At Risk: Latino Children's Wellness

At Risk: Latino Children’s Health is funded by grants from the California Endowment, the Marguerite Casey Foundation, the Houston Arts Alliance through the City of Houston, the W.K. Kellogg Foundation, the Simmons Foundation and the Texas Commission on the Arts. We are grateful for their support.

Recovering the past, creating the future

Arte Público Press

University of Houston

452 Cullen Performance Hall

Houston, Texas 77204-2004

Cover design and cover photo by Pilar Espino

At Risk: Latino Children’s Health / edited by Rafael Pérez-Escamilla and Hugo Melgar-Quiñonez.

p. cm.

Includes bibliographical references.

ISBN: 978-1-55885-708-7 (alk. paper)

1. Children—Health and hygiene—United States. 2. Hispanic Americans—Social conditions. 3. Hispanic Americans—Economic conditions. I. Pérez-Escamilla, Rafael. II. Melgar-Quiñonez, Hugo.

[DNLM: 1. Child Welfare—United States. 2. Health Policy—United States. 3. Hispanic Americans—United States. 4. Socioeconomic Factors—United States. WA 320]

RJ102.A87 2011

362.198'920089968—dc23

2011025376

CIP

The paper used in this publication meets the requirements of the American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI Z39.48-1984.

© 2011 by Arte Público Press

Printed in the United States of America

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To Sofia, Alejandro and Rafaelito. In memory of my father, Ricardo Pérez Escamilla.

—RPE

To the ones who preceded us in the search for a better and more dignified life.

—HMQ

INTRODUCTION

LATINO CHILDREN SOCIOECONOMIC, DEMOGRAPHIC AND HEALTH PROFILE

Rafael Pérez-Escamilla¹ and Hugo Melgar-Quiñonez²

Introduction³

Latinos will continue to account for over half of the population growth in the USA in the decades to come. Thus, the future of the country is very much tied to the health and wellbeing of Latino children. Overall Latinos in the United States confront higher rates of poverty, as well as lower levels of school education and English proficiency, and less access to the nation’s health care services, which is highly determined by the financial resources available to the families, and policies affecting millions of Latino immigrants and migrant farm workers. Thus, social and environmental factors strongly influence the health status of Latino children in the United States. These factors also help explain the fact that millions of Latinos in the United States lack access to enough nutritionally adequate foods for a healthy and active life. Almost 27% of Latino households faced food insecurity in 2009, compared to a national rate of 14.7%. About 75% of Mexican-American adults are overweight or obese and over 20% of the children have a Body Mass Index above the 95-percentile for age and gender. Disparities in risk factors for subsequent obesity among Latinos can be detected since infancy. While Latinos have a higher rate of breastfeeding than the general population, supplementation with infant formula starting very early on after birth is also higher when compared to other ethnic groups. Suboptimal dietary and lifestyle behaviors increase the risk of obesity and the development of chronic diseases among Latino children and youth. The rate of diabetes in Latino adults is 50% higher than among the general population. If the current trends in obesity persist half of the Latino children in the United States will develop type 2 diabetes during their lifetime. In addition to obesity and chronic diseases, Latino children are more likely than their white counterparts to grow up in environments strongly affected by violence and opportunities for abusing addictive substances, both of which have negative consequences on their psychosocial and emotional development, as well as their mental health.

