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Darvish S, Mahoney SA, Venkatasubramanian R, Rossman MJ, Clayton ZS, Murray KO. Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions. J Appl Physiol (1985) 2024; 137:194-222. [PMID: 38813611 DOI: 10.1152/japplphysiol.00188.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.
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Affiliation(s)
- Sanna Darvish
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Sophia A Mahoney
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | | | - Matthew J Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Kevin O Murray
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
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Farhat G, Mellor DD, Sattar N, Harvie M, Issa B, Rutter MK. Effectiveness of lifestyle interventions/culturally bespoke programmes in South Asian ethnic groups targeting weight loss for prevention and/or remission of type 2 diabetes: a systematic review and meta-analysis of intervention trials. J Hum Nutr Diet 2024; 37:550-563. [PMID: 38234263 DOI: 10.1111/jhn.13279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND People from South Asian heritage are at high risk of type 2 diabetes, but there are limited specific strategies to prevent and manage this condition. The aim was to assess the effectiveness of culturally bespoke lifestyle programmes in South Asians that target weight loss for the prevention or remission of type 2 diabetes mellitus (T2DM). METHODS We performed a systematic review and meta-analysis of intervention trials. PubMed, Scopus, MEDLINE (EBSCOhost), CINAHL, PsycINFO and CENTRAL were searched. Human intervention trials (randomised controlled trials and quasi-experimental) investigating the effect of lifestyle interventions on the prevention and remission of T2DM in South Asians were included. Studies including participants at risk of T2DM (prevention trials) and having the disease (remission trials) with duration ≥12 weeks were eligible. For prevention trials, the primary outcome was change in weight (kg) from baseline; for remission trials, it was decrease in HbA1c to non-diabetic levels (HbA1c ≤ 6.5%) without diabetes medications. Prevention trials were separated into (i) lifestyle modification advice and (ii) lifestyle modification advice including a supervised physical activity programme. RESULTS Twenty-four trials were eligible (21 prevention trials and 3 remission trials). In T2DM prevention trials involving only lifestyle modification advice, the mean postintervention difference in weight between intervention and control groups was -0.65 kg (95% confidence interval [CI]: -1.04, -0.26; p = 0.01). Lifestyle modification advice including a physical activity programme was associated with greater decreases in weight: -1.13 kg (95% CI: -2.04, -0.21; p = 0.02). Fasting blood glucose levels were slightly lower in intervention groups for both intervention subtypes, although there was no significant change in HbA1c levels or 2-h plasma glucose levels. Diabetes remission trials showed potential acceptability but were limited in number and involved a small sample size, and some did not include a control group. CONCLUSIONS In South Asians, lifestyle interventions for prevention of T2DM offer only modest impacts on weight and glucose control and will unlikely reduce diabetes incidence. Alternative lifestyle interventions co-designed with members of the communities and aimed at both prevention and remission of T2DM must be urgently considered. Systematic review registration number: PROSPERO CRD42022385174 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=385174.
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Affiliation(s)
- Grace Farhat
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Duane D Mellor
- Aston Medical School, Aston University, Birmingham, UK
- Centre for Health and Society, Aston University, Birmingham, UK
| | - Naveed Sattar
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Michelle Harvie
- Prevent Breast Cancer Research Unit, Manchester University Hospital Foundation NHS Trust, Manchester, UK
- UK Division of Cancer Sciences, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, NIHR, Manchester, UK
| | - Basil Issa
- Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Martin K Rutter
- Division of Endocrinology, Diabetes and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
- Diabetes, Endocrinology and Metabolism Centre, Manchester, UK
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Nisar M, Kolbe-Alexander TL, Khan A. Physical activity and sedentary behaviour among south Asian immigrants in Australia. Health Promot J Austr 2024; 35:57-67. [PMID: 36871190 DOI: 10.1002/hpja.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/17/2023] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
ISSUE ADDRESSED South Asians make up the second-largest group of immigrants in Australia and experience a higher burden of chronic diseases compared with non-immigrants. Most chronic diseases are associated with insufficient physical activity (PA) and sedentary behaviour (SB); however, studies involving PA and SB in immigrants are limited. This study aimed to explore PA and SB and associated factors among South Asian immigrants in Australia. METHODS South Asian adult immigrants in Australia were surveyed online (from November 2020 to March 2021) about PA, SB, knowledge and barriers to PA. Logistic regressions were used to examine factors associated with insufficient PA (<150 minutes/week) and a high sitting time (>8 hours/day). RESULTS A total of 321 participants provided complete data. Approximately 76% of participants reported insufficient PA and 27% reported high sitting time. Only 6% of participants walked or bicycled. The main reported barriers to PA were lack of time, costs, transport facilities, skills, and culturally appropriate resources. Around 52% of participants were not aware of the importance of PA. Participants with self-reported poor health and who used motorized travel were more likely to have inadequate PA. High sitting time was more common among middle-aged, overweight/obese, and middle-income participants. CONCLUSIONS Most South Asian immigrants are insufficiently active with a lack of socio-economically appropriate PA facilities identified as a major challenge. A stronger collaboration between policymakers and community is required for sustainable solutions. SO WHAT?: Affordable and appropriate PA facilities in neighbourhoods could overcome major barriers. Also, information about PA should incorporate cultural expectations in the general recommendations to encourage participation.
