Peer Reviewed Articles
As we celebrate World Breastfeeding Week we are very happy to share with you two CEHDL articles recently published that have important implications for breastfeeding promotion in Connecticut and beyond.
Haughton J, Gregorio D, Pérez-Escamilla R. Factors Associated With Breastfeeding Duration Among Connecticut Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participants. J Hum Lact. 2010 Aug;26(3):266-73. PubMed PMID: 20689103.
Chapman DJ, Morel K, Anderson AK, Damio G, Pérez-Escamilla R. Breastfeeding Peer Counseling: From Efficacy Through Scale-Up. J Hum Lact. 2010 Aug;26: 314-326, doi:10.1177/0890334410369481
Both articles can be found in the August 2010 issue of the Journal of Human Lactation http://jhl.sagepub.com (subscription may be required).
Place of Residence Modifies the Association Between Acculturation and Dietary Tools Knowledge Among Latina WIC Participants: A Multi-State Study.
J Immigr Minor Health. 2010 Jun 13. [Epub ahead of print] PMID: 20549357
Pérez-Escamilla R, Song DS, Taylor CA, Mejia A, Melgar-Quiñonez H, Balcazar HG, Anders RL, Segura-Pérez S, Duarte-Gardea MO, Ibarra JM.
Corresponding author: Rafael Pérez-Escamilla, PhD
Email: rafael.perez-escamilla@yale.edu
Yale School of Public Health, New Haven, CT, 06510
ABSTRACT: This cross-sectional study assessed: (a) awareness and knowledge of federal dietary tools (MyPyramid, Food Guide Pyramid (FGP), and food labels (FL)), and (b) the influence of acculturation and state of residence on FGP knowledge (FGPK) indicators among low-income Latina WIC participants (N = 479) living in Connecticut, Ohio, Texas, and California. Participants were familiar with FGP but only 37% recognized MyPyramid. FGPK was highest for fruits (71%) and lowest for the 'breads and cereals' group (12%). Less than half (47%) used FL's when grocery shopping. Living in OH, was associated with the lowest FGPK. Multivariate analyses showed that more acculturated individuals living in CT/CA had better FGPK than participants living in TX and their less acculturated counterparts in CT/CA. The forthcoming revised federal dietary tools need to be adequately disseminated among Latinos, with special emphasis on those with lower acculturation levels, living in rapid emerging Latino communities or in the US-Mexico border.
The article can be downloaded here. (pdf)
Dietary quality among Latinos: Is acculturation making us sick?
From UConn you can access article pdf here.
If you are a member of the American Dietetic Association you can access it here.
Adaptation of the U.S. food security survey module for low-income pregnant Latinas: Qualitative phase
Journal Hunger Environmental Nutrition 2009;4:62-80.
Hromi-Fiedler A, Bermúdez-Millán, A, Segura-Perez S, Damio G, Perez-Escamilla R.
Psychometric properties of an adapted version of the U.S. household food security survey module for assessing food insecurity among low-income pregnant Latinas
Journal Hunger Environmental Nutrition 2009;4:81-94.
Hromi-Fiedler A, Bermúdez-Millán, A, Melgar-Quiñonez H, Perez-Escamilla R.
US National Breastfeeding Monitoring and Surveillance: Current Status and Recommendations
J Hum Lact. First published on March 13, 2009 as doi:10.1177/0890334409332437
Donna J. Chapman and Rafael Pérez-Escamilla
The abstract for this article can be viewed here. (subscription may be needed)
Nutrition knowledge, food label use, and food intake patterns among Latinas with and without type 2 diabetes.
J Am Diet Assoc. 2008 Jun;108(6):960-7.
Fitzgerald N, Damio G, Segura-Pérez S, Pérez-Escamilla R.
OBJECTIVE: To examine the associations of nutrition knowledge, food label use, and food intake patterns among Latinas with and without diagnosed diabetes.
DESIGN: This was a case-control study.
SUBJECTS/SETTING: A convenience sample of 201 (100 cases with diagnosed type 2 diabetes, 101 controls without diagnosed diabetes) nonpregnant, nonbreastfeeding Latinas without severe health conditions, aged 35 to 60 years were interviewed by bicultural interviewers. Diverse community-based recruitment methods were used.
STATISTICAL ANALYSES PERFORMED: Independent samples t test, Mann-Whitney U, and chi(2) tests, and multivariate logistic regression were performed.
RESULTS: Food labels self-efficacy and stage of change, and average nutrition knowledge scores were similar between cases and controls (P>0.05). Within the diabetes group, nutrition knowledge was greater among those who had seen a registered dietitian or a diabetes educator (P=0.020). Cases reported consuming artificially sweetened desserts and beverages more frequently than controls (P<0.001). Pooled sample cross-sectional analyses showed that nutrition knowledge was positively related to food label use, which in turn was related to a more healthful food intake pattern (P<0.05). After adjusting for likely confounders, socioeconomic status (SES) was positively related to nutrition knowledge (P=0.001) and intakes of fruits, vegetables, and meats (P<or=0.01). SES was not related to food label use independently of nutrition knowledge. Acculturation was positively related to soft drink and salty snack intakes (P<0.01).
