The Gerontologist
Vol. 49, No. S1, S79–S85
doi:10.1093/geront/gnp086
© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America.
All rights reserved. For permissions, please e-mail: [email protected].
“Una persona derechita (staying right in the
mind)”: Perceptions of Spanish-Speaking
Mexican American Older Adults in South
Texas Colonias
Joseph R. Sharkey, PhD, MPH,1,2,3 Barbara F. Sharf, PhD,4
and Julie A. St. John, MPH, MA3
be focused on development of programs that provide
satisfying culturally appropriate activities for older
participants and the delivery of health messages that
take into consideration culture and language.
Purpose: This study describes the perceptions of
brain health among older Spanish-speaking Mexican
Americans who reside in colonia areas of the Lower
Rio Grande Valley of Texas. Design and Methods: In 2007, 33 Mexican American older adults
(9 men and 24 women) were recruited by promotoras (community health workers) from clusters of colonias in Hidalgo County to participate in focus group
discussions conducted in Spanish. After participants
completed a 19-item questionnaire (in Spanish), a
bilingual and bicultural researcher from the community, trained as a moderator, conducted 4 focus
groups using a semistructured interview guide, culturally modified with the assistance of promotoras. All
discussions were audio recorded; audio recordings
were transcribed verbatim in Spanish and then translated into English. Analyses were conducted in English. Results: Almost 85% had less than a high
school education and 100% reported a household
income less than $20,000/year. Groups attached
cultural meaning to aging well. The idea of “staying
straight in the mind” resonated as a depiction of
brain health. Participants also mentioned the types of
activities they could do to stay “right in the
mind.” Implications: Particular attention must
Key Words: Mexican-Americans, Spanish-speaking
seniors, Brain health, Focus groups, Colonias
Hispanics are now the fastest growing, largest,
and most heterogeneous ethnic minority group in
the United States, and the majority of Hispanics are
of Mexican descent (Heller et al., 2006). As a group,
Hispanics are living longer and growing older with
lower quality of life than any other group (Office of
Aging Policy and Information, Texas Department
on Aging, 2002). They are also disproportionately
affected by decreased access to health care services
(Hunter et al., 2004). There is a greater prevalence
of poverty, chronic disease, and disability among
older Hispanics than among all older persons
(Centers for Disease Control and Prevention, 2004).
Previous studies of Hispanics and Mexican Americans
have identified the association of a variety of factors,
such as diet, depressive symptoms, and ethnocultural
assimilation, to cognitive function (Haan et al.,
2007; Heller et al.; Raji, Reyes-Ortiz, Kuo, Markides, &
Ottenbacher, 2007; Ramos et al., 2005).
The number of Hispanics (primarily Mexican
Americans) in Texas who are at least 60 years of
age represents almost 20% of all older Hispanics in
the United States. Social and health disparities are
even more prominent among Mexican Americans
who live along the U.S. border with Mexico (Mier
et al., 2008). The Lower Rio Grande Valley (LRGV)
1
Address correspondence to Joseph R. Sharkey, PhD, MPH, Department of Social and Behavioral Health, Center for Community Health Development, School of Rural Public Health, Texas A&M Health Science
Center, MS 1266, College Station, TX 77843-1266. E-mail: jrsharkey@
srph.tamhsc.edu
2
Department of Social and Behavioral Health, School of Rural Public
Health, Texas A&M Health Science Center, College Station.
3
Center for Community Health Development, School of Rural Public
Health, Texas A&M Health Science Center, College Station.
4
Department of Communication, Center for Community Health Development, Texas A&M University, College Station.
Vol. 49, No. S1, 2009
S79
of Texas is one of the most rapidly growing areas
of the United States, with many residents living in
persistent poverty (U.S. Census Bureau, 2000).
Much of the population increase in the LRGV has
been into colonias. A colonia, Spanish for neighborhood, is a residential area of mostly substandard housing (trailers and self-built houses of
recycled materials or cinderblocks) along the Texas–
Mexico border that may lack some of the most basic living necessities (e.g., drainage, safe drinking
water, paving, and street lighting; Texas Secretary
of State, 2008; Trotter & Chavira, 1997). Most of
the colonias are geographically rural or remote and
legally isolated from neighboring cities (Ward,
1999). More than 75% of all Texas colonias are
located in Hidalgo County, which has the largest
number of colonia residents in the state and is typical of many border counties in terms of sociodemographics (e.g., income, race, unemployment,
education; U.S. Department of the Interior, U.S.
