Health behaviors and health status of at-risk Latino students for diabetes.
Abstract: This research study examined the behavioral lifestyle patterns and health status of at-risk Latino college students for future diabetes onset in relation to their age, gender, and acculturation status. Participants were 156 Latino (34% male and 66% female) university students who had a first and/or second degree relative afflicted with diabetes. Findings indicated that Latino students exhibit similar lifestyle patterns in terms of dietary intake, physical activity, and drinking and smoking behaviors observed in the general and college population that have been linked to obesity--a particularly problematic risk factor among those who already have a genetic predisposition for diabetes. The reported findings are of importance for the development of culturally-relevant treatment interventions targeting young Latinos in college.
Subject: Obesity (Risk factors)
Obesity (Research)
Diabetes (Risk factors)
Diabetes (Research)
Students (Behavior)
Physical fitness
Authors: Hurtado-Ortiz, Maria T.
Santos, Silvia
Reynosa, Astrid
Pub Date: 09/22/2011
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Fall, 2011 Source Volume: 26 Source Issue: 4
Topic: Event Code: 240 Marketing procedures; 310 Science & research Advertising Code: 80 Targets & Markets
Organization: Government Agency: United States. Department of Health and Human Services; United States. Centers for Disease Control and Prevention; United States. National Institutes of Health Organization: American College Health Association
Accession Number: 308741492
Full Text: Diabetes among Latinos is increasing at a disturbing rate, with 2.5 million of all Latino Americans being affected with the disease (National Diabetes Education Program, 2007). The prevalence rate of diabetes is higher for Latinos than for non-Hispanic whites (11.8 percent versus 7.1 percent, respectively; Centers for Disease Control and Prevention, 2011). Researchers report that the obesity epidemic is primarily responsible for the heightened incidence of type 2 diabetes seen in younger age groups (Anding, Suminski, & Boss, 2001; Centers for Disease Control and Prevention, 2011; Graves, 2010; Hatcher & Whittemore, 2007; Manzella, 2009; Mokdad et al., 2003). Genetic factors combined with adopting a "westernized" lifestyle are two factors believed to contribute to the obesity epidemic seen among Latinos and their increased health risk for diabetes (Mainous, Diaz, & Geesey, 2008; Morales, Lara, Kington, Valdez, & Escarce, 2002; Perez-Escamilla, 2011).

Type 2 diabetes has been reported to be especially problematic in young Latinos (e.g., Brown, Garcia, Kouzekanani, & Hanis, 2002; Centers for Disease Control and Prevention, 2011). Numerous research studies indicate that Latinos, in particular Mexican Americans, are at a disproportionately higher risk of developing Type 2 diabetes during adolescence and young adulthood (i.e., Brown et al., 2002; Centers for Disease Control and Prevention, 2011). According to the National Institutes of Health (2004), the rate of obesity among Latino youth has doubled over the past ten years with a vast number of such youth, who have a family history of diabetes, already exhibiting pre-diabetic symptoms.

Because of this increased prevalence of diabetes among young Latino adults, an examination of the lifestyle practices of those who are at a heightened risk for the disease due to family history is clearly warranted. The present study is part of a larger NIH investigation that attempts to respond to the Latino diabetic health crisis by examining the behavioral health patterns and health status of Latino college students who present a heighted risk for future onset of type 2 diabetes (i.e., have a parent, sibling, grandparent, or aunt/uncle with the disease). In line with the Healthy People 2010 initiative, the data gathered can be used to address ethnic health disparities, reduce preventable health threats, and improve the quality of long-term health (US Department of Health and Human Services, 2000).

DIABETES AND COLLEGE STUDENTS

Epidemiological health studies are reporting a dramatic increase in the incidence of Type 2 diabetes in college age individuals (Mokdad et al., 2001; Mokdad et al., 2003; Mokdad et al., 1999; Wolpert & Anderson, 2001). In addition to the obesity epidemic being one of the factors responsible for the heightened incidence of type 2 diabetes seen in younger age groups (Centers for Disease Control and Prevention, 2011; Hatcher & Whittemore, 2007), college students are believed to be at risk for type 2 diabetes because of increased alcohol use, physical inactivity, and poor dietary intake; three factors linked to the university lifestyle and culture which contribute to obesity among the young.

In terms of alcohol consumption, recent studies indicate that 59.8 percent of college students report drinking alcohol within the past 30 days, with slightly more males consuming alcohol than females (61.2 percent versus 59.1 percent; American College Health Association, 2010). Other studies have found similar findings, with more men than women reporting the use of alcohol (Brunt, Rhee, & Zhong, 2008).