CONCLUSIONS: There is a need to improve nutrition knowledge and skills for both groups, especially for those with low SES. Culturally appropriate interventions should emphasize the healthful nutritional behaviors from one's primary culture for effective retention of such traits.
Breastfeeding Status on US Birth Certificates: Where Do We Go From Here?
Pediatrics 2008; 122: e1159-e1163.
Donna J. Chapman, Anne Merewood, Robert Ackatia Armah, and Rafael Pérez-Escamilla
Corresponding author: Donna Chapman
Email: donna.chapman@uconn.edu
Department of Nutritional Sciences, Center for Eliminating Health Disparities among Latinos, University of Connecticut, Storrs
OBJECTIVES. The objectives of this study were to assess the extent to which states collected breastfeeding data on the birth certificate, to verify the wording of the breastfeeding questions used, and to develop recommendations for future revisions of the breastfeeding question asked on the US Standard Certificate of Live Birth.
METHODS. Registrars of vital statistics in US states and territories were contacted via telephone with e-mail follow-up between April 2006 and May 2008 to determine whether their state/territory collected breastfeeding data on its birth certificate. Responses were categorized as follows: (1) breastfeeding data currently collected; (2) breastfeeding data not currently collected but implementation date set; or (3) breastfeeding data not currently collected and no implementation plans.
RESULTS. In May 2008, 56.6% (30 of 53) of US states and territories were collecting data on breastfeeding status at hospital discharge on their birth certificate. The questions used to collect breastfeeding data, however, had not been standardized. Approximately one quarter (12 of 53) reported that they were not yet collecting breastfeeding data on their birth certificate but that an implementation date had been set. Approximately one fifth (11 of 53) indicated that their state birth certificate did not plan to collect breastfeeding data by January 2010.
CONCLUSIONS. A total of 79% of the registrars reported that breastfeeding data were collected on the birth certificate or that the process would begin within the next 2 years. Future revisions to the Standard Certificate of Live Birth breastfeeding question should assess breastfeeding exclusivity. The revision process should include feedback from health professionals who collect these data, pretesting of the revised question for feasibility, and extensive training before data collection.
The abstract for this article can be downloaded here.
The Connecticut Center of Excellence for Eliminating Health Disparities among Latinos
Rafael Pérez-Escamilla, Grace Damio, Jeannette DeJesús, Laurine Bow, Jyoti Chhabra, Nancy H. Bull
Journal of Higher Education Outreach and Engagement, Volume 12, Number 3, p. 167, (2008)
ABSTRACT: CEHDL's mission is to contribute to the elimination of health disparities among Latino(a)s through the formation of human resources, community-based research, and culturally appropriate outreach/extension. CEHDL is structured as a consortium led by the University of Connecticut (UConn) in close partnership with the Hispanic Health Council (HHC), a community health agency located in inner-city Hartford, and Hartford Hospital (HH). Demonstrating best practice and culturally skilled, evidence-based outreach, and bringing the best of academic, community, and health institutions to socioeconomically disadvantaged communities, CEHDL fosters scientific- community interactions and supports training of undergraduate, graduate, and medical students. Building capacity in other agencies is one method through which CEHDL seeks to accomplish its goals. Thus far, CEHDL has made substantial progress demonstrating that interdisciplinary community-academic- hospital partnerships are essential for addressing health inequities in our country.
View Full Article (pdf)
Impact of Peer Nutrition Education on Dietary Behaviors and Health Outcomes among Latinos: A Systematic Literature Review
Rafael Pérez-Escamilla, Amber Hromi-Fiedler, Sonia Vega-Lopéz, Angela Bermúdez-Millán, Sofia Segura-Pérez
Journal of Nutrition Education and Behavior, 2008 40:208-225
Address correspondence to: rafael.perez-escamilla@uconn.edu
Black ‘N Mild and Carcinogenic: Cigar Smoking among Inner City Young Adults in Hartford, CT.
Merrill Singer, Greg Mirhej, J. Bryan Page, Erica Hastings, Hassan Salaheen, Giorelly Prado.
Journal of Ethnicity in Substance Abuse 2007;Volume 6(3) (Special Theme Issue: Ethnicity and Tobacco in the 21st Century).
For more information on this publication please contact Dr. Merrill Singer at MerrillS@hispanichealth.com
The Role of Acculturation in Nutrition, Lifestyle, and Incidence of Type 2 Diabetes among Latinos.
Perez-Escamilla R, Putnik P.
J Nutr. 2007 Apr;137(4):860-70.
Rafael Pérez-Escamilla* and Predrag Putnik
Department of Nutritional Sciences, Center for Eliminating Health Disparities among Latinos, University of Connecticut, Storrs, CT 06269-4017
* To whom correspondence should be addressed: E-mail: rafael.perez-escamilla@uconn.edu.
