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Hu EA, Turner-McGrievy GM, Wilson MJ, Davey M, Bailey S, Okpara N, Frongillo EA, Wilcox S. Adherence to a culturally adapted soul food vegan diet among African American adults increases diet quality compared to an omnivorous diet in the NEW Soul Study. Nutr Res 2024; 128:1-13. [PMID: 38981142 PMCID: PMC11294497 DOI: 10.1016/j.nutres.2024.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 07/11/2024]
Abstract
Adherence to a vegan diet may lower risk of cardiovascular disease among African Americans (AAs). Feasibility and sustainability of adopting a vegan diet may be challenging among AAs who live in regions where soul food is a predominant cuisine. Our hypothesis was that AAs randomized to a culturally adapted vegan diet will have greater adherence to their assigned diet compared with those randomized to a culturally adapted omnivorous diet. AAs (N = 113) with overweight/obesity from South Carolina were included. Dietary intake was measured at months 0, 3, 6, and 12 using 24-hour recalls. Adherence was defined based on recommended animal product intake for each group. Differences in nutrient intakes and dietary indices (Alternative Healthy Eating Index 2010 and healthy plant-based diet index) between groups were evaluated using t-tests. At 12 months, adherence was higher to the vegan (51%) versus omnivorous (35%) diet. Participants assigned to the vegan diet had higher intake of carbohydrates (P = .01) and fiber (P < .001), and lower intake of cholesterol P< .001) and protein (P = .001) compared with participants assigned to the omnivorous diet. Participants adherent to the vegan diet had lower cholesterol intake (P < .001) and higher fiber intake (P = .02) compared with those adherent to the omnivorous diet. Compared with those assigned to the omnivorous diet, participants assigned to the vegan diet had higher Alternative Healthy Eating Index 2010 (P = .01) and healthy plant-based diet index (P < .001) scores. AAs with overweight/obesity were more adherent to a culturally adapted vegan diet versus an omnivorous diet after 1 year, and nutrient and food group intake changes were sustained.
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Affiliation(s)
- Emily A Hu
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, South Carolina, USA.
| | - Gabrielle M Turner-McGrievy
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, South Carolina, USA
| | - Mary J Wilson
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, South Carolina, USA
| | - Marty Davey
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, South Carolina, USA
| | - Shiba Bailey
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, South Carolina, USA
| | - Nkechi Okpara
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, South Carolina, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, South Carolina, USA
| | - Sara Wilcox
- Prevention Research Center and Department of Exercise Science, Arnold School of Public Health, University of South Carolina, South Carolina, USA
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Kelly RM, McDermott JH, Coogan AN. Thematic Daily Sleep Routine Analysis of Adults Not in Employment Living with Type 2 Diabetes Mellitus. Clocks Sleep 2023; 6:11-23. [PMID: 38247882 PMCID: PMC10801551 DOI: 10.3390/clockssleep6010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Day-to-day variations in sleep timing have been associated with poorer glycemic control in type 2 diabetes mellitus, although the factors that influence this sleep timing variability are poorly understood. METHODS Daily routines of sleep in a sample of seventeen adults with type 2 diabetes mellitus who were either retired or not currently working were examined qualitatively through the application of semi-structured interviews and a thematic analysis of the resulting transcripts. RESULTS Four themes were identified: "Consistent Sleeping Patterns", "Fluctuating Sleep Timing", "Night-Time Disruptions" and "Lasting Effort Needed with Type Two Diabetes Mellitus". The subthemes reflected that many participants had consistent sleep schedules across the seven-day week, but that a desire to maintain a sense of normality, household routines, television schedules and socializing were associated with different sleep timing on weekends. Active disease monitoring and timed medication taking were not identified as important factors in shaping sleep timing. Nocturia, stress and rumination were identified as important factors linked to disrupted sleep. Sleep was not reported as an issue discussed during routine clinical care. CONCLUSION Sleep timing in participants appears to be driven by interacting psychosocial and physiological factors, although active disease management does not emerge as a major influence on sleep schedules.