Although not as many college students are smoking cigarettes as compared to using alcohol, it is still a health concern among our college population (US Department of Health and Human Services, 2000). Specifically, 12.5 percent of females and 18.9 percent of males report smoking cigarettes within the past 30 days (American College Health Association, 2010). Similar results were found in another study, with 14 percent of students being smokers (Brunt et al., 2008). However, other studies (e.g., Patterson, Lerman, Kaufmann, Neuner, & Audrain-McGovern, 2004) have reported higher smoking rates. For example, Patterson and colleagues (2004) who reviewed the findings of several large scale studies found that one third of college students report smoking in the past year. Thus, results are mixed in relation to rates of cigarette smoking; therefore, more research is necessary.

Studies conducted specifically targeting college students suggest that a substantial proportion of students lead a sedentary lifestyle (Anding et al., 2001; Behrens & Dinger, 2003; Blanchard et al., 2008; Liang, Lee, Tam, Bridges, & Keating, 2007; Suminski, Petosa, Utter, & Zhang, 2002) and show a high prevalence of unhealthy dietary practices and eating patterns (Brunt et al., 2008; Huang et al., 2003; Lowry, Galuska, Fulton, Wechsler, & Kann, 2000). Specifically, the American College Health Association (2010) found that 28.9 percent of college students engage in vigorous-intensity cardio or aerobic exercise 3-7 days for at least 20 minutes per day and only 4.8 percent of college students eat 5 or more fruits and vegetables per day. According to the most recent report by the American College Health Association (2010), 32.5 percent of college students are overweight or obese, in large part due to their unhealthy dietary and physical activity practices (Anding et al., 2001; Myers, Romero, Anzaldua, & Trinidad, 2011).

Although many research studies indicate that college students are not meeting dietary and physical activity guidelines, rates of physical inactivity tend to be higher for college females than males (American College Health Association, 2010; Huang et al., 2003; Suminski et al., 2002) and college females engage in less than healthy dietary behaviors, such as consume less fiber in their diets, than males (Huang et al., 2003). Conversely, other studies have found that there are no significant differences in physical activity between genders (Behrens & Dinger, 2003), and yet, other studies have found that the dietary intake of college males is less healthy than that of females, with college males consuming more foods high in fat (Dinger, 1999; Haberman & Luffey, 1998). Thus, results are mixed in relation to gender differences and dietary behaviors and physical activity. However, a recent report by the American College Health Association (2010) indicates that 28.9 percent of college female students are likely to be overweight or obese as compared to 39.3 percent of college male students; thus, warranting further study of college students' dietary and physical activity behaviors.

Similarly, minority college students tend to be less physically active (Crespo, Smit, Anderson, Carter-Pokras, & Ainsworth, 2000; Suminski et al., 2002) and do not engage in healthy dietary practices (DeBate, Topping, & Sargent, 2001). In general, studies (e.g., Graves, 2010; Mokdad et al., 2003) show that obesity rates are highest among African American and Latino adults as compared to white adults.

Furthermore, studies (Crespo et al., 2000; Dinger, 1999; Huang et al., 2003) indicate that physical inactivity increases with age. Specifically, Huang and colleagues (2003) found that physical activity slowed down for the older sample of college students ([greater than or equal to] 20 years versus [less than or equal to] 19 years) in their study. In addition, Huang and colleagues (2003) found no age differences in dietary habits within this college sample. Specifically, most of the college students in the study were not consuming "the recommended intake of at least 5 servings of fruits and vegetables per day or the minimum of 20 grams of dietary fiber per day" (Huang et al., 2003, p. 85). Not only do physical inactivity and poor dietary habits increase with age, but also diabetic rates increase with age (Centers for Disease Control and Prevention, 2011).

DIABETES AND LATINO COLLEGE STUDENTS.

Unfortunately, research conducted on Latinos in college demonstrates that they also exhibit lifestyle patterns that are linked to obesity and an increased risk for diabetes (Miller-Hagan & Janas, 2002; Patten, 1994; Suminski et al., 2002; Sundquist & Winkleby, 2000). Studies of college students that compared the levels of physical activity among different ethnic groups have found that ethnic minorities, among them Latinos, reported lower levels of physical activity when compared to White students (Crespo et al., 2000; Suminski et al., 2002). Furthermore, other studies indicate that Latino college students have less favorable attitudes regarding physical activity than White college students (Sherman, Ruiz, Yarbrough, Cantu, & Huff, 2000), thus possibly affecting exercise patterns. Then again, Ryan's (2005) findings "cast doubt on the hypothesis that physical activity levels might be lower for young adult Hispanics than for young adult Whites because physical fitness is less valued among Hispanics" (p. 724). He found no differences between Latinos and Whites in terms of the value placed on exercise.

In regard to dietary patterns, although Patten's (1994) study is dated, it is the most recent one that has compared the dietary habits of Latino and White students. Patten (1994) found that a considerable number of undergraduates from both ethnic groups had unhealthy dietary practices. Students' poor dietary practices (i.e., high fat, refined sugar, and carbohydrates) are of particular concern when it comes to Latino students since they are two times more likely to develop diabetes than are White students (Centers for Disease Control and Prevention, 2011).