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Affiliation(s)
- Mehwish Nisar
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Tracy L Kolbe-Alexander
- School of Health and Medical Sciences, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Asaduzzaman Khan
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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Stolte A, Nagy GA, Zhan C, Mouw T, Merli MG. The impact of two types of COVID-19-related discrimination and contemporaneous stressors on Chinese immigrants in the US South. SSM - MENTAL HEALTH 2022; 2:100159. [PMID: 36188193 PMCID: PMC9509533 DOI: 10.1016/j.ssmmh.2022.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/28/2022] [Accepted: 09/10/2022] [Indexed: 12/15/2022] Open
Abstract
The global rise of the COVID-19 pandemic has been accompanied by an increase in anti-Asian discrimination with potentially deleterious effects on individuals of Asian descent. In the present study, we examine how two types of COVID-19-related anti-Asian discrimination and other contemporaneous stressors independently contribute to perceptions of stress in a population-representative sample of Chinese immigrants in North Carolina, as well as the moderating role of ethnic identity on the association between COVID-related discrimination and stress. Analyses rely on data collected among participants ages 18+ in the Chinese Immigrants in Raleigh-Durham (ChIRDU) study who completed surveys in 2018 and during the COVID-19 pandemic (July-September 2020). We utilize ordinary least squares regressions to examine associations of two types of COVID-related discrimination (measured by changes in perceptions of being feared by others and racism-related vigilance) and contemporaneous stressors (measured by general COVID-19-related stressors and acculturative stressors) with perceptions of stress by respondents' pre-pandemic reports of ethnic identity. Controlling for sociodemographic predictors and other stressors, racism-related vigilance is significantly associated with higher perceived stress for Chinese immigrants who identify as completely Chinese. For those who identify as at least partly American, new perceptions of being feared by others during the pandemic are significantly associated with higher perceived stress. Acculturative and COVID-related stressors are independently associated with higher perceived stress for both groups. These results suggest that COVID-related anti-Asian discrimination aggravates the psychological burden of multiple stressors in Chinese immigrants' lives by uniquely contributing to perceptions of stress alongside contemporaneous stressors. The results also highlight the heterogeneous mental health needs of Chinese immigrants and hold important implications for intervention development in the community studied here as well as in other Chinese communities in the US.
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Affiliation(s)
- Allison Stolte
- Department of Sociology, Duke University, Durham, NC, USA
| | - Gabriela A. Nagy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA,Duke University School of Nursing, Durham, NC, USA,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Chanel Zhan
- Duke University School of Medicine, Durham, NC, USA
| | - Ted Mouw
- Department of Sociology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - M. Giovanna Merli
- Department of Sociology, Duke University, Durham, NC, USA,Duke Global Health Institute, Duke University, Durham, NC, USA,Sanford School of Public Policy, Duke University, Durham, NC, USA,Duke University Population Research Institute, Duke University, Durham, NC, USA,Corresponding author. Sanford School of Public Policy, Duke University, 201 Science Drive Durham, NC, 27708, USA
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Mirza S, Kandasamy S, de Souza RJ, Wahi G, Desai D, Anand SS, Ritvo P. Barriers and facilitators to healthy active living in South Asian families in Canada: a thematic analysis. BMJ Open 2022; 12:e060385. [PMID: 36368751 PMCID: PMC9660572 DOI: 10.1136/bmjopen-2021-060385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The study objective was to understand the barriers and facilitators to healthy active living in South Asian families living in Canada. DESIGN Semi-structured interviews of 30-60-minute duration with South Asian women with young families, and analysed using a thematic analytical approach. SETTING Community-dwelling South Asian women interviewed in the home environment or by phone. PARTICIPANTS Fifteen married South Asian women (mean age=34.2 years) living in the Peel region of Ontario, Canada, with at least 1 child under the age of 5 years. The majority of women had immigrated to Canada (13/15), during a 5-10-year interval preceding interviews. RESULTS 57 different codes were derived from 18 interview hours, and further evaluated through member checking. The top three barriers to healthy eating were: (1) not having enough time for healthy food preparation, (2) lack of knowledge about what is healthy eating and (3) viewing healthy eating as a matter of engaging in time limited dieting. These barriers were addressed with: (1) knowledge and awareness of healthy eating, (2) clear goal setting, (3) access to fresh vegetables and fruits and (4) better arrangements and more time for food preparation. The top five barriers to physical activity were: (1) not enough time and energy, (2) competing priorities, (3) lack of childcare, (4) lack of family-engaging exercise and (5) limited access to interesting exercise programming. These barriers were addressed by: (1) experiencing exercise as enjoyable and stress releasing, (2) commitments to walking exercise, (3) use of an electronic exercise-tracking device, (4) offspring exercise supported by spouse and family and (5) success stories about exercise from others. CONCLUSIONS Barriers to healthy active living in South Asian women with young families can be addressed with facilitators that stimulate clear goal setting and healthy food preparation skills, and exercise formats that engage mothers and offspring, with or without exercise tracking.
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Affiliation(s)
- Sabina Mirza
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Gita Wahi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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Nisar M, Khan A, Kolbe‐Alexander TL. 'Cost, culture and circumstances': Barriers and enablers of health behaviours in South Asian immigrants of Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3138-e3149. [PMID: 35181973 PMCID: PMC9543603 DOI: 10.1111/hsc.13759] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/30/2021] [Accepted: 02/06/2022] [Indexed: 05/10/2023]
Abstract
The health behaviours related to chronic diseases experienced by South Asian immigrants are interrelated with their culture and socioeconomic conditions. South Asian immigrants experience a disproportionate burden of chronic disease compared with non-immigrants Australian-born general population. The primary aim of this study was to gain an in-depth understanding of health behaviours and healthcare access in the South Asian immigrant population of Australia. Five focus group discussions (FGDs) were conducted with South Asian immigrants (n = 29; 18 females) aged 27-50 years in Brisbane, Australia. Separate FGDs were conducted for males and females in the English language. Semi-structured guided questions related to the perception, barriers and facilitators of health behaviours. Data were analysed with Nvivo-12 following a thematic analysis. A conceptual model is proposed to provide a summarised understanding of barriers and facilitators of health behaviours in South Asian immigrants. The major reported constraints for participating in physical activity were cultural beliefs, lack of time, work stress and high fees of fitness activities, while parks and peer modelling were mentioned as a strong motivator for walking, cycling and participating in group sports activities. The cultural and religious connections, cost of cigarettes and drink driving penalties were the most mentioned facilitators for a healthy lifestyle. The important factors related to unhealthy eating habits were the traditional cooking methods, social interactions and the high cost of fruits and vegetables. Community perceptions and language barriers were also acknowledged as the main factors for the decrease in accessing health care services. This study illustrates that cultural beliefs, high cost of healthy food and facilities and social circumstances are mainly linked with the health behaviours and healthcare access in South Asian immigrant's lifestyles.
