Understanding the nutrition information needs of migrant communities: the needs of African and Pacific Islander communities of Logan, Queensland

"We Eat Without Thinking: We Just Eat, Eat, Eat" - A Thematic Exploration of Cultural Practices of Ethnically Diverse Youth and Their Parents Who Are at Risk for Prediabetes and Type 2 Diabetes

PURPOSE

Cultural beliefs and practices influence management of type 2 diabetes (T2D) in youth and their parents, and have been minimally explored, limiting our understanding and implementation of preventative healthcare. An enhanced evidence base may inform comprehensive, effective community health nursing (CHN). Thus, the purpose of this research was to explore the influence of youths' and their parents' understandings of cultural practices on risk for prediabetes and T2D.

DESIGN

A secondary thematic analysis was conducted. Qualitative data were obtained from semi-structured interviews with 24 participants who were purposefully recruited from two mid-western Canadian high schools.

FINDINGS

Three themes and one subtheme were developed including: 1) Food Culture and related subtheme, Acculturation to New Food Choices; 2) Exercise Culture: Adapting Physical Activity in a New Country; and, 3) Risk Perception of the Effects of T2D on Loved Ones: Behavior Modifications and Motivation. Cultural practices and acculturation to food such as dietary choices, preparation, large portions, different dietary staples, food availability, and food gathering patterns influenced health behaviors. Similarly, changes in exercise patterns including adapting to Western video game culture, weather in Canada, and the new way of life emerged as important factors that impacted health. Participants who perceived a familial risk of diabetes identified behavior modifications such as regular diabetes screening, nutrition counseling, healthier food choices, smaller food portions, and an increase in physical activity as strategies to reduce risk of prediabetes and diabetes.

CONCLUSIONS

There is a critical need for research aimed at prediabetes and T2D prevention, and intervention programs targeting ethnically diverse groups where prediabetes and T2D is most prevalent.

CLINICAL EVIDENCE

Community health nurses are at the core of implementing and supporting disease prevention and, therefore, may consider the findings from this research to develop family-focused, intergenerational, and culturally-based interventions.

Past and projected growth of Australia's older migrant populations

In recent years, Australia’s older population (aged 65 and over) has been growing rapidly, accompanied by a shift in its country of birth composition. Although a great deal of research has been undertaken on past and current aspects of Australia’s migrant groups, little attention has been paid to future demographic trends in older populations. The aim of this paper is to examine recent and possible future demographic trends of Australia’s migrant populations at the older ages. We present population estimates by country and broad global region of birth from 1996 to 2016, and then new birthplace-specific population projections for the 2016 to 2056 period. Our findings show that substantial growth of the 65+ population will occur in the coming decades, and that the overseas-born will shift from a Europe-born dominance to an Asia-born dominance. Cohort flow (the effect of varying sizes of cohorts moving into the 65+ age group over time) will be the main driver of growth for most older birthplace populations. The shifting demography of Australia’s older population signals many policy, planning, service delivery and funding challenges for government and private sector providers. We discuss those related to aged care, health care, language services, the aged care workforce, regulatory frameworks and future research needs in demography and gerontology.

Exploring abnormal glucose metabolism in pregnancy among Australian Chinese migrants

OBJECTIVE

Gestational diabetes mellitus (GDM) is a metabolic disorder of pregnancy that is increasingly prevalent among Chinese women. Few studies have examined whether the migration status of Chinese women contributes to the risks of developing GDM during pregnancy.

RESEARCH DESIGN AND METHODS

In this observational, cross-sectional and hospital-based study, we examined the prevalence of GDM and glycemic levels at oral glucose tolerance test (OGTT) among 491 Australian Chinese migrants (n=491) and native Chinese (n=1000). We defined GDM using the International Association of Diabetes and Pregnancy Study Groups guidelines. We collected data on maternal age, body mass index (BMI) and gestational age (GA) at booking and GA at delivery from medical records. We used multiple logistic and linear regression models to calculate the OR of having GDM and mean differences in glycemic levels in Australian Chinese migrants, relative to native Chinese.

RESULTS

Age-at-booking and BMI-at-booking adjusted GDM prevalence was significantly higher in Australian Chinese migrants than native Chinese (19.7% vs 14.6%; p=0.01). After adjusting for age, BMI at booking and GA at booking, fasting glucose levels were significantly lower (β -0.08 mmol/L; 95% CI -0.14 to 0.02), while 2-hour glucose levels were significantly higher (0.22 mmol/L; 0.02 to 0.43) in Australian Chinese immigrants than native Chinese.