An unfortunate aspect of the college culture is the consumption of alcohol (Miller-Hagan & Janas, 2002), which presents an additional health concern for Latino college students. Past research suggests that Latinos show a high risk for alcohol use. According to a national survey, Latino youth reported higher rates of drinking relative to White and Black students (Johnston, O'Malley, & Backman, 2000). However, a more recent national health survey (Adams & Schoenborn, 2006) found that alcohol consumption is lower among Latinos than Whites. Then again, when examining intergenerational differences, Vega, Sribney, and Achara-Abrahams (2003) found that among his Mexican-origin participants alcohol and drug abuse were highest in US-born than in immigrant males and females. Because the findings on Latino alcohol consumption are mixed and because Latino cultural patterns of consuming large amounts of alcohol during special occasions ("fiestas") combined with mainstream norms for frequent drinking ("happy hour") can be particularly problematic (Markides, Krause, & Mendes de Leon, 1998), more research on Latino alcohol consumption and its relation to intergenerational differences is essential.

Cigarette smoking is associated with using alcohol or other substances (Jackson, Colby, & Sher, 2010; Patterson, et al., 2004), making cigarette smoking another health concern for Latino college students. Patterson and colleagues (2004) found that White college students are more likely to smoke than are African American or Latino students. Others (Acevedo-Garcia, Pan, Jun, Osypuk, & Emmons, 2005) have found that smoking rates are highest among Latinos born in the United States than among foreign-born Latinos. In addition, it is important to point out that the prevalence rates of Latino college students' smoking behaviors vary across studies (Patterson et al., 2004). Regardless of the prevalence rates of smoking, findings indicate that many students want to quit smoking, many have attempted to quit smoking, and many have failed to quit smoking (Patterson et al., 2004; Van Volkom, 2008). For this reason, it is vital to understand and study the smoking behaviors of college students in order to help develop effective intervention programs.

ACCULTURATION AND DIABETES

Although we know of no studies that have examined differences in lifestyle patterns among Latino college students as a result of psychological acculturation, the literature has linked acculturation to both positive and negative health outcomes in Latinos. Less acculturation has been associated with better dietary habits and greater occupational and transportation-related physical activity among Latino American adolescents (Ham, Yore, Kruger, Moeti, & Heath, 2007; Unger et al., 2004) and adults (Hubert, Snider, & Winkleby, 2005; Mainous et al., 2008; Neuhouser, Thompson, Coronado, & Solomon, 2004), less leisure-time and household exercise (Ham et al., 2007; Mainous et al., 2008), less cigarette smoking (Acevedo-Garcia et al., 2005), and less frequency of alcohol consumption and probability of becoming a heavy drinker (Adams & Schoenborn, 2006; Epstein, Botvin, & Diaz, 2000; Morales et al., 2002; Vega et al., 2003). Likewise, the findings reported from the National Latino HANES study revealed that body mass index (BMI) was larger for second- and third-generation Mexican Americans than for first-generation Mexican Americans (Khan, Sobal, & Martorell, 1997). In another study, it was found that Latinos who have lived in the US more years have greater BMI scores (Hubert et al., 2005). Similarly, waist circumference was found to be smaller among Mexican-born men and women than among US-born English and Spanish speaking men and women (Sundquist & Winkleby, 2000). Diabetes has also been found to be more common among more Americanized Latino women than low acculturated women (Coonrod, Bay, & Balcazar, 2004). More studies are needed to understand how acculturation differences influence health promoting behaviors and risky behaviors among male and female Latino college students. To this end, descriptive analyses of gender, age, and acculturation differences in lifestyle practices and physical health status will be conducted in order to identify within group differences among Latino students.

PURPOSE OF STUDY

There is a paucity of research on diabetes in college students. The little research that has been done focuses primarily on individuals afflicted with type 1 diabetes and the difficulties such people face in maintaining good health control and in adapting to living with the disease as independent young adults (Mellinger, 2003; Miller-Hagan & Janas, 2002; Ramchandani et al, 2000; Wdowik, Kendall, & Harris, 1997; Wdowik, Kendall, Harris, & Auld, 2001). To our knowledge, no systematic studies have been conducted on the health behaviors of Latino college students who present a high-risk profile for developing type 2 diabetes. The present study will address this gap by examining the dietary, exercise, alcohol, and smoking practices of Latino college students who are at risk for type 2 diabetes.

