Hispanic Male's Perspectives of Health Behaviors Related to Weight Management

Deciphering Dichos for Nutrition and Health Discussion: A Qualitative Study Among Men of Mexican Origin With or At-Risk of Type 2 Diabetes

OBJECTIVE

This study investigates the potential use of dichos (colloquial Spanish sayings) in nutrition and health education for men of Mexican origin, focusing on their recognizability, traditional meanings, and health topic applicability.

DESIGN

A qualitative study that included individual interviews (n = 12) and pile sort methodology to explore 16 dichos. Interviews discussed dicho recognizability and traditional meaning. The pile sort explored the applicability of dichos for health topics. Finally, participants elaborated on the potential utility of dichos for nutrition and health education.

SETTING

At-home, one-on-one interviews.

PARTICIPANTS

Mexican-origin, native-Spanish-speaking males with a body mass index ≥ 30 kg/m2.

PHENOMENON OF INTEREST

The potential application of dichos for nutrition and health education.

ANALYSIS

Dichos were scored for recognizability (total of 12 participants). The qualitative analysis involved 4 cycle coding for the identification of the traditional meaning and health topic applicability of dichos.

RESULTS

Eleven of the 16 dichos were recognized and defined by 100% of participants. Qualitative analysis revealed the meanings of dichos that are applicable to the health topics of healthy eating, physical activity, health motivation, social support, and stress management. All participants supported the viability of dichos as a linguistic educational tool.

CONCLUSIONS AND IMPLICATIONS

Dichos may serve as a cultural-linguistic strategy in nutrition education for men of Mexican origin with or at risk for type 2 diabetes.

Behavioral Weight Management Interventions for Hispanic Men in the United States: A Systematic Review

Hispanic men have the highest prevalence of obesity relative to other racial and ethnic subgroups; however, this population is consistently underrepresented in weight management interventions. This systematic review aims to provide an overview of behavioral weight management interventions adapted for Hispanic men and describe their tailoring strategies and efficacy. Six online databases were selected for their abundant collection of high-quality, peer-reviewed literature and searched for studies which evaluated and reported weight outcomes for a cohort of adult (>18 years) Hispanic men. Of 6,508 unique publications screened, 12 interventions met inclusion criteria, the majority of which were published in the past 10 years. Only one study regarding an intervention tailored for Hispanic men was a randomized controlled trial adequately powered to assess a weight-based outcome; the remaining assessed feasibility or utilized quasi-experimental methods. Intervention characteristics and tailoring strategies varied considerably, but content was most frequently based on the Diabetes Prevention Program. Tailoring strategies commonly focused on improving linguistic access and incorporating social or family support. Follow-up varied from 1 month to 30 months and mean change in weight, the most common outcome, ranged from 0.6 to -6.3 kg. Our findings reveal a need for more fully powered randomized controlled trials evaluating the efficacy of interventions systematically tailored specifically for Hispanic men. Although the majority were not fully powered, these interventions showed some efficacy among their small cohorts for short-term weight loss. Future directions include exploring how to tailor goals, concepts, and metaphors included in interventions and comparing individual to group delivery settings.

Physical activity and sedentary behavior perceptions in overweight and obese adults: A systematic review of qualitative study

Background

One of the largest hazards to human health is obesity, which is intimately related to sedentarism and physical inactivity. Understanding the perspectives and attitudes of adults with overweight or obesity towards their lifestyle choices related to sedentary behavior and physical activity is essential for mitigating associated health risks.

Objective

This systematic review aims to collate the extent of qualitative research on the perception of sedentary behavior and physical activity among adults with overweight and obesity.

Methods

A comprehensive search of Scopus, PubMed, CINAHL, and Web of Science, databases was conducted, which yielded 2,881 articles. A total of 2591 abstracts were screened, and 45 full-text articles were examined. A total of nine qualitative studies involving adults with overweight or obesity (BMI > 25 kg/m 2) were included in this systematic review. Data extraction utilized Rayyan.qcri.org software, and studies were critically appraised using Joanna Briggs's Institute checklist for qualitative research.