Geological Survey, 2005).
Although much is being written about the perceptions and attitudes of aging well and brain
health among diverse U.S. populations (Laditka
et al., 2009), less is known about the beliefs on
the meaning of aging and cognitive health among
low-income Spanish-speaking populations, especially among hard-to-reach colonia residents. The
purpose of this study, which was conducted in
Spanish, was to describe how Spanish-speaking
older adults who reside in impoverished areas of
South Texas view cognitive health and how they
may be motivated to improve lifestyle behaviors
to maintain it. This project builds on our relationship with promotoras (indigenous community
health workers) who are committed to serving
residents of the area’s colonias, who traditionally
lack access to tradition health care, by connecting
residents with health care providers (Hunter et
al., 2004).
Methods
Setting and Participants
Focus groups participants were recruited by local promotoras who were affiliated with the South
Texas Center for Community Health Development
(CCHD) and worked in two targeted colonia areas
in the western and eastern parts of the county. The
regional director of the CCHD, who served as moderator for the four focus groups, was born and raised
in the region, was academically trained in epidemiology and social and behavioral health, and was
S80
Table 1. Sociodemographic Characteristics of Participants in
Focus Groups Conducted in Spanish (N = 33)
Gender
Female
Age (years)
50–64
65–74
≥75
Race/ethnicity
Hispanic
White
Education
Less than high school
High school/some college
Marital Status
Not married
Married
Household income
Less than $20,000/year
Number in household
1
2
3–6
%
n
75.8
25
39.4
24.2
36.4
13
8
12
90.9
9.1
30
3
84.8
15.2
28
5
48.5
51.5
16
17
100.0
33
33.3
42.4
24.2
11
14
8
fluent in the Spanish language and in the culture of
the setting. In the western part of the county, the
promotoras collaborated with a senior center
director they regularly worked with and recruited
participants from individuals involved in senior
center programs (e.g., nutrition and games) for
two focus groups. In the targeted colonia area in
the eastern part of county, there is not a similar
senior center. Here, promotoras recruited door-todoor in neighborhoods in which they were providing outreach services. Participants for the four
groups were colonia residents who met two criteria: (a) age 55 years and older and (b) Spanish as
preferred language. Focus groups were conducted
in private rooms in two nonmetropolitan locations; two discussions took place in a private room
in a senior center (n =20); and two were conducted
in a private room in a community health center
(n = 13). The moderator was assisted by two promotoras; one served as an observer and the other
assisted the moderator (e.g., wrote lists on a flip
chart and assisted with clarification for participants/moderator). All four focus groups were conducted in July and August 2007.
Sociodemographic characteristics from the
survey are shown in Table 1. All participants reported a household income less than $20,000/
year, which was the lowest category on the survey. Although three participants self-identified
themselves on the survey as being “White, not
The Gerontologist
Hispanic,” all participants reported that Spanish was their preferred spoken language. As one
person put it, “many Anglos consider themselves
functionally Hispanic.”
Survey and Interview Guide
A 19-item paper survey, previously used in focus groups in other parts of the United States, was
translated into Spanish and given to each participant to complete prior to the start of the focus
group discussion (Laditka et al., 2009). Conceptual and semantic equivalence of Spanish and English versions of the survey were verified by the
promotoras working in this project; a pilot test of
the survey was conducted among eight promotoras
who were not directly involved in this project. The
survey collected data on socioeconomic characteristics of the participants, as well as information
about health behaviors and emotional health. Promotoras assisted participants with survey completion as needed.
A nine-item interview guide, previously used in
focus groups in other parts of the United States,
was slightly modified with the involvement of promotoras to ensure conceptual, semantic, and normative equivalence (Laditka et al., 2009). The
interview guide was then translated into Spanish
and back translated into English to ensure the accuracy of the translation. All focus groups were
conducted in Spanish and were 60–90 min in length.
All participants provided consent to participate in a
focus group and to have the focus group audio
recorded. The institutional review boards at the
University of South Carolina (lead center) and
Texas A&M University approved this study.
