Original Article

Cardiovascular Disease Risk Factors in Hispanic Adolescents in South Texas

Authors: Sharon P. Cooper, PhD, Eva M. Shipp, PhD, Deborah J. del Junco, PhD, Charles J. Cooper, MS, Leonelo E. Bautista, MD, DrPH, Jeffrey Levin, MD, MS

Abstract

Objectives: Despite a national crisis of increased prevalence of obesity and type 2 diabetes mellitus in adolescents, especially among Hispanics, there is a paucity of data on health indicators among farmworker adolescents and their peers. The main aim of this study was to estimate the prevalence of cardiovascular disease risk factors in a population of Hispanic adolescent students in south Texas. The study also aimed to compare the prevalence of these risk factors between students enrolled in the Migrant Education Program (MEP) and other students, and between boys and girls.

Methods: In partnership with the Weslaco (Texas) Independent School District and the Migrant Education Department, a cohort study was conducted from 2007 to 2010 to estimate the prevalence of overall obesity (body mass index ≥85th percentile for age and sex), abdominal obesity (waist circumference ≥75th percentile for age, sex, and ethnicity), acanthosis nigricans (AN), and high blood pressure (HBP; ≥90th percentile for age, height, and sex or systolic/diastolic BP ≥120/80 mm Hg) among MEP students compared with other students from two south Texas high schools. Multilevel logistic regression was used to assess the relation between sex and our main outcomes of interest while accounting for within-school nesting of participants.

Results: Among 628 sampled students, 508 (80.9%) completed the consent procedure and participated in the study. Of these, 257 were MEP students and 251 were non-MEP peers. Approximately 96.7% of participants were Hispanic and 50.0% were boys. Analyses of data across the years comparing MEP students and non-MEP students show an average prevalence of 44.8% versus 47.7% for overall obesity, 43.2% versus 43.7% for abdominal obesity, 24.7% versus 24.7% for AN, and 29.2% versus 32.8% for HBP. Across recruitment and follow-up years, the prevalence of overall obesity, abdominal obesity, and HBP was 1.3 to 1.5, 1.2 to 1.8, and 2.9 to 4.6 times higher in boys than in girls, respectively. In contrast, the prevalence of AN varied little by sex.

Conclusions: The high prevalence of cardiovascular risk factors in both groups suggests a compelling need for comprehensive, culturally targeted interventions to prevent future cardiovascular diseases in these high-risk Hispanic adolescents, especially among boys. There were not, however, substantial differences between MEP students and other students. These findings also support the feasibility of conducting future epidemiologic studies among adolescent farmworkers and their families, as well as culturally appropriate school or community-based interventions.

 

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References

1. Villarejo D. Health-related inequities among hired farm workers and the resurgence of labor-intensive agriculture. http://kresge.org/library/health-related-inequities-among-hired-farm-workers-and-resurgence-labor-intensive-0. Published 2012. Accessed July 24, 2015.
 
2. Farmworker Justice. Selected statistics on farmworkers. http://www.farmworkerjustice.org/sites/default/files/NAWS%20data%20factsht%201-13-15FINAL.pdf. Accessed July 21, 2015.
 
3. US Department of Education, Office of the Under Secretary. The same high standards for migrant students: holding Title 1 schools accountable. Volume II: measurement of migrant student educational achievement: final report. http://www.ed.gov/offices/OUS/PES/esed/title1-accountable/vol-ii.pdf. Published 2002. Accessed July 24, 2015.
 
4. Villarejo D. The health of U.S. hired farm workers. Annu Rev Public Health 2003;24:175-193.
 
5. Borre K, Ertle L, Graff M. Working to eat: vulnerability, food insecurity, and obesity among migrant and seasonal farmworker families. Am J Ind Med 2010;53:443-462.
 
6. Kilanowski JF, Moore LC. Food security and dietary intake in midwest migrant farmworker children. J Pediatr Nurs 2010;25:360-366.
 
7. Schlesselman JJ. Sample size requirements in cohort and case-control studies of disease. Am J Epidemiol 1974;99:381-384.
 
8. Texas Education Agency. Education of migratory children. http://www.tea.state.tx.us/index4.aspx?id=4863&menu_id=798. Published 2012. Accessed August 18, 2013.
 
9. Barlow SE, Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(Suppl 4):S164-S192.
 
10. Fernandez JR, Redden DT, Pietrobelli A, et al. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 2004;145:439-444.
 
11. King-Tryce K, Garza L, Ozias JM. Acanthosis nigricans and insulin resistance. Dis Prev News 2002;62:1-4.
 
12. University of Texas-Pan Am Border Health Office. The Texas Risk Assessment for Type 2 Diabetes in Children program: A Report to the Governor and the 82nd Legislature of the State of Texas. https://rfes.utpa.edu/resources/TRAT2DC_Legislative_Report_2011.pdf. Published 2011. Accessed August 19, 2015.
 
13. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(2 Suppl 4th Report):555-576.
 
14. Otto DE, Wang X, Tijerina SL, et al. A comparison of blood pressure, body mass index, and acanthosis nigricans in school-age children. J Sch Nurs 2010;26:223-229.
 
15. Urrutia-Rojas X, Egbuchunam CU, Bae S, et al. High blood pressure in school children: prevalence and risk factors. BMC Pediatr 2006;6:32. .
 
16. Shay CM, Ning H, Daniels SR, et al. Status of cardiovascular health in US adolescents: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2005Y2010. Circulation 2013;127:1369-1376.
 
17. Rosner B, Cook NR, Daniels S, et al. Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988-2008. Hypertension 2013;62:247-254.
 
18. Ogden CL, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999Y2010. JAMA 2012;307:483-490.
 
19. Cote AT, Phillips AA, Harris KC, et al. Obesity and arterial stiffness in children: systematic review and meta-analysis. Arterioscler Thromb Vasc Biol 2015;35:1038-1044.
 
20. American Medical Association. Obesity as a disease. http://www.ama-assn.org/ama/pub/news/news/2013/2013-06-18-new-ama-policies-annual-meeting.page. Published 2013. Accessed July 24, 2015.
 
21. Din-Dzietham R, Liu Y, Bielo MV, et al. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation 2007;116:1488-1496.
 
22. Freedman DS, Goodman A, Contreras OA, et al. Secular trends in BMI and blood pressure among children and adolescents: the Bogalusa Heart Study. Pediatrics 2012;130:e159-e166.
 
23. Centers for Disease Control and Prevention. National diabetes fact sheet. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Published 2011. Accessed July 24, 2015.
 
24. American Diabetes Association. Standards of medical care in diabetes (position statement). Diabetes Care 2006;29(Suppl 1):S4-S42.
 
25. Abraham C, Rozmus CL. Is acanthosis nigricans a reliable indicator for risk of type 2 diabetes in obese children and adolescents? A systematic review. J Sch Nurs 2012;28:195-205.
 
26. Harrell JS, Jessup A, Greene N. Changing our future: obesity and the metabolic syndrome in children and adolescents. J Cardiovasc Nurs 2006;21:322-330.
 
27. Moyer VA, US Preventive Services Task Force. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013;159:613-619.
 
28. US Preventive Services Task Force. Blood pressure in children and adolescents (hypertension): screening. http://www.uspreventiveservicestaskforce.org/uspstf/uspshypechld.htm. Accessed August 19, 2015.