Latinos have become the largest ethnic minority group in the U.S. and will become 25% of the population by 2050. The purpose of this critical review is to examine the influence of acculturation on type 2 diabetes and corresponding risk factors, including 1) dietary intake, 2) physical activity patterns, 3) smoking and alcohol consumption, and 4) obesity. Among Latinos, acculturation has been associated with obesity risk, suboptimal dietary choices including lack of breast-feeding, low intake of fruits and vegetables, a higher consumption of fats and artificial drinks containing high levels of refined sugar, smoking, and alcohol consumption. In contrast, acculturation has been positively associated with physical activity and a lower likelihood of type 2 diabetes among Latinos. However, findings have been inconsistent across acculturation indicators and appear to be strongly modified by Latino subethnicity and gender. It is important to improve existing acculturation measures available. Mexican Americans have been the target group in the majority of studies. Research in this group must continue but it is important to conduct additional research with other Latino subgroups that have been left out of most of the acculturation, lifestyles, and health outcomes research. Differences between acculturation and health-related outcomes may be confounded by socio-economic status, age, and movement from urban to rural areas. Longitudinal multivariate acculturation research is essential to disentangle these relations and to develop sound behavioral change theories that adequately predict behavioral change among Latinos.
Article can be viewed here (subscription may be required)
The same issue includes the following excellent commentary on this article:
Acculturation and biomarkers for type 2 diabetes in Latinos.
Fernandez ML. J Nutr. 2007 Apr;137(4):871-2.
Article can be viewed here (subscription may be required)
Address correspondence to: MARIA-LUZ.FERNANDEZ@uconn.edu
Differential Response to an Exclusive Breastfeeding Peer Counseling Intervention: The Role of Ethnicity
Alex K. Anderson, Grace Damio, Donna J. Chapman, and Rafael Pérez-Escamilla
J Hum Lact 2007 23: 16-23
This publication can be downloaded here.
Acculturation, socioeconomic status, obesity and lifestyle factors among low-income Puerto Rican women in Connecticut, U.S., 1998-1999.
Fitzgerald N, Himmelgreen D, Damio G, Segura-Perez S, Peng YK, Perez-Escamilla R.
Rev Panam Salud Publica/Pan American Journal of Public Health. 2006 May;19(5):306-13.
Department of Family and Community Health Sciences, Rutgers, the State University of New Jersey, New Brunswick, New Jersey 08901, United States of America. nfitzgerald@rcre.rutgers.edu
OBJECTIVES: To examine the associations of socioeconomic status and acculturation with obesity and lifestyle characteristics that may be risk factors for diabetes and cardiovascular disease among low-income Puerto Rican women.
METHODS: This cross-sectional study was conducted between 1998 and 1999 by interviewing a convenience sample of 200 low-income Puerto Rican female caretakers of young children in Hartford, Connecticut, United States of America. Various recruitment methods were used to ensure adequate representation of the target community. The associations of obesity (body mass index > or = 30.0) and lifestyle factors (physical activity, cigarette smoking, alcohol consumption, food intake) with socioeconomic status (education, employment, car ownership), acculturation, age, and marital status were examined with Spearman rho, chi-squared, and Mann-Whitney U tests and logistic regression analyses.
RESULTS: Mean age was 29 years. Obesity (40%), physical inactivity (47%), and cigarette smoking (32%) were common. Less acculturated participants were 57% less likely to smoke and 54% less likely to be obese than their more acculturated counterparts. Lower socioeconomic status (not finishing high school or not owning a car) was associated with a higher likelihood of obesity, but unemployed (vs. employed) women were less likely to be obese (P < 0.05). Women who did not own a car consumed meat, eggs and fish less often than those who owned a car. Smokers were more likely to have an unhealthy food intake pattern than nonsmokers.
CONCLUSIONS: The associations of acculturation and socioeconomic status with some lifestyle characteristics suggest the need for culturally appropriate programs to promote healthy lifestyle behaviors in this low-income community.
Click here for full text. (pdf)
Symposium: Evidence-Based Public Nutrition: An Evolving Concept
Rafael Pérez-Escamilla and Janet King
Evidence-Based Public Nutrition: An Evolving Concept
J. Nutr. 2007 137: 478-479. [Full Text]* [PDF]
Janet C. King
An Evidence-Based Approach for Establishing Dietary Guidelines
J. Nutr. 2007 137: 480-483. [Abstract] [Full Text]* [PDF]
Rafael Pérez-Escamilla
Evidence Based Breast-Feeding Promotion: The Baby-Friendly Hospital Initiative
J. Nutr. 2007 137: 484-487. [Abstract] [Full Text]* [PDF]
Tim Byers and Rebecca L. Sedjo
Public Health Response to the Obesity Epidemic: Too Soon or Too Late?
J. Nutr. 2007 137: 488-492. [Abstract] [Full Text]* [PDF]
Barbara Schneeman
FDA's Review of Scientific Evidence for Health Claims
J. Nutr. 2007 137: 493-494. [Abstract] [Full Text]* [PDF]
*Full Text requires a subscription to the Journal of Nutrition