Data Analysis
Survey data were entered into a relational database (Microsoft Office Access 2007); frequencies
were estimated using Stata statistical software release 9 (Stata Corp., College Station, TX). The audio files from the focus groups were transcribed
verbatim into a Word document in Spanish. The
Spanish text was then translated into English. With
the benefit of fluency in the Spanish language and
in the culture of the area, the moderator and promotoras who assisted with the focus group reviewed each translation to ensure that the correct
meaning was evident. A computer-aided long-table
approach was used to identify themes and categorize results (Krueger, 1998). Each focus group was
analyzed separately and the results compared
Vol. 49, No. S1, 2009
across groups. Initial themes were determined
a priori (from the interview guide); additional themes
and categories emerged from the analysis. Briefly,
after reviewing the transcripts at least two times, cut
versions of participant quotes were pasted on separate sheets by interview guide question, theme, and
categories. Each category was reviewed and a short
summary was written for each category.
Results
After review of the discussions, which were
translated from Spanish into English, participants’
comments were organized into four themes. The
themes, which followed the interview guide, included the following: (a) meaning of aging well,
(b) meaning of not aging well, (c) concerns about
aging and memory, and (d) distraction to improve/
maintain the mind.
Meaning of Aging Well
One of the four discussion groups struggled
without success to think of anyone they knew who
had aged well with a good memory. In this group
(and not mentioned in the other groups), it was generally believed that “aging happens so quickly …
one ages well only with medicine.”
The other groups described aging well as being
derechita or “right in the mind.” An intact memory
and remaining independent were two main characteristics that were associated with being derechita.
Derechita is the diminutive form of the word derecha, meaning right or straight, pertaining to direction as well as a person’s right (according to laws).
In the local context, it also means “being right/
straight” in the mind (but is not used to mean
someone is right or wrong in opinion). The suffix
“ita” denotes a positive term of endearment. So,
derechita is a term of praise or acknowledgement
that a person has maintained his/her mind, that is,
is right in the mind, “can think straight.” Several
participants commented in response to the question of what does it mean to age well:
My mother-in-law is 85 or 86—I can’t remember
her age—but she is very derechita, very active, has
the mind that doesn’t forget anything. At my age,
I already forgot everything.
Another participant replied that
My mom had a good memory and lived 85 year
and she knew everything well. She never lost her
memory. She could remember very well. She was
very happy, very good; she sang me songs.
S81
One participant described aging well and having an intact memory in the following way:
They say the person has the evil eye and forgets
everything, they do not know them, they are lost.
Well, my mom had her memory and died at 91
years. She remembered everything. She didn’t forget
anything. She would ask others why they forgot
things because she still had her mind.
The object, then, is to prevent the evil eye or
other bad influences from leading one to lose their
soul. These comments resonate with the growing
movement of spiritualism in South Texas (Trotter &
Chavira, 1997).
Participants also made the connection between
aging well and freedom or independence. One participant was quick to describe aging well and keeping your memory as “someone that still has all
their freedoms.” People are able to “do the things
that you want to do.” They are able to be out and
“talk to people.”
Concerns About Aging and Memory
Concerns for now and for what the future might
hold were given voice by many of the participants
in all four groups. “Being alone in the world,”
“not able to do for myself,” and “not want to have
someone have to take care of me and my arthritis”
were concerns along with the following:
Meaning of Not Aging Well
All groups were able to list characteristics that
described someone who was not aging well. Key
responses included negative or pejorative labels
and being lost. Participants provided ample examples of the negative labels attached to not aging
well. Frequently mentioned terms included “someone messed up,” “mixed up and not right in the
mind,” “retarded,” “dumb,” “have beens,” “forgetful,” “demented,” “useless,” and “lazy.”
Among the pejorative or offensive labels were tata
(dummy) and tonto (idiot/stupid).
Several participants used the term “lost” and referred to someone as “their mind has left them.”
And I don’t know. I am 72 but I don’t know why. I
am older, and I’m not able to do all, but I am forgetting everything. I don’t know if this is normal but
that’s what has happened to me. What you all think,
your thoughts, your worries, what I will lose . . .
that’s what I want to know.
For many, the fear of the future was connected
to their living alone. Responding to the general
discussion, participants described their concerns
and made the following comments:
And I live alone and I have a fear that one day I will
have a heart attack and I will lie there and who will
know? That is my concern.
One thing is that the person has lost it. It has left
them. They can’t take things into account. . . . they
do nothing and they’re gone. They are not there.
