Factors related to physical activity in Hispanic women

Change in Neighborhood Socioeconomic Status and Adherence to the Cancer Prevention Lifestyle Guidelines in Hispanic/Latino Adults: Results from the HCHS/SOL Study

Neighborhood conditions are dynamic; the association of changing neighborhood socioeconomic factors with cancer preventive behaviors remains unclear. We examined associations of neighborhood socioeconomic deprivation, gentrification, and change in income inequality with adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention in The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The HCHS/SOL enrolled 16,415 adults, ages 18–74 years, at baseline (2008–2011), from communities in the Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA. Geocoded baseline addresses were linked to the 2000 decennial Census and 5-year American Community Survey (2005–2009 and 2012–2016) tracts to operationalize neighborhood deprivation index (NDI), gentrification, and income inequality. Complex survey multinominal logistic regression models estimated the relative risk ratio (RRR) with overall guideline adherence level (low, moderate, high) and by components—diet, physical activity, body mass index (BMI), and alcohol intake. Overall, 14%, 60%, and 26% of the population had low, moderate, and high ACS guideline adherence, respectively. NDI was negatively associated with risk of high (vs. low) guideline adherence [RRR = 0.87, 95% confidence interval (CI) = 0.78–0.98], although attenuated after controlling for individual socioeconomic status (SES; RRR = 0.89, 95% CI = 0.80–1.00), and associated with lower adherence to BMI recommendations (low vs. moderate RRR = 0.90, 95% CI = 0.84–0.97; high RRR = 0.86, 95% CI = 0.77–0.97). Gentrification was associated with higher likelihood of meeting the dietary recommendations (low vs. moderate RRR = 1.04, 95% CI = 1.01–1.07), but not with overall adherence or individual components. Change in income inequality was not associated with outcomes. Neighborhood deprivation may be negatively associated with ACS guideline adherence among Hispanic/Latino adults.

SIGNIFICANCE

This study provides new evidence on the link between neighborhood gentrification, changing income inequality and adoption and maintenance of cancer preventive behaviors in an understudied population in cancer research. We observed that while neighborhood deprivation may deter from healthy lifestyle behaviors, positive changes in neighborhood SES via the process of gentrification, may not influence lifestyle guideline adherence among Hispanic/Latino adults.

Barriers and facilitators of physical activity among Latina immigrant and Mexican mothers living in the US and Mexico: A qualitative study

Latina immigrant women are among the least physically active when compared with women in other racial/ethnic groups in the US. Similarly, Mexican mothers in Mexico have low rates of physical activity. Motherhood and immigration experiences are recognized barriers to engage in physical activity among Latina immigrant mothers. Less is known about the factors that promote and limit physical activity engagement among Mexican mothers in Mexico, and how their experiences compare with their immigrant counterparts. This transnational qualitative study aimed to investigate the barriers and facilitators of physical activity of 25 Latina mothers in Mexico and the US. Low-income Mexican mothers of kindergarten aged children and Latino mothers of similar aged children were recruited in San Luis Potosí, Mexico and central Illinois, US. Semi-structured interviews were administered by two bilingual and bicultural researchers in participants language of preference. Interviews were transcribed verbatim and analyzed using a thematic network approach and multi-stage coding analysis guided by the Socio-Ecological Model framework. We found that at the macro-level: 1) familial obligations, and 2) cold weather after migrating; at the mezzo-level: 1) changes in walking patterns, and 2) social cohesion (e.g., lack of an invitation to engage in activities); and at the micro-level: 1) individual perceptions, particularly unattainable perceptions of physical activity and 2) shift exhaustion were perceived as barriers and occasionally facilitators of physical activity by mothers in both countries. Context-specific interventions are needed to increase women's physical activity levels in the US and Mexico.

"My Body, My Rhythm, My Voice": a community dance pilot intervention engaging breast cancer survivors in physical activity in a middle-income country

BACKGROUND

Interventions to promote physical activity among women breast cancer survivors (BCS) in low- to middle-income countries are limited. We assessed the acceptability and preliminary effectiveness of a theory-driven, group-based dance intervention for BCS delivered in Bogotá, Colombia.

METHODS

We conducted a quasi-experimental study employing a mixed-methods approach to assess the 8-week, 3 times/week group dance intervention. The effect of the intervention on participants' physical activity levels (measured by accelerometry), motivation to engage in physical activity, and quality of life were evaluated using generalized estimating equation analysis. The qualitative method included semi-structured interviews thematically analyzed to evaluate program acceptability.

RESULTS

Sixty-four BCS were allocated to the intervention (n = 31) or the control groups (n = 33). In the intervention arm, 84% attended ≥ 60% of sessions. We found increases on average minutes of moderate-to-vigorous physical activity per day (intervention: +8.99 vs control: -3.7 min), and in ratings of motivation (intervention change score = 0.45, vs. control change score= -0.05). BCS reported improvements in perceived behavioral capabilities to be active, captured through the interviews.

CONCLUSIONS

The high attendance, behavioral changes, and successful delivery indicate the potential effectiveness, feasibility, and scalability of the intervention for BCS in Colombia.

TRIAL REGISTRATION

ClinicalTrial.gov NCT05252780, registered on Dec 7th, 2021-retrospectively registered unique protocol ID: P20CA217199-9492018.