Furthermore, a noted concern in the literature on acculturation research is that most studies examine language usage and generational status as a crude proxy variable for acculturation (Bernal, Woolley, Schensul, & Dickinson, 2000; Elder, Apodaca, Parra-Medina, & Zuniga de Nuncio, 1998). Such operational definitions are inadequate measures of acculturation or individuals' sociocultural orientation to the United States. In the process of acculturation individuals may adopt various strategies in negotiating two cultural worlds (i.e., assimilation/ US orientation, integrated/bicultural orientation, traditional/Latino orientation, and marginalization/ neither US nor Latino orientation) which contribute to large within group differences observed in this population (Unger et al., 2002). Past research has indicated that higher acculturation levels have been associated with greater knowledge of diabetes in Mexican American samples (Brown et al., 2000) and greater access to health care information and medical resources (Ortega et al., 2007; Vitullo & Taylor, 2002). Future research must incorporate valid and reliable measures of psychological acculturation if we are to fully understand the complex influences of this process on Latino individuals' health behaviors and corresponding health outcomes. The present study addresses this concern by using Unger and colleagues (2002) acculturation measure for individuals living within a multicultural society.

One other limitation is that there are few studies on within group variations. Yet, researchers have emphasized the importance of examining within group variations due to acculturation and have shown that gender and age are also likely to moderate health practices and health-related outcomes (Arcury, Skelly, Gesier, & Dougherty, 2004; Perez-Escamilla & Putnik, 2007). To our knowledge, no prior studies have been conducted on the behavioral health practices of at-risk Latino college students that considered age, gender, and acculturation differences within one study. Hence, the primary goal of this investigation was to explore differences in Latinos' behavioral health practices as a function of psychological acculturation, immigrant status, age, and gender. More specifically, the behavioral lifestyle patterns of Latino college students in terms of their eating habits, frequency of fast-food consumption, alcohol use, smoking, and physical activity were examined in relation to their overall health status--BMI and Diabetes Risk Test--and the findings cast within a socio-cultural context that considered age, gender, and acculturation as important variables.

METHODS

PARTICIPANTS

The sample consisted of 156 Latino undergraduate college students who were recruited from a state university located in Southern California. Thirty-four percent of the participants were male and 66% were female and ranged in ages from 18 to 60 years (M = 23.3 years, SD = 6.78). The gender composition of our sample mirrored the Latino students at this university. Study participants were deemed to be at-risk for future onset of type 2 diabetes because they had a blood relative currently afflicted with the disease. A large percentage reported having a parent (42.3%) with diabetes, followed by a grandparent (31.4%), a sibling (14.1%), and an aunt/uncle (12.2%). Approximately half (50.4%) of the participants self-identified as being of Mexican descent, 22.3% Latino, 21.1% Hispanic, and 6.2% Central American, with 21% stating that they were first generation in the United States and 65% indicating that they were second generation. Many worked full-time (53%) and lived with parents (57%) and reported a median family income ranging from US$25,001 to $35,000.

MEASURES

Sociodemographic and Health Profile. Participants answered a background demographic questionnaire (e.g., age, gender, ethnicity, income, generational status, etc.) and a brief health profile which allowed computation of both the BMI and NIH diabetes risk score (www.diabetes.org). The latter two measures were used as objective indicators of participants' health status.

Psychological Acculturation. The AHIMSA (Unger et al., 2002), an 8-item scale, was used as a measure of socio-cultural orientation which taps into four different acculturation styles: assimilation (United States/American orientation), separation (Latino orientation), integration/biculturalism (both American and Latino orientation), and marginalization (neither American nor Latino orientation). Sample items include "The way I do things and the way I think are from..." and "I am most comfortable being with people from..."

Physical Activity. Four items from the Youth Risk Behavior Survey (Kann et al., 2000) were used to assess levels of physical activity within the past 7 days. For example, participants were asked whether their physical activity led to breathing hard or sweating, to name a few.

Dietary Lifestyle Patterns. The nutrition subscale of the Lifestyle Assessment Questionnaire developed by the National Wellness Institute, Inc., with a total of 13 items, was used to evaluate individuals' choice of foods in terms of meeting the dietary goals stipulated by the United States Committee on Nutrition and Human Needs (Patten, 1994). The scale ranged from (1) almost never, (2) occasionally, (3) often, (4) very often, and (5) almost always.

Fast Food Consumption. Six items were used to assess participants' frequency of fast food dinning in mainstream (e.g., McDonalds), ethnic specific (e.g., Tacos), and sit-down (e.g., El Torito) establishments during the week and on weekends (Lowry et al., 2000).

Alcohol Patterns. A three-item scale was used in this study to evaluate drinking patterns in terms of quantity, frequency, and drunkenness (Epstein et al., 2000). This scale has been previously used with Hispanic samples.

Smoking. Participants were asked to report the number of cigarettes smoked in the past 7 days. In addition, they were asked to report the average number of cigarettes smoked per day.

PROCEDURE

Study participants were recruited via announcements made at ethnic clubs/organizations and classrooms, as well as flyers posted in visible areas throughout the university campus (e.g., student union, library, and health center). All participants were screened by phone to ensure that they met the criteria for inclusion in the study (i.e., had a first and/or second degree relative afflicted with type 2 diabetes). Those that qualified were scheduled for an appointment to complete a 45 minute paper and pencil health belief questionnaire and told that they would be paid US$15 for participating in the study. The researchers followed ethical guidelines stipulated by the American Psychological Association (2002) and all participants signed an informed consent, were paid for their participation, and were fully debriefed at the completion of the study. Furthermore, participants viewed a brief NIH diabetes film as part of the debriefing procedure and were given educational brochures regarding the causes of diabetes and measures that they can take to prevent or delay its onset.