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Affiliation(s)
- Mehwish Nisar
- School of Health & Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
| | - Asaduzzaman Khan
- School of Health & Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
| | - Tracy L. Kolbe‐Alexander
- School of Health & WellbeingUniversity of Southern QueenslandIpswichAustralia
- Division of Exercise Science and Sports MedicineDepartment of Human BiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
- School of Human Movement and Nutrition SciencesThe University of QueenslandBrisbaneAustralia
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Factors Influencing Physical Activity Participation among Midlife Immigrant Women: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115590. [PMID: 34073788 PMCID: PMC8197266 DOI: 10.3390/ijerph18115590] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
Immigrant women are less likely to be physically active and face many barriers to participation in physical activity. This systematic review aims to identify the influencing factors and adaption approaches of physical activity interventions among midlife immigrant women. A systematic literature search was performed using various databases, such as MEDLINE, PsycINFO, and CINAHL, in February 2021. Studies were included if they investigated midlife immigrant women participating in physical activity interventions and were published in an English peer-reviewed journal in or after 2000. Twenty-two papers were included in this review. Guided by the Ecosocial theory, thematic analysis was utilized for data analysis. Among midlife immigrant women, influencing factors associated with physical activity participation included individual factors (a lack of time, current health status, motivation, and a lack of proficiency in various life skills), familial factors (familial support and seasonality), and community factors (social support and neighbourhood environment). The appropriate adaptation of physical activity interventions included adjustments in language, physical activity intensity, physical activity duration, logistical intervention adjustments and other potential technology-based adjustments. The findings can inform community stakeholders, healthcare professionals and researchers to design appropriate physical activity interventions that meet the needs of midlife immigrant women and improve their health outcomes.
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Ahmed S, Uddin R, Ziviani J, Khan A. Global Prevalence of Physical Activity, Sedentary Behaviour, and Sleep of Immigrant Children: a Systematic Review. J Racial Ethn Health Disparities 2020; 8:1364-1376. [PMID: 33124002 DOI: 10.1007/s40615-020-00898-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/18/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although insufficient physical activity (PA), high sedentary behaviour (SB), and inadequate sleep are fairly common among children, little is known about these behaviours in immigrant children. This systematic review examined the prevalence of PA, SB, and sleep among immigrant children aged 5-17 years around the globe. METHODS Four electronic databases were searched to retrieve the English language peer-reviewed original articles published between 2000 and 2019. Cross-sectional, cohort, or longitudinal studies that reported on the prevalence of PA, SB, or sleep-related outcomes among immigrant children were included. RESULTS Of 2724 retrieved articles, 55 were selected for full-text screening and 12 met the eligibility criteria. Five studies were based on nationally representative samples. Over half (n = 7; 58%) of the studies assessed only PA, one reported only sleep, three reported both PA and SB, and one reported all three behaviours. Only one study used device-based measure. Assessment of PA and SB varied greatly across the studies with their differing definitions. The prevalence of doing PA ranged from 48 to 72%. Three studies reported an average sedentary time ranging from 1 to 3 h/day. One study reported that 10-13% of immigrant children in the USA had inadequate sleep. All of the studies reviewed were from Western countries with no study from non-Western countries. CONCLUSIONS Future studies should include all three movement behaviours and use standard assessment tools and definitions. Future research should extend beyond Western countries to non-Western countries with immigrant children.
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Affiliation(s)
- Shahnawaz Ahmed
- School of Health and Rehabilitation Sciences, Therapies Annexe (84A), The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia.
| | - Riaz Uddin
- School of Health and Rehabilitation Sciences, Therapies Annexe (84A), The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia.,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, Therapies Annexe (84A), The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia
| | - Asaduzzaman Khan
- School of Health and Rehabilitation Sciences, Therapies Annexe (84A), The University of Queensland, St. Lucia, Brisbane, QLD, 4072, Australia
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Social networks, health and identity: exploring culturally embedded masculinity with the Pakistani community, West Midlands, UK. BMC Public Health 2020; 20:1432. [PMID: 32957934 PMCID: PMC7507824 DOI: 10.1186/s12889-020-09504-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Migrants from South Asia living in developed countries have an increased risk for developing cardiovascular disease (CVD), with limited research into underlying social causes. Methods We used social capital as an interpretive lens to undertake analysis of exploratory qualitative interviews with three generations of at-risk migrant Pakistani men from the West Midlands, UK. Perceptions of social networks, trust, and cultural norms associated with access to healthcare (support and information) were the primary area of exploration. Results Findings highlighted the role of social networks within religious or community spaces embedded as part of ethnic enclaves. Local Mosques and gyms remained key social spaces, where culturally specific gender differences played out within the context of a diaspora community, defined ways in which individuals navigated their social spheres and influenced members of their family and community on health and social behaviours. Conclusions There are generational and age-based differences in how members use locations to access and develop social support for particular lifestyle choices. The pursuit of a healthier lifestyle varies across the diverse migrant community, determined by social hierarchies and socio-cultural factors. Living close to similar others can limit exposure to novel lifestyle choices and efforts need to be made to promote wider integration between communities and variety of locations catering to health and lifestyle.
