Race/Ethnicity 549from stroke, which they attribute to lower socioeconomic sta-
tus, and higher prevalence of other disabling conditions.
Major Behavioral Risk and Protective Factors
Tobacco Use. Research on self-reported nicotine depen-
dence shows that Hispanics were less likely than Caucasians
to smoke on a daily basis, to smoke at least 15 cigarettes a
day, and, among daily smokers, to smoke within 30 minutes
of awakening (Navarro, 1996). Interestingly, acculturation
appears to play an important role in the incidence of smoking
among Hispanics. Navarro (1996) also found that Hispanics
from households in which English was a second language
(less acculturated), were less likely to be daily smokers and to
smoke more than 15 cigarettes a day than those who were
acculturated (those from households in which English was
the primary language).
Diet. In relation to eating habits, Hispanics have been
found to be more likely than Caucasians to report inadequate
intake of vegetables, problems with teeth or dentures that lim-
ited the kinds and amounts of food eaten, dif“culty preparing
meals, and lack of money needed to buy food (Marshall,
1999). Hispanic women also report more nutritional risk fac-
tors than Hispanic men; however, other indicators suggest
that Hispanic men may be at higher risk of nutritional de“-
ciency (Marshall, 1999).
Physical Activity. While research clearly demonstrates
physical activity is inversely related to the development of
chronic illnesses, the data on the level of physical activity
among Hispanics is mixed. Some evidence suggests that
Hispanics are more physically active than other ethnic groups.
For example, in a telephone study of African American,
Hispanic, American Indian/Alaskan Native, and Caucasian
women age 40 and older, Hispanic women were more likely to
have high physical activity scores than the other racial/ ethnic
groups investigated (Eyler et al., 1999). However, the larger
body of evidence suggests that Hispanics do not differ from
the low levels reported in other ethnic groups. For example,
data from National Health and Nutrition Examination Survey
(NHANES) show rates of inactivity are greater for women,
older persons, non-Hispanic blacks, and Mexican Americans
(Crespo, Keteyian, Heath, & Sempos, 1996).
Sexual Behavior. There appear to be increasing trends of
HIV/AIDS among Hispanic populations. The trends seem to
be accounted for by unprotected sex, unprotected sex with in-
jected drug users, reporting heterosexual contact with an HIV-
infected partner whose risk was not speci“ed, and an increase
in the cases among foreign-born Hispanics (e.g., Diaz &
Klevens, 1997; Klevens, Diaz, Fleming, Mays, & Frey, 1999;
Neal, Fleming, Green, & Ward, 1997). Of all modes of expo-
sure to HIV, heterosexual contact has increased the most
rapidly (Neal et al., 1997). African Americans and Hispanics
account for three-fourths of all AIDS cases that could be
attributed to heterosexual contact between 1988 and 1995
(Neal et al., 1997).
Culture and acculturation appear to be important factors in
HIV/AIDS among Hispanics. There appears to be differences
in behavioral risks for HIV/AIDS among Hispanics, depend-
ing on the subgroup and cultural factors of subgroups. For
example, Diaz and Klevens (1997) found in a sample of
Latinos that Puerto Rican men were more likely to have
injected drugs than men from Central America. In contrast,
they also found that male-male sex was the most common
mode of exposure to HIV, except among Puerto Ricans.
Results from research by Hines and Caetano (1998) indicate
that less acculturated Hispanic men and women were more
likely to engage in risky sexual behavior than those who
were more acculturated.Alcohol Abuse. In general, Hispanics continue to be
more at risk than Caucasians for developing a number of
alcohol-related problems (Caetano, 1997). Prevalence rates of
past heavy drinking among Mexican American and Puerto
Rican males are approximately three times higher than rates
reported for non-Hispanic male populations (D. Lee,
Markides, & Ray, 1997). Research on trends in frequent heavy
drinking and alcohol-related problems in Hispanics shows rel-
atively stable patterns for women but increased rates for men
over the same period (Caetano & Clark, 1998). Research on al-
cohol use among Hispanics indicates that less acculturated
men drank more than those who were more acculturated, but
among women the opposite was true (Hines & Caetano, 1998).Social Support. Although low levels of social support
have been related to CVD mortality among African Americans,
little is known about the role of social support among Mexican
Americans. In the Corpus Christi Heart Project (Farmer et al.,
1996), survival following myocardial infarction was greater
for those with high or medium social support than for those
with low social support. Speci“cally for Mexican Americans,
the relative risk of mortality was 3.38 (95% Con“dence Inter-
vals (CI), 1.73...6.62)for those with low social support (Farmer
et al., 1996). Furthermore, informal social support networks,
such as extended families and civic clubs, were seen as more
helpful for African Americans and Hispanics as compared with
Caucasians in assisting cancer patients with continuing treat-
ment (Guidry, Aday, Zhang, & Winn, 1997).