RESULTS

OVERVIEW OF DATA ANALYSIS

Statistical Package for the Social Sciences (SPSS) was used to analyze the data. A series of analyses of variance and t-test procedures were conducted to examine within group differences--gender, age, and generational status--on participant's health status and the behavioral risk factors. Furthermore, a series of bivariate correlations were performed to assess the association between psychological acculturation (assimilation, integration, separation, and marginalization), health status variables, and behavioral risk factors. Finally, a multivariate regression analysis was conducted to examine the overall influence that demographic variables, psychological acculturation, and behavioral risk factors had on participants' future risk for diabetes (i.e., NIH Diabetes Risk Test Score).

ANALYSES OF HEALTH STATUS BY GENDER, AGE, AND GENERATIONAL STATUS

Results pertaining to the health status of participants--BMI and Diabetes Risk Test--were previously summarized by Santos, Hurtado-Ortiz, and Sneed (2009) and point to the following:

Based on the Diabetes Risk Test, Latinas were classified to be at higher risk for developing diabetes than were Latino men, with 28% of females classified as "high risk" compared to 20% of males. T-tests examining the diabetic risk score of males and females confirmed that females (M = 5.74) were at a higher risk for future onset of type 2 diabetes than were males (M = 4.22), t(149) = 2.32, p < .05.

Finally, analyses of variances (ANOVA) were conducted on participants' BMI and their "Diabetes Risk Test" score by three age groups (i.e., 18 to 24 years, 25 to 35 years, and 36 years and above) and by generational status (i.e., 1st, 2nd, and 3rd- plus generations). These analyses revealed no significant differences among the three age groups or by generational status of participants.

ANALYSIS OF HEALTH RISK BEHAVIORS BY GENDER

Second, t-test analyses by gender were also conducted on risky behaviors--fast food consumption, alcohol use, and smoking. No differences were observed for weekly/weekend fast food consumption which was high for both genders, with both eating out about 3 days out of the week. Males, however, reported having more sit-down meals at restaurants than females (see Table 1). In addition, male college students were drinking more alcoholic beverages and smoking than were females (see Table 1).

Finally, t-tests were used to examine the healthy habits of college students. Results indicated that females were significantly more likely to eat fresh and cooked fruits and vegetables, to include fiber, to minimize foods made with refined flour, and to minimize fat and oil intake such as margarine and animal fat in their daily diet than men (see Table 1). Although females reported better nutritional dietary patterns than their male counterparts, t-test analyses revealed that Latino males were significantly more likely to participate in 20 minutes physical activity that resulted in breathing hard and sweating and to engage in exercises that strengthened and toned muscles (see Table 1). Results also indicated that Latino college students were exercising less than 3 days out of the week.

ANALYSIS OF HEALTH RISKS BEHAVIORS BY AGE GROUPS

A series of analyses of variances (ANOVA) were conducted on the behavioral risk factors and health status variables by three age groups (i.e., 18 to 24 years, 25 to 35 years, and 36 years and above). These analyses revealed significant age differences on the overall Dietary Lifestyle questionnaire, with younger college-age participants (18 to 24 years) reporting having less healthy eating patterns when compared to the 25 to 35 year-old participants and to those who were 36 years and above (see Table 2). Analyses of variances conducted on the individual items of Dietary Lifestyle questionnaire revealed a number of significant findings with a pattern of results that mirrored, in general, those found for the overall scale. More specifically, younger college-age participants were less likely to eat breakfast as compared to students 36 years of age and older and were less likely to eat dinner as compared to students 25 to 35 years of age (see Table 2). Furthermore, when compared to students 36 years of age and older, younger college-age students reported eating less fruits and vegetables and making less of an effort to incorporate fiber in their diet or plan meals that ensured a sufficient intake of vitamins and minerals (see Table 2). Likewise, in comparison to students 25 and older groups, younger college-age students were less likely to include the four food groups in their diet or to reduce their consumption of pre-sweetened foods and add sugar to meals/beverages (see Table 2). Similarly, college-age participants made less of an effort to minimize their consumption of fats and oils or salt in their diet as compared to students who were 25 to 35 years of age (see Table 2).

In regard to eating-out, a significant difference was found for the fast food subscale, with college-age students and the 25 to 35 year-olds reporting greater weekly fast food consumption as compared to participants 36 years and older (see Table 2). Furthermore, a significant age difference was found for the low impact physical activity item, with participants 36 years and older reporting more days per week of 30 minutes of physical activity that did not lead to breathing hard or sweating (for instance walking, slow bicycling, or mopping floors) as compared to college-age students and those between 25 to 35 years of age (see Table 2).

