Skip to main content
SpringerLink
Log in

Association of Acculturation and Health Literacy with Prevalent Dysglycemia and Diabetes Control Among Latinos in the Boston Area Community Health (BACH) Survey

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

This study assessed the effect of acculturation on type 2 diabetes and whether health literacy may mediate this association. The Boston Area Community Health cohort is a multi-stage stratified random sample of adults from Boston including 744 Latinos. We defined dysglycemia as a HbA1c ≥5.7 %. Multivariable analyses examined the associations between acculturation and health literacy adjusting for demographic and clinical variables. Similar analyses were performed among participants with HbA1c ≥7.0 % to assess the association between acculturation and diabetes control. Among an insured primarily foreign born Spanish speaking Latino population, with a long residence period in the US and good healthcare utilization, higher levels of acculturation were not associated with dysglycemia. Lower levels of acculturation were associated with worse diabetes control. Health literacy level did not modify these associations. Elucidating the components of heterogeneity among Latinos will be essential for understanding the influence of acculturation on diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Diabetes Association. Standards of medical care in diabetes–2014. Diabetes Care. 2014;37(Suppl. 1):S14–80.

    Article  Google Scholar 

  2. Levitzky YS, Pencina MJ, D’Agostino RB, et al. Impact of impaired fasting glucose on cardiovascular disease: the Framingham Heart Study. J Am Coll Cardiol. 2008;51:254–70.

    Article  Google Scholar 

  3. Gregg EW, Cadwell BL, Cheng YJ, et al. Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the US. Diabetes Care. 2004;27:2806–12.

    Article  PubMed  Google Scholar 

  4. Cowie CC, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988–1994 and 2005–2006. Diabetes Care. 2009;32:287–94.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cowie CC, Rust KF, Byrd-Holt DD, et al. Prevalence of diabetes and high risk for diabetes using hemoglobin A1C criteria in the U.S. population in 1988–2006. Diabetes Care. 2010;22:562–8.

    Article  Google Scholar 

  6. Boltri JM, Okosun IS, Davis-Smith M, Vogel RL. Hemoglobin A1c levels in diagnosed and undiagnosed black, Hispanic, and white persons with diabetes: results from NHANES 1999–2000. Ethn Dis. 2005;15:562–7.

    PubMed  Google Scholar 

  7. Gonzalez LS, Berry DC, Davison JA. Diabetes self-management education interventions and glycemic control among hispanics: a literature review. Hisp Health Care Int. 2013;11(4):157–66. doi:10.1891/1540-4153.11.4.157.

    Article  PubMed  Google Scholar 

  8. Lara M, Gamboa C, Kahramanian MI, Morales LS, Bautista DE. Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context. Annu Rev Public Health. 2005;26:367–97.

    Article  PubMed  Google Scholar 

  9. Zambrana RE, Carter-Pokras O. Role of acculturation research in advancing science and practice in reducing health care disparities among Latinos. Am J Public Health. 2010;100:18–23.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Thomson MD, Hoffman-Goetz L. Defining and measuring acculturation: a systematic review of public health studies with Hispanic populations in the United States. Soc Sci Med. 2009;69:983–91.

    Article  PubMed  Google Scholar 

  11. Daviglus ML, Talavera GA, Avilés-Santa ML, et al. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA. 2012;308:1775–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Ayala GX, Baquero B, Klinger S. A systematic review of the relationship between acculturation and diet among Latinos in the United States: implications for future research. J Am Diet Assoc. 2008;108:1330–44.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nielsen-Bohlman L, Panzer AM, Kindig DA. Health literacy: a prescription to end confusion. Washington, DC: The National Academies Press; 2004.

    Google Scholar 

  14. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97–107.

    Article  PubMed  Google Scholar 

  15. Getaneh A, Light LS, Brillon DJ. Diabetes control among Hispanics in the action to control cardiovascular risk in diabetes trial. J Gen Intern Med. 2012;27:1499–505.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fransen MP, Beune EJ, Baim-Lance AM, Bruessing RC, Essink-Bot ML. Diabetes self-management support for patients with low health literacy: perceptions of patients and providers. J Diabetes. 2014. doi:10.1111/1753-0407.12191.

    PubMed  Google Scholar 

  17. McKinlay JB, Link CL. Measuring the urologic iceberg: Design and implementation of the Boston area community health (BACH) survey. Eur Urol. 2007;52:389–96.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Piccolo RS, Araujo AB, Pearce N, McKinlay JB. Cohort profile: the Boston area community health (BACH) survey. Int J Epidemiol. 2012;43:42–51.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Marin G, Gamba RJ. A new measurement of acculturation for Hispanics: the bidimensional acculturation scale for Hispanics (BAS). Hisp J Behav Sci. 1996;18:297–316.

    Article  Google Scholar 

  20. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study Group. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med. 2011;364:818–28.

    Article  Google Scholar 

  21. Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38:33–42.

    Article  CAS  PubMed  Google Scholar 

  22. Nurss JR, Parker RM, Williams MV, Baker DW. Test of functional health literacy in adults. 2nd ed. Snow Camp, NC: Peppercorn Books & Press; 2001.