At Risk: Latino Children’s Health examines key maternal, child and youth issues that affect the wellbeing of our very diverse Latino communities. In Chapter One, Flores et al. analyze key Latino childhood health issues, including childhood obesity, within the context of a socio-ecological framework perspective. A framework that strongly acknowledges the major influence that the physical and psychosocial environments where Latino children are born and grow have on their lifestyles including dietary and physical activity habits. Segura-Pérez et al. in Chapter Two review the evidence behind the effectiveness of community health workers (CHW) or promotores de salud at improving the health of Latino children. Their chapter first covers prenatal care, a key issue for addressing the childhood obesity epidemic as there is strong evidence suggesting that the intrauterine environment the fetus is exposed to influences the risk of childhood obesity and the development of chronic diseases later on in life. They also address CHW-led programs for dealing with childhood asthma, immunizations and youth sex education. Infant feeding practices are important determinants of maternal and child health and also influence childhood obesity risk. In Chapter Three, Chapman and Zubieta address the factors that influence breastfeeding and complementary feeding choices among Latino infants. They also review optimal infant feeding promotion approaches, including breastfeeding peer counseling models that are likely to help improve infant feeding behaviors. Olvera, George and Kaiser in Chapter Four present a critical review of the evidence on the influence of parental feeding styles on eating behaviors of children. Because food preferences get established very early on in life, this area of inquiry is crucial for understanding how to protect young Latino children against the risk of obesity and how to maximize their health through fostering optimal caregiver-child feeding interactions. Nutrition is essential not only for physical health but also for attaining adequate academic achievement. Children receive a substantial amount of their nutrition at school, ideal setting for also exposing children to sound nutrition education. Thus, the review by Woodward Lopez and Gosliner in Chapter Five on school feeding programs and how they affect the health and wellbeing of Latino children is very timely. Food insecurity is prevalent in Latino households. This is unfortunate as household food insecurity has consistently been identified as a major nutritional and psycho-emotional stressor. Television viewing has consistently been identified as a risk factor for childhood obesity. In Chapter Six, Mendoza and Barroso examine the evidence for an association between television viewing and physical inactivity, and provide best practice examples of community-based approaches that can be used to both reduce television viewing time and increase physical activity levels of Latino children. Melgar-Quiñonez and Pérez-Escamilla in Chapter Seven review the evidence of an association between food insecurity and the physical and psycho-emotional development of Latino children. They discuss the impact of food insecurity as multifold since this phenomenon not only affects the quantity of the food available but also the quality of the foods families consume.

Accidents and violence are the major cause of premature death among young Latinos. Thus, in Chapter Eight, Vaca and Anderson review recent epidemiological trends regarding violence-related injuries and motor vehicle accidents among Latino youth and propose ways to address them, including ways to curve alcohol consumption. Castro et al. in Chapter Nine also address the major concern on substance abuse among Latino youth. They present results from a recent innovative study that conducted an in-depth examination of the relationship between parental acculturation trajectories and substance abuse (alcohol, tobacco, marijuana) among Latino adolescents. At Risk concludes in Chapter Ten with a health economics analysis by Treviño of type 2 diabetes and ways to prevent or address this major public health epidemic that disproportionately affects Latinos through lifestyle modification approaches including diet and physical activity. As illustrated in this chapter, the risk for type 2 diabetes starts to develop very early on in life and obesity is a major risk factor for this condition. Thus, cost-effective approaches to curve this epidemic need to start since gestation and need to be based on the socio-ecological framework emphasized throughout this book.

Our intention in this book is not only to discuss the existence of major challenge and problems but also to provide examples and suggestions with each chapter as to which policies and programmatic approaches may be relevant for improving the health and wellness of Latino children. Although At Risk does not include a specific chapter on health care access we fully acknowledge the relevance of this and other topics (e.g. immigration reform) for the health of Latino children and their families. Thus the reader is advised to read recent reviews in these rapidly evolving areas of concern.

References

Melgar-Quiñonez, H. (2008). The growing Latino community: New challenges for nutrition and health professionals in the United States. Clinical Nutrition Insight, 34(7):1-4

Pérez-Escamilla R., Garcia J., & Song D. (2010). Health care access among Hispanic immigrants: Alguien está escuchando? [is anybody listening?]. NAPA Bull, 34:47-67.

Pérez-Escamilla R. (2010) Health care access among latinos: Implications for social and health care reforms. Journal of Hispanic Higher Education, 9: 43-60.

Notes

¹ Yale School of Public Health. Dr. Peréz-Escamilla was partly supported by the Connecticut NIH EXPORT Center of Excellence for Eliminating Health Disparities among Latinos (CEHDL), NIH-NCMHD grant P20MD001765.

²Department of Human Nutrition, OSU Extension, The Ohio State University.