Neighborhood segregation and cancer prevention guideline adherence in US Hispanic/Latino adults: Results from the HCHS/SOL

Background

Adherence to the American Cancer Society (ACS) guidelines for cancer prevention is associated with a lower risk of cancer and mortality. The role of neighborhood segregation on adherence to the guidelines among Hispanic/Latino adults is relatively unexplored.

Materials and methods

The Hispanic Community Health Study/Study of Latinos is a community-based prospective cohort of 16,462 Hispanic/Latino adults, ages 18-74 years enrolled in 2008-2011 from the Bronx, Chicago, Miami and San Diego. Dimensions of neighborhood segregation were measured using 2010 United States' census tracts:-evenness (the physical separation of a group), exposure (the propensity for contact between groups), and their joint effect (hypersegregation). ACS guideline adherence levels - low, moderate, high - were created from accelerometry-measured physical activity, dietary intake, alcohol intake, and body mass index. Weighted multinominal logistic regressions estimated relative risk ratios (RRR) and 95% confidence intervals (CI) for guideline adherence levels and its components.

Results

Hispanic/Latino adults were classified as low (13.7%), moderate (58.8%) or highly (27.5%) adherent to ACS guidelines. We found no evidence of an association between segregation and overall guideline adherence. Exposure segregation associated with lower likelihood of moderate adherence to alcohol recommendations (RRR_{moderate vs. low}:0.86, 95%CI:0.75-0.98) but higher likelihood for diet recommendations (RRR_{moderate vs. low}:1.07, 95%CI:1.01-1.14). Evenness segregation associated with lower likelihood of high adherence to the physical activity recommendations (RRR_{high vs. low}:0.73, 95%CI:0.57-0.94). Hypersegregation was associated with individual guideline components.

Conclusion

We found evidence of a cross-sectional relationship between neighborhood segregation and ACS cancer prevention guideline components, but not with overall ACS guideline adherence.

Conversational Physical Activity Coaches for Spanish and English Speaking Women: A User Design Study

Introduction: Digital technologies, including text messaging and mobile phone apps, can be leveraged to increase people's physical activity and manage health. Chatbots, powered by artificial intelligence, can automatically interact with individuals through natural conversation. They may be more engaging than one-way messaging interventions. To our knowledge, physical activity chatbots have not been developed with low-income participants, nor in Spanish-the second most dominant language in the U.S. We recommend best practices for physical activity chatbots in English and Spanish for low-income women. Methods: We designed a prototype physical activity text-message based conversational agent based on various psychotherapeutic techniques. We recruited participants through SNAP-Ed (Supplemental Nutrition Assistance Program Education) in California (Alameda County) and Tennessee (Shelby County). We conducted qualitative interviews with participants during testing of our prototype chatbot, held a Wizard of Oz study, and facilitated a co-design workshop in Spanish with a subset of our participants. Results: We included 10 Spanish- and 8 English-speaking women between 27 and 41 years old. The majority was Hispanic/Latina (n = 14), 2 were White and 2 were Black/African American. More than half were monolingual Spanish speakers, and the majority was born outside the US (>50% in Mexico). Most participants were unfamiliar with chatbots and were initially skeptical. After testing our prototype, most users felt positively about health chatbots. They desired a personalized chatbot that addresses their concerns about privacy, and stressed the need for a comprehensive system to also aid with nutrition, health information, stress, and involve family members. Differences between English and monolingual Spanish speakers were found mostly in exercise app use, digital literacy, and the wish for family inclusion. Conclusion: Low-income Spanish- and English-speaking women are interested in using chatbots to improve their physical activity and other health related aspects. Researchers developing health chatbots for this population should focus on issues of digital literacy, app familiarity, linguistic and cultural issues, privacy concerns, and personalization. Designing and testing this intervention for and with this group using co-creation techniques and involving community partners will increase the probability that it will ultimately be effective.

Effect of aerobic and resistance exercise on the mitochondrial peptide MOTS-c in Hispanic and Non-Hispanic White breast cancer survivors

MOTS-c is a mitochondrial derived peptide with exercise mimetic activity that elicits beneficial effects on metabolism and exercise capacity. Furthermore, MOTS-c effects in humans are affected by race, potentially via ethnic-specific mtDNA variations. Women treated for breast cancer are at an increased risk for cardiovascular disease, diabetes and obesity, due to side effects of cancer-treatments. We conducted a secondary analysis of the effects of a 16-week aerobic and resistance exercise intervention on MOTS-c in Hispanic and Non-Hispanic White breast cancer survivors (BCS). BCS (Stage I-III) were randomized to exercise or standard care. The intervention promoted aerobic and resistance exercise for 16 weeks. MOTS-c was analyzed in fasting plasma using an in-house ELISA. Within and between group differences were assessed by paired t-test and repeated measures ANOVA. Pearson's correlation was computed to assess the association between MOTS-c and metabolic biomarkers at baseline and post-exercise. Twenty-five Hispanic-BCS and 24 non-Hispanic White BCS were included. Hispanic BCS were younger, of greater adiposity, had higher stage cancers, and had worse metabolic profiles at baseline compared to non-Hispanic White BCS (p < 0.001). Post-exercise, MOTS-c levels significantly increased when compared to baseline and the usual care group among non-Hispanic White BCS (p < 0.01) but not among Hispanic breast cancer survivors (p > 0.01). Post-exercise levels of MOTS-c among non-Hispanic White BCS were significantly associated with reductions in fat mass, body weight, HOMA-IR, CRP, and an increase in lean mass (p < 0.01). A 16-week aerobic and resistance intervention increased MOTS-c levels among non-Hispanic White BCS. Trial registration: This trial is registered on ClinicalTrials.gov: NCT01140282 as of June 9, 2010. https://clinicaltrials.gov/ct2/show/NCT01140282 .

