Focused interviews with Sudanese Americans: perceptions about diet, nutrition, and cancer

Looking Across and Within: Immigration as a Unifying Structural Factor Impacting Cardiometabolic Health and Diet

Introduction

Immigration has been identified as an important social determinant of health (SDH), embodying structures and policies that reinforce positions of poverty, stress, and limited social and economic mobility. In the public health literature with regard to diet, immigration is often characterized as an individual-level process (dietary acculturation) and is largely examined in one racial/ethnic subgroup at a time. For this narrative review, we aim to broaden the research discussion by describing SDH common to the immigrant experience and that may serve as barriers to healthy diets.

Methods

A narrative review of peer-reviewed quantitative, qualitative, and mixed methods studies on cardiometabolic health disparities, diet, and immigration was conducted.

Results

Cardiometabolic disease disparities were frequently described by racial/ethnic subgroups instead of country of origin. While cardiovascular disease and obesity risk differed by country of origin, diabetes prevalence was typically higher for immigrant groups vs United States (US)-born individuals. Common barriers to achieving a healthy diet were food insecurity; lack of familiarity with US food procurement practices, food preparation methods, and dietary guidelines; lack of familiarity and distrust of US food processing and storage methods; alternative priorities for food purchasing (eg, freshness, cultural relevance); logistical obstacles (eg, transportation); stress; and ethnic identity maintenance.

Conclusions

To improve the health of immigrant populations, understanding similarities in cardiometabolic health disparities, diet, and barriers to health across immigrant communities-traversing racial/ethnic subgroups-may serve as a useful framework. This framework can guide research, policy, and public health practices to be more cohesive, generalizable, and meaningfully inclusive.

The Health of Arab Americans in the United States: An Updated Comprehensive Literature Review

Background: Arab Americans are a historically understudied minority group in the United States and their health needs and risks have been poorly documented. We aim to provide an updated comprehensive review of the literature on Arab American physical and mental health and provide suggestions for future work in this field.

Methods: A comprehensive review of the English language medical and public health literature published prior to 2017 identified through multiple database searches was conducted with search terms describing Arab Americans and health outcomes and behaviors. The literature was qualitatively summarized by health behavior (vaccination, tobacco use, drug and alcohol use, and physical activity), health outcome (diabetes, mental health, cardiovascular disease, cancer, women's, and child health), and populations at increased risk of poor health outcomes (adolescents and the elderly).

Results: The majority of studies identified exploring Arab American health have been published since 2009 with an increase in the number of longitudinal and intervention studies done with this population. The majority of research is being undertaken among individuals living in ethnic enclaves due to the lack of an ethnic or racial identifier that may help identify Arab Americans from population-based studies. Studies highlight the conflicting evidence in the prevalence of diabetes and cardiovascular disease based on study sample, an increased understanding of cancer incidence and barriers to identification, and an increased level of knowledge regarding mental health and sexual health needs in the population. Information on health behaviors has also increased, with a better understanding of physical activity, alcohol and drug use, and vaccination.

Conclusion: More research on Arab American health is needed to identify risks and needs of this marginalized population given the current social and political climate in the United States, especially with regard to acculturation status and immigrant generation status. We provide recommendations on approaches that may help improve our understanding of Arab American health.

Sex Differences in the Association of Perceived Ambiguity, Cancer Fatalism, and Health-Related Self-Efficacy with Fruit and Vegetable Consumption

Adequate fruit and vegetable (FV) consumption is promoted as a means of preventing chronic health conditions, such as cardiovascular disease and cancer. This study investigated whether perceived ambiguity about cancer prevention recommendations, fatalistic beliefs about cancer, and health-related self-efficacy were associated with FV consumption and whether sex moderated these associations. Data from the five most recent waves (spanning 2011 to 2017) of the nationally representative Health Information National Trends Survey (N = 16,965) were used. Participants reported levels of perceived ambiguity, cancer fatalism, health-related self-efficacy, and daily FV consumption. Perceived ambiguity and cancer fatalism were negatively associated with FV consumption, ps <.001, whereas health-related self-efficacy was positively associated with FV consumption, b = 0.34, p < .001. Sex moderated these associations, ps <.05. Perceived ambiguity and cancer fatalism were more strongly associated with less FV consumption for men, bs < -0.31, ps <.001, than women, bs < -0.14, ps <.01. In contrast, health-related self-efficacy was more strongly associated with more FV consumption for women, b = 0.43, p < .001, than men, b = 0.26, p < .001. These results suggest that tailoring health messaging to target sex-specific barriers may improve their effectiveness.

Construction and Validation the Lifestyle Questionnaire Related to Cancer

Background:

Healthy lifestyle is a significant factor in cancer etiologic and prevention of cancer. There are instruments to measure a healthy life style, but the lifestyle questionnaires only examine one or a few more aspects of lifestyle.

Objectives:

The purpose of this study was to construct a comprehensive instrument to examine all aspects of lifestyle related to cancer.