³ The views expressed in this book are those of the authors and do not necessarily reflect the views of the NIH or NCMHD.

CHAPTER ONE

LATINO CHILDREN’S HEALTH AND THE ENVIRONMENT

George R. Flores, Emma V. Sanchez-Vaznaugh, Lisa G.-Rosas, Liz U. Schwarte, Robert Garcia, Sandra R. Viera, Mariah S. Lafleur, Manal J. Aboelata, Seth H. Strongin and Amanda M. Navarro

. . . If you grow up in a neighborhood with a good school, where it’s safe, where you can walk and play outside, where you have a regular doctor and where you have access to good food, you are more likely to live a long and healthy life. On the other hand, if you grow up in a neighborhood where you’re not safe, where your school is failing you and where you do not have a place to go when you are sick or need a basic grocery store, then you are far more likely to live a shorter life, to earn less money, to be party to or victim of violence and to be far less healthy emotionally and physically. If you are . . . Latino, you are likely to face not just one of those challenges, but many or all of them at once. (Policy Link, 2010)

Introduction

Generally speaking, health and wellness is influenced to a greater degree by environments where children are born, grow, play and go to school than by genetics or the medical care that children receive (McGinnis, Williams-Russo et al., 2002). The social, political, economic and physical conditions in the environment shape children’s physical, emotional and social wellbeing through each developmental stage (WHO Commission on Social Determinants of Health, 2008; Braveman & Barclay, 2009). These conditions are commonly referred to as social and environmental determinants of health (Marmot, 2000; Subramanian, Belli et al., 2002; WHO Commission on Social Determinants of Health, 2008). Relative to non-Hispanic whites, Latino children that experience less favorable environments are at risk for poorer health outcomes (Carter-Pokras, Zambrana et al., 2007). In Spanish, the term bienestar conveys a sense of health and wellbeing that extends beyond physical wellness and that reflects favorable social and environmental conditions. It stands to reason that efforts to improve the health and wellbeing of Latino children ought to address their environments as well.

This chapter reviews scientific literature to identify environmental conditions commonly experienced by Latino children that have bearing on their health during childhood and throughout life. We provide promising models from Latino communities working toward healthier environments. Finally, we list policy goals for policymakers and the public to improve environments for healthier, safer, more productive Latino children, families and communities.

The determinants of health are illustrated in Figure 1 as a sphere of environments that interact with behavior and biology, and that are shaped by policies and interventions. Scientists examining the factors that lead to health and wellbeing use a broad systems view, based on the understanding that health outcomes are the result of multiple determinants—social, behavioral, environmental and genetic—that work in concert through complex interactions (Hernandez & Blazer, 2006). Environments may have direct (i.e., exposure causes illness) or indirect (i.e., exposure influences behavior to cause illness) impacts on health. Community-level health advocates recognize that many environmental conditions can be shaped through policy change to bring about favorable health outcomes (Center for Health Improvement, 2009). The general understanding is that distinct environments operate in unique ways to influence children’s health and wellness, and that policies largely determine the extent to which environments can optimize health and support healthy behaviors.

In Figure 2, Diez-Roux and Mair describe processes through which neighborhood environments contribute to health and health inequalities (Diez-Roux and Mair, 2010). For example, characteristics of the physical environment such as lack of safety in public spaces can affect the nature of social interactions within the neighborhood, which in turn has consequences for the ability of neighbors to advocate for improved public safety. Additionally, environments can induce stress. While some environmentally mediated behaviors (e.g., physical activity in school) may buffer the adverse effects of stress, exposure to stress-inducing environments may be a factor in leading children to adopt unhealthy behaviors (e.g., diet, smoking) as mechanisms to cope. Environmental conditions illustrated in Figure 2 are amenable to policy interventions, ranging from policies that minimize resource inequalities to those that target neighborhood-level features such as increasing access to healthy food.