Aerobic and resistance exercise improve patient-reported sleep quality and is associated with cardiometabolic biomarkers in Hispanic and non-Hispanic breast cancer survivors who are overweight or obese: results from a secondary analysis

STUDY OBJECTIVES

Poor sleep quality affects nearly one-third of breast cancer survivors and is associated with insulin resistance. The purpose of this secondary analysis was to examine the effects of a 16-week exercise intervention on patient-reported sleep quality among breast cancer survivors and assess whether changes in patient-reported sleep quality were associated with cardiometabolic biomarkers. We explored Hispanic ethnicity as a moderator of the effects of exercise on patient-reported sleep quality.

METHODS

Breast cancer survivors who were overweight or obese were randomized to exercise (n = 50) or usual care (n = 50). The 16-week intervention included aerobic and resistance exercise. Patient-reported sleep quality (Pittsburgh Sleep Quality Index [PSQI]) and biomarkers of cardiometabolic health were assessed at baseline and post-intervention. Within- and between-group differences were assessed using general linear models repeated-measures analyses of variance and mixed-model repeated-measure analysis, respectively. Associations between changes in PSQI and cardiometabolic biomarkers were computed using Pearson correlations. Linear mixed-models were used to evaluate effect modification by ethnicity.

RESULTS

Participants were 52 ± 10.4 years old, and over half were of Hispanic ethnicity. As compared to usual care, PSQI global scores improved significantly in the exercise group (mean between-group difference -2.2; 95% CI -3.2 to -0.6). Change in PSQI was inversely associated with changes in all cardiometabolic biomarkers (p < 0.01) among the exercise group. Ethnicity was found to moderate the effects of exercise training on global sleep quality (p < 0.001).

CONCLUSIONS

An aerobic and resistance exercise intervention effectively improved patient-reported sleep quality in breast cancer survivors. Hispanic ethnicity as a moderator showed greater improvement in patient-reported sleep indicating Hispanic versus non-Hispanic breast cancer survivors may derive larger sleep benefits.

CLINICAL TRAIL INFORMATION

NCT01140282.

The Implementation of a National Physical Activity Intervention in Colombia

Background: In 2011, the Colombian government started a nationwide program, Hábitos y Estilos de Vida Saludable (HEVS; Healthy Life Habits), providing free, community-based physical activity classes for individuals across Colombia. This study describes the HEVS program, participant characteristics, and changes in anthropomorphic and health measures following the program. Methods: In this observational study, demographic information, current health status, lifestyle habits, and anthropomorphic measures were collected from adult HEVS participants at baseline and after program completion 11 months later. Changes in anthropomorphic and health measurements after the HEVS program were compared in the same participants using a paired t test and McNemar test, respectively. Results: A total of 56,472 adult participants (86.5% female) enrolled in the HEVS program. The greatest proportion of participants was between the ages of 18 and 34 years. Prior to participating in HEVS, mean body mass index and waist circumference were 26.3 kg/m² and 85.7 cm, respectively. Postprogram data from 17,145 individuals showed statistically significant decreases in body mass index, waist circumference, and the proportion of patients with self-reported hypertension. Conclusions: The HEVS program successfully engaged a large number of Colombians in physical activity and resulted in significant improvements in their health, demonstrating the effectiveness of a government-supported, community-based physical activity program.

Systematic Review of Physical Activity Interventions in Hispanic Adults

INTRODUCTION

Physical activity (PA) has demonstrated substantial physical and psychological benefits. However, Hispanics engage in less leisure-time PA when compared with other groups, putting them at higher risk for diseases associated with obesity, such as diabetes mellitus type 2. This literature review was conducted to identify best practices with regard to interventions designed to increase PA among Hispanic adults.

METHODS

Extensive searching located 21 randomized controlled studies conducted in the United States.

RESULTS

Common conceptual frameworks were the transtheoretical model and social cognitive theory. Most interventions used educational sessions with a variety of topics and many used promotoras to increase PA. Outcomes were predominantly examined using self-report PA measures. Walking was the most commonly reported PA behavior. Studies with significant results were those that measured moderate-to-vigorous PA and used theory to guide interventions. Male and older participants were underrepresented.

CONCLUSIONS

Effective culturally appropriate PA interventions for Hispanics adults are needed. Particular attention to intervention tailoring based on country of origin could enhance intervention effectiveness.

