Methods. Latinx parents and their 6th-8th grade children were recruited from eligible middle schools in Maricopa County to participate in a larger intervention study. A sample of parent-youth dyads from the first cohort of the larger study was selected for cross-sectional analysis of baseline data in this study (n=124). Participants completed a survey requesting demographics, family meal habits, and dietary intake. Participants were asked to report annual income, education level, and number of family meals in the home in the past week. They were also asked to complete an Acculturation Rating Scale for Mexican Americans, a 6-item Household Food Security Questionnaire, and a 26-question Dietary Screener Questionnaire. Analyses were run using Spearman’s Rank Correlation test and a Chi Square test of Independence.
Results. Mean daily youth intake of FV was 2.7 ± 1.4 cup equivalents, and daily youth intake of sugars from SSBs was 8.6 ± 4.9 teaspoon equivalents per day. Fifty percent of parents reported 7 or more family meals per week, while 38.7% reported 3-6 family meals per week and 11.3% reported 2 or fewer family meals per week. There was no significant association between family meal frequency and youth FV (r=-0.154; p=0.256) or added sugar from SSBs (r=0.027; p=0.807) intake. Similarly, results from Chi Square analyses suggested there was no association between family meal frequency and parent income level (p=0.392), Mexican-oriented acculturation level (p=0.591), Anglo-oriented acculturation level (p=0.052) and food insecurity (p=0.754). In contrast, a significant association between parent education and family meal frequency was found (p=0.014).
Conclusions. Parent education may play a role in shaping family meal practices in Latinx families. More research is needed to further understand this relationship and the relationship between family meal habits and youth dietary intake.
Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes.
Methods
Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance.
Discussion
The proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth.
Background: Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements.
Methods: The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage), having a perceived need for specialty care (i.e., second stage), and utilization of specialty care (i.e., third stage). In the sequential logit model, all stages are nested within the previous stage.
Results: Gender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62) or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20) were significant barriers to utilization of specialty care.
Conclusions: Use of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities diminish to non-significance. Findings from this study represent how Americans use the health care system and more precisely reveals the disparities and inequalities in the U.S. health care system.