Date of Conferral





Public Health


Angela W. Prehn


Diabetes, a silent, chronic disease that involves demanding long-term self-care skills, affects adult Puerto Ricans disproportionately. Based on the health belief model, a theory that predicts health behavior, and the theory of language barriers, which predicts the effects of language on beliefs and behavior, this quantitative nonexperimental study analyzed the relationship of the preference of Puerto Ricans in Boston to use and speak Spanish (language acculturation) to diabetes prevalence and 4 diabetes self-care skills (healthy eating, being active, taking medication, and healthy coping). Data on 1,506 initial participants in the Boston Puerto Rican Health Study were used from 3 study stages (baseline, 2-year, and 5-year follow-up). The data were analyzed using logistic regression. The study findings indicated that diabetes prevalence was high and steady across all study stages (50%), and it was associated with sociological factors (length of stay in the United States) and anthropometric measures (waist circumference and body mass index). Language acculturation had a statistically significant association with diabetes prevalence (decrease) and the 4 self-care skills variably across the 3 study stages, even after adjusting for confounders. These findings indicate that language acculturation permeates the perceptions, beliefs, and decision-making processes of Puerto Ricans. Further research is necessary to overcome the understudied nature of Puerto Ricans and the consequences of their limited English proficiency when managing diabetes. The study's implications for social change involve the inclusion of language acculturation in health care and public health initiatives to prevent, manage, and reduce the long-term consequences and rising management costs of diabetes.