Clashing paradigms: An empirical examination of cultural proxies and socioeconomic condition shaping Latino health

Objective: Much debate exists regarding the role of culture versus socioeconomic position in shaping the health of Latino populations. We propose that both may matter for health and explicitly test their independent and joint effects on smoking and physical activity. Methods: We used the 2010 National Health Interview Survey, a population-based survey of the U.S. population, to estimate the prevalence of smoking and physical activity by language use (cultural proxy) and education among Latino adults (n=4929). We fit log binomial regression models to estimate prevalence ratios and test for interaction. Results: English-language use and educational attainment were each independently associated with smoking and physical activity. Joint effect models showed that individuals with both greater use of the English language and low levels of education were nearly three times more likely to smoke (prevalence ratio, 2.59; 95% confidence interval,1.83-3.65) than those with low English language use and high education (referent group); high acculturation and high education were jointly associated with increased activity (prevalence ratio 2.24, 95% confidence interval, 1.79-2.81). Conclusions: Cultural proxies such as language use and educational attainment are both important determinants of health among Latinos. Their joint effect suggests the need to simultaneously consider Latinos' socioeconomic position and their increased risk of adopting health-damaging behaviors while addressing culturally-specific factors that may mitigate risk.