No significant age differences were found for alcohol consumption, smoking, or the health status variables.

ANALYSES OF HEALTH RISK BEHAVIORS BY GENERATIONAL STATUS

A series of analyses of variances were conducted on risky lifestyle behaviors by generational status of Latinos as a group. No differences were observed for weekly/weekend fast food consumption which was high for 1st, 2nd, and 3rd- plus generations, with all groups eating out about 3 days out of the week. Third-plus generation Latinos, however, reported having more sit-down meals at restaurants than first or second generation Latinos (see Table 3). In addition, there were no significant generational differences in drinking and smoking.

Finally, analyses of variances were used to examine the healthy habits of Latino college students by generational status. Results indicated that third-plus generation Latinos were significantly more likely to ensure a sufficient intake of vitamins and minerals, to choose water as beverage, to reduce their consumption of presweetened foods, and to add sugar meals/ beverages than more recent generations (see Table 3). Results also indicated that third-plus generation Latinos were significantly more like to have dinner than first and second generations (see Table 3). Although third-plus generation Latinos were more likely to report partaking in some healthy dietary behaviors than earlier generations, no significant differences were found in participation of physical activity by generational status.

CORRELATION OF PSYCHOLOGICAL ACCULTURATION, BEHAVIORAL RISK FACTORS, AND HEALTH STATUS VARIABLES

A series of bivariate correlational analyses were conducted between psychological acculturation (i.e., assimilation, integration, separation, and marginalization), the behavioral risk factors (i.e., physical activity, dietary lifestyle, eating-out, alcohol use, and smoking), and the health status variables (i.e., diabetes risk test, BMI, and weight status). Although no associations were found between acculturation styles and the overall dietary lifestyle questionnaire, analyses with the individual items revealed that endorsing an assimilation orientation was positively associated with drinking enough fluids during the day (r = .165, p < .05) and planning a diet that included a sufficient intake of vitamins and minerals (r = .188, p < .05). On the other hand, an integration orientation was negatively associated with drinking enough daily fluids (r = -.185, p < .05).

Accordingly, eating-out patterns and acculturation styles were found to be associated, with participants who endorsed an assimilation orientation reporting greater fast food consumption (r = .171, p < .05) than those who were lower on this dimension. In regard to alcohol patterns, a separation orientation was positively linked to greater frequency of drunkenness (r = .131, p = .05) and quantity of alcohol consumption per occasion (r = .140, p < .05). Finally, bivariate correlations between psychological acculturation and participants' health status revealed that an assimilation orientation was positively associated with having a higher diabetes risk score (r = .156, p < .05), a higher BMI score (r = .137, p < .05), and an unhealthier weight status (r = .135, p < .05).

CORRELATIONS OF HEALTH STATUS VARIABLES WITH BEHAVIORAL RISK FACTORS

Correlational analyses performed between the health status variables (i.e., diabetes risk test, BMI, and weight status) and behavioral risk factors (i.e., dietary lifestyle, eating-out, alcohol use, and smoking) revealed a number of significant associations. Participants who scored higher on the diabetes risk test reported engaging in greater weekly fast foods consumption (r = .226, p < .05) and frequency of smoking (r = .131, p = .05) than those who scored lower on this test. Furthermore, those with higher diabetes risk levels also scored lower on healthy dietary lifestyle questionnaire (r = -.205, p < .05) and reported fewer days per week of high impact physical activity (r = - .456, p < .05), low impact weekly physical activity (r = - .205, p < .05), or participating in strengthening and toning exercises (r = -.399, p < .05). Finally, a negative correlation was found between diabetes risk score and frequency of drunkenness (r = -.137, p < .05). Furthermore, there were positive correlations between BMI score and eating out at sit-down restaurants (r = .206, p < .05) and participating in physical education classes (r = .149, p < .05).

MULTIVARIATE REGRESSION ANALYSIS

A multivariate regression analysis was conducted on the diabetes risk test using the demographic variables, behavioral risk factors, and psychological acculturation as predictor variables in the model. The overall multivariate regression model was significant [F(11, 140) = 4.491, p < .001], with the following variables emerging as significant predictors of level of risk for diabetes: eating out ([beta] = .16, p = .05), lack of exercising ([beta] = -.307, p < .001), smoking ([beta] = .15, p = .05), less drinking ([beta] = -.15, p = .067), being female ([beta] = -.17, p < .04), and having more generations in the United States ([beta] = .19, p < .03). These variables accounted for 27% of explained variance in Latino students' level of risk for future onset of diabetes (R Square = .277; R = .526), suggesting that the variables examined in this investigation are relevant indicators of health among this at-risk population.

DISCUSSION

This study sought to examine the behavioral lifestyle patterns of Latino college students in terms of their eating habits, frequency of fast-food consumption, alcohol use, smoking, and physical activity in relation to their overall health status--BMI and Diabetes Risk Test. Because few studies have considered within group variations and because gender and age have been found to moderate health practices and health-related outcomes (Arcury et al., 2004; Perez-Escamilla & Putnik, 2007), differences in Latinos' behavioral health practices as a function of psychological acculturation, generational status, age, and gender were explored in this study.

