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The primary objective of this dissertation project was to describe the pattern of effect modification caused by sociocultural status on identified risk factors for Type 2 diabetes. This case-control study included 244 Mexican American women, between the ages of 50-79, who were enrolled in the Observational Study of the Women's Health Initiative (WHI) in San Diego, Tucson, or San Antonio between 1994-1997. Seventy-eight diabetics and 166 nondiabetics were included in the study. As a supplement to data already collected by the WHI, a telephone survey was used to gather information on acculturation and diabetes related knowledge and behavior. Results support previous findings that increased age; a positive family history of diabetes, obesity, and centralized adiposity; and a sedentary lifestyle are important independent predictors of diabetes. The risk of diabetes associated with obesity is moderated by acculturation in a nonlinear fashion. Specifically, risk of diabetes associated with obesity was lowest at either the high or the low end of the acculturation spectrum, but highest in the midrange. The risk of diabetes associated with a higher waist hip ratio increases with income and acculturation. With respect to educational status, the risk of disabetes is related in a nonlinear fashion and is magnified for women with 7th-12th grade education. However, in the presence of other risk factors such as family history of diabetes and age, the importance of sociocultural status as an effect modifier diminishes.
In their later years, Americans of different racial and ethnic backgrounds are not in equally good-or equally poor-health. There is wide variation, but on average older Whites are healthier than older Blacks and tend to outlive them. But Whites tend to be in poorer health than Hispanics and Asian Americans. This volume documents the differentials and considers possible explanations. Selection processes play a role: selective migration, for instance, or selective survival to advanced ages. Health differentials originate early in life, possibly even before birth, and are affected by events and experiences throughout the life course. Differences in socioeconomic status, risk behavior, social relations, and health care all play a role. Separate chapters consider the contribution of such factors and the biopsychosocial mechanisms that link them to health. This volume provides the empirical evidence for the research agenda provided in the separate report of the Panel on Race, Ethnicity, and Health in Later Life.
The number of persons diagnosed with diabetes increased 5x between 1958 & 1997. More than 16 million Amer. have diabetes, more than half of them women, with the prevalence of diabetes at least 2-4 times higher among women of color. The report looks at the socioeconomic environ. that has contributed to the increase of diabetes & the challenges we face as we seek to educate women about the behavioral changes necessary for prevention. The report is structured to reflect the manifestations of diabetes at different stages of women's life, including the threat of type 1 & the emergence of type 2 diabetes in youth, gestational diabetes among women of childbearing age, & type 2 diabetes as a disease of middle-aged & older women. Charts & tables.
Social factors, signals, and biases shape the health of our nation. Racism and poverty manifest in unequal social, environmental, and economic conditions, resulting in deep-rooted health disparities that carry over from generation to generation. In Perspectives on Health Equity and Social Determinants of Health, authors call for collective action across sectors to reverse the debilitating and often lethal consequences of health inequity. This edited volume of discussion papers provides recommendations to advance the agenda to promote health equity for all. Organized by research approaches and policy implications, systems that perpetuate or ameliorate health disparities, and specific examples of ways in which health disparities manifest in communities of color, this Special Publication provides a stark look at how health and well-being are nurtured, protected, and preserved where people live, learn, work, and play. All of our nation's institutions have important roles to play even if they do not think of their purpose as fundamentally linked to health and well-being. The rich discussions found throughout Perspectives on Health Equity and Social Determinants of Health make way for the translation of policies and actions to improve health and health equity for all citizens of our society. The major health problems of our time cannot be solved by health care alone. They cannot be solved by public health alone. Collective action is needed, and it is needed now.
Type 2 diabetes mellitus represents a daunting self-management challenge due to its complicated daily treatment regimen which includes adhering to diet, exercise, and medication recommendations. Little research has evaluated perceived barriers to diabetes self-care in a group that is at particular risk for diabetic complications: U.S. Latinos. This study had two aims. The first was to provide evidence that experimental and validated self-report instruments selected for this study functioned in a comparable manner in both Spanish and English in a sample of low income, predominantly Spanish-speaking diabetic patients (n = 77). The second aim was to examine hypothesized relationships of selected predictors to two criterion variables measuring health status (i.e., glycosylated hemoglobin A1c and Diabetes Impact) using a method described by Baron & Kenny (1986). Predictors included age, education, and income as covariates, and perceived environmental barriers to self-care, self-efficacy for treatment adherence, fatalistic beliefs (external health locus of control), and Latino cultural diabetes beliefs. Potential moderator and mediator variables of the relationship between perceived barriers to self care and criterion variables included self-efficacy for treatment adherence, fatalistic beliefs and Latino cultural diabetes beliefs. Scales used in this study had coefficient alpha values ranging from .82-.96 in Spanish and .74-.97 in English and also demonstrated strong factor structure integrity. Bivariate correlations indicated that higher scores on perceived barriers to self-care were significantly related to lower self-efficacy scores [r = −.34, p
The primary purpose of fitness and body composition standards in the U.S. Armed Forces has always been to select individuals best suited to the physical demands of military service, based on the assumption that proper body weight and composition supports good health, physical fitness, and appropriate military appearance. The current epidemic of overweight and obesity in the United States affects the military services. The pool of available recruits is reduced because of failure to meet body composition standards for entry into the services and a high percentage of individuals exceeding military weight-for-height standards at the time of entry into the service leave the military before completing their term of enlistment. To aid in developing strategies for prevention and remediation of overweight in military personnel, the U.S. Army Medical Research and Materiel Command requested the Committee on Military Nutrition Research to review the scientific evidence for: factors that influence body weight, optimal components of a weight loss and weight maintenance program, and the role of gender, age, and ethnicity in weight management.
Decades of research have demonstrated that the parent-child dyad and the environment of the familyâ€"which includes all primary caregiversâ€"are at the foundation of children's well- being and healthy development. From birth, children are learning and rely on parents and the other caregivers in their lives to protect and care for them. The impact of parents may never be greater than during the earliest years of life, when a child's brain is rapidly developing and when nearly all of her or his experiences are created and shaped by parents and the family environment. Parents help children build and refine their knowledge and skills, charting a trajectory for their health and well-being during childhood and beyond. The experience of parenting also impacts parents themselves. For instance, parenting can enrich and give focus to parents' lives; generate stress or calm; and create any number of emotions, including feelings of happiness, sadness, fulfillment, and anger. Parenting of young children today takes place in the context of significant ongoing developments. These include: a rapidly growing body of science on early childhood, increases in funding for programs and services for families, changing demographics of the U.S. population, and greater diversity of family structure. Additionally, parenting is increasingly being shaped by technology and increased access to information about parenting. Parenting Matters identifies parenting knowledge, attitudes, and practices associated with positive developmental outcomes in children ages 0-8; universal/preventive and targeted strategies used in a variety of settings that have been effective with parents of young children and that support the identified knowledge, attitudes, and practices; and barriers to and facilitators for parents' use of practices that lead to healthy child outcomes as well as their participation in effective programs and services. This report makes recommendations directed at an array of stakeholders, for promoting the wide-scale adoption of effective programs and services for parents and on areas that warrant further research to inform policy and practice. It is meant to serve as a roadmap for the future of parenting policy, research, and practice in the United States.