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Affiliation(s)
- Rachael M. Kelly
- Department of Psychology, Maynooth University, National University of Ireland, W23 X021 Maynooth, Ireland;
| | - John H. McDermott
- Academic Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital Blanchardstown, D15 X40D Dublin, Ireland;
| | - Andrew N. Coogan
- Department of Psychology, Maynooth University, National University of Ireland, W23 X021 Maynooth, Ireland;
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Tzeng WC, Feng HP. Dietary Management in Individuals With Serious Mental Illness and Comorbid Diabetes: A Focused Ethnography Study. J Nurs Res 2023; 31:e292. [PMID: 37522625 DOI: 10.1097/jnr.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Patients with serious mental illness (SMI) are more likely to have Type 2 diabetes mellitus (T2DM). However, studies that discuss the eating habits of patients with both T2DM and SMI are lacking. PURPOSE This study was designed to explore the beliefs and experiences of Taiwanese patients with SMI who also have T2DM. METHODS Fieldwork for this study included 2 years of participant observation and individual interviews with 13 patients with SMI. Data from transcripts of observational field notes and interviews were transcribed verbatim and analyzed. RESULTS The participants described their experiences and concerns regarding dietary management during the period after receiving their T2DM diagnosis. The results of the data analysis were distinguished into three categories, including (a) increased difficulty in life, (b) positive view of dietary control, and (c) inability to abide by dietary restrictions. CONCLUSIONS The findings suggest that healthcare professionals should work to better understand the challenges faced by patients with SMI and T2DM in implementing changes and resisting the temptation to eat unhealthy food and provide suggestions tailored to their cultural background, lifestyle, and eating characteristics.
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Affiliation(s)
- Wen-Chii Tzeng
- PhD, RN, Professor, School of Nursing, National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Hsin-Pei Feng
- PhD, RN, Assistant Professor, School of Nursing, National Defense Medical Center, Taipei City, Taiwan, ROC
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Van Dyke N, Murphy M, Drinkwater EJ. What do people think of intuitive eating? A qualitative exploration with rural Australians. PLoS One 2023; 18:e0278979. [PMID: 37590273 PMCID: PMC10434910 DOI: 10.1371/journal.pone.0278979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
Evidence supports that intuitive eating is associated with many indicators of positive physical and mental health, with more recent longitudinal studies establishing causality. Most research, however, comprises either survey data or clinical trials. This study attempts to fill this evidentiary gap by using a qualitative methodology to explore people's understandings and reactions to intuitive eating, including perceived barriers and enablers to implementation. Three focus group discussions were conducted in a non-metropolitan region of Victoria, Australia, with a total of 23 participants. Focus group transcripts were thematically analysed using an inductive descriptive approach within a constructionist perspective. Findings indicate that the concept of intuitive eating was either unknown or misunderstood. Once intuitive eating was explained, most responses to implementing intuitive eating were negative. Participants felt that having complete choice around what they ate was unlikely to equate to a healthy or balanced diet, at least in the short term. They also argued that because everyday life was not intuitive in its structures, it would be difficult to eat intuitively. Despite these difficulties, participants appreciated that if they were able to overcome the various barriers and achieve a state of intuitive eating, they anticipated a range of long-term benefits to health and weight management. For intuitive eating to become a viable public health approach, this research suggests that intuitive eating needs to be much more widely publicised and better explained, and perhaps renamed. More significantly, people would need assistance with how to eat intuitively given the barriers identified.
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Affiliation(s)
- Nina Van Dyke
- Mitchell Institute, Victoria University, Melbourne, Victoria, Australia
| | | | - Eric J. Drinkwater
- School of Exercise and Sport Science, Charles Sturt University, Bathurst, New South Wales, Australia
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Lemacks JL, Abbott LS, Navarro C, McCoy S, Greer T, Aras S, Madson MB, Reese-Smith J, Lawrick C, Gipson J, Buck BK, Johnson M. Passive recruitment reach of a lifestyle management program to address obesity in the deep south during the COVID-19 pandemic. AIMS Public Health 2023; 10:116-128. [PMID: 37063359 PMCID: PMC10091136 DOI: 10.3934/publichealth.2023010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 03/04/2023] Open
Abstract
Obesity is a significant public health concern, especially in the Deep South and in Mississippi where prevalence is among the worst in the nation paired, with other poor health outcomes and socioeconomic conditions. Lifestyle management programs that address modifiable risk factors, such as nutrition and physical activity, can be effective mitigation strategies to halt weight accumulation patterns and ameliorate metabolic risk factors for some populations. However, there is limited evidence regarding the implementation of effective practice models to address obesity risk in underserved and underrepresented populations, such as African Americans, and people in the stage of earlier adulthood. Furthermore, there is growing evidence supporting the impact of the COVID-19 pandemic on lifestyle management programs that should be considered in these populations. The purpose of this manuscript was to describe the development and telehealth implementation of a weight management program during the COVID-19 pandemic and provide a preliminary examination of recruitment strategies and baseline characteristics for enrolled participants. Passive recruitment (social media, web, email, and other media advertisements) resulted in 157 screening initiations, and 79 of those participants met the study inclusion criteria. Further, of the 79 eligible participants, 38 completed all study enrollment requirements and presented with metabolic abnormalities. The study findings add to the emerging body of evidence for how the pandemic may have impacted lifestyle management programs and is representative of an understudied and underrepresented population.