Besides operating across the life course, the impact of environments can be modified by personal characteristics. For example, some children may possess certain characteristics that could increase their vulnerability to adverse neighborhood conditions, while others with similar characteristics may have families with resources to permit overcoming deficiencies or hazards in their neighborhoods (Diez-Roux et al., 2010). Additionally, a single environmental agent may influence multiple personal, social and structural characteristics and health outcomes for many children, and over a lifetime. For example, a policy that improves neighborhood walk-ability can simultaneously benefit children’s physical fitness, reduce stress, increase safety, strengthen social connections and improve neighborhood aesthetics. In effect, that single policy may have multiple benefits by preventing obesity, and reducing the risk of diabetes, cancer and heart disease later in life.

Environmental conditions may have profound and long-term effects on health at all stages of life, from pregnancy through childhood and adulthood (Braveman et al., 2009). Sensitive and critical periods of development, such as the prenatal period, early childhood and the school years present windows of opportunity to promote lifelong health and wellbeing through policies that can shape environments. Health care services are important, but alone are insufficient to produce health and wellness for children (Wizemann & Anderson, 2009). The holistic notion of bienestar requires health-supportive environments (i.e., in places where children are born, grow, play and go to school) for optimal health and wellbeing throughout the lifespan.

Environments and Health—The Evidence

To investigate how the physical and social features of environments impact the health and wellbeing of Latino children, we selected from studies identified by key terms in the scientific literature. We also examined selected best available unpublished sources of community-based research and program evaluations. We found in the literature that some types of environments overlap with others (e.g., food and physical activity environments in neighborhoods and in schools), just as the actual environments do in our surroundings. Thus, our discussion of food and physical activity environments, for example, is presented in multiple sections of the chapter. Further, many of the references and examples are drawn from work to prevent childhood obesity. Since obesity is a precursor of multiple chronic diseases (Visscher & Seidell, 2001) and is influenced by behavioral factors such as diet (Bray & Popkin, 1998; Peters, 2003) and physical activity (Jimenez-Pavón, Kelly j., 2010), this field offers the most salient and accessible evidence to demonstrate the links between the environment and children’s health.

There is a growing, but still insufficient, evidence base in the published scientific literature specific to Latino children that illuminates the nexus of environments and health. Consequently, to develop this chapter, we also applied our considerable collective practical experience with environments and Latino children’s health.

Home and Neighborhood

The home environment is most closely associated with early childhood development and reflects family structure, socioeconomic status, culture and other factors. Many Latino children experience home environments different than non-Hispanic children with regard to Spanish-language use, food availability and types, male parent involvement in rearing and introduction to reading; but the effect of poverty on how children experience environments is greater than that of ethnicity (Bradley, Corwyn et al., 2001). In many places across the United States, Latinos overall, but particularly recent Latino immigrants (Ramirez & de la Cruz, 2002) are the poorest population group. Latino children living in poor urban neighborhoods may have inadequate housing, experience crowded and unsafe living conditions and be exposed to toxins, traffic and other hazards. Latino children in remote rural areas, especially those supported by seasonal labor at risk of economic and food insecurity and lack of health insurance, may have limited access to transportation and be far from essential services like medical care and healthy food sources.

Neighborhoods play a critical role with regard to health (Kawachi & Berkman, 2003) because residents share common exposure to environmental risks and health-supporting opportunities. Physical and social features of neighborhood environments are linked with a wide range of health outcomes, especially among adults (O’Campo, Xue, Wang et al. 1997; Winkleby & Cubbin 2003; Robert & Reither 2004; Mujahid, Roux, Shen et al. 2008; Diez-Roux & Mair 2010) but also among children (Carter & Dubois, 2010; Singh, Siahpush et al., 2010).

Because Latino children are more likely to live in socioeconomically disadvantaged neighborhoods than even poorer non-Hispanic white children (Acevedo-Garcia, Osypuk et al., 2008) and evidence indicates that these neighborhoods offer fewer health promoting opportunities (Larson, Story & Nelson 2009; Lovasi, Hutson, Guerra et al. 2009; Singh, Siahpush & Kogan 2010), Latino children are especially at risk of multiple health damaging exposures and deprivation.

