Family Health in Hispanic Communities

The United States is more diverse than it has ever been. In 1960, 85.2% of the US population was white, 10.5% was African American, and 3.5% was Hispanic. By contrast, in 2015 whites consisted of 61.5% of the population, a reduction of 38%, and the racial/ethnic minority population grew immensely. African Americans consisted of 12.3% (an increase of 17%), and Hispanics consisted of 17.6% (an increase of over 500%) of the US population.1 Notably, the Hispanic population is the largest and fastest-growing minority group in the United States, and according to projections, will consist of 24% of the US population by 2065.1 Within Hispanic communities health disparities are persistent. While Hispanics have an overall lower death rates (24%) than whites, Hispanics have a 50% higher death rate from diabetes, are more likely to have poorly controlled hypertension (24% higher), are less likely to get colorectal screenings (28% lower), and experience higher rates of obesity (23% higher).2 In addition, 19% of the Hispanic population lacks health insurance, which is the second highest uninsured rate among racial and ethnic groups (American Indian/Alaskan Natives have the highest uninsured rate at 22%, compared with whites who have the lowest uninsured rate at 7%).3

Given this backdrop, we developed a request for manuscripts that focused on family-related factors that influence determinants of health among Hispanic populations. Within the Hispanic culture, the family has been noted as the primary unit for which decisions are made.4 This call led to a number of excellent manuscripts that described innovative studies, cutting across spectrums of health outcomes and behaviors. Presented in this issue are 6 diverse articles that evaluate various Hispanic and Latino populations, using quantitative and qualitative research methods.

In the first study, Frongillo and colleagues recruited and interviewed a purposive sample of 16 Hispanic families at risk of food insecurity from rural and nonrural areas. The purpose of the study was to address how concordant/discordant the knowledge and understanding of food insecurity was in the household between adults and their children. This was done by conducting separate qualitative interviews with both the children and adults living in the same household. The results were quite interesting, as adults in the families were overwhelmingly unaware of the food insecurity experienced by their children. This also highlights a greater need for public health researchers to understand how specific family members are impacted by food insecurities, since family members may be reluctant to communicate with each other honestly and openly.

In the next study, Lin and colleagues used a sample of multigenerational Mexican-heritage families (n = 497) and interviewed them based on their family's health history. Afterward, the families received a packet containing individualized feedback about their health and health risks, and families also received follow-up telephone calls from the research team. Results from the study showed that when family members are given this type of personalized feedback about their health risk, they are more likely to communicate to one another about it, and encourage one another to avert risk. This study is especially important as it again reinforces the theme of this special issue. When interventions occur within Hispanic communities, the family should play a central role in predisposing, enabling, and reinforcing healthy behaviors and lifestyles.

While having close family ties is traditionally viewed as a positive asset, the next study sought to develop a measure of family obligation stress, which represents the stress individuals can feel from putting their family's needs above their own. Molina and colleagues recruited Latinas (n = 539) from clinics to promote mammography, and used qualitative and quantitative methods to develop and validate this new construct. While more work is needed to cross-validate this scale in other populations, we believe this is an excellent start to developing a tool that will be useful in future research.

Lora and colleagues examined the home food environment (home availability of fruits and vegetables and maternal feeding practices) and how they are related to children's total fruit and vegetable intake. While most research has focused on white families with children older than 5 years, Lora and colleagues contribute to the literature by focusing on Hispanic families with preschool-aged children. In addition, most research measures dietary intake by combining fruits and vegetables. This study is different because it examines consumption of fruits and vegetables separately. A convenience sample of 238 low-income Hispanic mothers was administered a survey where questions were read out loud and responses were recorded. Findings indicate that total fruit availability and maternal food modeling were related to preschool children consuming more than 1 cup of fruit a day. On the other hand, maternal pressure and female child gender were related to greater than 1 cup of vegetables a day. Thus, characteristics of the home food environment create disparities in fruit and vegetable consumption among Hispanic preschool children. This study provides a foundation for future studies that focus on the home environment and Hispanic preschool children's dietary intake.

Letiecq and colleagues focus on a highly relevant topic-the mental health of undocumented Central American mothers who are raising children in the United States. Grounded in ecosystemic framework, the authors consider macrolevel structural and familial stressors, parental stressors, and mental health indicators that could potential contribute to maternal depression. Using community-based participatory research (CBPR) methods, an interview-assisted survey was constructed and conducted on 134 undocumented immigrant mothers of children. Mothers' perception of child affect, food insecurity, and mental health indicators were the most salient correlates. Consistent with CBPR, the authors concluded by describing several action steps they have engaged in that have been particularly important, as anti-immigrant hostilities have escalated. This included several examples of assisting their community partners, such as Know Your Rights training, engaging in advocacy, and disseminating study findings.

Also focusing on immigrant health disparities, Brewer and colleagues uniquely concentrate on how dimensions of the food landscape at the county level could be contributing to higher rates of food insecurity among foreign-born Mexican and foreign-born non-Mexican Hispanic households compared with US-born Hispanic households. Drawing from an ecosocial perspective on health disparities and prior research on food hardship, the authors use the Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011, along with the 3 sources of contextual data-data from the US Department of Housing and Urban Development, US Census 2000 and American Community Survey, and Map the Meal Gap to examine how county-level characteristics contribute to disparities in household food insecurity. Using random-intercept multilevel logistic regression models and a sample of 2700 households, county-level characteristics did not eliminate food insecurity experiences among Hispanic immigrant households. While growth in noncitizen population does contribute to a higher probability of food insecurity experiences among foreign-born non-Mexican Hispanic households and US-born Hispanic households, foreign-born Mexican households experience high levels of food insecurity regardless of the fluctuations in the noncitizen population. In line with the theme of the volume, authors describe how the findings have implications for Hispanic families and at-risk communities.

In conclusion, we believe you will find the articles in this special issue reflect advancements and innovations in the field of family Hispanic health.

-Paul Branscum, PhD, RD

Department of Kinesiology and Health, Miami University

Oxford, Ohio

-Daphne C. Hernandez, PhD, MSEd

Department of Health and Human Performance, University of Houston

Houston, Texas

REFERENCES