CONCLUSIONS

Migration status may be a marker for abnormal glucose metabolism during pregnancy among Australian Chinese migrants, possibly due to socio-economic disadvantages and lifestyle changes associated with migration.

Exploring Factors Influencing Childhood Obesity Prevention Among Migrant Communities in Victoria, Australia: A Qualitative Study

Despite the availability of numerous obesity prevention initiatives in developed countries including Australia, rising childhood obesity levels have been found among migrant communities which contribute to widening obesity-related disparities in these countries. We sought to understand the factors influencing the participation of migrant communities in childhood obesity prevention initiatives. We conducted a qualitative study using semi-structured interviews among 48 migrant parents from African, Middle Eastern, Indian and Vietnamese origins living in disadvantaged areas of Victoria, Australia to explore their views on childhood obesity and its prevention. Thematic analysis showed low obesity literacy among migrant communities, cultural influences negatively impacting their healthy lifestyle behaviours and cultural, family-level and community-level barriers impacting their participation in childhood obesity prevention initiatives. There is an urgent need to improve obesity literacy among migrant communities using bicultural workers in order to improve their responsiveness to childhood obesity prevention initiatives. Health interventionists are urged to incorporate culturally-mediated influences in the design of obesity prevention programs to achieve energy balance and maintain healthy weight among migrants. Such culturally appropriate approaches have the potential of reducing the widening ethnic-related obesity disparities in Australia.

Trends in overweight, obesity, and waist-to-height ratio among Australian children from linguistically diverse backgrounds, 1997 to 2015

OBJECTIVE

To report the cross-sectional prevalence and 18-year trends in overweight, obesity and abdominal obesity among Australian children from culturally and linguistically diverse (CALD) backgrounds.

SUBJECTS/METHODS

Four cross-sectional population health surveys conducted among children (age 4-16 years; n=26, 449) in 1997-2004-2010-2015 in New South Wales, (NSW) Australia. Adiposity outcomes were measured by trained field staff using standard procedures. Binomial regression models with a robust error variance were used to estimate prevalence ratio (PR) and 95% confidence intervals (CI) for overweight and obesity, obesity, and waist-to-height ratio (WHtR) ≥ 0.5 for children from Asian, European, and Middle Eastern language backgrounds compared with children from English-speaking backgrounds, adjusted for sociodemographic characteristics.

RESULTS

Over time, children from Middle Eastern language backgrounds were consistently more likely to be overweight-obese (PR: 1.29-1.42), obese (PR: 1.49-1.65), and have WHtR ≥ 0.5 (PR: 1.42-1.90), compared with children from English-speaking backgrounds. Children from European language backgrounds generally had higher prevalence and children from Asian language backgrounds had lower prevalence, compared with children from English-speaking backgrounds. Between 1997 and 2015, there were significant trends in the prevalence of overweight and obesity combined among children from English-speaking (PR: 1.06, 95%CI: 1.02, 1.09), Middle Eastern (PR: 1.14, 95%CI: 1.05, 1.24), and Asian language backgrounds (PR: 1.14, 95%CI: 1.05, 1.24). The prevalence of WHtr ≥ 0.5 increased among children from English-speaking (PR: 1.21, 95%CI: 1.13, 1.31) and Middle Eastern (PR: 1.35, 95%CI: 1.16, 1.56) language backgrounds.

CONCLUSIONS

Overall, the prevalence of overweight and obesity and abdominal obesity is high among NSW children from CALD backgrounds and has increased over time. This suggests that there is a greater scope in understanding, developing, and implementing interventions across the early life-course of children from CALD backgrounds.

Lifestyle Interventions for People with, and at Risk of Type 2 Diabetes in Polynesian Communities: A Systematic Review and Meta-Analysis

