Hispanic Adolescent Obesity

A Study on the Effects of Low Socioeconomic Status

Michael Lucio
DePaul University 6/12/2013

Hispanic Adolescent Obesity

According to the Center for Disease Control (CDC), males within the ages of less than 20 years have a higher prevalence of obesity among Mexican Americans compared to that on nonHispanic whites and non-Hispanic Blacks. As of July 1st, 2011, there were 52 million Hispanics living in the United States. This number is expected to increase by 2050 to 132.8 million, which is about 30% of the U.S. population (Centers for Disease Control and Prevention. "Hispanic or Latino Populations."). Obesity is a health disorder that affects both male and female adolescents alike that can lead to many health complications further down in life such as diabetes, heart disease, stroke, or cancer. Several factors are believed to contribute to obesity; some of the factors include culture, amount of physical exercise, level of social income, and amount of television watched. In this literature review, social income will be the primary factor that is investigated and whether it has a stronger impact on Hispanic adolescent obesity compared to other factors. It is hypothesized that the level of social income dictates other roles played in the rise of adolescent obesity and how it can be treated. With a growing Hispanic population in the U.S., further studies need to be done to slow obesity rates in adolescents in order to attain high quality longer lives free from preventable disease, disability, injury and premature death, as stated by Healthy People 2020 as an overarching goal. The literature tells us that obesity in Hispanic adolescents is primarily due to these main factors: social income, culture, time spent in front of television, and physical inactivity. Hispanic families coming from a low income status have to overcome many struggles such as access to health care, being able to put a child through a physically active program, or being within an area that allows a child to be physically active. Culture can be applied to the ethnic and family standpoint. The word Hispanic is meant to be applied to many cultures that are very distinct from

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one another. Obesity and its implications are understood differently to the Hispanic culture. For example, Hispanic women view plump as an ideal weight for their children and that overweight signifies healthiness and vitality (Lindberg, Stevens, & Halperin, 2013). What also is a factor in regards to culture in family is that parents who take part in physical inactivity and do also do not make nutritious values when it comes to food has a strong impact on their children. The literature also makes connections between time spent in front of a television and physical activity; these two factors are inversely related in more time spent watching television will result in less physical activity. What is lacking from the literature is that in most of the studies found, there is an absence of identifying and differentiating the different types of cultures within the Hispanic ethnicity. In the Weight-Loss Interventions for Hispanic Populations: The Role of Culture. Journal of Obesity article, it makes a valid point about studies about Hispanics by stating Much of the information about the health status of ethnic minorities in the United States has treated Hispanics as a single, monolithic population, without exploring the variation by ethnic ancestry(Lindberg, Stevens, & Halperin, 2013) We can understand more fully about the different cultures within the Hispanic ethnicity if researchers can look more closely at each individual one and not consider it as being one large heritage. Information that can be gathered which could further develop understanding amongst these different cultures can subsequently lead to a better way to execute a health intervention that can decrease childhood obesity amongst Hispanic adolescents and increase physical activity and general well-being. Literature was first located by using the search engine www.Pubmed.com. The key words used in the search were Hispanic, adolescent, obesity, and social income. Publication dates were

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updated to read January 1st, 2007 to December 31st, 2013. The free full text available, located on left side of search results page must be checked off or the results will only give shortened versions of abstract, results and discussions of the article chosen. Author clicked on article chosen to find full text. Link to database EBSCO HOST was chosen to view full article but link to full article lead to EBSCO HOST search page instead. Logging into school library website www.lib.depaul.edu, author navigated to database EBSCO HOST writing down name of article found on PubMed. Google Scholar was also used to find information entering the same keywords used in PubMed. In the research article, Racial/Ethnic, Socioeconomic, and Behavioral Determinants of Childhood and Adolescent Obesity in the United States: Analyzing Independent and Joint Associations, there are three questions that are being asked. The first was based on large U.S. sample of children, what is the estimated obesity prevalence among adolescent between the ages of 10-17 by important characteristics such as socioeconomic status, race/ethnicity, place of residency and physical activity? The second question that was asked was what is the extent in which racial/ethnic variations in childhood obesity are due to physical activity and sedentary behaviors? The third asked whether social and behavioral influences on obesity differ by child's age, gender, race/ethnicity, and socioeconomic status? (Singh, 2008) The authors were able to present their hypothesis causal model that links social, behavioral, and environmental characteristics to obesity and overweight.