Results

The included studies revealed a diverse array of themes, wherein a few perceived factors reported towards sedentary behavior were lack of awareness about the hazards, mode of relaxation, family commitment, technology use, motivation deficits, and fatigue. Barriers to physical activity encompassed social, cultural, and environmental factors. In contrast, peer support, fitness facility access, accountability, mental health awareness, well-being, and weight management facilitate physical activity involvement.

Conclusion

Perceptions in overweight and obese adults on sedentary living and exercise are intricate and multifaceted. This review provides valuable insights that can inform clinicians and researchers in promoting regular physical activity for adults with overweight and obesity.

The Hombres Saludables Physical Activity Web-Based and Mobile Phone Intervention: Pilot Randomized Controlled Trial With Latino Men

BACKGROUND

Owing to structural-level, interpersonal-level, and individual-level barriers, Latino men have disproportionately high rates of physical inactivity and experience related chronic diseases. Despite these disparities, few physical activity (PA) interventions are culturally targeted for Latino men.

OBJECTIVE

This study reported the feasibility and acceptability of Hombres Saludables PA intervention for Latino men. We also reported the preliminary efficacy of the intervention on PA change and provided the results of the exploratory moderator and mediator analysis.

METHODS

We completed a 6-month, single-blind, pilot randomized controlled trial of Hombres Saludables with Latino men aged between 18 and 65 years. Men were randomized to either (1) a theory-driven, individually tailored, internet-based and SMS text message-based, Spanish-language PA intervention arm or (2) a nutrition and wellness attention contact control arm that was also delivered via the web and SMS text message. We assessed the primary study outcomes of feasibility using participant retention and acceptability using postintervention survey and open-ended interview questions. We measured the preliminary efficacy via change in minutes of moderate to vigorous PA per week using ActiGraph wGT3X-BT accelerometry (primary measure) and self-reported minutes per week using 7-day Physical Activity Recall. Participants completed the assessments at study enrollment and after 6 months.

RESULTS

The 38 participants were predominantly Dominican (n=8, 21%) or Guatemalan (n=5, 13%), and the mean age was 38.6 (SD 12.43) years. Retention rates were 91% (21/23) for the PA intervention arm and 100% (15/15) for the control arm. Overall, 95% (19/20) of the intervention arm participants reported that the Hombres study was somewhat to very helpful in getting them to be more physically active. Accelerometry results indicated that participants in the intervention group increased their PA from a median of 13 minutes per week at study enrollment to 34 minutes per week at 6 months, whereas the control group participants showed no increases. On the basis of self-reports, the intervention group was more likely to meet the US PA guidelines of 150 minutes per week of moderate to vigorous PA at 6-month follow-up, with 42% (8/19) of the intervention participants meeting the PA guidelines versus 27% (4/15) of the control participants (odds ratio 3.22, 95% CI 0.95-13.69). Exploratory analyses suggested conditional effects on PA outcomes based on baseline stage of motivational readiness, employment, and neighborhood safety.

CONCLUSIONS

The PA intervention demonstrated feasibility and acceptability. Results of this pilot study indicate that the Hombres Saludables intervention is promising for increasing PA in Latino men and suggest that a fully powered trial is warranted. Our technology-based PA intervention provides a potentially scalable approach that can improve health in a population that is disproportionately affected by low PA and related chronic disease.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03196570; https://classic.clinicaltrials.gov/ct2/show/NCT03196570.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/23690.

Recruitment and Retention Strategies for Underrepresented Populations and Adults With Arthritis in Behavioral Interventions: A Scoping Review

OBJECTIVE

To identify strategies used to recruit and retain underrepresented populations and populations with arthritis or fibromyalgia (FM) into behavioral programs targeting exercise, physical activity, or chronic disease self management.