Materials and Methods:

This study was a cross-sectional study that was conducted in Yazd city in Iran. A questionnaire was designed to assess and measure various aspects of lifestyle related to cancer using similar studies. Researchers used the Cronbach’s alpha and test-retest method to determine the reliability. Also, construct validity was determined using the factor analysis method in SPSS 16 software.

Results:

Face validity was examined using a panel of experts. Cronbach’s alpha for the whole scale was appropriate (α = 0.87). Also, Cronbach’s alpha for all dimensions of questionnaire was acceptable (perfect score). Test-retest method was used to determine the reliability. The results indicated that ICC was in the range of 0.84 to 0.94. Based on the obtained results of factor analysis method, 8 dimensions of the questionnaire were extracted (physical health, physical activity and exercise, mental health, drug and alcohol avoidance, balanced consumption of food, environmental pollutants and harmful substances, weight control and nutrition, and reproductive health).

Conclusions:

This study showed that the present questionnaire can be used as a valid and reliable tool for collecting data about the lifestyle of people related to cancer.

Turkish social attitudes towards to cancer prevention: a health belief model study

This research was planned to reveal society's attitude towards cancer and early diagnosis using the health belief model. This study was planned as descriptive research in Isparta. A random sample of n=256 individuals of both genders was recruited at the largest shopping center. As a means of collection tool, a survey consisted of two forms, the first designed for sociodemographic information and the second covering 29 questions suitable for the content of Health Belief Model. Of the participants, 66.8% were female and 33.2% were male, and the average age was 33.3±11.0 years. Some 46.1% partly thought that they may develop cancer, and 49.6% were afraid of this possibility. As many as 50% indicated that cancer is an issue that comes from Allah. A significant difference was found between not going for control unless feeling bad, and blood analysis for cancer screening (χ2=3.780 p= 0.03). It was seen that in an area with a high rate of cancer, people's awareness of cancer prevention and early diagnosis and attitudes towards these are insufficient.

Somali Perspectives on Physical Activity: PhotoVoice to Address Barriers and Resources in San Diego

BACKGROUND

Although many immigrants enter the United States with a healthy body weight, this health advantage disappears the longer they reside in the United States. To better understand the complexities of obesity change within a cultural framework, a community-based participatory research (CBPR) approach, PhotoVoice, was used, focusing on physical activity among Muslim Somali women.

OBJECTIVES

The CBPR partnership was formed to identify barriers and resources to engaging in physical activity with goals of advocacy and program development.

METHODS

Muslim Somali women (n=8) were recruited to participate, trained and provided cameras, and engaged in group discussions about the scenes they photographed.

RESULTS

Participants identified several barriers, including safety concerns, minimal culturally appropriate resources, and financial constraints. Strengths included public resources and a community support system. The CBPR process identified opportunities and challenges to collaboration and dissemination processes.

CONCLUSIONS

The findings laid the framework for subsequent program development and community engagement.

Health-promoting lifestyle behaviour for cancer prevention: a survey of Turkish university students

BACKGROUND

Health risks associated with unhealthy behaviours in adolescent and university students contribute to the development of health problems in later life. During the past twenty years, there has been a dramatic increase in public, private, and professional interest in preventing disability and death through changes in lifestyle and participation in screening programs. The aim of the study was to evaluate university students' health-promoting lifestyle behaviour for cancer prevention.

METHOD

This study was carried out on university students who had education in sports, health and social areas in Celal Bayar University, Manisa, Turkey. The health-promoting lifestyles of university students were measured with the "health-promoting lifestyle profile (HPLP)" The survey was conducted from March 2011 to July 2011 and the study sample consisted of 1007 university students. T-test, ANOVA and multiple regression analyses were used for statistical analyses.

RESULTS

In the univariate analyses, the overall HPLP score was significantly related to students' school, sex, age, school grades, their status of received health education lessons, place of birth, longest place of residence, current place of residence, health insurance, family income, alcohol use, their status in sports, and self-perceived health status. Healthier behaviour was found in those students whose parents had higher secondary degrees, and in students who had no siblings. In the multiple regression model, healthier behaviour was observed in Physical Education and Sports students, fourth-year students, those who exercised regularly, had a good self-perceived health status, who lived with their family, and who had received health education lessons.

CONCLUSION

In general, in order to ensure cancer prevention and a healthy life style, social, cultural and sportive activities should be encouraged and educational programmes supporting these goals should be designed and applied in all stages of life from childhood through adulthood.

Attitudes to cancer and cancer prevention: what do people aged 35-54 years think?

The aim of this study was to explore the knowledge, attitudes and behaviours of people in mid-life towards cancer prevention. The study was undertaken in Northern Ireland between 2003 and 2007. This was a mixed methods study using a sequential exploratory design. The theoretical framework was the Theory of Planned Behaviour and the methodology was based on Sutton's framework. There were three methodological stages in the study using focus groups, a large cross-sectional survey and a volunteer sample survey. This paper focuses on the findings of the cross-sectional survey relating to the attitudes of people in mid-life towards cancer and cancer prevention. Findings are considered in relation to the respondents' level of knowledge, age, gender, level of educational attainment and socio-economic status. Evidence from this study shows that attitudes towards cancer and cancer prevention are associated significantly with level of knowledge about cancer, gender, socio-economic status and level of educational attainment. In conclusion, the evidence from this study shows that men, those with a lower level of education, those with a lower level of knowledge and those in a lower socio-economic group were more likely to hold negative attitudes about cancer and cancer prevention.