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Figure 1. A model of social and behavioral determinants of childhood obesity. The results that were found for Hispanics in this study were that income effects had a substantial effect; compared to non-Hispanic white children, poor Hispanic adolescents had a 2.7 time more likely chance of becoming obese. In regards to television viewing, it was found that Hispanic children who watch three or more hours a day have 1.8 time the chances of being obese. These were much lower odds compared to non-Hispanic white (1.9) or black children (2.5). The authors were able to discover that while television viewing was associated with higher odds of obesity among children in each age group, physical inactivity, lack of sports participation, and recreational computer use were all more strongly associated with obesity among adolescents aged 1214 and 1517 years(Singh, 2008). After data was further analyzed researchers found that ethnic minority status, high television viewing, non-metropolitan status, and higher levels of physical inactivity were all independently associated with prevalence of obesity. It was concluded that joint effects by
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gender, race/ethnicity, and SES indicate the potential for considerable reduction in the existing disparities in childhood obesity in the United States (Singh, 2008). A new topic that can be said about childhood obesity in Hispanics is that of culture. In the article Weight-Loss Interventions for Hispanic Populations: The Role of Culture it is stated that most weight-loss studies with Hispanic participants have provided little or no information on how Hispanic ethnicity was determined and have frequently failed to examine or report key variables such participants' countries of origin, acculturation, level of education, urban/rural origin, or the confounding effects of SES and ethnicity (Lindberg, Stevens, & Halperin, 2013). What this means is that although much research has been done to understand the Hispanic ethnicity in order to provide a proper weight loss intervention, many studies have not taken into account the different sub-cultures within the Hispanic ethnicity. A research article that acknowledges this problem is written by Delva, OMalley, and Johnston. They state that they have recognized the restraints of other studies done before them and go on to explain that one of the purposes of their research is to examine overweight prevalence of both boys and girls from the Mexican-American, Puerto Rican-American and other Latino cultures specifically. Similarly to the previously discussed article, another purpose of this research was to examine if being overweight is associated with the following factors: socioeconomic status, lifestyle habits, physical activity, amount of sleep, amount of television watched, and family parenting characteristics. The sample used was data 8th-10th graders from 1991 - 2004 that had participated in the University of Michigans Monitoring the Future survey. There were three steps that the researchers took in the procedure: 1. Selection of geographic region. 2. Randomly selected schools that were probability proportionate to size. 3. The selection of 31,000 - 33,000 students from these schools.

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What was discovered after the data was collected was that females of Mexican-American and Puerto Rican descent were more likely to be overweight when compared to other Latin American girls. As for males, it was found that Mexican-American and Puerto Rican boys are more likely to overweight when compared to Other Latin American boys before factors such as socioeconomic status, health related behaviors and family characteristics were controlled for. Socioeconomic status had statistical significance for both boys and girls; socioeconomic status and overweight carried an inverse relationship for the youth in that the higher a childs BMI, the higher the likelihood they come from low socioeconomic status. Similarly to the first research study, it was found that children who engage in more time watching television and less time exercising were more likely to be overweight. In this research study, however, the authors mention that from a national survey, it was discovered that in areas containing a large Latino population do no lack proper physical activity settings compared to communities that are predominantly white or black. What was found had statistical significance even after the data was adjusted for factors such as household income, population density, and location. This finding was noted that there was a need for more research in this area but also more research needed to be done on family characteristics such as dietary habits and how often a person may engage in physical activity. This is needed because of lack of association between family characteristics and overweight points to the important role that Latino caregivers play in meeting nutritional and physical needs or adolescents to prevent overweight (Delva, et. al., 2013) Understanding these factors can lead to better comprehension on Latino families and how they can prevent obesity amongst children.

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In the final portions of this research study, it claims that a modifiable behavior that may result in a decrease in obesity amongst children is less time watching television and increase time in physical activity. Amount of time spent watching television is a factor that is shared amongst many studies that have taken place and usually have the same results: more television watched and less exercise leads to higher chances of being overweight/obese. In a research study published in 2009 named TV Viewing is not predictive of BMI in Black and Hispanic young adult females, researchers hypothesized that a high BMI in young adult women was associated with high levels of television viewing and that the association between television watched and BMI was different between Whites versus Black and Hispanic young adult females. In this research study, the data was derived from The National Longitudinal Study of Adolescent Health based on children enrolled in grades 7 to 12. There were two comparative data sets: data collected in 1994 - 1995 (wave I) and data collected in 2001 - 2002 (wave III). BMI was the expected outcome that could be caused by reasons. The first one was the amount of television watched with amount of hours ranging from 0-7 hrs. /week, 8-14 hrs. /week, and more than 14 hours a week. A second independent variable that was accounted for was race/ethnicity. In regards to participants from Hispanic/Latino origin, the researchers divided those participants into subcultures based on responses when asked about their Hispanic/Latino background. These subcultures consisted of Mexican, Chicano, Puerto Rican, Cuban, Central/South American, and Other Hispanic/Latino. Levels of socioeconomic status were also examined but only from Wave I due to differences in age groups of the participants from the two time periods. Highest level of education received from the participants mother and total household income was taken from