The relationship of education and acculturation with vigorous intensity leisure time physical activity by gender in Latinos

OBJECTIVES

Latinos have poorer health outcomes among certain conditions (e.g. diabetes, obesity, mental health) compared to non-Latino Whites in the U.S., in part due to difference in the amount of physical activity, which are heavily influenced by sociocultural factors such as educational attainment and acculturation. Vigorous-intensity leisure time physical activity (VLTPA) may provide health benefits with a shorter amount of time than moderate-to-light physical activity. However, VLTPA has been significantly understudied compared to LTPA in general. The purpose of this study is to examine the associations between educational attainment, acculturation, and VLTPA by gender among Latino adults in the U.S.

DESIGN

Nationally representative samples of Latino adults aged 25 years and older (n = 4393) from the 2010 National Health Interview Survey were analyzed. VLTPA was measured as the number of hours per week of VLTPA consisting of heavy sweating or large increases in breathing and heart rate. Acculturation was measured as the degree to which the English language versus the Spanish language was spoken most often. The zero-inflated Poisson regression model was constructed using the full information maximum likelihood estimation and controlling for a series of sociodemographic characteristics and relevant health behaviors.

RESULTS

Educational attainment was positively associated with VLTPA among Latino adults [exp(b) = 1.09, p < 0.05)]. Similarly, greater acculturation was associated with greater hours/week of VLTPA [exp(b) = 1.10, p < 0.05)]. Lastly, the effect of educational attainment on VLTPA significantly varied by gender.

CONCLUSIONS

Education had a positive association and acculturation had negative association with the hours/week of VLTPA among Latinos. Also, the association between education and VLTPA was significantly stronger among women than men. These findings inform culturally and socially sensitive approaches to improve the health of Latinos, in hopes to address health disparities by race/ethnicity the U.S.

Qualitative Focus Groups: Perceived Influences on Decision Making About Diet and Physical Activity Among Hispanic/Latino Participants

Disparities in minority health are strongly associated with reduced access to culturally familiar food and physical activity opportunities. This qualitative study explores a Midwest, urban Hispanic/Latino community, the members' experiences with their multidimensional environment and its influence on their nutrition and physical activity choices. Using the principles of community-based participatory research in collaboration with a trusted, local Hispanic/Latino community agency, we conducted five bilingual focus groups with a total of 46 self-selected participants (44 women and 2 men). We find that one's perception of the environmental factors of access, convenience, affordability, and safety influence food and physical activity decision making. Findings can be used to inform interventions to enhance culturally appropriate outreach, increase food equity, and decrease health disparities.

Social Norms, Acculturation, and Physical Activity Among Latina Women

Physical activity promotes health and is important for preventing chronic conditions, such as obesity and cardiovascular disease. Little is known about factors associated with different types of PA among Latina women, particularly Dominicans, who now constitute the fifth largest group of Latinos in the United States. The purpose of this study was to examine whether occupational physical activity, acculturation, familism, and norms held by family and friends are associated with three types of PA: vigorous and moderate leisure-time physical activity (LTPA), and resistance training. Interviews were conducted with 418 Dominican women. We assessed self-reported PA using standardized measures. Data were collected between July 2010 and July 2012 in New York City. Most women reported no vigorous LTPA or resistance training (74.5 and 73.1 %, respectively); about half (52.1 %) reported no moderate LTPA. After adjusting for sociodemographic factors, occupational physical activities were associated with greater LTPA. Acculturation was not associated with any outcome. Positive family norms about exercise were associated with increased LTPA and resistance training. Family norms may play a critical role in PA and should be included in programs to increase PA among Latina women.

Parks as Social and Cultural Spaces Among U.S.- and Foreign-Born Latinas

Parks provide opportunities for people to engage in activities that can promote physical and emotional well-being. Using focus groups and personal interviews conducted in select neighborhoods of a Northeastern city with a high rate of obesity, we examined perceptions of barriers and facilitators regarding the use of parks and park features that would promote physical activity among Latina women ( N = 39). Foreign-born Latinas emphasized the environmental characteristics of parks and the types of amenities that can support preferred cultural and social activities, while U.S.-born Latinas emphasized the use of parks for physical activity and weight management. Most striking were the different ways in which foreign-born participants conceptualized parks as sociocultural family centers, extending more common conceptualizations centered on exercise or individual health gain. These findings suggest the need for new policies that incorporate culturally specific park programming to promote national goals of increasing levels of physical activity for health.

Latino Immigrants, Acculturation, and Health: Promising New Directions in Research

This article provides an analysis of novel topics emerging in recent years in research on Latino immigrants, acculturation, and health. In the past ten years, the number of studies assessing new ways to conceptualize and understand how acculturation-related processes may influence health has grown. These new frameworks draw from integrative approaches testing new ground to acknowledge the fundamental role of context and policy. We classify the emerging body of evidence according to themes that we identify as promising directions--intrapersonal, interpersonal, social environmental, community, political, and global contexts, cross-cutting themes in life course and developmental approaches, and segmented assimilation--and discuss the challenges and opportunities each theme presents. This body of work, which considers acculturation in context, points to the emergence of a new wave of research that holds great promise in driving forward the study of Latino immigrants, acculturation, and health. We provide suggestions to further advance the ideologic and methodologic rigor of this new wave.