Neighborhood environments that recent immigrants from Mexico and Central America encounter in the United States may contrast sharply with the environments that they experienced in their home countries. Latino immigrants are primarily concentrated in six states (California, New York, Florida, Texas, New Jersey and Illinois), however over the past 15 years, greater dispersal of Latinos throughout the United States has occurred (Capps, Passel, Perez-Lopez et al., 2003). Neighborhoods more recently settled by Latino immigrants tend to have limited capacity to assist Spanish-speaking, low income and less well-educated populations, whereas neighborhoods populated by Latinos for generations tend to have fewer language barriers and greater Latino political representation. Thus, programs and services developed by and for populations in well-established Latino neighborhoods may not be directly transferable to newer Latino neighborhoods. Still, most low-income Latinos, both immigrants and U.S.-born, live in segregated neighborhoods that offer inexpensive housing, comfortable language, trusted relationships and familiar goods. These neighborhoods often have fewer structural resources to support healthy behavior such as grocery stores and parks, school yards that are open for recreation after-hours, sidewalks and streets that are safe for walking and biking, clean air and water (Schulz, Williams, Israel et al., 2002).

Food Environments

The food environment refers to the availability of food retailers, including convenience stores, supermarkets and fast food restaurants (Morland, Wing & Diez Roux 2002; Morland, Wing, Diez Roux et al. 2002; Morland, Diez Roux & Wing 2006) within cities, neighborhoods or near schools.

Several descriptive studies have shown that access to healthy food environments is unequally distributed by race/ethnicity and class, where minority and poor neighborhoods typically have the least access to supermarkets and the highest concentration of convenience stores and fast food restaurants (Papas, Alberg, Ewing et al. 2007; Black & Macinko 2008; Larson, Story & Nelson 2009; Lovasi, Hutson, Guerra et al. 2009).

A limited but growing number of investigations have characterized food environments in Latino neighborhoods. For example, a study in Los Angeles found fewer supermarkets in Latino neighborhoods than non-Hispanic white neighborhoods (Shaffer, 2002). Another recent study that used U.S. Census and commercial food store data reported that neighborhoods in a Texas locality with a high percentage of Hispanic residents had almost four times the number of convenience stores compared to neighborhoods with a low percentage of Hispanic residents (Lisabeth, Sanchez et al., 2010). Although local convenience stores are potential sources of culturally favored fruits and vegetables, research in Latino neighborhoods in Chicago found this not to be the case (Grigsby-Toussaint, Zenk et al., 2010). In addition to convenience store availability, studies have shown that a greater number of fast food outlets are found in minority compared with non-Hispanic white neighborhoods (Larson, Story et al., 2009; Lovasi, Hutson et al., 2009).

A recent review of the food environment-obesity literature reported that access to supermarkets was inversely related to body weight and concluded that this was the strongest and most consistent association across the studies reviewed (Lovasi et al., 2009). Similarly, a study using national data documented that supermarket availability was inversely associated with the adolescent body mass index (BMI) (Powell, Auld et al., 2007). The same study reported a positive association between the number of convenience stores and BMI.

Although availability and density of fast food restaurants in disadvantaged neighborhoods is widely considered a contributor to obesity, the limited evidence of these linkages is equivocal: some studies showed an association while others did not (Lovasi et al., 2009). Despite increasing interest in this area, there is still insufficient research to fully understand the associations between neighborhood supermarkets, fast food and convenience stores, diet and obesity among Latino children (Larson, Story and Nelson 2009; Lovasi, Hutson, Guerra et al. 2009). Nevertheless, previously mentioned studies documenting a preponderance of smaller grocery and convenience stores in Latino neighborhoods may translate into fewer healthy food options for Latino children.