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this data. Additional variables that may have affected being overweight were U.S. citizenship, family history of obesity, work status, and whether or not participant was a smoker. Similar to other studies, females of Hispanic descent had higher rates of BMIs compared to White females. With higher levels of BMI came an association with more time spent watching television; Also, having a parent who is obese can increase obesity risk compared to those without an obese parent. However the data found was before the researchers had applied race/ethnicity to their results. Among both Black and Hispanic subpopulations we found no association between TV viewing and BMI (Richmond, Walls, Gooding, Field, 2009). The results justify the researchers hypotheses that there is an association between television viewing and obesity level but how well these two factors are associated is different by with each different race/ethnic group. There was no association found between obesity and television viewing amongst the Hispanic participants of this study; participants from this ethnic group have not been included in studies as much as Blacks or Whites so it was noted that television viewing and BMI information is still needed for this association to be more clear. Ethnic diversity within the Hispanic culture may lead to inconsistent findings in associations between television viewing and obesity, but more participants are needed in order to come to a conclusion about this. Race/ethnicity, cultural differences, and behaviors have all been discussed that present strong evidence in what may be leading factors in causing obesity in Hispanic adolescents. In each of the research studies presented, the authors also claim that there is an association between socioeconomic status and weight. It was hypothesized that socioeconomic status was the leading factor that determined whether a person of Hispanic origin would suffer from obesity or not.

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There certainly is enough evidence to support this hypothesis, however, an article was found that may have an argument against socioeconomic status. In an article published Overweight in Latino/Hispanic Adolescents: Scope of the Problem and Nursing Implications, Susan Harrington examines the different factors that may contribute to obesity in Hispanic children; these factors include: biological contributors, socioeconomic status, acculturation, physical activity, and recreational lifestyle. Harrington explains that socioeconomic is a well-established factor in childhood obesity in Hispanics as realized in previous research studies. She discusses that Hispanic/Latino households usually are of low income status and that there are strong health outcomes related to this. Economic insecurity can influence food choices directly by encouraging the purchase of cheaper, energy-dense foods, as well as indirectly by producing stress that affects parenting (Drewnowski & Darmon, 2005, quoted by Harrington, 2008). Although socioeconomic status may have an influence on weight, Harrington argues that even if this was to be increased, that does not mean that there will be any benefits reaped from the change. It is well known that there has been much research on socioeconomic status and its association with obesity, there is not much research on how socioeconomic status affects the lifestyle behaviors of the children. Harrington states that even if income and education was equalized amongst ethnic groups, there would be no elimination of health disparities; amount of money will not help solve the obesity problem that is observed in the Hispanic/Latino culture. It is clear that there is more than one factor that is contributing to the obesity rate in the Hispanic culture. Evidence that seems to be too limited in the research discussed were factors such as levels of education received and biological factors that may contribute to a childs weight. Some of the research designs that seemed unsatisfactory were first noticed in the

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Television research study. This research study, although bringing valuable data, didnt take into account the male counterpart of the ethnic groups. It leads to the questions of: Does the evidence presented only qualify for women of different ethnicities? Also, do men and women who have the same television viewing habits as be predetermined to have the same BMI level? One of the biggest limitations was the data used as a baseline was from years prior to article and did not have all information available since it was self-reported. This may have skewed the data to one side or the other; also placing many cultures into one group could have been a limiting factor for example placing Argentineans, Colombians, and Dominican Republicans under one group. Views that need to be further tested are the effects that an individual culture of the Hispanic ethnicity has on the weight of a child. Socioeconomic status should be optimal for a study such as this to occur so that it mainly focuses on what behaviors are really attributed to the prevalence of obesity in Hispanic adolescents. Also, when given an optimal socioeconomic status, conclusive results can also derive from ideal environment placement and access to health care. If such a study can take place two things can be analyzed in depth. The identification of specific culture influences that can have an effect on a childs weight and specific behaviors that Hispanic/Latinos engage or dont engage in which can lead to further problems with weight. These results can be evaluated and health interventions may take place that will be better equipped to deal with these problems and give the families proper tools to defeat childhood obesity. It is important to learn and understand the causes for childhood obesity in all ethnic groups but more importantly in the Hispanic ethnicity due to a growing population in the United States that will soon double in the next 40 years. In conclusion, socioeconomic status is not the