English language proficiency and physical activity among Mexican-origin women in South Texas and South Carolina

OBJECTIVES

To examine the relationship between English language proficiency (ELP), physical activity, and physical activity-related psychosocial measures (i.e., exercise self-efficacy, exercise social support, perceptions of environmental supports) among Mexican-origin women in South Carolina and Texas.

DESIGN

Adjusted robust regression and interaction modeling to evaluate baseline questionnaire data on self-reported ELP with CHAMPS leisure-time moderate-to-vigorous physical activity (MVPA), accelerometry data, Physical Activity Self-Efficacy, Physical Activity Social Support, and Environmental Support for Physical Activity in 118 Mexican-origin women.

RESULTS

The adjusted regression revealed a significant association between ELP and perceived physical activity self-efficacy (β = 234.2, p = .004), but not with physical activity social support. In South Carolina, CHAMPS leisure-time MVPA (411.4 versus 114.3 minutes, p < .05) was significantly different between women in the high ELP quartile and those in the very low quartile. Among high ELP Mexican-origin women, participants in Texas reported significantly higher MVPA measured by accelerometry (p = .042) than those in South Carolina.

CONCLUSION

Our findings indicate that ELP was associated with physical activity and that contextual factors may also play a role.

Neighborhood Social Cohesion and Depressive Symptoms Among Latinos: Does Use of Community Resources for Physical Activity Matter?

BACKGROUND

Greater neighborhood social cohesion is linked to fewer depressive symptoms and greater physical activity, but the role of physical activity on the relationship between neighborhood social cohesion and depression is poorly understood. The purpose of the study was to examine the effects of physical activity on the association between neighborhood social cohesion and depressive symptoms.

METHODS

Multivariate logistic regression tested the moderation of self-reported leisure-time moderate-to-vigorous physical activity (LTMVPA) and active use of parks or recreational facilities on the association between neighborhood social cohesion and depressive symptoms among 295 randomly selected Latino adults who completed a face-to-face interview.

RESULTS

After adjusting for age, gender, and income, neighborhood social cohesion and depressive symptoms were inversely related (OR = 0.8; 95% CI: 0.5-1.2). Active use of parks or recreational facilities moderated the association between neighborhood social cohesion and depressive symptoms but meeting the recommendations for LTMVPA did not. Latinos who reported active use of parks or recreational facilities and higher levels of neighborhood social cohesion had fewer depressive symptoms than peers who did not use these spaces.

CONCLUSIONS

Future studies are needed to test strategies for promoting active use of parks or recreational facilities to address depression in Latinos.

Moderating Effects of Health Literacy on Change in Physical Activity Among Latinas in a Randomized Trial

INTRODUCTION

Latinas report low rates of physical activity (PA) and are at risk for poor health outcomes. Language and literacy barriers impede access and utilization of PA-related resources. This study examined health literacy as a moderator on changes in moderate-to-vigorous physical activity (MVPA) in 196 Latinas enrolled in Seamos Saludables, a randomized-controlled trial of a 6-month culturally and linguistically adapted PA print intervention

METHODS

Secondary analyses were conducted on demographics, acculturation and generation status, and health literacy (Newest Vital Sign). MVPA was determined by 7 day physical activity recall, assessed at baseline and 6 months. General linear models examined interaction effects between health literacy (HL), experimental condition (treatment vs. control), and generation status.

RESULTS

Health literacy moderated change in MVPA from baseline to 6 months. The intervention effect was greater among first-generation Latinas with limited health literacy.

DISCUSSION

Differences in health literacy level appear to influence MVPA outcomes. Formative research is recommended to ensure that materials are appropriate when developing print-based PA interventions, particularly among first-generation Latinas who are more likely to have limited health literacy.

A comparison of a social support physical activity intervention in weight management among post-partum Latinas

BACKGROUND

Weight gain during the childbearing years and failure to lose pregnancy weight after birth contribute to the development of obesity in postpartum Latinas.

METHODS

Madres para la Salud [Mothers for Health] was a 12-month, randomized controlled trial exploring a social support intervention with moderate-intensity physical activity (PA) seeking to effect changes in body fat, fat tissue inflammation, and depression symptoms in sedentary postpartum Latinas. This report describes the efficacy of the Madres intervention.

RESULTS

The results show that while social support increased during the active intervention delivery, it declined to pre-intervention levels by the end of the intervention. There were significant achievements in aerobic and total steps across the 12 months of the intervention, and declines in body adiposity assessed with bioelectric impedance.

CONCLUSIONS

Social support from family and friends mediated increases in aerobic PA resulting in decrease in percent body fat.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01908959.

Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association

BACKGROUND AND PURPOSE

This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA's 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers.

METHODS

Writing group members were nominated by the AHA's Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee.

RESULTS

This statement documents the status of knowledge regarding CVD among Hispanics and the sociocultural issues that impact all subgroups of Hispanics with regard to cardiovascular health. In this review, whenever possible, we identify the specific Hispanic subgroups examined to avoid generalizations. We identify specific areas for which current evidence was less robust, as well as inconsistencies and evidence gaps that inform the need for further rigorous and interdisciplinary approaches to increase our understanding of the US Hispanic population and its potential impact on the public health and cardiovascular health of the total US population. We provide recommendations specific to the 9 domains outlined by the chair to support the development of these culturally tailored and targeted approaches.