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Affiliation(s)
- Jennifer L Lemacks
- Telenutrition Center, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, Mississippi
- School of Health Professions, College of Nursing and Health Professions, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Laurie S Abbott
- College of Nursing, Florida State University, Tallahassee, Florida
| | - Cali Navarro
- Telenutrition Center, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, Mississippi
- School of Health Professions, College of Nursing and Health Professions, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Stephanie McCoy
- School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Tammy Greer
- Telenutrition Center, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, Mississippi
- School of Psychology, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Sermin Aras
- Telenutrition Center, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, Mississippi
- School of Health Professions, College of Nursing and Health Professions, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Michael B Madson
- School of Psychology, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Jacqueline Reese-Smith
- Telenutrition Center, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Chelsey Lawrick
- School of Health Professions, College of Nursing and Health Professions, The University of Southern Mississippi, Hattiesburg, Mississippi
- School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - June Gipson
- My Brother's Keeper, Inc., Mississippi INBRE Community Engagement and Training Core, Jackson, Mississippi
| | - Byron K Buck
- Telenutrition Center, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, Mississippi
- My Brother's Keeper, Inc., Mississippi INBRE Community Engagement and Training Core, Jackson, Mississippi
| | - Marcus Johnson
- Telenutrition Center, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, Mississippi
- My Brother's Keeper, Inc., Mississippi INBRE Community Engagement and Training Core, Jackson, Mississippi
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Abdul Basir SM, Abdul Manaf Z, Mohd. Noor N, Mat Ludin AF, Shahar S, Abdul Manaf MR. The Challenges and Strategies towards Healthy Eating during COVID-19 Home Confinement Period among Working Adults with BMI ≥ 25 kg/m 2 Enrolled in a Weight Loss Program: Qualitative Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116656. [PMID: 35682248 PMCID: PMC9180068 DOI: 10.3390/ijerph19116656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has been affecting our lifestyles, such as work, living, and health. In Malaysia, the Restriction of Movement Order (RMO) was first announced in March 2020 to curb the spread of the virus. Since then, many Malaysians have been confined to their own home. This new lifestyle can cause a change of eating habits where healthy eating may be a challenge. Hence, our qualitative study explored the challenges and strategies for healthy eating during the first wave of the COVID-19 home confinement period among working adults overweight and obese in Malaysia. Eleven participants were individually interviewed through phone calls. The interviews were audio-recorded, transcribed verbatim, and then coded with NVIVO 12 based on thematic analysis. We found that social pressure, changes in the social setting, more free time to access food, and extra stock of unhealthy foods at home were among the challenges to healthy eating. Some participants countered these perceived challenges by reducing unhealthy food stock, limiting kitchen visits, and utilizing self-monitoring apps to monitor their calorie intake. Social media was not consistently perceived to influence their eating behavior during this period. We conclude that COVID-19 home confinement has created challenges to healthy eating habits among overweight and obese adults with overweight and obesity. Our study provides evidence that vulnerable groups such as overweight and obese individuals require specific nutritional support during pandemic-related confinement to enhance eating self-efficacy.
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Affiliation(s)
- Siti Munirah Abdul Basir
- Centre for Healthy Aging and Wellness and Dietetic Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Aziz, Kuala Lumpur 50300, Selangor, Malaysia; (S.M.A.B.); (S.S.)
| | - Zahara Abdul Manaf
- Centre for Healthy Aging and Wellness and Dietetic Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Aziz, Kuala Lumpur 50300, Selangor, Malaysia; (S.M.A.B.); (S.S.)