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one and only determining factor that leads to childhood obesity in Hispanic adolescents. Although its effect on childhood obesity is profound, there are many other contributing factors that play a role and may also have a much greater impact. These factors include biological factors, physical activity, environment, culture, and eating habits. The literature has had two articles in which another factor, television viewing, in which it was argued whether this factor had a true impact on ethnic cultures and in extension, more than one culture within the Hispanic ethnicity. It was found that there is such an association but the level of impact of this association needs to be further studied for conclusive results. The next steps that need to be taken in order to improve the obesity problem with the Hispanic culture is to identify individually each Hispanic culture within the United States and learn the values that they have and how much understanding they have regarding nutritional meals and physical activity. Understanding each culture can lead to a successful execution of a health intervention that can lead to further development of even more successful health interventions which, ideally, can lead to the decrease of childhood obesity in Hispanic/Latinos in the United States.

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References

Bender, M. S., Nader, P. R., Kennedy, C., & Gahagan, S. (2013). A Culturally Appropriate Intervention to Improve Health Behaviors in Hispanic Mother-Child Dyads. Childhood Obesity, 157-163. Delva, J., O'Malley, P. M., & Johnston, L. D. (2007). Health-Related Behaviors and Overweight: A Study of Latino Adolescents in the United States of America. Revista Panamericana de Salud Publica, 11-20. Haboush, A., Phebus, T., Tanata Ashby, D., Zaikina-Montgomery, H., & Kindig, K. (2011). Still Unhealthy 2009: Building Community Research to Identify Risk Factors and Health Outcomes in Childhood Obesity. Journal of Community Health, 111-120. Harrington, S. (2008). Overweight in Latino/Hispanic Adolescent: Scope of the Problem and Nursing Implications. Pediatric Nursing, 389-394. Lindberg, N. M., Stevens, V. J., & Halperin, R. O. (2013). Weight-Loss Interventions for Hispanic Populations: The Role of Culture. Journal of Obesity. Myers, D. L., Romero, Z., Anzaldua, N., & Trinidad, M. L. (2011). Exercise Intervention at a Hispanic-Serving Institution. College Student Journal, 428-438. Richmond, T. L., Walls, C., Gooding, H. C., & Field, A. E. (2009). Television Viewing is not Predictive of Body Mass Index in Black and Hispanic Young Adult Females. Obesity, 1015-1020. Siegel, R., Naishadham, & Jemal, A. (2012). Cancer Statistics for Hispanics/Latinos. A Cancer Journal For Clinicians. Singh, G. K., Kogan, M. D., Van Dyck, P. C., & Siahpush, M. (2008). Racial/Ethnic, Socioeconomic, and Behavioral Determinants of Childhood and Adolescent Obesity in the United States: Analyzing Independent and Joint Associations. Annals of Epidemiology, 682-695. Ziebarth, D., Healy-Haney, N., Gnadt, B., Cronin, L., Jones, B., Jensen, E., et al. (2013). A Community-Based Family Intervention Program to Improve Obesity in Hispanic Families. Wisconsin Medical Journal, 261-266.

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Figure 1. A model of social and behavioral determinants of childhood obesity. Reprinted from Racial/Ethnic, Socioeconomic, and Behavioral Determinants of Childhood and Adolescent Obesity in the United States: Analyzing Independent and Joint Associations. Singh, G. K., Kogan, M. D., Van Dyck, P. C., & Siahpush, M. (2008).

CDC - Hispanic - Latino - Populations - Racial - Ethnic - Minorities - Minority Health. (n.d.). Centers for Disease Control and Prevention. Retrieved June 5, 2013, from http://www.cdc.gov/minorityhealth/populations About Healthy People - Healthy People 2020. (n.d.). Healthy People 2020 - Improving the Health of Americans. Retrieved June 5, 2013, from http://www.healthypeople.gov/2020/about

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