CONCLUSION: Providing greater choices and opportunities for food and physical activity can promote healthier behaviors among adolescents, impacting upon the prevalence of obesity in this population. In particular, minority students may have different needs than others. General internists can have a large impact on adolescent obesity and the subsequent development of related diseases by working together with community leaders and other health care professionals in advocating policies to provide adolescents with these opportunities. PURPOSE: While some studies have suggested that there may be sex differences in access to cardiac procedures, others have found no evidence of`gender bias' in cardiac care. Possible explanations for these inconsistent results include the focus, in some studies, on nonrepresentative patient populations, and the occasional use of data sources that lack clinical detail. We used a clinically-detailed cardiac database to study crude and adjusted rates of cardiac revascularization for males and females in a population-based cohort of patients undergoing cardiac catheterization. METHODS: The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) is an inception cohort of all patients undergoing cardiac catheterization in the province of Alberta, Canada. We studied 21,816 patients undergoing catheterization in calendar years 1995 through 1998, and determined rates of percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG) for males and females in the year following cardiac catheterization. Cox proportional hazards models were then used in a two-step analysis to determine adjusted relative risks for revascularization and adjusted procedure rates. An initial`partial adjustment'; controlled for variables such as age and comorbidities that are routinely available in most databases, including administrative databases. A subsequent`full adjustment' additionally controlled for extent of coronary artery disease and ejection fraction, variables that are only available in detailed clinical databases. RESULTS: For the endpoint of any revascularization procedure (PCI or CABG), the unadjusted relative risk for revascularization for females relative to males was 0.67 ( 1, 1995, and December 31, 1998 . Cases were linked via postal codes to Canadian census data to determine population rates of cardiac catheterization by census-defined geographic regions. Individuals were flagged as being of aboriginal ethnicity when they resided in regions where greater than 95% of 1996 census respondents indicated that they were of aboriginal ethnicity. Such regions generally represent native reservations. Using the Alberta-wide population as a reference, we employed indirect standardization to adjust rates of cardiac catheterization to sequentially control for 1) age and sex, 2) income quintile, and 3) urban vs. rural residence. We also evaluated survival and the occurrence of revascularization procedures after catheterization (i.e., coronary artery bypass grafting [CABG] The prevalence of type II diabetes is much higher among Mexican Americans than among non-Hispanic Whites. Although much of this difference is thought to be genetic, environmental factors such as diet and exercise may also play a role. One way to try to separate genetic from environmental factors is to use acculturation data in immigrant populations. Prior studies on the effects of acculturation on the prevalence of diabetes in Mexican Americans have reported conflicting results. A study of Mexican Americans in San Antonio, Texas showed a decrease in diabetes rate with increasing acculturation. This decrease was hypothesized to be secondary to improved diet and increased levels of exercise in the more acculturated group. The Hispanic Health and Nutrition Examination Survey (HHANES) studied Mexican Americans in the Southwestern United States and found no effect of acculturation on rate of diabetes in Mexican Americans. METHODS: All patients seen in the adult clinic of a large community health center in Denver, Colorado over a fifteen month period were included in our analysis. For each patient seen, diabetes was considered present if the ICD9 code for diabetes was billed as the primary diagnosis on at least one visit during the 15 months. Level of acculturation was assessed by using language preference. Hispanic patients who spoke primarily Spanish were considered less acculturated than those who spoke English. Demographic and language preference data were obtained from registration records. RESULTS: Approximately 5,300 patients were included in our analysis. Of these, 1,500 patients were non-Hispanic, 2,600 were English-speaking Hispanics, and 1,200 were Hispanic who spoke primarily Spanish. By our current diagnostic criteria, overall diabetes prevalence was 14%. Hispanics had a higher prevalence of diabetes than non-Hispanics at all age groups and this difference was more pronounced with increasing age. In the 55 ± 64 yo age group, 31% of Hispanics vs. 20% of non-Hispanics had diabetes. There was no significant difference in diabetes prevalence between primarily Spanish-speaking and English-speaking Hispanics. CONCLUSION: We found no significant effect of acculturation on diabetes prevalence in this clinic population of Mexican Americans. Our findings also support previous reports of increased diabetes prevalence among Mexican Americans when compared to non-Hispanics, and a magnification of this effect in the higher age groups.