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Mahmood B, Tang TS, Afshar R, Ashe MC. Objective measurement of physical activity and sedentary behavior among South Asian adults: A systematic review. PLoS One 2020; 15:e0236573. [PMID: 32756595 PMCID: PMC7406035 DOI: 10.1371/journal.pone.0236573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/09/2020] [Indexed: 12/22/2022] Open
Abstract
Background South Asians are one of the fastest growing ethnic groups in western countries with a high incidence of chronic diseases like metabolic syndrome and cardiovascular disease occurring at younger ages and lower body weight compared with white Europeans. Physically active lifestyle and reduced sedentary time are modifiable risk factors that can decrease burden of chronic diseases. Population-level surveys based on self-report show South Asians engage in low levels of physical activity. Because of known limitations with self-report data, we aimed to synthesize available evidence to generate a physical activity /sedentary time profile of South Asians from studies using accelerometry. Methods We systematically searched Medline, EMBASE, CINAHL, PsycINFO, and SportDiscus. We included studies applying accelerometry to measure physical activity /sedentary time under free-living. Studies with an exclusive focus on drugs or including participants with health conditions/physical disability, and special populations (athletes/pregnant women) were excluded. Two authors independently adjudicated inclusion of citations at title/abstract and full text. We applied a standardized data abstraction form to extract relevant data. We evaluated methodological quality using Newcastle Ottawa Quality Assessment Scale. Due to variability and inconsistencies in measurement and reporting of physical activity /sedentary time, we only provide a narrative synthesis. Findings We identified only 14 studies(n = 1,338). Despite using similar accelerometry assumptions, we noted variability in reported outcomes for physical activity and sedentary time. Sedentary time ranged from 482(98) to 587 min/day. Mean light physical activity ranged from 211.69(67. 38) to 574(227) min/day. Moderate to vigorous physical activity among South Asian women ranged from 17–41 min/day and among men, 32–43 min/day. Conclusion South Asians exhibited higher levels of physical activity when compared to the Canadian population level survey but not when compared to the American population level survey. Overall, fewer studies, and small sample sizes led to considerable variability limiting any effective comparisons. Results highlight the importance of conducting methodologically robust studies based on random sampling to advance the field, and to capture true levels of sedentary time and physical activity in the South Asian population.
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Affiliation(s)
- Bushra Mahmood
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Tricia S. Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rowshanak Afshar
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maureen C. Ashe
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Weber MB, Hennink MM, Narayan KMV. Tailoring lifestyle programmes for diabetes prevention for US South Asians. Fam Med Community Health 2020; 8:e000295. [PMID: 32341773 PMCID: PMC7174025 DOI: 10.1136/fmch-2019-000295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective The purpose of this study was to develop and test the feasibility of a culturally tailored Diabetes Prevention Programme (DPP) for US South Asians, a large population with high diabetes risk. Design The South Asian Health and Prevention Education (SHAPE) study included: (1) focus group discussions with South Asian adults to understand views of lifestyle behaviours and diabetes prevention; (2) modification of the US DPP for South Asians and (3) a pilot, pre–post study to test the feasibility and impact of delivering the culturally tailored programme. Setting The study was conducted in Atlanta, Georgia, USA. Focus group discussions and intervention classes were held at locations within the community (eg, South Asian restaurants, a public library, university classrooms, a South Asian owned physical therapy studio). Participants The focus group discussions (n=17 with 109 individuals) included adults aged 25 years of older who self-identified as South Asian. Groups were stratified by age (25–40 years or older than 40 years) and sex. The SHAPE pilot study included 17 (76.5% male with a mean age of 46.9±12 years) South Asian adults aged 25 years or older with pre-diabetes and body mass index (BMI) >22 kg/m2. Results Formative data from 17 focus group discussions and a community board guided the modification of the DPP curriculum to reflect cultural food preferences and include tools to leverage social support, create a stronger foundation in exercise and overcome culturally specific barriers. The SHAPE pilot study included 17 South Asian adults with pre-diabetes and BMI >22 kg/m2. There were positive changes in participants’ weight, waist circumference, blood pressure, plasma lipids, HbA1c and other cardiometabolic markers postintervention and 55% of participants regressed to normoglycaemia. Conclusion These results provide important information on the barriers faced by US South Asians in participating in ‘standard’ lifestyle change programs, indicate the feasibility of culturally tailored programmes and show positive impact of a culturally tailored programme for diabetes prevention in the South Asian population.
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Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Monique M Hennink
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
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Kim Y, Lee H, Lee MK, Lee H, Jang H. Development of a Living Lab for a Mobile-Based Health Program for Korean-Chinese Working Women in South Korea: Mixed Methods Study. JMIR Mhealth Uhealth 2020; 8:e15359. [PMID: 31913134 PMCID: PMC6996741 DOI: 10.2196/15359] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/04/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Korean-Chinese (KC) women make up the largest group of female migrants in South Korea. To prevent and manage chronic diseases in middle-aged KC women working full time, it is necessary to develop health promotion programs that utilize an online platform because such a platform would allow individuals to participate in health promotion interventions at their convenience. OBJECTIVE This study aimed to develop a living lab for a mobile-based health (LLm Health) program focused on improving the physical activity and cultural adaptation of KC women workers. METHODS We used a mixed methods design. Living lab principles were factored into the LLm Health program, including the use of multiple methods, user engagement, multistakeholder participants, real-life settings, and cocreation. The program was developed using the 4 steps of the intervention mapping method: needs assessment, setting of objectives, identification of intervention strategies, and intervention design. Needs assessment was conducted through a literature review, focus group interviews with a total of 16 middle-aged KC women, and an online survey related to health promotion of migrant workers given to 38 stakeholders. KC middle-aged women participated in the early stages of program development and provided the idea of developing programs and mobile apps to enhance physical activity and acculturation. The mobile app developed in the program was validated with the help of 12 KC women and 4 experts, including 3 nursing professors and a professor of physical education. They were asked to rate each item based on content, interface design, and technology on a 4-point scale using a 23-item Smartphone App Evaluation Tool for Health Care. RESULTS The LLm Health program comprised a 24-week walking program using Fitbit devices, the mobile app, and social cognitive interventions. The mobile app contained 6 components: a step counter, an exercise timer, an online chat function, health information, level of cardiovascular risk, and health status. The cultural aspects and lifestyles of KC women were accommodated in the entire process of program development. The content validity of the mobile app was found to be 0.90 and 0.96 according to the 12 KC women and 4 experts, respectively. CONCLUSIONS The mobile app was found to be valid and acceptable for KC women. The living lab approach was a useful strategy for developing a culturally adaptive LLm Health program for KC women workers, leading to their active participation in the overall research process, including needs assessment, program composition, and pre-evaluation.
