas Behavioral Risk Factor Surveillance System (BRFSS) linked to 2000 census data to access the relationship between prevalence of obesity, Hispanic ethnic concentration, poverty and level of education at a county-level. The findings suggest that the association of Hispanic ethnic concentration and obesity varies by socioeconomic environment. Although little influence was observed for % poverty, the relationship between Hispanic ethnic concentration and obesity differed by county-level educational attainment. High proportion of residents with a bachelor’s degree is associated with a low prevalence of obesity; counties with both high % Hispanic and high % with Bachelor’s degrees had the lowest prevalence of obesity. Our results suggest that promoting and improving education, perhaps including training on healthful living, may serve as an effective means of curbing current obesity trends and associated health problems in Hispanic and possibly other ethnic communities.
PMCID: PMC3366608  PMID: 22690191
Hispanic; education; poverty; obesity; county
4.  Type 2-Diabetes is Associated With Elevated Levels of TNF-alpha, IL-6 and Adiponectin and Low Levels of Leptin in a Population of Mexican American: A Cross-Sectional Study 
Cytokine  2011;57(1):136-142.
The goal of the study was to determine the association between diabetes and inflammation in clinically diagnosed diabetes patients. We hypothesized that low-grade inflammation in diabetes is associated with the level of glucose control. Using a cross-sectional design we compared pro and anti-inflammatory cytokines in a community recruited cohort of 367 Mexican Americans with type 2-diabetes having a wide range blood glucose levels. Cytokines (IL-6, TNF-α, IL-1β, IL-8) and adipokines (adiponectin, resistin and leptin) were measured using multiplex ELISA. Our data indicated that diabetes as whole was strongly associated with elevated levels of IL-6, leptin, CRP and TNF-α, whereas worsening of glucose control was positively and linearly associated with high levels of IL-6, leptin. The associations remained statistically significant even after controlling for BMI and age (p = 0.01). The association between TNF-α, however, was attenuated when comparisons were performed based on glucose control. Strong interaction effects between age and BMI and diabetes were observed for IL-8, resistin, and CRP. The cytokine/adipokine profiles of Mexican Americans with diabetes suggest an association between low-grade inflammation and quality of glucose control. Unique to in our population is that the chronic inflammation is accompanied by lower levels of leptin.
PMCID: PMC3270578  PMID: 22035595
Cytokine; Inflammation; Mexican Americans; Diabetes
5.  Perceived Barriers to Exercise in Hispanic Adults by Level of Activity 
National data show that Hispanics report low levels of physical activity. Limited information on barriers to exercise in this population exists in the literature.
Surveys were administered to 398 Hispanic participants from two colonias in South Texas to investigate self-reported levels of and perceived barriers to exercise. One-way ANOVA by level of activity and t tests by gender were conducted. Exploratory factor analysis was used to examine patterns by level of activity.
Results sho w that 67.6% of respondents did not meet physical activity recommendations of at least 150 minutes per week, as compared with 55.6% nationally. Overall, the most frequently reported barriers included “lack of time,” “very tired,” and “lack of self-discipline” to exercise. An exploratory factor analysis of the barriers reported by participants not meeting physical activity recommendations resulted in a 3-factor structure. A unidimensional scale was found for participants meeting recommendations.
Fin dings suggest that future interventions should be specific to gender and exercise level to address the high prevalence of inactivity in this population.
PMCID: PMC3174095  PMID: 21885882
Mexican Americans; physical activity; survey research
6.  Response to H1N1 in a U.S.-Mexico Border Community 
Public health experts from a county health department and a school of public health in Texas collaborated to establish a simple, functional surveillance system to monitor 2009 H1N1 influenza virus as it crossed from Mexico into a Texas border community. They used GIS mapping and reports of school and daycare absences to guide their response to the outbreak.
Public health experts from a county health department and a school of public health collaborated to establish a simple, functional surveillance system to monitor swine-origin influenza virus as it crossed from Mexico into a Texas border community during the 2009 pandemic. The draft national and state preparedness plans were found to be cumbersome at the local level, so a simple, more practical real-time surveillance and response system was developed, in part by modifying these documents, and immediately implemented. Daily data analyses, including geographical information system mapping of cases and reports of school and daycare absences, were used for outbreak management. Aggregate reports of influenzalike illness and primary school absences were accurate in predicting influenza activity and were practical for use in local tracking, making decisions, and targeting interventions. These simple methods should be considered for local implementation and for integration into national recommendations for epidemic preparedness and response.
PMCID: PMC2982707  PMID: 20825334
7.  Utilizing spatiotemporal analysis of influenza-like illness and rapid tests to focus swine-origin influenza virus intervention 
Health & place  2010;16(6):1230-1239.
In the spring of 2009, a novel strain of H1N1 swine-origin influenza A virus (S-OIV) emerged in Mexico and the United States, and soon after was declared a pandemic by the World Health Organization. This work examined the ability of real-time reports of influenza-like illness (ILI) symptoms and rapid influenza diagnostic tests (RIDTs) to approximate the spatiotemporal distribution of PCR-confirmed S-OIV cases for the purposes of focusing local intervention efforts. Cluster and age-adjusted relative risk patterns of ILI, RIDT and S-OIV were assessed at a fine spatial scale at different time and space extents within Cameron County, Texas on the U.S.-Mexico border. Space-time patterns of ILI and RIDT were found to effectively characterize the areas with highest geographical risk of S-OIV within the first two weeks of the outbreak. Based on these results, ILI and/or RIDT may prove to be acceptable indicators of the location of S-OIV hotspots. Given that S-OIV data is often difficult to obtain real-time during an outbreak, these findings may be of use to public health officials targeting prevention and response efforts during future flu outbreaks.
PMCID: PMC2998411  PMID: 20810301
cluster; H1N1; swine flu; ILI; RIDT; GIS
8.  Developing measures on the perceptions of the built environment for physical activity: a confirmatory analysis 
Minimal validity evidence exists for scales assessing the built environment for physical activity. The purpose of this study was to assess the test-retest reliability and invariance of a three-factor model (Neighborhood Characteristics, Safety/Crime, and Access to Physical Activity Facilities) across gender, race, geographic location, and level of physical activity.
To assess measurement invariance, a random sample of 1,534 adults living in North Carolina or Mississippi completed a computer assisted telephone interview that included items examining perceptions of the neighborhood for physical activity. Construct level test-retest reliability data were collected from a purposeful sample of 106 participants who were administered the questionnaire twice, approximately two weeks apart. Fit indices, Cronbach's alpha, Mokken H and Spearman correlation coefficients (SCC) were used to evaluate configural and co/variance invarianc,e and intraclass correlation coefficients (ICC) were used to assess reliability.
Construct test-retest reliability was strong (ICC 0.90 to 0.93). SCC for Neighborhood Characteristics and Crime/Safety were weak with Access (0.21 and 0.25), but strong between Crime/Safety and Neighborhood Characteristics (0.62). Acceptable fit and evidence of measurement invariance was found for gender, race (African American and White), geographic location, and level of physical activity. Fit indices consistently approached or were greater than 0.90 for goodness of fit index, normed fit index, and comparative fit index which is evidence of configural invariance. There was weak support of variance and covariance invariance for all groups that was indicative of factorial validity.
Support of the validity and reliability of the three-factor model across groups expands the possibilities for analysis to include latent variable modeling, and suggests these built environment constructs may be used in other settings and populations.
PMCID: PMC2959084  PMID: 20929571

Results 1-8 (8)