- Correspondence: ; Tel.: +60-392897677
| | - Norhayati Mohd. Noor
- Center of Community Education and Wellbeing, Faculty of Education, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia;
| | - Arimi Fitri Mat Ludin
- Centre for Healthy Aging and Wellness and Biomedical Science Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Aziz, Kuala Lumpur 50300, Selangor, Malaysia;
| | - Suzana Shahar
- Centre for Healthy Aging and Wellness and Dietetic Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Aziz, Kuala Lumpur 50300, Selangor, Malaysia; (S.M.A.B.); (S.S.)
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Selangor, Malaysia;
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Rao D, Meyer J, Maurer M, Shiyanbola OO. Perceptions of psychosocial and interpersonal factors affecting self-management behaviors among African Americans with diabetes. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100057. [PMID: 35480599 PMCID: PMC9029920 DOI: 10.1016/j.rcsop.2021.100057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Deepika Rao
- Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, United States of America
| | - Jodi Meyer
- School of Pharmacy, University of Wisconsin-Madison, United States of America
| | - Martha Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison, United States of America
| | - Olayinka O. Shiyanbola
- Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, United States of America
- Corresponding author at: School of Pharmacy, University of Wisconsin, 777 Highland Avenue, Madison, WI 53705, United States of America.
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Hurt TR, Francis SL, Seawell AH, Krisco MP, Flynn MH, O'Connor MC, Rudolph CS, Hill A. Revising Diabetes Programming for Black Men and Their Families. Glob Qual Nurs Res 2020; 7:2333393620960183. [PMID: 33088849 PMCID: PMC7545759 DOI: 10.1177/2333393620960183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022] Open
Abstract
Type-2 diabetes has increased 160% for African American males in the United States. This two-part study's purpose was to apply social marketing theory to understand the Type-2 diabetes education needs of men in Iowa. Study One was a preference assessment of Type-2 diabetes education strategies. Four African American men participated in a series of four focus groups and indicated that they were interested in diabetes prevention programming with their families but not in having it labeled as diabetes education. Participating men would rather increase their physical activity as opposed to tracking their food intake. As a follow-up to this study, nine other African American males took part in Study Two, which used cooking demonstrations and recipe taste-testing with the men to examine their relationship to food in the context of managing their Type-2 diabetes. The findings of both studies, which provided insight into these African American men's lifestyle as related to their Type-2 diabetes, could be useful for nursing professionals who have a critical role in navigating cultural, gender, and family norms while developing care plans, offering patient education, and promoting quality of life.
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Goheer A, Holzhauer K, Martinez J, Woolf T, Coughlin JW, Martin L, Zhao D, Lehmann H, Clark JM, Bennett WL. What influences the "when" of eating and sleeping?A qualitative interview study. Appetite 2020; 156:104980. [PMID: 32980457 DOI: 10.1016/j.appet.2020.104980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/16/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
Timing of eating relative to sleep and endogenous circadian rhythm impacts weight and cardiometabolic health. We used qualitative methods to explore what influences the "when" of eating and sleeping. We conducted 37 one-on-one semi-structured interviews among participants with a body mass index (BMI) ≥ 25 kg/m2 recruited from three internal medicine clinics affiliated with an urban academic hospital. Participants (70.3% Female; 51.4% White; Age range: 21-83 years old) completed measures of social jetlag, physical activity, eating habits, and mobile application use and participated in interviews following a guide developed by the study team. Responses were recorded, transcribed and coded sequentially by two trained researchers using editing-style analysis to identify themes. We identified two main themes, each with subthemes: 1) influences on the "when" of eating and sleeping, with subthemes including social jetlag and being overscheduled, and 2) contextualizing beliefs and perceptions about the "when" of eating and sleeping, with subthemes including perceived recommendations for timing of eating and sleeping, and alignment of behaviors with perceived recommendations. Many participants noted being more flexible in their eating and sleeping times on work-free vs work days. The themes this study identified should be considered when designing interventions that influence the timing of eating and sleeping for weight management.