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Affiliation(s)
- Youlim Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyeonkyeong Lee
- Mo-im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Mi Kyung Lee
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyeyeon Lee
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyoeun Jang
- College of Nursing, Yonsei University, Seoul, Republic of Korea
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Kandula N, Ahmed M, Dodani S, Gupta L, Hore P, Kanaya A, Khowaja A, Mathur A, Mehta D, Misra R, Paracha M, Bharmal N, Aghhi M, Leng J, Gany F. Cardiovascular Disease & Cancer Risk Among South Asians: Impact of Sociocultural Influences on Lifestyle and Behavior. J Immigr Minor Health 2019; 21:15-25. [PMID: 28493115 PMCID: PMC7646689 DOI: 10.1007/s10903-017-0578-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A comprehensive literature review revealed cultural beliefs, societal obligations, and gender roles within the South Asian community to be indirect contributors to the health of South Asian immigrants (SAIs). Health professionals need to increase their work with SAI communities to change less beneficial cultural elements such as misconceptions about health and exercise, and lack of communication when using alternative medicines. Community engaged efforts and continuing medical education are both needed to improve the health of the South Asian immigrant population in a culturally appropriate manner.
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Affiliation(s)
- Namratha Kandula
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Munerah Ahmed
- Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Sunita Dodani
- Division of Cardiology, Department of Medicine & Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Leena Gupta
- Life Sciences Research and Surveys, Gerson Lehrman Group, New York, NY, USA
| | - Paromita Hore
- Bureau of Environmental Disease and Injury Prevention, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Alka Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Ashish Mathur
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | - Darshan Mehta
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ranjita Misra
- Department of Health and Kinesiology, College of Education and Human Development, Center for the Study of Health Disparities, Texas A&M University, College Station, TX, USA
| | - Muhammad Paracha
- Asian Human Services Family Health Center, Inc., Chicago, IL, USA
| | - Nazleen Bharmal
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, CA, USA
| | | | - Jennifer Leng
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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Afaq S, Kooner AS, Loh M, Kooner JS, Chambers JC. Contribution of lower physical activity levels to higher risk of insulin resistance and associated metabolic disturbances in South Asians compared to Europeans. PLoS One 2019; 14:e0216354. [PMID: 31063476 PMCID: PMC6504088 DOI: 10.1371/journal.pone.0216354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/18/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Insulin resistance and related metabolic disturbances are major risk factors for the higher T2D risk and associated morbidity and mortality amongst South Asians. The contribution of physical activity to the increased prevalence of insulin resistance and related disturbances amongst South Asians is unknown. METHODS We recruited 902 South Asian and European men and women, aged 35-85 years from the ongoing LOLIPOP study. Clinical characterisation comprised standardised questionnaire and measurement of height, weight, waist and hip circumference and blood pressure. Fasting bloods were taken for assessment of glucose, insulin, lipids and HbA1c. Physical activity was quantified using a validated accelerometer, Actigraph GT3X+, worn for 7 days. Univariate and multivariate approaches were used to investigate the relationship between ethnicity, physical activity, insulin resistance and related metabolic disturbances. RESULTS Total physical activity was ~31% (P = 0.01) lower amongst South Asians compared to Europeans (Mean MET.minutes [SD]: 1505.2 [52] vs. 2050.9 [86.6], P<0.001). After adjusting for age and sex, total physical activity had a negative association with HOMA-IR (B [SE]: -0.18 [0.08], P = 0.04) and fasting glucose levels (B[SE]: -0.11 [0.04], P = 0.02). There was no association between physical activity and other glycemic and lipid parameters. Total physical activity per week contributed towards the differences in insulin resistance and associated metabolic disturbances between South Asians and Europeans. CONCLUSION Lower levels of physical activity may contribute to the increased insulin resistance in South Asians compared to Europeans. Our results suggest that lifestyle modification through increased physical activity may help to improve glucose metabolism and reduce the burden of excess T2D and related complications amongst South Asians.
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Affiliation(s)
- Saima Afaq
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
- Institute of Public health and Social Sciences, Khyber medical university, Peshawar, Pakistan
- * E-mail: ,
| | - Angad S. Kooner
- Hillingdon hospital, NHS Trust, Hillingdon, Greater London, United Kingdom
| | - Marie Loh
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Jaspal S. Kooner
- Hammersmith Hospital, London, United Kingdom
- Ealing Hospital, Southall, Middlesex, United Kingdom
- NHLI, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - John C. Chambers
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
- Hammersmith Hospital, London, United Kingdom
- Ealing Hospital, Southall, Middlesex, United Kingdom
- MRC-HPA Centre for Environment and Health, Imperial College London, Norfolk Place, London, United Kingdom
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Tharmaratnam T, Iskandar MA, Doherty S, D'Urzo KA, Kopalakrishnan S, Tabobondung TC, Gopee-Ramanan P, Sivagurunathan S, Sivananthan N. The Role of Physical Activity Prescription in Cardiovascular Disease Prevention Amongst South Asian Canadians. Front Cardiovasc Med 2018; 5:165. [PMID: 30488037 PMCID: PMC6246639 DOI: 10.3389/fcvm.2018.00165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/26/2018] [Indexed: 01/07/2023] Open
Abstract
Unequivocal evidence suggests an increased prevalence of cardiovascular disease (CVD) amongst South Asian Canadians (SACs) compared to other ethnic cohorts, due to a combination of their unique cardiometabolic profile and environmental factors. This unfavorable CVD profile is characterized by an elevated risk of dyslipidemia, high apolipoprotein B/apolipoprotein A1 ratio, hypertension, glucose intolerance, type 2 diabetes mellitus, as well as increased BMI, body fat percentage, abdominal and visceral adiposity. Despite the overwhelming evidence for the effectiveness of physical activity (PA) in circumventing the onset of CVD and in the reduction of CVD risk factors, SACs are among the most physically inactive cohorts in Canada. This relates to a set of common and unique socio-cultural barriers, such as gender, beliefs and perceptions about illness, immigration, unfavorable PA environments, and their high prevalence of debilitating chronic diseases. Several strategies to improve PA participation rates in this high-risk population have been suggested, and include the implementation of culturally sensitive PA interventions, as well as clinician training in PA prescription through workshops that emphasize knowledge translation into clinical practice. Therefore, the purpose of this mini-review is to highlight and discuss: (1) the burden of heart disease in SACs (2) the cardiovascular benefits of PA for SACs; (3) factors affecting PA participation among SACs and how they can be addressed; (4) the impact of culturally sensitive PA prescription on CVD prevention; (5) barriers to culture-specific PA prescription by clinicians, and strategies to improve its use and impact.