Dietary consumption practices and cancer risk in African Americans in the rural South

This study describes the dietary consumption practices of a sample of African Americans in the rural South. A qualitative research design involving a cross-sectional food diary was utilized. Complete datasets were collected from 114 participants, 66% female, between the ages of 19 and 79 years. The consumption of a variety of fruits, non-starchy vegetables and unprocessed cereals in daily meals was low in this sample. Frequent consumption of fried foods; fast foods; sugary, carbonated beverages; processed, high-fat and high-sodium foods; and low fruit and non-starchy vegetable intake were evident. The findings are crucial to the development for culturally-specific nutrition education intervention programs for African Americans in the rural South targeted at the modification of not only diet, but food preparation methods to reduce cancer risk.

The utility of focus group interviews to capture dietary consumption data in the distant past: dairy consumption in Kazakhstan villages 50 years ago

From 1949 to 1962, residents of several villages in Kazakhstan received substantial doses of radiation to the thyroid gland resulting from nuclear tests conducted at the Semipalatinsk Nuclear Test Site. The primary source of radiation was internal from an intake of radioactive iodine by consumption of contaminated dairy products. A previous research study of childhood exposure and thyroid disease in this region gathered limited data on study participants' dairy intake at the time of the fallout for the purpose of estimating past radiation doses. As many participants were too young at the time of the nuclear tests to recall dietary consumption and existing sources of archival data are limited, it was necessary to interview parents and other village residents who cared for children during this time - older adults ranging in age from 75 to 90 years. Results from 11 focus group interviews conducted in 2007 with 82 women from 4 villages in Kazakhstan yielded group-level estimates of age-, gender-, ethnicity- and village-specific dairy consumption patterns in rural Kazakhstan during the 1950s. Children typically consumed cow's milk with limited consumption of mare, goat and sheep milk; and consumed dairy products such as sour milk (airan), soft cottage cheese (tvorog) and fermented mare milk (koumiss) with the greatest amounts of koumiss reported at ages 15-21 years. The consumption patterns differed by age, and between Kazakh and Russian children, which should lead to different estimates of radiation exposure to the thyroid. This study showed the utility of focus groups to obtain quantitative estimates for dietary intake in the distant past.

Use of focus groups to understand African-Americans' dietary practices: Implications for modifying a food frequency questionnaire

OBJECTIVE

To generate information about dietary practices, food preferences and food preparation methods from African-Americans in Macon County, Alabama, as a precursor to an intervention designed to modify an existing dietary health questionnaire (DHQ).

METHOD

African-American males (30) and females (31) ages 20 to 75 years participated in eight focus groups in Macon County Alabama between June and July, 2007.

RESULTS

The core topics identified were dietary practices; food preferences; food preparation methods; fast food practices; and seasonal/specialty foods. The younger focus group participants reported consuming mostly fast foods such as hamburgers for lunch. Fruits, vegetables, salads, fish, chicken and sandwiches were the most common lunch foods for the older males and females. Across the groups, rice, cornbread and potatoes were reportedly the most commonly consumed starchy foods at dinner. Frying and baking were the most common cooking methods. Fewer participants reported removing the skin when cooking chicken versus those who did not remove. Traditional foods including fried green tomatoes and cracklings were selected for addition to the modified DHQ, while those not commonly consumed, were deleted.

CONCLUSIONS

Participants described high-fat traditional food preferences, common frying and addition of salted meats to vegetables, which informed the modification of a DHQ.

Ethical, legal and social issues of genetic studies with African immigrants as research subjects

There is growing interest in exploring gene-environment interactions in the etiology of diseases in immigrants from sub-Saharan Africa. Our experience working with the Sudanese immigrant population in Omaha, NE, makes clear the pressing need for geneticists and federal and local funding agencies to address the ethical, legal and social implications of genetic research with such vulnerable populations. Our work raises several questions. How does one design research with African immigrant participants to assure it is ethical? Many immigrants may not understand the purposes, risks and benefits involved in research because of low literacy rates, one of the results of civil wars, or concepts of biologic science foreign to their cultures. Is it possible to obtain truly informed consent? Do African immigrants perceive genetic research using them as subjects as racist? Is genetic research on minorities "biopiracy" or "bio-colonialism?" In our experience, some Sudanese immigrants have challenged the legality and ethics of genetic studies with profit-making as an end. We have concluded that it is essential to educate African immigrant or any other non-English-speaking immigrant participants in research using lay language and graphic illustrations before obtaining consent. Cultural proficiency is important in gaining the trust of African immigrants; profit-sharing may encourage their participation in genetic research to benefit all; involvement of African immigrant community leaders in planning, delivery and evaluation using the community-based participatory research approach will facilitate healthcare promotion, health literacy education, as well as genetic research. It is crucial to address the ethical, legal and social implications of genetic studies with African immigrants as research subjects.