Prices constitute an important component of the food environment. Recent economic studies document the influence of food prices on children’s body weight. One study found that higher prices for fruits and vegetables were associated with higher BMI, while higher fast food prices were related to lower BMI (Powell, 2009). Although Latinos represent a small proportion of the population under investigation (Powell & Bao, 2009; Powell, Zhao et al., 2009), findings from these studies may have important implications for Latino children. Despite living under the same roof of those who grow our nation’s food, children of agricultural workers may not have ready and affordable access to fresh nutritious food at home or at school (Weigel, Armijos et al., 2007). Further, compared with whites, Latino children are more likely to live in poverty (Suro, Kocchar et al., 2007) and poverty is associated with greater consumption of energy-dense foods and lower quality diets (Drewnowski & Specter, 2004).

Farmers’ markets and community gardens are growing in popularity and have been highlighted as a potential tool in addressing poor food environments. Although more research is needed to understand accessibility of farmers’ markets and their influence on consumption of fruits and vegetables and obesity, preliminary research of the Supplemnetal Nutrition Program for Women Infants and Children (WIC) Farmers’ Market Nutrition Program suggests that providing coupons for purchase of allowed foods at these markets increases fruit and vegetable consumption (McCormack, Laska et al., 2010). However, farmers’ markets and community gardens may not always be accessible for Latino populations; and the quality and prices of produce may differ between farmers’ market venues, depending on the neighborhood demographics.

Traditional food outlets sometimes carry a unique connotation in Latino neighborhoods where a variety of ready-to-eat foods are commonly offered by street vendors. Despite their popularity, little research has been conducted to understand the impact of street vendors on Latino children’s health. Observational studies have noted a consistent customer base for street vending of ice cream and candy on property adjacent to elementary and middle schools that have implemented policies prohibiting on-campus sales of such products (Healthy Eating and Active Communities, 2010). While policies to restrict street vending have been implemented (with varying degrees of enforcement) in a number of places, assessment of street vending in Latino communities needs to consider the range of food offerings as well as the impact on jobs and economics, cultural traditions and access to healthy alternatives (Woodward-Lopez & Flores, 2006).

Sugar-sweetened beverages have unique implications for Latino children. In 2009, Mexico and the United States were respectively the first and fourth largest per capita consumers of Coca-Cola products worldwide (Coca-Cola Co, 2010). Recent studies suggest that sugar-sweetened beverages are one of single largest contributors to the obesity epidemic (Vartanian, Shwarts et al., 2007; Brownell & Freiden, 2009). Forty-one percent of children (ages 2-11), 62% of adolescents (ages 12-17) and 24% of adults in California drink at least one soda or other sugar-sweetened beverage every day (Babey, Jones et al., 2009). Rising consumption of sugary drinks is likely due to a variety of factors, including larger portion sizes, pervasive marketing and increasing accessibility of these products. Marketers spend close to $500 million dollars a year to reach children and adolescents, including targeting Latino youth, with messages about sugar-sweetened drinks, more than they spend on any other category of food or beverage (Berkeley Media Studies Group, 2009).

Compounding the influence of food and beverage marketing on Latino children, prominent Latino civic and health organizations may accept support from and have longstanding loyalties to the food and beverage industries, including major purveyors of beer, soda, snack foods and fast foods (National Council of La Raza, 2009). The food and beverage industry plays a vital role in many Latino neighborhoods, fueling commerce, jobs and donations for programs and celebrations. Consequently, policy measures to improve health that involve regulating the food and beverage industry are not always met with support from prominent organizations that speak for Latino children (Geiger & Hamburger, 2010).

Physical Activity Environments

There is strong evidence that consistent and vigorous physical activity in combination with healthy nutrition is instrumental to prevent obesity and its complications, such as type 2 diabetes, coronary heart disease, hypertension, sleep apnea and some cancers (U.S. Department of Health and Human Services 2001; U.S. Department of Health and Human Services and U.S. Department of Education 2001; U.S. Department of Health and Human Services 2002; White House Task Force on Childhood Obesity 2010). Neighborhood environments also matter when it comes to physical activity (Sallis & Glanz, 2009). Access to safe recreational facilities, such as parks, playgrounds, open spaces and trails, has been demonstrated to increase physical activity among youth and adolescents (Babey, Brown et al., 2005). However, compared with white and high socioeconomic status populations, minority and low-income communities have less access to public and private facilities for recreation (Sallis et al., 2009). Lack of access to safe parks in particular is a significant barrier to physical activity for Latino children and youth. In California, more than 29% of Latino adolescents do not have access to a safe park as compared with 22% of non-Hispanic white teens (Babey et al., 2005).