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Affiliation(s)
| | - Mina A. Iskandar
- School of Medicine, Royal College of Surgeons in Ireland, Adliya, Bahrain
| | - Sally Doherty
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland, Adliya, Bahrain
| | - Katrina A. D'Urzo
- School of Kinesiology and Health Studies, Queens University, Kingston, ON, Canada
| | | | - Tyler Cameron Tabobondung
- Department of Family Medicine, Michael G. DeGroote School of Medicine, Brantford General Hospital, McMaster University, Hamilton, ON, Canada
| | - Prasaanthan Gopee-Ramanan
- Department of Diagnostic Radiology, Hamilton Health Sciences Centre, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Seyon Sivagurunathan
- Department of Family Medicine, Stonechurch Family Health Clinic, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nirunthan Sivananthan
- Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Samari G, Alcalá HE, Sharif MZ. Islamophobia, Health, and Public Health: A Systematic Literature Review. Am J Public Health 2018; 108:e1-e9. [PMID: 29672152 DOI: 10.2105/ajph.2018.304402] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In 2017, a "Muslim ban" on immigrants to the United States was coupled with a continued rise in Islamophobia and hate crimes toward Muslims. Islamophobia undermines health equity, yet delineating the effects of Islamophobia globally is challenging as it affects a myriad of groups (geographically, racially, and socially). Additionally, stereotypes equate all Muslims with populations from the Middle East and South Asia. To date, health research pays insufficient attention to Islamophobia, Muslims, and those racialized to be Muslim. OBJECTIVES This literature review advances our understanding of racism and health by examining the racialization of religion, by specifically examining Islamophobia as a form of discrimination. SEARCH METHODS Per PRISMA guidelines, we conducted a search in October 2017 using PubMed-MEDLINE and a combination of terms. We identified additional articles using other search engines. For inclusion, articles needed to include a descriptor of discrimination, contain an identifier of Muslim or Muslim-like identity (i.e., groups commonly perceived as Muslim, including Arabs, Middle Easterners, North Africans, and South Asians), include a health outcome, be in English, and be published between 1990 and 2017. SELECTION CRITERIA We identified 111 unique peer-reviewed articles. We excluded articles that did not meet the following criteria: (1) examined Islamophobia, discrimination, or racism among a Muslim or Muslim-like population; (2) included a health outcome or discussion of health disparities; and (3) was conducted in North America, Europe, Australia, or New Zealand. This yielded 53 articles. RESULTS The majority of studies (n = 34; 64%) were quantitative. The remaining studies were qualitative (n = 7; 13%), mixed methods (n = 2; 4%), or reviews (n = 10; 19%). Most studies were based in the United States (n = 31; 58%). Nearly half of the reviewed studies examined mental health (n = 24; 45%), and one fourth examined physical health or health behaviors (n = 13; 25%). Others focused on both physical and mental health (n = 10; 19%) or health care seeking (n = 7; 13%). Studies showed associations between Islamophobia and poor mental health, suboptimal health behaviors, and unfavorable health care-seeking behaviors. CONCLUSIONS This study elucidates the associations between Islamophobia, health, and socioecological determinants of health. Future studies should examine the intersectional nature of Islamophobia and include validated measures, representative samples, subgroup analyses, and comparison groups. More methodologically rigorous studies of Islamophobia and health are needed. Public Health Implications. Addressing the discrimination-related poor health that Muslims and racialized Muslim-like subgroups experience is central to the goals of health equity and assurance of the fundamental right to health.
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Affiliation(s)
- Goleen Samari
- Goleen Samari is with Advancing New Standards in Reproductive Health, the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Héctor E. Alcalá is with the Department of Family, Population and Preventative Medicine, Program in Public Health, Stony Brook University, Stony Brook, NY. Mienah Zulfacar Sharif is with the Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - Héctor E Alcalá
- Goleen Samari is with Advancing New Standards in Reproductive Health, the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Héctor E. Alcalá is with the Department of Family, Population and Preventative Medicine, Program in Public Health, Stony Brook University, Stony Brook, NY. Mienah Zulfacar Sharif is with the Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - Mienah Zulfacar Sharif
- Goleen Samari is with Advancing New Standards in Reproductive Health, the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. Héctor E. Alcalá is with the Department of Family, Population and Preventative Medicine, Program in Public Health, Stony Brook University, Stony Brook, NY. Mienah Zulfacar Sharif is with the Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
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Kandula NR, Dave S, De Chavez PJ, Bharucha H, Patel Y, Seguil P, Kumar S, Baker DW, Spring B, Siddique J. Translating a heart disease lifestyle intervention into the community: the South Asian Heart Lifestyle Intervention (SAHELI) study; a randomized control trial. BMC Public Health 2015; 15:1064. [PMID: 26475629 PMCID: PMC4609098 DOI: 10.1186/s12889-015-2401-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background South Asians (Asian Indians and Pakistanis) are the second fastest growing ethnic group in the United States (U.S.) and have an increased risk of atherosclerotic cardiovascular disease (ASCVD). This pilot study evaluated a culturally-salient, community-based healthy lifestyle intervention to reduce ASCVD risk among South Asians. Methods Through an academic-community partnership, medically underserved South Asian immigrants at risk for ASCVD were randomized into the South Asian Heart Lifestyle Intervention (SAHELI) study. The intervention group attended 6 interactive group classes focused on increasing physical activity, healthful diet, weight, and stress management. They also received follow-up telephone support calls. The control group received translated print education materials about ASCVD and healthy behaviors. Primary outcomes were feasibility and initial efficacy, measured as change in moderate/vigorous physical activity and dietary saturated fat intake at 3- and 6-months. Secondary clinical and psychosocial outcomes were also measured. Results Participants’ (n = 63) average age was 50 (SD = 8) years, 63 % were female, 27 % had less than or equal to a high school education, one-third were limited English proficient, and mean BMI was 30 kg/m2 (SD ± 5). There were no significant differences in change in physical activity or saturated fat intake between the intervention and control group. Compared to the control group, the intervention group showed significant weight loss (−1.5 kg, p-value = 0.04) and had a greater sex-adjusted decrease in hemoglobin A1C (−0.43 %, p-value <0.01) at 6 months. Study retention was 100 %. Conclusions This pilot study suggests that a culturally-salient, community-based lifestyle intervention was feasible for engaging medically underserved South Asian immigrants and more effective at addressing ASCVD risk factors than print health education materials. Trial registration NCT01647438, Date of Trial Registration: July 19, 2012 Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2401-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Namratha R Kandula
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .,Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Swapna Dave
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Peter John De Chavez
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Himali Bharucha
- Metropolitan Asian Family Services, 7541 N Western Avenue, Chicago, IL, 60645, USA.