METHODS

Five bibliographic databases were searched for articles published between January 2000 and May 2022. The search focused on strategies and best practices for recruiting and retaining underrepresented populations or populations with arthritis or FM into disease self-management or physical activity/exercise programs. Abstracts and full-text articles were screened for inclusion by 2 independent reviewers, and 2 reviewers extracted data from included articles.

RESULTS

Of the 2,800 articles, a total of 43 publications (31 interventions, 8 reviews, 4 qualitative/descriptive studies) met criteria and were included. The majority of studies focused on physical activity/exercise (n = 36) and targeted African American (n = 17), Hispanic (n = 9), or arthritis populations (n = 7). Recruitment strategies that were frequently used included having race- or community-matched team members, flyers and information sessions in areas frequented by the population, targeted emails/mailings, and word of mouth referrals. Retention strategies used included having race- or community-matched team members, incentives, being flexible, and facilitating attendance. Most studies used multiple recruitment and retention strategies.

CONCLUSION

This scoping review highlights the importance of a multifaceted recruitment and retention plan for underrepresented populations and populations with arthritis or FM in behavioral intervention programs targeting exercise, physical activity, or chronic disease self management. Additional research is needed to better understand the individual effects of different strategies and the costs associated with the various recruitment/retention methods in underrepresented populations and populations with arthritis.

Breaking Down Machismo: Shifting Definitions and Embodiments of Latino Manhood in Middle-Aged Latino Men

There is a notable gap in empirical research regarding how Latino men define and demonstrate machismo, masculinity, and manhood as well as the behavioral consequences associated with these concepts. In our study, we employed a phenomenological thematic approach to analyze 20 semi-structured individual interviews conducted with Latino men residing in South Florida. Our primary objectives were twofold: to examine (1) how do Latino men ages 35 to 60 years describe what it means to be a man and (2) what are the attributes that these men seek to show others that demonstrate their character, cultural values, and gender identity. Findings suggest that Latino men understood expectations associated with machismo and explained that fulfillment of their role as provider, protector, and head of the family was important to their perception of self. While some participants reported a desire to embody characteristics associated with traditional machismo, others strived to demonstrate character, familism, and respect and to provide financial and other instrumental support to their families. Participants reported that their transition into middle age was accompanied by a shift in their perspectives on gender roles, moving away from rigid patriarchal views. Exposure to a more fluid and flexible approach to manhood offered relief from the pressures associated with inflexible manifestations of machismo, which can have negative social, behavioral, and physical health implications. The implications of our research extend to the conceptualization of gender ideals, highlighting the need to incorporate intersectionality, role strain, precarious manhood, and culturally specific notions of manhood as foundational elements in this discourse.

Salud Latina: feasibility of a synchronous online chat for latinos at risk for type 2 diabetes

This study examined the feasibility of Salud Latina, a weekly synchronous online chat intervention, aimed at engaging Latinos in diabetes prevention conversations. Participants were Latino English- and Spanish-speaking individuals. Salud Latina comprised of six synchronous weekly online chats moderated by bilingual Latina moderators trained in diabetes and online engagement. Online chats used open-ended questions. We assessed feasibility, acceptability, and satisfaction of the intervention and qualitatively analyzed the chats to identify barriers and facilitators to healthy behaviors and identify types of support exchanged. Participants (N = 20) were mostly female and English/Spanish bilingual and 80% completed at least four chats. Salud Latina was acceptable, feasible and highly satisfactory. Four themes were identified: (1) barriers to engaging in healthy behaviors, (2) facilitators of healthy behaviors, (3) Salud Latina provides a community of support, and (4) the need to build a Latino culture of health. Participants recognized the importance of engaging in healthy behaviors to prevent or delay T2D. Findings provide insight in how a synchronous online chat intervention could be used to build a social media community within a Latino population to support healthy behaviors. Future research could explore combining synchronous online chats with in-person community or family-level interventions.