    Google Scholar 

  23. McKinlay S, Kipp D, Johnson P, Downey K, Carelton R. A field approach for obtaining physiological measures in surveys of general populations: response rates, reliability and costs. In: Health Survey Research Methods: proceedings of the fourth conference on Health Survey Research Methods, Washington DC, 1982. Washington, DC: DHHS Pub. No. (PHS) 84-3346, 1984. pp. 195–204.

  24. Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987.

    Book  Google Scholar 

  25. Little R, Rubin DB. Statistical analysis with missing data. New York: Wiley; 2002.

    Book  Google Scholar 

  26. Schafer J. Analysis of incomplete multivariate data. New York: Chapman and Hall; 1997.

    Book  Google Scholar 

  27. van Buuren S, Groothuis-Oudshoorn K. mice: Mutlivariate imputation by chained equations in R. J Stat Softw. 2011;45:1–67.

    Article  Google Scholar 

  28. Golden SH, Brown A, Cauley JA, et al. Health disparities in endocrine disorders: biological, clinical, and nonclinical factors—an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2012;97:E1579–639.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Meigs JB, Wilson PW, Nathan DM, D’Agostino RB Sr, Williams K, Haffner SM. Prevalence and characteristics of the metabolic syndrome in the San Antonio Heart and Framingham Offspring Studies. Diabetes. 2003;52(8):2160–7.

    Article  CAS  PubMed  Google Scholar 

  30. Kandula NR, Diez-Roux AV, Chan C, et al. Association of acculturation levels and prevalence of diabetes in the multi-ethnic study of atherosclerosis (MESA). Diabetes Care. 2008;31:1621–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hazuda HP, Haffner SM, Stern MP, Eifler CW. Effects of acculturation and socioeconomic status on obesity and diabetes in Mexican Americans. The San Antonio Heart Study. Am J Epidemiol. 1988;128:1289–301.

    CAS  PubMed  Google Scholar 

  32. Sundquist J, Winkleby MA. Cardiovascular risk factors in Mexican American adults: a transcultural analysis of NHANES III, 1988–1994. Am J Public Health. 1999;89:723–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Oza-Frank R, Stephenson R, Narayan KM. Diabetes prevalence by length of residence among US immigrants. J Immigr Minor Health. 2011;13:1–8.

    Article  PubMed  Google Scholar 

  34. Colón-López V, Haan MN, Aiello AE, Ghosh D. The effect of age at migration on cardiovascular mortality among elderly Mexican immigrants. Ann Epidemiol. 2009;19:8–14.

    Article  PubMed  Google Scholar 

  35. Schwartz SJ, Pantin H, Sullivan S, Prado G, Szapocznik J. Nativity and years in the receiving culture as markers of acculturation in ethnic enclaves. J Cross Cult Psychol. 2006;37:345–53.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31(Suppl. 1):S19–26.

    Article  PubMed  Google Scholar 

  37. Fransen MP, von Wagner C, Essink-Bot ML. Diabetes self-management in patients with low health literacy: ordering findings from literature in a health literacy framework. Patient Educ Couns. 2012;88:44–53.

    Article  PubMed  Google Scholar 

  38. Al Sayah F, Majumdar SR, Williams B, Robertson S, Johnson JA. Health literacy and health outcomes in diabetes: a systematic review. J Gen Intern Med. 2013;28:444–52.

    Article  PubMed  Google Scholar 

  39. Borrell LN, Crawford ND, Dallo FJ, Baquero MC. Self-reported diabetes in Hispanic subgroup, non-Hispanic black, and non-Hispanic white populations: National Health Interview Survey, 1997–2005. Public Health Rep. 2009;124:702–10.

    PubMed  PubMed Central  Google Scholar 

  40. Pabon-Nau LP, Cohen A, Meigs JB, Grant RW. Hypertension and diabetes prevalence among US Hispanics by country of origin: the National Health Interview Survey 2000–2005. J Gen Intern Med. 2010;25:847–52.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

Dr. Lenny López acknowledges the support of the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program and NIDDK 1K23DK098280-01. This funding body was not involved in the design, data collection, analysis, interpretation nor the preparation of the manuscript. Also supported by NIDDK R01 DK080786: Upstream Contributors to Downstream Disparities in Type 2 Diabetes, and NIDDK K24 DK 080140 (J.B. Meigs).

Authors’ Contributions

L.L. and J.B.M. conceived the study, guided the analyses, wrote and edited the manuscript. R.P. did the analyses. All authors reviewed and edited the manuscript.

Author information

Authors and Affiliations

  1. Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA

    Lenny López

  2. Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA

    James B. Meigs

  3. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Richard W. Grant

  4. New England Research Institutes, Boston, MA, USA

    Lisa Marceau, Rebecca Piccolo & John B. McKinlay

Authors
  1. Lenny López
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard W. Grant
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa Marceau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rebecca Piccolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John B. McKinlay
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James B. Meigs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lenny López.

Ethics declarations

Conflict of interest

The authors have no relevant conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

López, L., Grant, R.W., Marceau, L. et al. Association of Acculturation and Health Literacy with Prevalent Dysglycemia and Diabetes Control Among Latinos in the Boston Area Community Health (BACH) Survey. J Immigrant Minority Health 18, 1266–1273 (2016). https://doi.org/10.1007/s10903-016-0362-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-016-0362-x

Keywords

Search

Navigation