CONCLUSIONS

Healthcare professionals and researchers need to consider the impact of culture and ethnicity on health behavior and ultimately health outcomes. There is a need to tailor and develop culturally relevant strategies to engage Hispanics in cardiovascular health promotion and cultivate a larger workforce of healthcare providers, researchers, and allies with the focused goal of improving cardiovascular health and reducing CVD among the US Hispanic population.

Self-reported physical activity patterns among low-income Latina women in Arizona

BACKGROUND

Adherence to recommendations for physical activity (PA) among adults in the United States is reported as poor, particularly among low-income Latinos. In particular, Latina women are at increased risk for inactivity and chronic illness, but national health survey reports aggregate data across demographic strata, limiting descriptive information that could guide targeted PA promotion. The purpose of the study was to determine PA patterns among a low-income group of Latina women in the southwestern United States.

METHODS

As part of a large community intervention trial to increase cancer prevention behaviors, PA data were collected from 1,006 Latina women using a modified version of the Arizona Activity Frequency Questionnaire.

FINDINGS

The weekly PA mean across all exercise types was calculated to be 9.3 ± 16.4 hours, which is substantially higher than the daily PA recommendation of 30 minutes most days of the week. The highest daily PA means were associated with occupational activities: Cleaning, 2.7 hours; walking, 2.5 hours; lifting, 1.9 hours; and light yard work, 1.0 hours.

CONCLUSIONS

In this sample of low-income Latina women, the average PA hours per week exceed the current PA recommendations. Data collection instruments used in this population could more accurately assess PA if they included a wider range of activities and specific questions about work-related activity.

Promotoras as facilitators of change: Latinas' perspectives after participating in a lifestyle behaviour intervention program

AIM

To describe immigrant Latinas' perspectives of a lifestyle behaviour intervention, focusing on their interactions with and perceptions of the promotoras who delivered the program in the USA.

BACKGROUND

Immigrant Latinas in the USA have high obesity rates, which contribute to increased risk for cardiovascular disease and other long-term diseases. Interventions using the promotora model appear to be effective in reducing cardiovascular disease risk by improving dietary habits, physical activity and selected clinical variables among Latinas. However, there has been very limited enquiry into what it is about these interventions and promotoras that facilitates behaviour change, from the perspective of participants.

DESIGN

Grounded theory methodology guided the data collection and analysis.

METHODS

This qualitative study was completed in 2012 in California, after the end of a lifestyle behaviour intervention. Four focus groups and seven one-on-one interviews were conducted with a total of 18 immigrant Latina intervention participants.

RESULTS

Women described promotoras as helping them change by motivating them through three interconnected elements: tools, support and knowledge. Latinas viewed their ability to make lifestyle changes as connected with their emotional and psychological health and saw promotoras as counsellors who gave emotional and social support. In this respect, the intervention was emotionally therapeutic for this sample of Latinas, although this was not the original intention of the program.

CONCLUSION

Promotoras gave the backbone of the intervention and were crucial in motivating Latinas to implement lifestyle changes. Future lifestyle behaviour interventions should include a strong component of mental and emotional well-being.

Barriers to performing stretching exercises among Korean-Chinese female migrant workers in Korea

OBJECTIVE

The purpose of this study was to investigate the barriers to performing stretching exercise experienced by Korean-Chinese female migrant workers during a community-based 12-week stretching exercise intervention trial.

DESIGN AND SAMPLE

Qualitative secondary data analysis was conducted using telephone counseling interview transcripts from 27 middle-aged, Korean-Chinese migrant women workers.

MEASURES

A semistructured interview question asking barriers to performing stretching exercise was given to women who did not adhere to recommended stretching exercise. During the 12-week home-based stretching exercise intervention trial, six telephone calls were made to participants biweekly to elicit barriers to performing stretching exercise. Directed content analysis approach was utilized using three barrier categories: intrapersonal, interpersonal, and work-related environmental factors based on the ecological model.

RESULTS

Participants experienced an average of 2.5 barriers during the study period. Intrapersonal barriers included lack of time and lack of motivation, and interpersonal barriers included no family to provide support and also a feeling resistance from coworkers. Work-related environmental barriers included frequent job changes, long working hours, lack of rest time, and unpredictable job demands.

CONCLUSIONS

The findings highlight that migrant workers in Korea face unique work-related difficulties which present barriers to exercise.

Physical activity in Latinas: social and environmental influences

Latinas are the largest, fastest growing female ethnic minority group in the USA, and also report the lowest levels of physical activity. Following the framework of the social ecological model, this review examines unique social and environmental factors that influence physical activity in Latinas. Research shows that Latinas receive little social support for activity despite having large, close-knit social networks. Interventions incorporating social support components are generally efficacious. Latinas also face many environmental barriers, including crime, heat, traffic, lack of facilities and a fear of immigration enforcement, and there have been few attempts to address environmental barriers in Latino communities. Successful future interventions will need to consider unique social and environmental barriers affecting Latinas, and help Latinas learn to incorporate social networks into physical activity participation.