They don’t do anything. . . . This is a person who is
not active. They’ve lost it.
This is what happens when people live alone . . .
those that do not have anybody and for this reason, I worry. And why I don’t shut my doors. When
I’m asleep at night, I leave the door open. People
ask me aren’t I afraid but I have more fear of a
closed door because with an open door, someone
can come check on me.
Along with being lost was the sense of being
“closed off” from things and people. The concept
of loss was also expressed in terms of lost soul. As
one participant describes loss of soul and mind:
Participants agreed that it was important “not
[to] be a burden.” One participant was “concerned
for her children”; similarly, another stated, “I do
not want to leave my children in a way that I do
not remember and forget everything.” Still another
participant was concerned for children, but for a
different reason, remarking, “There are children
that don’t have a heart, thus, that’s my biggest
concern.” She appeared to fear that her children
will not take care of her or will mistreat her.
Because you don’t have any movements . . . any
experiences . . . no thoughts about anything. . . .
[Y]our soul has left you . . . you don’t talk with
anyone. . . . [E]verything passes you by. And it
passes you and passes you and passes you. And if
you socialize with people, you are like a small child
or little animal and you become lower and lower.
Little by little, part of you dies . . . you have nothing more than a little conversation and then your
body will start to behave like your mind (with
nothing there).
Distraction to Improve/Maintain the Mind
According to several participants, aging well
and maintaining a good memory required that
“we have to occupy or distract our minds” by
An interesting comment injected the additional
meaning of there being a supernatural or malicious
element to being lost. As one participant said:
S82
The Gerontologist
something—to clear the mind . . . because if you do
not do anything, you can’t clear the mind.
thinking or doing mental or physical activities.
These comments focused on the concept of distraction by thinking or doing but not dwelling on
problems or having “bad thoughts.” As a participant reaffirmed, “Don’t think about this/that problem because it will end up bad.”
Activities to keep the mind distracted included
singing, embroidery, playing chalupa (a game),
listening to music and tapes, having pets, and
reading. In response to the suggestion that embroidery was good, a participant said “that is
good because you use your mind when you embroider or weave.” Another participant reaffirmed
this by saying “well, I weave and embroider and I
don’t forget anything.” Playing chalupa was mentioned frequently:
I work in my house with my tools. Yes, that is what
occupies my mind. I am occupied with what I need
to do. I don’t have time to think about anything
bad. Just about the work I have in my house to do.
Thus, we need to occupy our minds . . . occupy them
in something. And now I have my work . . . now I fix
machines, weed eaters, tractor motors. This is how I
occupy my mind. If I don’t work, my mind begins to
remember my family and I get sentimental.
Another participant described individual tasks
as directing activity: “I work a lot in the yard.
I work on everything until it is finished. With the
cilantro is done, the melon starts. After the melon,
I look for another ‘boss’ and have a smile.” Interestingly, whereas many activities, including listening to music, were deemed as helpful (and
healthful), watching television was perceived negatively. A participant stated the importance of “not
watching a lot of television.” Another participant
said that “when someone watches a lot of television, after a while, they don’t know what to do.”
Whereas reading was mentioned often as distraction to keep the mind occupied and to stay right in
the mind, the preponderance of reading material
was the Bible. Several participants mentioned the
importance of “study[ing] the Bible”; that is,
“read[ing] the Bible to stay occupied.” Another participant mentioned that “reading [Bible] is good
therapy.” The four groups were consistent in expressing that “the Bible is better [to read than other
things].” In particular, “nothing compares with the
Bible.” The connection between reading, in general,
and specifically reading the Bible may be explained
as a combination of following factors: (a) the possibility that there are not many other books available to read in this community, (b) the activities of
many religious groups that target the colonias for
distribution of Bibles, and (c) a general belief that it
is not only sufficient to keep one’s mind active but
also to keep it focused on good or Godly matters.
Imagine this. This man played here fifteen rounds
of chalupa (a game). This is an intelligent person
because he doesn’t let things go by him.
A participant quickly commented that “I also
played 10 rounds.” This comment was important
because it was her way of letting the group know
that she was mentally alert and able—“straight in
the mind”—because it was important to her.
Being around animals was another important
way of distracting oneself.
I have my little dogs. I talk with them . . . they don’t
talk to me but they keep my mind occupied and I
don’t think about bad things. It’s something also,
chickens. I walk with them and talk with them.