| | - Yasin Patel
- National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - Paola Seguil
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Santosh Kumar
- Metropolitan Asian Family Services, 7541 N Western Avenue, Chicago, IL, 60645, USA.
| | - David W Baker
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
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Daniel M, Wilbur J, Fogg LF, Miller AM. Correlates of lifestyle: physical activity among South Asian Indian immigrants. J Community Health Nurs 2015; 30:185-200. [PMID: 24219639 DOI: 10.1080/07370016.2013.838482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
South Asian immigrants are at increased risk for cardiovascular disease and diabetes, but little is known about their physical activity patterns. In this cross-sectional study, 110 participants were recruited to describe lifestyle physical activity behavior of this at-risk population. Education (p = .042), global health (p = .045), and self-efficacy (p = .000) had significant positive independent effects on leisure-time physical activity. Depression (p = .035) and waist circumference (p = .012) had significant negative independent effects, and frequency of experiencing discrimination a significant positive independent effect (p = .007) on daily step counts. Culture-sensitive physical activity interventions need to target South Asian Indian immigrants who are less educated, in poor health, concerned about racial discrimination, and have low self-efficacy.
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Affiliation(s)
- Manju Daniel
- a Northern Illinois University , School of Health and Human Sciences , DeKalb , Illinois
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Daniel M, Wilbur J, Marquez D, Farran C. Lifestyle physical activity behavior among South Asian Indian immigrants. J Immigr Minor Health 2014; 15:1082-9. [PMID: 23686529 DOI: 10.1007/s10903-013-9842-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Little is known of the physical activity behavior of South Asian Indian immigrants (SAIs), though they have more than twice the risk for cardiovascular disease and diabetes than Whites. This was a cross-sectional descriptive face-to-face survey design, comparing between men and women in leisure time (LTPA), household (HPA), and occupational physical activity (OPA). Participants also wore a Lifecorder EX (NL2200) accelerometer for 7 days. Just over half (51.8 %) of the participants met the recommended PA guidelines (≥150 min moderate-intensity or ≥75 min vigorous-intensity) through LTPA. The average number of daily steps was 6,904.3, which is in the "low active" classification. Increasing lifestyle PA among SAIs is important; PA interventions appealing to gender and culture and with an aerobic component are needed.
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Affiliation(s)
- Manju Daniel
- College of Nursing, Rush University, Chicago, IL, USA,
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Kukaswadia A, Pickett W, Janssen I. Time since immigration and ethnicity as predictors of physical activity among Canadian youth: a cross-sectional study. PLoS One 2014; 9:e89509. [PMID: 24586835 PMCID: PMC3931791 DOI: 10.1371/journal.pone.0089509] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 01/21/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about patterns of physical activity engaged in by youth after they immigrate to a new country. This study aims to investigate relationships between immigrant generation and ethnicity with physical activity, and to determine if the relationship between immigrant generation and physical activity was modified by ethnicity. METHODS The data sources were Cycle 6 (2009-2010) of the Canadian Health Behaviour in School-Aged Children Study and the 2006 Canada Census of Population. Participants (weighted n = 23,124) were young people from grades 6-10 in 436 schools. Students were asked where they were born, how long ago they moved to Canada, their ethnicity, and how many days a week they accumulated at least 60 minutes of moderate-to-vigorous physical activity (MVPA). RESULTS Youth born outside of Canada were less likely to be active than peers born in Canada; 11% vs 15% reported 7 days/week of at least 60 minutes of MVPA (p = .001). MVPA increased with time since immigration. Compared to Canadian-born youth, youth who immigrated within the last 1-2 years were less likely to get sufficient MVPA on 4-6 days/week (odds ratio: 0.66, 95% confidence interval: 0.53-0.82) and 7 days/week (0.62; 0.43-0.89). East and South-East Asian youth were less active, regardless of time since immigration: 4-6 days/week (0.67; 0.58-0.79) and 7 days/week (0.37; 0.29-0.48). CONCLUSION Time since immigration and ethnicity were associated with MVPA among Canadian youth. Mechanisms by which these differences occur need to be uncovered in order to identify barriers to physical activity participation among youth.
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Affiliation(s)
- Atif Kukaswadia
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - William Pickett
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Clinical Research Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Ian Janssen
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
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Kandula NR, Patel Y, Dave S, Seguil P, Kumar S, Baker DW, Spring B, Siddique J. The South Asian Heart Lifestyle Intervention (SAHELI) study to improve cardiovascular risk factors in a community setting: design and methods. Contemp Clin Trials 2013; 36:479-87. [PMID: 24060673 DOI: 10.1016/j.cct.2013.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 01/13/2023]
Abstract
Disseminating and implementing evidence-based, cardiovascular disease (CVD) prevention lifestyle interventions in community settings and in ethnic minority populations is a challenge. We describe the design and methods for the South Asian Heart Lifestyle Intervention (SAHELI) study, a pilot study designed to determine the feasibility and initial efficacy of a culturally-targeted, community-based lifestyle intervention to improve physical activity and diet behaviors among medically underserved South Asians (SAs). Participants with at least one CVD risk factor will be randomized to either a lifestyle intervention or a control group. Participants in both groups will be screened in a community setting and receive a primary care referral after randomization. Intervention participants will receive 6weeks of group classes, followed by 12weeks of individual telephone support where they will be encouraged to initiate and maintain a healthy lifestyle goal. Control participants will receive their screening results and monthly mailings on CVD prevention. Primary outcomes will be changes in moderate/vigorous physical activity and saturated fat intake between baseline, 3-, and 6-month follow-up. Secondary outcomes will be changes in weight, clinical risk factors, primary care visits, self-efficacy, and social support. This study will be one of the first to pilot-test a lifestyle intervention for SAs, one of the fastest growing racial/ethnic groups in the U.S. and one with disparate CVD risk. Results of this pilot study will provide preliminary data about the efficacy of a lifestyle intervention on CVD risk in SAs and inform community-engaged CVD prevention efforts in an increasingly diverse U.S. population.