Overall, findings indicated that Latino students exhibited similar lifestyle patterns observed in the general population and among college populations that have been linked to obesity (Huang et al., 2003; Mokdad et al., 2003; Myers et al., 2011; Suminski et al., 2002). For example, Latino college students--whether male or female and whether 1st, 2nd, and 3rd- plus generational status--averaged a high level of fast food consumption during the weekdays and weekends and also averaged less than three days of physical exercise per week. Albeit reporting that they (in particular, women and 3rd- plus generations) often (i.e., approximately 50% of the time) made healthy dietary intake choices, their high rate of fast food consumption and lack of exercise undermined the potential benefits of these healthy dietary behaviors. Male students, on the other hand, reported participating more in physical activity than females. However, their healthy behaviors were undermined by their high rate of fast food consumption, drinking of alcoholic beverages, and smoking practices. These gender differences in exercise, diet, and drinking habits mirror those of other studies, with female college students displaying higher rates of physical inactivity as compared to males (Suminski et al., 2002); both male and female college students making poor dietary choices (American College Health Association, 2010; Brunt et al., 2008); and male college students consuming more alcohol than females (Brunt et al., 2008). Like other studies (e.g., Akresh, 2007), findings point to some generational differences in dietary patterns; however, fast food consumption and eating out were high for the majority of this college sample, most likely affecting their weight status. This observation was corroborated with the high BMI scores and unhealthy weight status of this entire Latino college sample, with 57.7 percent of the sample being classified as overweight and/or obese and only 38.5 percent of the sample being classified at a healthy weight.

In addition, even though no age differences were found for alcohol consumption and smoking, the dietary intake choices and exercise routines of younger college-age participants were not as healthy as those of older participants. For example, younger college-age participants were less likely to eat breakfast or dinner; to eat fruits and vegetables; to incorporate fiber into their diet; or to plan meals that afford an adequate intake of vitamins and minerals. Not only were younger college-age students "skipping" meals and avoiding healthy food choices, but they were consuming more fast food than older college-age students. Moreover, the exercise regimen of younger college-age students further illustrates their unhealthy lifestyle behaviors. Specifically, these students reported engaging in less frequency of weekly low impact physical activity, such as walking or slow bicycling than did older participants. Why do younger college-age students make these dietary and exercise choices? For many of the younger college-age students since it is their first time away from home, they may be having a difficult time managing their schedule and getting used to the overall busy lifestyle of a student; hence, opting out of exercising and choosing less healthy food alternatives (e.g., vending machine food items and fast foods) due to convenience and constraints for time (Yeh et al., 2008). For others, healthier options may not be affordable (Yeh et al., 2008). Intervention programs, targeting first-year college students, need to focus on teaching them better time management, organizational, and financial strategies that include budgeting time and money for meals and exercise.

In line with previous findings (Mainous et al., 2008; Morales et al., 2002; Perez-Escamilla, 2011), this study also found that Latino college students who adopted a more "westernized" lifestyle were more likely to include unhealthy changes to their dietary habits. For example, although Latino college students that endorsed an assimilation orientation reported drinking more fluids during the day and planning meals that contained adequate vitamins and minerals, these healthy behaviors were undermined by their great frequency of eating-out during the week and weekends.

It should also be noted that most studies on alcohol consumption focus on intergenerational differences (e.g., Vega et al., 2003). This study, on the other hand, examined psychological acculturation using the AHIMSA scale. Specifically, in this study Latino college students endorsing a separation/Latino orientation reported a greater frequency of drunkenness and more alcohol consumption per occasion. This finding points to an important within-group variation in regards to risk for drinking as a function of psychological acculturation among Latino students. Further study of Latino college students' alcohol consumption and within-group variation is necessary to confirm the results of this study and better understand the nature and scope of this problem.

Strengths of this study include within-group analyses conducted by gender, age, and psychological acculturation. In addition, this is the only study that we know that examines the health behaviors and status of Latinos who are at risk for diabetes.

Nevertheless, this study has some limitations. First, although participants were screened, it is a sample based on convenience and may not be generalizable to other Latino adults. Also, due to the number of individual t and F tests and bivariate correlations conducted in this study, there is a possible inflation of type I error. However, many of the findings in this study are in line with previous research conducted with community samples (e.g., Mainous et al., 2008; Perez-Escamilla, 2011) and college populations (American College Health Association, 2010; Brunt et al., 2008; Suminski et al., 2002) which enhance our confidence that the findings are valid. Finally, the findings of the overall multivariate regression analysis mirrored in several respects those reported for the individual item analyses. Specifically, level of risk for future diabetes onset was associated with being female, having more generations in the United States, and engaging in risky lifestyle habits (i.e., not exercising regularly, eating out frequently, and smoking).

