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University of Miami UNIVERSITY OF MIAMI ACCULTURATION AND HEALTH STATUS AMONG HISPANIC AMERICAN ELDERS By Charles Paul Buscemi A DISSERTATION Submitted to the Faculty of the University of Miami in partial fulfillment of the requirements for the degree of Doctor of Philosophy Coral Gables, Florida June 2005 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ©2005 Charles P. Buscemi All Rights Reserved Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UNIVERSITY OF MIAMI A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy ACCULTURATION AND HEALTH STATUS AMONG HISPANIC AMERICAN ELDERS Charles Paul Buscemi Approved: Christine Williams, DNSc, RN, BC Steven Ullmann, PhD Associate Professor of Nursing Dean of the Graduate School Rosemar^Hall, PhD, RN Dean and Professor of Nursing Assistant Professor of Nursing Jose/Szapocznik, PhD Processor and Director, Center of Eminent Scholar and Professor Family Studies Florida Atlantic University Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. BUSCEMI, CHARLES PAUL (Ph.D., Nursing) Acculturation and Health Status (June 2005) among Hispanic American Elders Abstract of a dissertation at the University of Miami. Dissertation supervised by Professor Christine Williams No. of pages in text (162) Hispanic Americans are at risk for health-related problems. Disparities in diseases such as diabetes and obesity, access to health services and health insurance have placed Hispanic Americans at a disadvantage. Sociocultural factors such as acculturation and its relationship to health requires further development. This study was a secondary analysis of a parent study titled Culture Bias in Testing Expressive Ability in Dementia (Tappen, Williams, Loewenstein, Rosselli, Touhy, & Morgan, 2000). The primary purpose of this dissertation was to identify the relationship between acculturation and health in Hispanic American elders. Specific aims were 1) identify the relationship between acculturation and cigarette smoking, 2) delineate the interrelationships between acculturation, medication use, and health care conditions, and 3) examine the relationship between acculturation and health status and its interrelationships with age, health care conditions, education and income. Findings from the study revealed that although no differences were evident in relationships between acculturation and some health related variables such as cigarette smoking, medication use and reported number of health care conditions, acculturation was related to self-reported health status. Participants who were more acculturated perceived their health to be better. This is an important contribution to advancing knowledge about cultural and health issues among Hispanic American elders. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Dedication To my partner Ernesto Guevara. Your love and support are what kept me going. m Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Acknowledgements I will be forever grateful to Dr. Christine Williams. Without you Dr. Williams, this dissertation would have never been completed. You have been a mentor and a role model to me and even though at times we did not see eye to eye, I always knew you were guiding down the right path. A special thank you is offered to my other committee members. To Dr. Ruth Tappen I thank you for your wisdom, guidance (and the data!). To Dr. Rosemary Hall for your expert editing techniques. Dr. Jose Szapocznik, an expert in acculturation theory, your contributions were invaluable. To Dean Nilda Peragallo, who took time from being a very busy Dean to help contribute to this future scholar. Your knowledge in Hispanic American issues was a tremendous help. Finally I would like to acknowledge my parents. My father always encouraged my to study what ever I wanted, and my mother was an example of what it meant to make it in this country. She fled communist Cuba in 1962, and despite huge obstacles was able to obtain her degree in education here in the U.S.. I will always admire her courage. iv Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS LIST OF TABLES.................................................................................... ............................... x LIST OF FIGURES................................................................................................................... xii CHAPTER I. Introduction ................................................................................................................ 1 Purpose and Aims ............................................................................................... 1 Problem .......................................................................................... :.................... 2 Significance ......................................................................................................... 6 Significance to Nursing ................................................................................ 8 II. Literature Review ..................................................................................................... 10 Introduction ......................................................................................................... 10 Development of Acculturation Theory ............................................................ 11 Evolution of Acculturation Theory ........................ 11 Acculturation & Transcultural Nursing ........................................................... 13 Acculturation & Health ...................................................................................... 17 Acculturation & Hispanic Health ..................................................................... 18 Acculturation & Confounding Variables ......................................................... 32 Education & Income .............................................................................. 32 Acculturation & Other Variables ...................................................................... 33 Health Status...................................................................................................... 34 Health & Hispanic Americans................................................ 34 Health Status Research...................................................................................... 36 Medication Use ................................................................................................... 38 v Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Age & Health Care Conditions ......................................................................... 41 Cigarette Use ....................................................................................................... 41 Summary ............................................................................................................. 43 Theoretical Framework ........................................................................................... 47 Introduction ......................................................................................................... 47 Acculturation ....................................................................................................... 48 Health Status........................................................................................................ 49 Acculturation & Health Status .......................................................................... 49 III. Methods ..................................................................................................................... 52 Research Questions ............................................................................................. 52 Hypotheses ................ 52 Description of Parent Study ............................................................................... 53 Study Design ....................................................................................................... 54 Sample.................................................................................................................. 54 Sample Size................................................................................................... 55 Measurement Methods ........................................................................................ 56 Demographic Data ......................................................................................... 57 Education & Income ..................................................................................... 57 National Origin, Years in U.S., Generation Status, Language Use and Ethnic Participation ...................................................................................... 57 Acculturation ................................................................................................. 58 Reliability .................................................................................................. 59 Validity ..................................................................................................... 59 vi Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Health Status....................................................................................................
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