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Affiliation(s)
- Namratha R Kandula
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA.
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Type 2 Diabetes Risk among Asian Indians in the US: A Pilot Study. Nurs Res Pract 2013; 2013:492893. [PMID: 23970965 PMCID: PMC3736461 DOI: 10.1155/2013/492893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/30/2013] [Indexed: 12/31/2022] Open
Abstract
The purpose of this pilot study was to investigate type 2 diabetes risk among Asian Indians of Kerala ethnicity living in a West Texas County of the USA. The study used a descriptive correlational design with thirty-seven adult nondiabetic Asian Indian subjects between 20 and 70 years of age. The measurement included nonbiochemical indices of obesity, family history of type 2 diabetes, length of immigration in the US, history of hypertension, physical activity pattern, and fruit and vegetable intake. The majority of the subjects showed an increased nonbiochemical indices corresponding with overweight and obesity, placing them at risk for type 2 diabetes and associated cardiovascular complications. The physical activity pattern indicated a sedentary lifestyle. The decreased physical activity was associated with a higher Body Mass Index (BMI) and body fat percentage; length of residence in the US greater than 10 years was associated with increased body fat percentage and BMI; family history of type 2 diabetes was associated with an increase in body fat percentage. Fruit and vegetable intake pattern was not associated with a risk for type 2 diabetes. Further studies are recommended for risk surveillance among Asian Indian population living in the US.
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Babakus WS, Thompson JL. Physical activity among South Asian women: a systematic, mixed-methods review. Int J Behav Nutr Phys Act 2012; 9:150. [PMID: 23256686 PMCID: PMC3542106 DOI: 10.1186/1479-5868-9-150] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 12/06/2012] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The objective of this systematic mixed-methods review is to assess what is currently known about the levels of physical activity (PA) and sedentary time (ST) and to contextualize these behaviors among South Asian women with an immigrant background. METHODS A systematic search of the literature was conducted using combinations of the key words PA, ST, South Asian, and immigrant. A mixed-methods approach was used to analyze and synthesize all evidence, both quantitative and qualitative. Twenty-six quantitative and twelve qualitative studies were identified as meeting the inclusion criteria. RESULTS Studies quantifying PA and ST among South Asian women showed low levels of PA compared with South Asian men and with white European comparison populations. However making valid comparisons between studies was challenging due to a lack of standardized PA measurement. The majority of studies indicated that South Asian women did not meet recommended amounts of PA for health benefits. Few studies assessed ST. Themes emerging from qualitative studies included cultural and structural barriers to PA, faith and education as facilitators, and a lack of understanding of the recommended amounts of PA and its benefits among South Asian women. CONCLUSIONS Quantitative and qualitative evidence indicate that South Asian women do not perform the recommended level of PA for health benefits. Both types of studies suffer from limitations due to methods of data collection. More research should be dedicated to standardizing objective PA measurement and to understanding how to utilize the resources of the individuals and communities to increase PA levels and overall health of South Asian women.
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Affiliation(s)
- Whitney S Babakus
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Janice L Thompson
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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de Munter JSL, Agyemang C, Brewster LM, Stronks K, van Valkengoed IGM. The association of leisure-time physical activity and active commuting with measures of socioeconomic position in a multiethnic population living in the Netherlands: results from the cross-sectional SUNSET study. BMC Public Health 2012; 12:815. [PMID: 22998730 PMCID: PMC3490879 DOI: 10.1186/1471-2458-12-815] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 09/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In most European origin populations measures of socioeconomic position are positively associated with leisure time physical activity (LTPA), this is unclear for active commuting. In addition, these associations have scarcely been studied in ethnic minority groups, who often have a high cardiovascular disease risk. Because of the expected public health potential, we assessed the relationship of active commuting and LTPA with measures of socioeconomic position across two large ethnic minority groups in the Netherlands as compared to the European-Dutch population. METHODS We included South Asian-Surinamese (n = 370), African-Surinamese (n = 689), and European-Dutch (n = 567) from the cross-sectional population-based SUNSET study (2001-2003). Active commuting and LTPA were assessed by the SQUASH physical activity questionnaire and calculated in square-root-transformed metabolic equivalents of task-hours/week (SQRTMET). Socioeconomic position was indicated by level of education (low/high) and occupational class (low/high). We used age-adjusted linear regression models to assess the association between physical activity and socioeconomic position. RESULTS Compared to the European-Dutch men, South Asian-Surinamese men engaged in lower levels of commuting activity and LTPA, and South Asian-Surinamese women engaged in lower levels of LTPA than their European-Dutch counterparts. Differences between the African Surinamese and the European-Dutch were small. We observed a positive gradient in active commuting activity for education in European-Dutch men (beta high education was 0.93, 95%CI: 0.45-1.40 SQRTMET higher versus low education), in South Asian-Surinamese men (beta: 0.56, 0.19-0.92), but not in African-Surinamese men (-0.06, -0.45-0.33, p for ethnicity-interaction = 0.002). In women we observed a positive gradient in active commuting activity and occupational class in European-Dutch women, and less strongly in South Asian-Surinamese and African-Surinamese women (p for ethnicity-interaction = 0.02). For LTPA and socioeconomic position, we observed no statistically significant interaction by ethnicity. CONCLUSIONS The positive gradient for socioeconomic position observed in European-Dutch was less strong, in particular for active commuting, among the South Asian-Surinamese and the African-Surinamese. This indicates that the typical focus on physical activity interventions in lower socioeconomic groups could work for European-Dutch populations, but this strategy may not be entirely applicable in the ethnic minority groups.
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Affiliation(s)
- Jeroen SL de Munter
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lizzy M Brewster
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene GM van Valkengoed
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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