Acculturation, physical activity and television viewing in Hispanic women: findings from the 2005 California Women's Health Survey

Latinos comprise approximately 36 % of the population in California, with 77 % from Mexico or having Mexican roots(1). Although Latinos comprise the largest minority group in the USA as of 2010, this population continues to be understudied(2). On account of the higher rates of hypertension, obesity, diabetes and metabolic syndrome in Latina women, this group is at higher risk for CVD compared with non-Latino whites(3). Poverty worsens the situation, with a higher rate of overweight among those living below the poverty line compared with those living above(4). Compared with non-Hispanic whites, Latinos experience considerably higher poverty rates, are more likely to be unemployed and earn less than non-Hispanic whites(1). Physical activity is an important factor in the prevention of overweight and associated chronic disease risk and is touted as an important modifiable component of healthy living(5). Numerous studies have shown a decreased risk of health conditions such as CHD(6), diabetes(7) and osteoporosis(8) with adequate physical activity. Although the importance of physical activity has been well established, many Americans fail to achieve the recommendations, with a high prevalence of minority women reporting being physically inactive during their leisure time(5). Given that Hispanic women appear to be at higher risk for chronic diseases that may be prevented through physical activity(9), this finding has adverse implications for public health. Of note, however, the 2003–2004 National Health and Nutritional Examination Survey (NHANES), which included accelerometers as an objective measure of physical activity, revealed that Hispanic men and women perform higher amounts of total physical activity compared with their white and black counterparts. These accelerometer-driven estimates of physical activity reflect activity across all domains, such as leisure-time, occupational and domestic care activities, as well as activity during active transportation, which may account for the discordant findings among studies on physical activity levels in Hispanic women. The NHANES data also revealed that Hispanic women spent significantly more time in light-intensity physical activity compared with their white and black counterparts(10). Acculturation, an important consideration in the exploration of health behaviours, may be defined as social, psychological and behavioural changes subsequent to immigration(11). In the Latino population, a higher degree of acculturation has been associated with several behaviours that increase the risk of chronic disease, such as low intakes of fruit and vegetables and higher consumption of fats and artificial drinks containing high levels of refined sugar, as well as high levels of alcohol consumption(12). The relationship between health behaviours and other measures of migration history, such as the duration of residence (in years) in the USA, has also been explored, with similar results in some cases. Studies in the Latino population have indicated an increase in intakes of refined sugar(13), cholesterol(14) and sweetened beverages such as soda and fruit drinks(15) and a decrease in complex carbohydrate(13) intake with an increase in the duration of residence in the USA. Acculturation also plays a role in influencing the physical activity level(12). An analysis of the relationship between acculturation and level of physical activity among Latina women has been reported in eight stu-dies(16–23). Among these eight studies, four studies did not distinguish between different components of activity, such as occupational v. leisure time(17,20,21,23). Each of these studies found an increase in physical activity with increasing acculturation, with the exception of one, which found no difference in physical activity across acculturation groups(23). The remaining four studies measured different domains of activity and also revealed differing relationships with acculturation on the basis of the type of activity. Two of these studies found a negative relationship between acculturation and occupational activity(19,22); one revealed no relationship between acculturation and walking(16) and a fourth indicated a positive relationship between acculturation and leisure-time activity(18). These studies generally reveal a shift from work-related endeavours to leisure-type activities with increasing acculturation and suggest that acculturation plays a role both in physical activity volume and in specific types and domains of physical activity in which individuals participate, with an increase in activity as a result of acculturation, particularly of the leisure type. Although all except one of the studies identified found a positive relationship between acculturation and some aspect of physical activity, the way in which physical activity was measured varied considerably and often did not include different domains of activity. More research is needed to explore the effects of factors related to social class, such as acculturation, in designing interventions to increase physical activity in low-income Spanish-speaking female populations(24). Although numerous researchers have explored the relationship between acculturation and diet, as well as the use of health services and substance abuse, relatively few have focused on acculturation and physical activity(25). In addition, although several studies have focused on the relationship between acculturation and physical inactivity in adults(25,26), no studies to our knowledge have specifically explored the association between acculturation and television (TV) viewing, an important component of sedentary time. It is important to explore other measures of migration history as well, such as the duration of residence (in years) in the USA, in relation to physical activity, as measures of acculturation are often based on language use without factoring in the duration of US residence. These two indicators of acculturation may be used together to obtain a more cohesive view of the influence of acculturation on health behaviours. Use of several indicators accounts for the fact that having learnt the language spoken in a host country may not reflect the adoption of core values of the host country, and that some Latinos who have lived in the USA for a number of years may do so without significant interaction with the host culture(27). The purpose of the present study was to explore the relationship between acculturation (measured by an English language scale and duration of residence in the USA) and physical activity, as well as sedentary behaviours, among self-identified Hispanics who participated in the California Women's Health Survey (CWHS) in 2005. We hypothesized that Hispanic women with greater acculturation to US culture would perform greater levels of physical activity. Increasing physical activity is a primary focus of federal education programmes for low-income individuals, such as the Supplemental Nutrition Assistance Program-Education (SNAP-Ed, formerly known as Food Stamp Nutrition Education), the Expanded Food and Nutrition Education Program, Head Start and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)(28–30), in which Hispanics participate to a great extent. In 2008, 14.8 % of participants in SNAP-Ed and 41.2% of those enrolled in WIC in the USA were Hispanic, representing the largest racial or ethnic group in the latter(31). Characterizing the relationship between level of acculturation and physical activity, as well as sedentary behaviour, will further provide a basis for educational interventions designed to increase activity in the population. Interventions should be tailored to reflect participants' level of acculturation and the corresponding level of physical activity.