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Affiliation(s)
- Attia Goheer
- The Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA.
| | - Katherine Holzhauer
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
| | - Jonathan Martinez
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
| | - Thomas Woolf
- The Johns Hopkins University School of Medicine, Department of Physiology, Baltimore, MD, USA.
| | - Janelle W Coughlin
- The Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore MD, USA.
| | - Lindsay Martin
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
| | - Di Zhao
- The Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Division of Cardiovascular and Clinical Epidemiology, Baltimore, MD, USA.
| | - Harold Lehmann
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of Health Sciences Informatics, Baltimore MD, USA.
| | - Jeanne M Clark
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
| | - Wendy L Bennett
- The Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
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Campbell JA, Yan A, Walker RE, Weinhardt L, Wang Y, Walker RJ, Egede LE. Relative Contribution of Individual, Community, and Health System Factors on Glycemic Control Among Inner-City African Americans with Type 2 Diabetes. J Racial Ethn Health Disparities 2020; 8:402-414. [PMID: 32588396 DOI: 10.1007/s40615-020-00795-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Health disparities disproportionately impact inner-city African Americans; however, limited information exists on the contribution of individual, community, and health system barriers on diabetes outcomes in this population. METHODS A cross-sectional study collected primary data from 241 inner-city African Americans with type 2 diabetes. A conceptual framework was used to specify measurements across the individual level, such as age and comorbidities; community level, such as neighborhood factors and support; and health system level such as access, trust, and provider communication. Based on current best practices, four regression approaches were used: sequential, stepwise with forward selection, stepwise with backward selection, and all possible subsets. Variables were entered in blocks based on the theoretical framework in the order of individual, community, and health system factors and regressed against HbA1c. RESULTS In the final adjusted model across all four approaches, individual-level factors like age (β = - 0.05; p < 0.001); having 1-3 comorbidities (β = - 2.03; p < 0.05), and having 4-9 comorbidities (β = - 2.49; p = 0.001) were associated with poorer glycemic control. Similarly, male sex (β = 0.58; p < 0.05), being married (β = 1.16; p = 0.001), and being overweight/obese (β = 1.25; p < 0.01) were associated with better glycemic control. Community and health system-level factors were not significantly associated with glycemic control. CONCLUSION Individual-level factors are key drivers of glycemic control among inner-city African Americans. These factors should be the key targets for interventions to improve glycemic control in this population. However, community and health system factors may have indirect pathways to glycemic control that should be examined in future studies.
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Affiliation(s)
- Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, WI, 53205, USA
| | - Alice Yan
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, WI, 53205, USA
| | - Renee E Walker
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, WI, 53205, USA
| | - Lance Weinhardt
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, WI, 53205, USA
| | - Yang Wang
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, WI, 53205, USA
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
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Campbell JA, Egede LE. Individual-, Community-, and Health System-Level Barriers to Optimal Type 2 Diabetes Care for Inner-City African Americans: An Integrative Review and Model Development. DIABETES EDUCATOR 2019; 46:11-27. [PMID: 31802703 DOI: 10.1177/0145721719889338] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this integrative review is (1) to elucidate the unique barriers faced by inner-city African Americans for type 2 diabetes (T2DM) care; (2) to identify effective interventions/programs for optimal T2DM care at the individual, community, and health systems levels; and (3) to integrate 2 behavioral models and 1 social ecological model for framing interventions for inner-city African American to optimize T2DM care. METHODS PRISMA guidelines were followed to systematically search PubMed, PsychInfo, and CINAHL. Integration of models was based on underlying principles of social ecological models. RESULTS The search returned 1183 articles. Forty-six articles were synthesized after applying inclusion criteria. Multiple barriers for the individual level, community level, and health system level were identified. Major barriers include lack of knowledge, lack of social support, and self-management support. Interventions identified in this review show that among inner-city African Americans with T2DM, the focus is placed at the health systems level, with very limited focus toward addressing individual- and community-level barriers. Final synthesis includes development of a new integrated model that explains barriers to care across multiple levels. CONCLUSIONS These findings highlight the fragmentation that may be occurring between policy, research, and practice for achieving health equity and addressing health disparities for T2DM care among inner-city African Americans. The new model is an important step in the pursuit of equity in T2DM by specifying the complex barriers that occur across multiple levels. The application of this model using the 2017 National Standards for Diabetes-Self Management Education and Support are discussed.