Racial and Ethnic Disparities in Weight Loss Behaviors Among US College Students

Purpose

Weight loss behaviors are prevalent among college students and are associated with adverse physical and psychological outcomes, such as an elevated risk of developing an eating disorder. While cross-ethnic differences have been reported, no consistent pattern has emerged. The purpose of this study was to examine racial and ethnic differences in weight loss behaviors among female and male college students.

Patients and Methods

The American College Health Association-National College Health Assessment (ACHA-NCHA) II-C survey data from the collection periods from 2015 to 2019 was used. A total of 426,425 students participated in the survey. Most participants were White (60%) and female (68.5%). Information on students' age, body mass index (BMI), and self-rated health was also collected. Logistic regression analyses were performed to determine cross-ethnic differences in weight loss methods among female and male students.

Results

Students' weight loss behaviors were assessed and included dieting, exercising, vomiting or taking laxatives, and the use of diet pills in the past 30 days. More than half of the participants attempted to lose weight through exercise (53.5%), and 40.3% of students dieted to lose weight in the past month. Purging and the use of diet pills were endorsed by 2.9% and 2.8% of the participants, respectively. With few exceptions, male students from racial and ethnic minority backgrounds were more likely to engage in extreme weight control practices (ie, vomiting or taking laxatives, taking diet pills) than White male students, while female students from racial and ethnic minority backgrounds were less likely to use diet and exercise as weight loss methods than White female students. For all outcomes, Biracial/Multiracial and Hispanic/Latino male students were more likely to attempt weight loss than White male students. Biracial/Multiracial female students more frequently endorsed extreme weight control behaviors than White female students.

Conclusion

The results of the present study add to the growing body of literature on the relationship between race and ethnicity and weight loss behaviors. The findings indicate the need for tailored educational and intervention programs on college campuses.

A Pilot Group-Based Lifestyle Intervention to Promote Weight Loss Among Mexican Immigrants

Mexican Americans are at increased risk for obesity upon immigration to the U.S., increasing their risk for diabetes, cardiovascular disease, and cancer. Our pilot individual lifestyle intervention culturally tailored for Mexican Americans, COMIDA (Consumo de Opciones Más Ideales De Alimentos) (Eating More Ideal Food Options), showed promising results. This paper presents outcomes from the group-based version of COMIDA. 129 overweight/obese Mexican Americans were enrolled in 'Group COMIDA'. Participants' weight (primary outcome), dietary intake and nutrition knowledge (secondary outcomes) were assessed pre- and post-intervention. Seventeen percent of participants experienced 5% weight loss at follow-up. Post-intervention, participants consumed more fruit and vegetables and fewer sweets and fried foods. A group-based, culturally adapted lifestyle intervention may be a more cost-effective approach than individual interventions to improve dietary behavior among underserved populations, though additional modifications may be considered to increase the intervention's effectiveness in promoting significant weight loss.

Technology-Based Obesity Prevention Interventions Among Hispanic Adolescents in the United States: Scoping Review

BACKGROUND

Given that today's adolescents are digital front-runners, technology-based obesity prevention strategies are age-appropriate for this population. The use of remote and wireless technologies may be suitable for extending the reach and engagement of obesity prevention efforts among high-risk Hispanic youths, as this subgroup is disproportionately affected by barriers that limit participation in traditional, in-person interventions.

OBJECTIVE

The purpose of this scoping review was to examine the intervention and sample characteristics of technology-based obesity prevention interventions among Hispanic adolescents. We also examined feasibility criteria to assess the acceptability and appropriateness of technology-based strategies among Hispanic youths.

METHODS

A comprehensive search of Embase and PubMed identified 7 studies that met the inclusion criteria. Data were extracted by 2 independent reviewers.