Social marketing: approach to cultural and contextual relevance in a community-based physical activity intervention

We report the social marketing strategies used for the design, recruitment and retention of participants in a community-based physical activity (PA) intervention, Madres para la Salud (Mothers for Health). The study example used to illustrate the use of social marketing is a 48-week prescribed walking program, Madres para la Salud (Mothers for Health), which tests a social support intervention to explore the effectiveness of a culturally specific program using 'bouts' of PA to effect the changes in body fat, fat tissue inflammation and postpartum depression symptoms in sedentary Hispanic women. Using the guidelines from the National Benchmark Criteria, we developed intervention, recruitment and retention strategies that reflect efforts to draw on community values, traditions and customs in intervention design, through partnership with community members. Most of the women enrolled in Madres para la Salud were born in Mexico, largely never or unemployed and resided among the highest crime neighborhoods with poor access to resources. We developed recruitment and retention strategies that characterized social marketing strategies that employed a culturally relevant, consumer driven and problem-specific design. Cost and benefit of program participation, consumer-derived motivation and segmentation strategies considered the development transition of the young Latinas as well as cultural and neighborhood barriers that impacted retention are described.

Assessing the awareness of and willingness to participate in cancer clinical trials among immigrant Latinos

Clinical trials are considered the gold standard of evidence about the efficacy of cancer prevention, early detection, and treatment interventions. A paucity of data exists on determinants of clinical trial participation in the growing US Latino population despite poor cancer outcomes in this group. This study seeks to describe correlates of awareness of and willingness to participate in clinical trials among largely Central, North, and South American Latinos using safety-net clinics. Between June 2007 and November 2008, we conducted an interviewer-administered, Spanish-language cross-sectional survey (n = 944). Logistic regression was used to assess effects of health information sources and psychosocial variables on awareness of and intention to participate in clinical trials. Analyses were completed in spring 2010. While only 48% knew what a clinical trial was, when explained, 65% indicated a willingness to participate. Providers were the most common source of health information. Use of Internet for health information, trust in health information, and higher education each independently increased the odds of clinical trial awareness, but obtaining information from providers did not. Contacting the Cancer Information Service and psychosocial factors were each independently associated with intent to join a clinical trial, while demographic factors were not. Information channels such as the Internet may be effective in conveying clinical trial information to Latinos. Providers being cited as the most common source of health information but not being associated with knowledge about or intent to participate in trials suggests a missed opportunity for communication to this population.

The influence of marianismo beliefs on physical activity of immigrant Latinas

PURPOSE

To verify and explicate the impact of marianismo beliefs on the physical activity behaviors of immigrant Latinas.

DESIGN

Twenty-eight immigrant Latinas, aged 18 to 40 years, were recruited to participate in two focus group interviews. Data collection and analysis were driven by Spradley's Developmental Research Sequence.

RESULTS

Two domain terms were identified: "Life is too fast here" and "The woman is the center of the family." Six included terms and five cultural themes were specified.

DISCUSSION

A combination of marianismo beliefs, acculturation stress, loss of social support, and conflicts between collectivist and individualist values combine to adversely influence physical activity behaviors of immigrant Latinas.

IMPLICATIONS

Physical activity interventions for Hispanic women should capitalize on the strengths of the marianista, address factors leading to acculturation stress among women and their families, and establish bridges of social support among new groups of immigrants.

Formative research for a community-based message-framing intervention

OBJECTIVE

To inform a community-based message framing intervention encouraging physical activity and fruit and vegetable consumption among medically underserved adults.

METHOD

Key informant interviews, focus groups, and a survey were conducted with limited-literacy Hispanics in the northeastern United States.

RESULTS

Barriers to healthy lifestyle behaviors exist at individual, community, and policy levels. A strong degree of networking among local organizations and elected officials exists that can be used to encourage healthy lifestyle initiatives.

CONCLUSIONS

Community-based health communication interventions must address neighborhood realities, the literacy levels of the target population, and existing networks of providers and consumers.

Mujeres en accion: design and baseline data

The majority of programs designed to promote physical activity in older Hispanic women includes few innovative theory-based interventions that address cultural relevant strategies. The purpose of this report is to describe the design and baseline data for Mujeres en Accion, a physical activity intervention to increase regular physical activity, and cardiovascular health outcomes among older Hispanic women. Mujeres en Accion [Women in Action for Health], a 12 month randomized controlled trial to evaluate the effectiveness of a social support physical activity intervention in midlife and older Hispanic women. This study tests an innovative intervention, Mujeres en Accion, and includes the use of a theory-driven approach to intervention, explores social support as a theoretical mediating variable, use of a Promotora model and a Community Advisory group to incorporate cultural and social approaches and resources, and use of objective measures of physical activity in Hispanic women.

Instrument selection for randomized controlled trials: why this and not that?