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Affiliation(s)
- Jennifer A Campbell
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Center for Advancing Population Science, Milwaukee, Wisconsin.,Joseph Zilber School of Public Health University of Wisconsin Milwaukee Community and Behavioral Health Promotion PhD Program, Milwaukee, Wisconsin
| | - Leonard E Egede
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Center for Advancing Population Science, Milwaukee, Wisconsin.,Joseph Zilber School of Public Health University of Wisconsin Milwaukee Community and Behavioral Health Promotion PhD Program, Milwaukee, Wisconsin
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12
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The Association between Food Insecurity and Diet Quality Varies by Race/Ethnicity: An Analysis of National Health and Nutrition Examination Survey 2011-2014 Results. J Acad Nutr Diet 2019; 119:1676-1686. [PMID: 30579633 PMCID: PMC6584552 DOI: 10.1016/j.jand.2018.10.011] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/22/2018] [Accepted: 10/04/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Food insecurity is believed to influence the quality and quantity of foods consumed; however, studies examining food insecurity and diet quality have been inconclusive and few studies have explored variability in these associations by sex and race/ethnicity. OBJECTIVE This study examined associations between food insecurity and diet quality, and variations by sex and race/ethnicity. DESIGN Cross-sectional analysis of data from the 2011-2014 National Health and Nutrition Examination Surveys. PARTICIPANTS The study population was composed of 4,393 adults (aged 20 to 65 years) with family incomes ≤300% of the federal poverty level with complete data on household food security and dietary intake via two 24-hour dietary recalls. MAIN OUTCOME MEASURES Diet quality was assessed using the Healthy Eating Index-2015. STATISTICAL ANALYSES PERFORMED Associations between food insecurity and Healthy Eating Index-2015 total and component scores were examined using linear regression models and generalized linear models. Models adjusted for sociodemographic and health covariates. RESULTS Compared with food-secure adults, food-insecure adults reported a 2.22-unit lower Healthy Eating Index-2015 score (95% CI -3.35 to -1.08). This association was most pronounced among non-Hispanic whites and adults of Asian or other races/ethnicities. There were no associations among non-Hispanic black or Hispanic adults, and no differences by sex. Among non-Hispanic whites, food insecurity was associated with lower scores for total protein foods, seafood and plant proteins, and added sugar. Among Asians, food insecurity was associated with lower scores for whole fruit. CONCLUSIONS Food insecurity was associated with lower diet quality primarily among non-Hispanic whites; Asians; and other adults, a group composed of American Indian or Alaska Natives, Native Hawaiian or Other Pacific Islanders, and multiracial adults. Further research is needed to better understand the nature of this association among understudied racial/ethnic groups.
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Sun R, Rohay JM, Sereika SM, Zheng Y, Yu Y, Burke LE. Psychometric Evaluation of the Barriers to Healthy Eating Scale: Results from Four Independent Weight Loss Studies. Obesity (Silver Spring) 2019; 27:700-706. [PMID: 30843367 PMCID: PMC6478518 DOI: 10.1002/oby.22414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/03/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the psychometric properties of the 22-item Barriers to Healthy Eating (BHE) scale in four independent weight loss studies conducted over 13 years. METHODS Principal axis factoring with promax rotation was performed to reveal the underlying factor structure. Internal consistency was assessed using Cronbach α, and convergent validity was assessed by correlating the baseline BHE with the Weight Efficacy Lifestyle questionnaire total and subscale scores. Predictive validity was examined by the association of BHE change with weight loss over 6 months. RESULTS The four studies had similar gender (82.9%-89.9% female) and race (70.5%-81.4% white) distributions. Factor analyses suggested removal of two items and a three-factor structure: self-control and motivation (10 items), daily mechanics (7 items), and social support (3 items). The Cronbach α for the 20-item BHE ranged from 0.849 to 0.881 across the four studies. The BHE and Weight Efficacy Lifestyle questionnaire total and subscale scores were all negatively correlated with each other, showing good convergent validity (r = 0.120-0.544, P < 0.05). BHE change was associated with weight loss from 0 to 6 months (r = 0.282-0.450, P < 0.05). CONCLUSIONS The BHE scale showed very good psychometric properties over time, supporting its use in measuring barriers to one's ability to adopt or maintain a healthy eating plan.
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Affiliation(s)
- Ran Sun
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey M Rohay
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan M Sereika
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yaguang Zheng
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yang Yu
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lora E Burke
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Lee LT, Jung SE, Bowen P, Clay OJ, Locher JL, Cherrington AL. Understanding the Dietary Habits of Black Men With Diabetes. J Nurse Pract 2019; 15:365-369. [PMID: 31700501 PMCID: PMC6836436 DOI: 10.1016/j.nurpra.2018.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Diabetes is highly prevalent in African American men. To provide nurse practitioners with practice strategies we explored African American men's perceived needs for dietary health and diabetes self-management using the Social Cognitive Theory. Twenty-five African American men participated in four focus groups. The data were analyzed using a combination of inductive/deductive content analysis approach. Focus group analysis identified personal, behavioral and environmental barriers to and facilitators for diabetes self-management. Nurse practitioners may need to provide extra emotional support in the absence of informal social support from families for diabetes self-management and dietary health in African American men with diabetes.