Compared to 8.5% of non-Hispanic white parents, more than 41% of Latino parents reported lack of neighborhood safety as a problem in relation to their children’s physical activity (Babey et al., 2005). Furthermore, Latino parents of nine- to thirteen-year-old children report more obstacles to their children’s physical activity than non-Hispanic white parents, including a lack of local opportunities, transportation problems, cost of participation in organized sports and safety concerns (Duke, Huhman et al., 2003). As a result, a far lower percentage of Latino youth participate in organized physical activity outside of a school setting than non-Hispanic children (Duke, Huhman et al., 2003). Neighborhood environments that support and promote physical activity among youth are measured not only by access to parks and recreational facilities, but also by safety, walkability and bikeability, access to organized sports and joint-use of school facilities for after-school recreation in the neighborhood as well as school and community design (Sallis et al., 2009).

Television and Advertising

Television viewing and exposure to advertisements is associated with multiple adverse health consequences such as obesity (Saelens, Sallis et al., 2002), alcohol consumption (Smith & Foxcroft, 2009) and smoking (Charlesworth & Glantz, 2005). TV viewing replaces activities like playing with friends, being physically active, playing outside, reading, doing homework and doing chores (Bickham & Rich, 2006).

Children see tens of thousands of TV commercials each year (American Academy of Child and Adolescent Psychiatry, 2001), two-thirds of which are for unhealthy food and drinks (McGinnis, Appleton et al., 2005). During the after-school time period, ads targeting children tend to focus on promotion of fast food and sugary drinks (Jago, Baranowski et al., 2005; Viner & Cole, 2005).

On average, two- to five-year-old children spend 32 hours a week, and their six- to eleven-year-old counterparts spend about 28 hours a week watching television, DVDs, DVR and videos or using a game console (McDonough, 2009). One study found that young children of Hispanic mothers whose dominant language was Spanish spent less time in front of the TV than children whose mothers spoke mostly English (Thompson, Sibinga et al., 2010).

Older Hispanic youth average about 1½ times as much of media exposure daily, compared to white youth (Rideout, Foehr et al., 2010). Children’s programming on Spanish-language TV is scant, so children in Spanish-speaking households may be more likely than children in English-speaking households to be exposed to adult content and advertising that is predominantly for unhealthy foods like sugary drinks and fast food (Thompson, Flores et al., 2008).

Despite industry self-regulation in response to pressure from the public and from Congress, 73% of the foods advertised on television to children are for products in the poorest nutritional category, and cartoon characters continue to be used to get children to influence parental food purchasing decisions (Kunkel, McKinley et al., 2009).

Advertising also influences and encourages smoking and alcohol consumption. Children see on average, about 2,000 beer and wine ads on TV each year (Strasburger, 2002) and although tobacco ads are banned on TV, young people still see characters smoking in movies and on TV, which has been associated with smoking initiation (Charlesworth et al., 2005). Some television and magazine ads for alcohol, such as alcopop, which combine the sweet taste of soda pop in a liquor-branded malt beverage, target youth, especially girls and Latinos (Jernigan & Ostorff, 2005).

Tobacco and Other Environmental Toxins

Tobacco use and exposure to second-hand smoke are toxins that can cause health problems for children and later in life. Children and teens are at greater health risk from tobacco use and exposure to second-hand smoke than adults because their respiratory, immune and nervous systems are still developing. Due to lower rates of tobacco use among Latino adults, Latino children may have a lower risk of exposure to second-hand smoke than African-American or non-Hispanic white children (U.S. Department of Health and Human Services, 2007), although a study by Acevedo-Garcia and colleagues found that the tobacco industry aggressively targeted immigrant groups, including Latinos (Acevedo-Garcia, Barbeau et al., 2004).

Tobacco users almost