Date of Award

2011

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

Abstract

Background: Cardiovascular disease (CVD) is the number one cause of death in the United States and affects persons of all races and ethnicities. The number of persons of Mexican ethnicity has increased significantly in the United States, notably in the community of Berwyn, a suburb of Chicago, IL where according to the U.S. 2010 census 60% of the community is now of Mexican descent. The factors that contribute to CVD risk in persons of Mexican decent within this community must be understood before culturally appropriate risk reduction strategies are designed and implemented.

Purpose: The purpose of this community-based study is to gain a better understanding of selected social and physical health determinants and risk factors which may contribute to cardiovascular disease in people of Mexican descent in the community of Berwyn.

Methods: The Healthy People 2010 model for assessing a community's health status guided this study. Multiple methods were used to characterize the prevalence of CVD risk factors among a community sample of Berwyn residents of Mexican descent. The impact of the selected social health determinants include language barriers, access to care, cultural behaviors, awareness of CVD and socioeconomic status and physical health determinants such as availability of parks and play lots, grocery stores and environmental pollution. Sources of data included: (1) community health screenings of 106 participants of Mexican descent who were assessed for blood pressure, total cholesterol, glucose, height, weight, body mass index, and age, (2) fifteen guided interviews of community key informants, (3) survey of participants in community/church-based CVD risk screenings, and (4) searches of publicly accessible internet databases related to the social and physical health determinants for this community.

Data Analysis: Guided interviews were analyzed using standard qualitative procedures.

STATA/MP version 1.1 was used for descriptive statistical analyses of the survey data and to determine proportions of individuals with abnormal risk values using accepted guidelines for cut-offs. The ARC geographic information system was used to plot locations of parks and stores within the community.

Results: Risk prevalence data gleaned from interviews, in combination with quantitative results, revealed a triad of risk factors in this population. The most common risk factors among the 106 who participated in screenings were high body mass index (45% of the sample as overweight and additional 38% as obese), 52% with low HDL, 44% with elevated glucose, 35% with pre-hypertension; 33% with elevated total cholesterol. Reports from informants suggested that atherogenic diets and lack of physical activity among community members are common. However, key informant and individual community member interviews suggested that CVD does not rank as one of the top overall concerns for this Mexican population. Key informants also believed that lack of access to preventive health care is a common concern, with economic factors creating the greatest barrier to access to health care. The physical health determinants examined revealed that there is availability of stores which sell produce, parks are plentiful and there is an infrastructure to support those parks. However, accessibility to the parks and the quality and size of the parks was variable. Public transportation appeared adequate.

Conclusions: Further in-depth research on each social and physical health determinant and risk factor is necessary to more completely understand CV health and risk in this community. However, this study did provide a snapshot and a starting point for targeted future work. While risk factor prevalence may vary somewhat between geographic location, race and ethnicity in the United States, any variance may not be significant enough to generate targeted interventions. Instead, it may be that social and physical health determinants should be the target for future risk reduction efforts.

Implications for Nursing Practice: Nursing care involves looking at the global picture of health, not only at the individual level, but also at the community level. Nurses are well-suited to study the factors that both contribute to health or increase risk, and ultimately provide strategies for prevention of CVD. The results of this study combined the scientific exploration of cardiovascular health/risk with the philosophical application of community stewardship, which is uniquely nursing based. As the population of people of Mexican descent grows in Berwyn and around the U.S., it is important that nurses be at the forefront to gain a better understanding of the risk factors and health determinants (both social and physical) that may influence cardiovascular health and risk in people of Mexican descent.

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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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