A fundamental linchpin for obtaining rigorous findings in quantitative research involves the selection of survey instruments. Psychometric recommendations are available for the processes for scale development and testing and guidance for selection of established scales. These processes are necessary to address the validity link between the phenomena under investigation, the empirical measures and, ultimately, the theoretical ties between these and the world views of the participants. Detailed information is most often provided about study design and protocols, but far less frequently is a detailed theoretical explanation provided for why specific instruments are chosen. Guidance to inform choices is often difficult to find when scales are needed for specific cultural, ethnic, or racial groups. This paper details the rationale underlying instrument selection for measurement of the major processes (intervention, mediator and moderator variables, outcome variables) in an ongoing study of postpartum Latinas, Madres para la Salud [Mothers for Health]. The rationale underpinning our choices includes a discussion of alternatives, when appropriate. These exemplars may provide direction for other intervention researchers who are working with specific cultural, racial, or ethnic groups or for other investigators who are seeking to select the 'best' instrument. Thoughtful consideration of measurement and articulation of the rationale underlying our choices facilitates the maintenance of rigor within the study design and improves our ability to assess study outcomes.

Acculturation, physical activity and television viewing in Hispanic women: findings from the 2005 California Women's Health Survey

OBJECTIVE

To assess the relationship of acculturation with physical activity and sedentary behaviours among Hispanic women in California.

DESIGN

Data from the 2005 California Women's Health Survey (CWHS) - a cross-sectional telephonic survey of health indicators and health-related behaviours and attitudes - were used.

SETTING

Using a random-digit dialling process, data were collected monthly from January to December 2005.

SUBJECTS

A total of 1298 women aged ≥18 years in California who self-identified as Hispanic.

RESULTS

Of the participants included in the analysis, 49 % were adherent to physical activity recommendations (with 150 min of weekly activity signifying adherence). There was no significant association between language acculturation and moderate or vigorous physical activity after controlling for potential confounders such as smoking, age and employment status. There was also no association between duration of residence in the USA and moderate or vigorous physical activity. Language acculturation was positively associated with television (TV) viewing, with highly acculturated women reporting more hours of TV viewing compared with women with an intermediate acculturation score (P = 0·0001), and those with an intermediate score reporting more hours of TV viewing compared with those with a low score (P = 0·003). This relationship persisted after inclusion of smoking, employment status, age and education in the model.

CONCLUSIONS

Higher levels of language acculturation may be associated with increased sedentary behaviours because of the influence of US culture on those women who have assimilated to the culture. Acculturation is an important factor to be taken into account when designing health education interventions for the Hispanic female population.

Promotion of Physical Activity Among Mexican-Origin Women in Texas and South Carolina: An Examination of Social, Cultural, Economic, and Environmental Factors

Interventions to improve physical activity levels among Latinos must take into consideration the social, cultural, economic, and environmental contexts of Latino communities. We report findings of formative assessments related to Mexican-origin women's levels of readiness, willingness, and ability to participate in regular leisure time physical activity in two diverse locations, the Texas Lower Rio Grande Valley and the South Carolina Midlands. The ENLACE project employed a Community-Based Participatory Research approach. Formative assessment activities focused on identification of community assets and resources and exploration of community members' experiences, opinions, values, preferences, and perceived needs related to physical activity. Data sources included windshield tours, walkability assessments of local neighborhoods; community inventory exercises, focus groups, and individual interviews. Barriers to regular physical activity included the dominance of work and family responsibilities, social norms, lack of social support, social isolation, environmental constraints, economics, and low levels of personal knowledge and motivation.

Attitudes of overweight and normal weight adults regarding exercise at a health club

OBJECTIVE

To compare attitudes of overweight (OW) and normal weight (NW) adults regarding health club exercise.

DESIGN

A 46-item survey (23 pairs of attitude/value statements) measured attitudes toward exercising at a health club 30 minutes, twice a week, for a month.

SETTING

Survey posted on surveymonkey.com. Respondents (men = 730, women = 822).

MAIN OUTCOME MEASURES

Attitudes toward exercise, exercise intent.

ANALYSIS

t tests, Mann-Whitney rank sum, 2-way analysis of variance, Pearson rank correlations. Significance set at P < .05.

RESULTS

More than NW, OW believe exercise improves appearance (P < .001) and self image (P < .03). OW feel more embarrassed and intimidated about exercising, exercising around young people, exercising around fit people, and about health club salespeople than NW (P < .001). OW and NW feel the same about exercising with the opposite sex, complicated exercise equipment, exercise boredom, and intention to exercise. Age rather than weight affects exercise intent. OW Caucasians (C) have less exercise intent than OW non-C. OW women are more embarrassed about exercising than NW women and OW men. The heavier the subject's weight, the lower his or her perception of health (r = -0.53, P < .001).

CONCLUSIONS AND IMPLICATIONS

Increasing the OW person's positive beliefs while decreasing negative beliefs about health club exercise will improve his or her intent to exercise at a health club.

Health and health behaviors among elderly Hispanic women

The purpose of this study was to describe and analyze the relationship between health and health behaviors among elderly Hispanic women who were lifetime U.S. residents. The number of elderly Hispanics is expected to grow faster than any other segment of the population within the United States. A random sample of 132 elderly Hispanic women enrolled in a health maintenance organization participated in this cross-sectional survey of health prevention, promotion, and protection behaviors and dimensions of health as measured by the Medical Outcomes Study Short Form-36. Results indicated that more than half of this group did not exercise regularly, one fourth did not eat regularly scheduled meals, and many had not participated in health screening. Among the women in this study, those whose lifestyles incorporated the more frequent practice of positive health behaviors also had better scores on 6 of the 8 specific health dimensions measured.