title: The Quality of Diabetes Management Among Mexican Adults in California: Does Generational Status Matter?
abstract: BACKGROUND
  Although there is increasing knowledge regarding the association between generational status on diabetes risk, less is known about the effects of generational status on diabetes management among Mexicans.
  
  
  OBJECTIVE
  We test whether generational status is associated with variations in diabetes processes of care among Mexican adults to optimize disease management.
  
  
  METHODS
  Weighted multivariate logistic regression was used to test the association between generational status on the quality of diabetes care processes and health care utilization adjusting for socioeconomic/demographic factors. Four generational cohorts were constructed: first generation immigrant; second generation; generation 2.5; and third generation.
  
  
  METHODS
  We conducted analyses of 3072 self-identified foreign and US-born Mexican adults with diabetes who participated in the 2005, 2007, 2009, and 2011/2012 California Health Interview Surveys.
  
  
  METHODS
  Three diabetes process outcomes were measured, including receipt of at least 1 eye examination, 1 foot examination, or 1 hemoglobin A1C test (HbA1c) in the past year. One secondary prevention outcome was measured, receipt of an annual influenza vaccine. Finally, we measured whether an individual with diabetes received an annual doctor visit.
  
  
  RESULTS
  A gradient of progressively decreased odds of receiving an eye examination and HbA1c test were observed and significant for most of the higher generations. Higher generations also had significantly decreased odds of receiving an annual flu vaccine.
  
  
  CONCLUSIONS
  Data collection on generational granularity and a specific focus on mixed acculturation status can vitally inform health system improvements in diabetes care among Mexicans in the United States.
authors.affiliation: *Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA †Annie E. Casey Foundation, Baltimore, MD ‡Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA.
authors.forename: Selena E
authors.initials: SE
authors.lastname: Ortiz
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Perez
authors.forename: Ninez A
authors.initials: NA
authors.lastname: Ponce
mesh_terms: D000069:Acculturation; D000328:Adult; D000368:Aged; D002140:California; D003920:Diabetes Mellitus / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000175:diagnosis; D017719:Diabetic Foot / Q000175:diagnosis; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D008297:Male; D017058:Mexican Americans / Q000706:statistics & numerical data*; D008875:Middle Aged; D017064:Process Assessment, Health Care / Q000592:standards*; D012307:Risk Factors; D012959:Socioeconomic Factors
chemical_list: D006442:Glycated Hemoglobin; D007252:Influenza Vaccines