There is evidence that lifestyle intervention among Polynesian people can reduce diabetes incidence and complications, but this evidence has not been systematically reviewed. The aim of this study was to systematically review the efficacy of lifestyle interventions, targeting the prevention and management of type 2 diabetes among Polynesian people. MEDLINE, Web of Science, Cochrane Library, and Embase were searched to find randomised controlled trials (RCTs) and pre-post studies. Eight studies (four RCTs and four pre-post studies) with 1590 participants met the inclusion criteria. The data on health outcomes that was reported in these studies included blood pressure, body mass index, waist circumference, weight, and glycated haemoglobin (HbA1c). The meta-analyses showed that the interventions had resulted in statistically significant reductions in systolic blood pressure (SBP) across four of the studies (WMD, −9.93 mmHg; 95% Cl, −10.77 to −9.09; and p < 0.00001). However, the effects on weight across five of the studies (WMD, −1.15 kg; 95% Cl, −2.80 to 0.51; p = 0.18) and the HbA1c levels across two of the studies (WMD, −0.38%; 95% Cl, −1.15 to 0.39; and p = 0.33) were not statistically significant. This review provides evidence that lifestyle interventions may be effective in achieving modest reductions in SBP in Polynesian people. Further research is needed to fully assess the effectiveness of these interventions in this population long-term.

Barriers and facilitators to childhood obesity prevention among culturally and linguistically diverse (CALD) communities in Victoria, Australia

OBJECTIVE

Childhood obesity is rising among culturally and linguistically diverse (CALD) groups who show poor engagement in obesity prevention initiatives. We examined the barriers and facilitators to the engagement of CALD communities in obesity prevention initiatives.

METHODS

We used the nominal group technique to collect data from 39 participants from Vietnamese, Burmese, African, Afghani and Indian origins living in disadvantaged areas of Victoria, Australia. Data analysis revealed ranked priorities for barriers and facilitators for CALD community engagement in obesity prevention initiatives.

RESULTS

CALD parents identified key barriers as being: competing priorities in the post-migration settlement phase; language, cultural and program accessibility barriers; low levels of food and health literacy; junk food advertisement targeting children; and lack of mandatory weight checks for schoolchildren. Key facilitators emerged as: bicultural playgroup leaders; ethnic community groups; and school-based healthy lunch box initiatives.

CONCLUSION

This study has identified several policy recommendations including: the implementation of robust food taxation policies; consistent control of food advertising targeting children; improving CALD health literacy using bicultural workers; and matching health promotional materials with CALD community literacy levels. Implications for Public Health: These recommendations can directly influence public health policy to improve the engagement of CALD communities in obesity prevention services and ultimately reduce the widening obesity disparities in Australia.

Refugees connecting with a new country through community food gardening

Refugees are a particularly vulnerable population who undergo nutrition transition as a result of forced migration. This paper explores how involvement in a community food garden supports African humanitarian migrant connectedness with their new country. A cross-sectional study of a purposive sample of African refugees participating in a campus-based community food garden was conducted. Semi-structured interviews were undertaken with twelve African humanitarian migrants who tended established garden plots within the garden. Interview data were thematically analysed revealing three factors which participants identified as important benefits in relation to community garden participation: land tenure, reconnecting with agri-culture, and community belonging. Community food gardens offer a tangible means for African refugees, and other vulnerable or marginalised populations, to build community and community connections. This is significant given the increasing recognition of the importance of social connectedness for wellbeing.

Informing a culturally appropriate approach to oral health and dental care for pre-school refugee children: a community participatory study

Background

Pre-school children in families of recently settled refugees often have very high rates of early childhood caries (ECC). ECC is associated with a high level of morbidity and is largely preventable, however effective culturally appropriate models of care are lacking. This study aimed to provide a deeper understanding of the refugee experience related to early oral health by exploring pre-school refugee families (i) understanding of ECC and child oral health, (ii) experiences of accessing dental services and (iii) barriers and enablers for achieving improved oral health. The knowledge gained will be critical to the development of effective early oral health programs in refugee children.

Methods

Community based participatory qualitative methodology using focus groups of resettled refugee families and community refugee nurse interviews. A community reference group was established and a bi-lingual community research associate was employed. Transcripts were analysed for thematic content using NVivo software.

Results

There were 44 participants: eight focus groups (nine countries of origin) and five interviews. Emergent themes were (i) the major influence of parents’ previous experience, including their beliefs about deciduous (baby) teeth, traditional feeding practices and poverty; and a consequent lack of understanding of the importance of early oral health and early dental caries, (ii) the burden of resettlement including prioritising, parenting, learning about new foods and how to assimilate into the community, and (iii) refugees’ difficulties in accessing both information and dental services, and the role of schools in addressing these issues. An Opportunities for Change Model was proposed.

Conclusions

The main implication of the study is the demonstration of how enhanced understanding of the refugee experience can inform improvement in early oral prevention and treatment. The community participatory methodology of the study provided a basis for cross-cultural understanding and has already assisted in translating the findings and raising awareness in the provision of targeted refugee oral health services.