Systemic lupus erythematosus in three ethnic groups - V. Acculturation, health-related attitudes and behaviors, and disease activity in Hispanic patients from the LUMINA cohort

Objective. To assess the relationship between acculturation and clinical, s ocioeconomic- demographic, and behavioral/psychosocial features in Hispanic patients with systemic lupus erythematosus (SLE) from the LUMINA (Lupus in Minority Populations, Nature versus Nurture) cohort. Methods, An empirically derived questionnaire was administered to 67 Mexica n American SLE patients participating in a longitudinal study of outcome. T his questionnaire inquired about place of birth, upbringing and length of s tay in the United States, language (proficiency, usage, and preferences; En glish/bilingual versus Spanish), type of neighborhood, self-identity, and s ocial interactions. Responses to this questionnaire and an informal interac tion with a single bilingual, bicultural Mexican American research assistan t were used to generate a score on a 10-cm anchored visual analog scale (VA S) (0 = no acculturation and 10 = maximum acculturation). The responses to the questionnaire were then quantified and scored by a physician who was un aware of the VAS. A composite score was then obtained utilizing 4 of the 6 components of the instrument. The VAS was found to have adequate sensitivit y (91%), specificity (88%), and overall predictive value (89%) when the com posite score was used as the validity criterion. Therefore, the VAS was use d in all subsequent analyses; the median in this VAS separated patients int o high and low acculturation groups. The relationship between acculturation and sociodemographic, behavioral/psychosocial (social support, abnormal il lness-related behaviors, and helplessness) and clinical variables (disease duration, onset type, number of American College of Rheumatology criteria m et, disease activity, and damage) at study entry was then explored. Results. Patients in the low acculturation group had fewer years of educati on, were less likely to have private health insurance, and had less social support as compared with those in the high acculturation group; they also e xhibited less disease activity as determined by the overall physician and p atient global assessments of the Systemic Lupus Activity Measure. Abnormal illness-related behaviors and helplessness were not increased in the low ac culturation group. Conclusions. Low levels of acculturation were associated with indicators of low socioeconomic status, but also with less disease activity at enrollmen t into LUMINA; they were, however, not associated with more abnormal illnes s-related behaviors or with helplessness, as measured in this study. The po ssible impact of acculturation and of its mediators in the course and outco me of SLE among Hispanic patients needs to be determined longitudinally.