In conclusion, the findings indicate that Latino students exhibit lifestyle patterns in terms of reported physical activity, dietary practices, and drinking behaviors that have been linked to obesity in young adults (e.g., American College Health Association, 2010; Brunt et al., 2008; Graves, 2010). This is a particularly problematic risk factor for this college sample being that they have a genetic predisposition for diabetes. Hence, in line with the Healthy People 2010 initiative, the reported findings are of importance when used for addressing ethnic health disparities by developing culturally-relevant treatment interventions targeting young Latinos in college (US Department of Health and Human Services, 2000).

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Maria T. Hurtado-Ortiz, PhD

Silvia Santos, PhD

Astrid Reynosa

Maria T. Hurtado-Ortiz, PhD, Silvia Santos, PhD, and Astrid Reynosa, are affiliated with the California State University, Dominguez Hills. Address correspondence to Maria T. Hurtado-Ortiz, PhD., Department of Psychology, California State University, Dominguez Hills, 1000 E. Victoria Street, Carson, CA 90747; Phone: 310-243-3508; Fax: 310-515-3642; Email: mhortiz@csudh.edu.
The BMI was used as an objective measure
   of whether participants were underweight,
   normal weight, overweight, or obese. The
   mean BMI score for the total sample was
   26.7 (considered overweight) with 57.7%
   of the sample classified as overweight and/
   or obese and 56.3% of Latinas and 60.3%
   of Latinos falling under this classification.
   Only 38.5% of the sample was classified to
   be at a healthy weight. The "Diabetes Risk
   Test" developed by the American Diabetes
   Association (2002; www.diabetes.org)
   which identifies individuals of being at a
   low, moderate, or high risk for diabetes was
   used to quantify a persons' level of risk. Of
   the total sample, 30.7% were "low risk,"
   44% were "low to moderate risk," and
   25.3% were "high risk." (p. 400-401)


Table 1. Mean Differences on Health Risk Behaviors by Gender

Health Variables              Gender               t test

                            Male   Female

Alcohol beverages           3.40   2.76     t(152) = -2.51, p < .05
Smoking                     0.13   0.03     t(152) = -2.48, p < .05
Sit-down meals              1.96   1.27     t(154) = -2.56, p < .05
Fruits & vegetables         3.00   3.42     t(153) = 2.22, p < .05
Fiber                       2.64   3.06     t(154) = 1.95, p < .05
Refined flour               2.49   2.83     t(153) = 1.65, p < .05
Fats & oils                 2.77   3.15     t(154) = 1.87, p < .05
Breathing hard & sweating   3.09   2.26     t(154) = -2.66, p < .05
Strengthened & toned        2.36   1.37     t(154) = -3.19, p < .05

Table 2. Mean Differences on Health
Risk Behaviors by Age Groups

Health Variable          Age Group

                      18-24     25-35
                      years     years

Dietary Lifestyle     3.00      3.33
Breakfast             2.76      3.07
Dinner                3.68      4.30
Fruits & vegetables   3.16      3.57
Fiber                 2.79      3.00
Vitamins & minerals   2.14      2.61
Four Food Groups      2.72      3.36
Sugar added           3.03      3.54
Fats & oils           2.91      3.46
Salt                  2.68      3.25
Fast food             3.56      2.79
Low impact            2.65      2.36

Health Variable       Age               F test
                      Group

                      36
                      years+

Dietary Lifestyle     3.54     F(2, 150) = 4.856, p < .05
Breakfast             3.91     F(2, 153) = 3.989, p < .05
Dinner                4.09     F(2, 154) = 4.091, p < .05
Fruits & vegetables   3.82     F(2, 154) = 3.016, p = .05
Fiber                 4.00     F(2, 155) = 4.788, p < .05
Vitamins & minerals   3.00     F(2, 155) = 3.782, p < .05
Four Food Groups      3.64     F(2, 155) = 6.231, p < .05
Sugar added           4.18     F(2, 150) = 6.146, p < .05
Fats & oils           3.00     F(2, 155) = 2.464, p = .08
Salt                  2.36     F(2, 155) = 2.897, p = .05
Fast food             2.18     F(2, 155) = 2.928, p = .05
Low impact            4.18     F(2, 155) = 3.281, p < .05

Table 3. Mean Differences on Health Risk
Behaviors by Generational Status

Health                Generational Status           F test
Variable

                      1st    2nd    3rd+

Dinner                2.73   3.68   4.45    F(2, 152) = 9.75, p < .05
Sit-down meals        1.44   1.37   2.33    F(2, 153) = 3.18, p < .05
Vitamins & minerals   2.00   2.22   3.10    F(2, 153) = 5.86, p < .05
Water                 3.19   3.62   4.00    F(2, 152) = 3.06, p = .05
Sugar added           2.88   3.18   3.81    F(2, 153) = 3.86, p < .05
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