To be occupied . . . a busy mind. Well, for me, I like
chickens, birds, cats, and dogs, all of the small animals I like. I have them in my house, I give them
food, I change their litter, and when I come here,
my birds sing—good singers.
Keeping the mind physically occupied was described by a participant as doing “manual labor”
for the mind.
This is very important, right, for our minds to be
employed in manual labor; for example, something
that makes us think, to pass the time, right, like
“crafts,” dressmaking, that I do to stimulate my
thinking, right, this is like exercise for the mind
I can do to stay well.
Discussion
Future projections for the growth and size of the
Hispanic population, primarily of Mexican descent,
portend to increasing health disparities (Heller
et al., 2006; Stone & Balderrama, 2008). Inclusion
of culture and language will be increasingly important in tailoring and delivering health messages.
This study is apparently the first to examine how, in
Another participant described occupying the
mind as “to do a job.” Several comments about
the work aspect of keeping the mind occupied include the following:
Well, to do a job, weaving, knitting, or embroidering, what you know how to do, but to be doing
Vol. 49, No. S1, 2009
S83
taken to ensure the integrity and accuracy of translations of participants’ discussions. Still, there were
probably some terms, for which there were no suitable semantic or conceptual equivalent.
There are a number of implications suggested
from this study. The first is consideration of heterogeneity within groups that requires an understanding of beliefs, attitudes, and context among
population subgroups. Second, particular attention must be focused on cultural and linguistic patterns in describing health and, correspondingly, in
delivering health messages. In addition to specific
health messages, importantly, public health interventions targeted to supporting communities in
promoting healthy brains among the aging population need to be broadened to include such nontraditional aspects as helping older adults find
satisfying activities and vocalizing fear about future dependence on children.
their native Spanish language, low-income Mexican
Americans, who reside in areas of persistent poverty, view cognitive health and how they may be motivated to improve lifestyle behaviors to maintain it.
Conducting all aspects of this study in Spanish afforded the seniors the opportunity to give their
voice to the meaning of aging well.
Common across all four groups was the importance of “keeping the mind” or derechita with aging. Discussions centered on beliefs about the
meaning of aging well, meaning of not aging well,
concerns about aging and memory, and distraction
to improve/maintain the mind.
Interestingly, there was a reference to the “evil
eye,” which supports an underlying “folk religion,”
including curanderismo. Curanderismo is a belief
system in the healing capacities of curanderos (people who have the power to cure), lay practitioners
acknowledged among the local Mexican American
population for treating certain somatic, psychological, or spiritual ailments. Curandismo is regarded
as parallel or synchronous with biomedical treatments, as well as aspects of Christian beliefs. It traces
its beginnings to Aztecan, Mayan, and Incan tribes
and their religious beliefs of harmony with nature,
spirit, and self (Padilla, Gomez, Biggerstaff, &
Mehler, 2001). One of the basic tenets of curandismo is that illness is the result of the punishment
for a sin. According to Trotter and Chavira (1997),
curanderismo will not disappear as Mexicans assimilate into U.S. society but will be transformed as
immigrants and their children adapt. Further exploration of this aspect of Mexican culture is warranted and may provide opportunities and challenges
for behavioral interventions.
The themes stressed by focus group participants
in this case study contrast with the themes and
subthemes identified by two English-speaking Hispanic focus groups on the same topic (Laditka
et al., 2009). This is not to say that language was
the main difference; we expect differences in household income, education, neighborhood deprivation, and degree of assimilation to say the least.
Throughout the discussions, there was a link
among conventional religion, folk religion, and the
supernatural. Noticeably absent from discussions
in this study were mentions on physical impairments or on the importance of social involvement.
This study is limited by the collection of data in
Spanish and analysis and interpretation in English.
This is not uncommon in studies where data are
collected in a language different from the researcher. As mentioned earlier, additional steps were
Funding
This research was supported in part by a cooperative agreement from
the Centers for Disease Control and Prevention’s Prevention Research
Centers Program Healthy Aging Research Network, Special Interest Project (SIP) 13-04 and SIP 8-06, and Cooperative Agreement 1-U48-DP000045 funded by a grant from the Centers for Disease Control and
Prevention through the Center for Community Health Development.