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Affiliation(s)
- Loretta T Lee
- University of Alabama at Birmingham, School of Nursing, Acute, Chronic, and Continuing Care, Birmingham, AL USA. 1-205-996-5826
| | - Seung E Jung
- The University of Alabama, Department of Human Nutrition and Hospitality and Management, Tuscaloosa, AL USA. 1-205-348-6560
| | - Pamela Bowen
- University of Alabama at Birmingham, School of Nursing, Acute, Chronic, and Continuing Care, Birmingham, AL USA. 1-205-934-2778
| | - Olivio J Clay
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL USA 1-205-934-2728
| | - Julie L Locher
- University of Alabama at Birmingham, School of Public Health, Department of Health Care Organization and Policy, Birmingham, AL USA. 1-205-934-7542
| | - Andrea L Cherrington
- University of Alabama at Birmingham, Department of Medicine, Division of Preventive Medicine, Birmingham, AL USA 1-205-996-2885
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Abstract
PURPOSE OF REVIEW This article discusses the state of type 2 diabetes (T2D) self-management research on non-Hispanic Black men with a focus on their knowledge of diabetes, factors that impact T2D self-management and intervention research that specifically targets non-Hispanic Black men with T2D. RECENT FINDINGS Studies on T2D knowledge and barriers and facilitators to T2D self-management in non-Hispanic Black men are limited to small qualitative focus group and in-depth interviews. To date, few T2D interventions for non-Hispanic Black men have been developed and tested. Research shows that non-Hispanic Black men's knowledge of T2D may be less than optimal compared to non-Hispanic white men. Factors that influence T2D self-management in non-Hispanic Black men include gender-related values and beliefs, and a range of other psychosocial (e.g., social support) and structural (e.g., access to health care) factors. Interventions with gender-specific programming may show promise. More studies with larger sample sizes and longitudinal designs are needed to develop programming to effectively target this at-risk population.
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Affiliation(s)
- Jaclynn M Hawkins
- School of Social Work, University of Michigan, 1080 S. University Ave, Ann Arbor, MI, 48109, USA.
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Bowen PG, Lee LT, McCaskill GM, Bryant PH, Hess MA, Ivey JB. Understanding health policy to improve primary care management of obesity. Nurse Pract 2018; 43:46-52. [PMID: 29528881 PMCID: PMC6377066 DOI: 10.1097/01.npr.0000531069.11559.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
NPs are ideal candidates for implementing positive health changes for obese patients. Providers have medical expertise and can promote obesity reduction strategies to their patients. Increased awareness of the influence of health policy and clinical implications for obesity management are needed.
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Affiliation(s)
- Pamela G. Bowen
- Acute, Chronic and Continuing Care Department, School of Nursing, UAB | The University of Alabama at Birmingham, NB 416 | Mailing address: 1720 2nd Avenue South | Birmingham, AL 35294-1210, P: 205.934.2778 | F: 205.996.7183 |
| | - Loretta T. Lee
- Acute, Chronic and Continuing Care Department, School of Nursing, UAB | The University of Alabama at Birmingham, NB 542 | Mailing address: 1720 2nd Avenue South | Birmingham, AL 35294-1210, P: 205.996.5826 | F: 205.996.9165
| | - Gina M. McCaskill
- UAB School of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, P: 205.393.5888
| | - Pamela H. Bryant
- Family/Community and Health Systems, School of Nursing, UAB | The University of Alabama at Birmingham, NB 428D | 1720 2ND AVE S | Birmingham, AL 35294-1210, P: 205.934-2640 | F: 205.996.7183
| | - M. Annette Hess
- Nursing Graduate Programs, School of Nursing Office 1515 A, P: 205-726-2708 | F: 205-726-2219
| | - Jean B. Ivey
- Family/Community and Health Systems Department, School of Nursing, UAB | The University of Alabama at Birmingham
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Lee LT, Bowen PG, Mosley MK, Turner CC. Theory of Planned Behavior: Social Support and Diabetes Self-Management. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2016.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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