The Lower Rio Grande Valley Nutrition Intervention Research Initiative, undertaken by a 10-member consortium of federal and Texas government agencies and Texas institutions of higher education, is the first program of its scope to select the Hispanic community as a focus for studying nutritional health and disproportionate rates of nutrition-related health problems. This monograph is the first work of the consortium providing review of data specific to the nutrition-related health problems of the predominately Mexican-American population that inhabits the Lower Rio Grande Valley and provides new data from its survey of the nutritional prevention and intervention activities and services available in the valley to respond to these health problems. The staggering health care costs associated with diabetes, estimated at $132 billion a year in the United States, and obesity, estimated at $78.5 billion a year, justify the urgency with which health professionals must turn their attention to this under-served region of the nation.
In choosing the Lower Rio Grande Valley, a four-county area along the U.S.–Mexico border at Texas's southernmost tip, the consortium focuses on a geographic region that is rural and urban, national and international, and Mexican and American. Eighty-seven percent of the population of almost one million is of Mexican descent, and up to 90% of residents in parts of the valley acknowledge Spanish as the language most often spoken at home. Estimates indicate there are at least 57,000 residents engaging in migrant and seasonal farm work. The area is home to the poorest of the U.S. poor, with its two major metropolitan areas ranking last in the nation in per capita income, falling to as low as $7069 in one county in 2000. About one third of Lower Rio Grande Valley residents older than 25 years have less than a ninth-grade education, which is about four times the national average.
The land, part of the Rio Grande delta, that stretches about 250 miles east-southeast to the confluence of the Rio Grande with the Gulf of Mexico, and the subtropical-semiarid climate foster a long growing season, which is further aided by supplemental irrigation. The result is a diverse commercial agricultural industry that claims about a third of the land, which in 2001 produced grain sorghum, cotton, and food, including vegetables, citrus, and sugar cane, most of it exported through a modern commercial supply chain. At the same time, according to the 2000 U.S. Census, the area is home to the fourth fastest growing metropolitan area in the United States—the McAllen-Edinburg-Mission triangle. Water, supplied in the region chiefly by the Rio Grande, has become an issue of contention between the United States and Mexico because of short supply and quality.
Like life-sustaining water, health care is also in short supply: All or part of all four counties is designated as medically underserved, one of the counties—Willacy—has no hospital at all, and only two of the four counties have county health departments. Health insurance coverage is also scarce, largely because of low participation in Medicaid and the paucity of jobs offering health benefits.
Lack of food and knowledge about food affects the health of Lower Rio Grande Valley families. Willacy County does not have a dietitian. Though few recent published reports describe the area's nutrient intake, a recent unpublished study of Pharr in Hidalgo County indicates the energy intake of the children in this area is approximately 75% of the national average and that only 63% of their energy goal is met. The children also had suboptimal intakes of such essential nutrients as calcium, folate, iron, and zinc, deficits that may lead to slower growth and higher morbidity. Other studies have indicated that only in about 30% to 50% of homes do children eat breakfast. Assessments from selected federal nutrition programs operating in the valley indicate that large percentages of participants have intakes of the major food groups that are below levels recommended by the federal government. Other indicators of poor nutritional status in the valley are the high rates of nutrition-related health outcomes such as diabetes, obesity, cardiovascular disease, cervical cancer, and neural tube defects. Among reported statistics are the following:
- Hispanics have the highest lifetime risk of diabetes of any racial or ethnic group, and five-year mortality rates for diabetes among the population of residents of the Lower Rio Grande Valley are higher than those for the state of Texas overall.
- Overweight and obesity are at alarming rates for both Hispanic adults and children. In 2002 in Texas, more than 37% of adults were overweight and 25.5% were obese.
- The prevalence of overweight for children in the fourth, eighth, and eleventh grades was highest in Texas among boys in the public health region that includes the Lower Rio Grande Valley, ranging from 30.9% among eighth graders to 36.8% among fourth graders. Rates of overweight among Texas school children in the fourth and eighth grades are higher than in the nation overall, and rates were higher among African-American and Hispanic children than among white children, according to data collected in the most recent School Physical Activity and Nutrition project. The scope of obesity's toll includes the diseases to which it is related, including diabetes, with its cascade of related ailments, and cardiovascular disease.
- Physical activity levels of children in the public health region including the Lower Rio Grande Valley were lower than desirable for the majority of the eighth- and eleventh-grade children. Between 30% and 53% of children reported spending three or more hours a day watching TV and/or videos, and 10% to 22% were using a computer or playing electronic games on the day before the survey.
- Cardiovascular disease, the leading cause of death in the United States, is also the leading cause of death among Americans of Hispanic descent. In the U.S. population, risk for heart disease is doubled in men with diabetes and quadrupled in women with diabetes in comparison to nondiabetics.
- Incidence and mortality rates for cervical cancer among residents of the Lower Rio Grande Valley are higher than they are for residents of Texas and the United States. Dietary factors may affect susceptibility to development and progression of this disease. Education regarding the importance of regular screening was limited in two of these counties because at least as recently as 2000 there were no gynecologists or obstetricians in Starr or Willacy counties.
- Prevalence of neural tube defects is higher in those of Mexican descent than among whites or African Americans, ranging from 14 to 16 per 10,000 live births in Mexican women who migrate to the United States. Prenatal care and education for women contemplating pregnancy is seriously lacking and, as stated above, until as recently as 2000, there were no gynecologists or obstetricians in Starr or Willacy counties.
- Osteoporosis is expected to affect more than 61 million women and men by 2020, among them the growing Hispanic population. In two studies, researchers have found 49% to 55% of Hispanic women enrolled had low bone mass. Displacement of milk in the adolescent diet and lack of adequate weight-bearing physical activity continues to grow, and both remain major concerns for later development of osteoporosis.
Having enough food is also a problem for Lower Rio Grande Valley families, though the precise dimensions of food insecurity and/or hunger are unclear; nonetheless, the documented prevalence of poverty, number of adults without high school education, high unemployment, and the number of female-headed households in Cameron, Hidalgo, Starr, and Willacy counties suggest that food insecurity exceeds the national average.The paucity of data specific to the valley prohibited detailed description of many factors. Thus to count and characterize the nutrition-related programs available in the Lower Rio Grande Valley, the Nutrition Intervention Research Initiative consortium undertook a study in 2003. Researchers, who identified 105 agencies offering 353 different programs, found that few reported addressing the major nutrition-related chronic diseases, including diabetes, obesity, cancer, cardiovascular disease, and neural tube defects. Most agencies offered nutrition education or general wellness curricula, most programs were for children (these included free school lunch and breakfast programs), and few addressed specific behavior change as an aim. The survey indicated that demand was sufficient to prompt residents to put their names on waiting lists if provided the opportunity by the agency. The consortium is developing a strategic plan to assess the depth and type of nutrition messages provided, to investigate access and interest issues, and to establish surveillance and monitoring systems to gather valley-specific data to benchmark future initiatives. Highlighted is the need to secure funding to prevent and control nutrition-related diseases in the Lower Rio Grande Valley.