Acknowledgments
We are grateful to the promotoras who provided valuable assistance in
the modification of the focus group interview guide and to the four promotoras who recruited the focus group participants and served as observers
during the focus groups. We also greatly appreciate the many older adults
who participated in the focus groups and shared their thoughts and ideas
with us. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease
Control and Prevention.
References
Centers for Disease Control and Prevention. (2004). Health disparities experienced by racial/ethnic minority populations. Morbidity and Mortality Weekly Report, 53, 755.
Haan, M. N., Miller, J. W., Aiello, A. E., Whitmer, R. A., Jagust, W. J., &
Mingas, D. M. (2007). Homocysteine, B vitamins, and the incidence of
dementia and cognitive impairment: Results from the Sacramento Area
Latino Study on Aging. American Journal of Clinical Nutrition, 85,
511–517.
Heller, P. L., Briones, D. F., Schiffer, R. B., Guerrero, M., Royall, D. R.,
Wilcox, J. A., et al. (2006). Mexican-American ethnicity and cognitive
function: Findings from an elderly southwestern sample. Journal of
Neuropsychiatry and Clinical Neurosciences, 18, 350–355.
Hunter, J. B., de Zapien, J. G., Papenfuss, M., Fernandez, M. L., Meister,
J., & Giuliano, A. R. (2004). The impact of a promotora on increasing
routine chronic disease prevention among women aged 40 and older at
the U.S.-Mexico border. Health Education and Behavior, 31(4), 18S–
28S.
Krueger, R. A. (1998). Analyzing and reporting focus group results (Vol. 6).
Thousand Oaks, CA: Sage.
Laditka, S. B., Corwin, S. J., Laditka, J. N., Liu, R., Teng, W., Wu, B.,
et al. (2009). Attitudes about aging well among a diverse group of
older Americans: Implications for promoting cognitive health. The
Gerontologist, 49(Suppl. 1), S30–S39.
S84
The Gerontologist
Mier, N., Ory, M. G., Zhan, D., Conkling, M., Sharkey, J. R., & Burdine,
J. N. (2008). Health-related quality of life among Mexican Americans
living in colonias at the Texas-Mexico border. Social Science & Medicine, 66, 1760–1771.
Office of Aging Policy and Information. (2002). Texas Department on Aging.
Older adult profile: Hispanics in Texas. Retrieved February 19, 2003,
from http://www.tdoa.state.tx.us/OAPIpubs/HispanicPopulation2.pdf
Padilla, R., Gomez, V., Biggerstaff, S. L., & Mehler, P. S. (2001). Use of
curanderismo in a public health care system. Archives of Internal Medicine, 161, 1336–1340.
Raji, M. A., Reyes-Ortiz, C. A., Kuo, Y.-F., Markides, K. S., & Ottenbacher, K. J. (2007). Depressive symptoms and cognitive change in
older Mexican Americans. Journal of Geriatric Psychiatry and Neurology,, 20, 145–152.
Ramos, M. I., Allen, L. H., Mungas, D. M., Jagust, W. J., Haan, M. N.,
Green, R., et al. (2005). Low folate status is associated with impaired
cognitive function and dementia in the Sacramento Area Latino Study
on Aging. American Journal of Clinical Nutrition, 82, 1346–1352.
Vol. 49, No. S1, 2009
Stone, L. C., & Balderrama, C. H. H. (2008). Health inequalities among
Latinos: What do we know and what can we do? Health & Social
Work, 33, 3–7.
Texas Secretary of State. (2008). Colonias FAQ. Retrieved May 22, 2008,
from http://www.sos.state.tx.us/border/colonias/faqs.shtml
Trotter, R. C., II, & Chavira, J. A. (1997). Curanderismo: Mexican American
folk healing. Athens: University of Georgia Press.
U.S. Census Bureau. (2000). American FactFinder. Retrieved May 14,
2005, from http://factfinder.census.gov/home/saff/main.html?_lang=en
U.S. Department of the Interior, U.S. Geological Survey. (2005). Border
health initiative: Data tables. Retrieved June 5, 2005, from http://
www.borderhealth.cr.usgs.gov/datatables.html
Ward, P. M. (Ed.), (1999). Colonias and public policy in Texas and Mexico.
Austin: University of Texas Press.
Received July 21, 2008
Accepted November 3, 2008
Decision Editor: Angela K. Hochhalter, PhD
S85