RESULTS

Of the 7 included studies, half (n=4, 57%) used a randomized control trial design, with equal implementation in school (n=3, 43%) and clinic (n=4, 57%) settings. Studies commonly targeted improvements in diet (n=4, 57%) and physical activity (n=7, 100%), with only 1 (14%) study focused on sedentary behaviors. Just 2 (29%) studies reported the use of behavioral theories or models. Studies focused primarily on youths in early (n=5, 71%) or middle (n=6, 86%) adolescence, and there was limited information reported on socioeconomic status. Only 3 (43%) study conducted formative work, and few (n=3, 43%) reported on acceptability. Only 1 (14%) study reported that materials were available in Spanish and English, and only 1 (14%) study used culturally tailored content. Additionally, 3 (43%) studies used strategies that considered social determinants of health.

CONCLUSIONS

To increase our understanding of the feasibility and effectiveness of technology-based obesity prevention strategies among Hispanic adolescents, there is a need for more feasibility studies that are theoretically grounded and comprehensively report on feasibility-related outcomes. Future studies should also leverage technology to simultaneously address multiple health behaviors beyond diet and physical activity. The result of this review can be used to guide the development of future technology-based obesity prevention strategies among Hispanic adolescents.

TRIAL REGISTRATION

CliniclaTrials.gov NCT04953442; https://clinicaltrials.gov/ct2/show/NCT04953442.

Mexican and Puerto Rican Men's Preferences Regarding a Healthy Eating, Physical Activity and Body Image Intervention

This study examined the logistical, practical, and cultural preferences of Latinos regarding the design of a healthy eating, physical activity, and body image intervention. Puerto Rican and Mexican men (n = 203) completed an interview as part of an NIH-funded study. Overall, 66.5% preferred the intervention to be in Spanish only or both Spanish and English; 88.67% said it was moderately, very or extremely important for the intervention leader to be bilingual; and 66.01% considered it moderately to extremely important for the leader to be Hispanic or Latino. Most participants (83.74%) reported they would be willing to attend an intervention that met twice per week and 74.38% said they would be willing to attend an intervention that met for 1.5 to 2 h, twice weekly. Overall, the majority said they would be moderately to extremely interested in attending an exercise program if it consisted of aerobics with Latin or salsa movements (74.88%) and if it consisted of aerobics with Latin or salsa music (70.44%). Some participants were moderately to extremely interested in attending an intervention if it included dichos (Latino sayings) (65.02%) and cuentos (folktales or stories) (69.46%). The findings have implications for lifestyle and body image interventions aimed at preventing cardiometabolic diseases.

Weight Loss Program Preferences of Men Working in Blue-Collar Occupations: A Qualitative Inquiry

Men who work in blue-collar occupations (skilled and unskilled trades) experience high rates of obesity and comorbid conditions. This group is underrepresented in behavioral interventions for weight management, which may stem from a mismatch between the features of available programs and these men's preferences. This qualitative study explored the views of these men, their experiences with weight loss, their preferences for weight loss programs, and messaging related to these programs. We conducted remote interviews with 20 men (age: 43 ± 13 years, M ± SD) currently working in blue-collar occupations (50% construction, 25% transportation, and 25% manufacturing) who had body mass indices (BMIs) in the overweight/obese categories (BMI: 33 ± 6 kg/m²). Deductive codes and summary themes were developed and discussed by the first two authors. A selection of transcripts was reviewed following theme development to confirm accuracy of the themes. Most participants (n = 16, 80%) reported a prior weight loss attempt. The most common approaches to weight loss reported were increased exercise and following their own approach to changing diet (e.g., "eating less junk food"). For program and message preferences, two major themes emerged: participants wanted accurate and trustworthy information and wanted programs that fit their lifestyle. Results suggest that weight loss programs targeting men working in blue-collar occupations should emphasize the accuracy of information related to the program and the ease of incorporating it into participants' lifestyles. There is an urgent need to incorporate these preferences into effective programs.

mHealth-Supported Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men With Overweight and Obesity: Single-Arm Pilot Study

BACKGROUND

Hispanic men have disproportionate rates of overweight and obesity compared with other racial and ethnic subpopulations. However, few weight loss interventions have been developed specifically for this high-risk group. Furthermore, the use of mobile health (mHealth) technologies to support lifestyle behavior changes in weight loss interventions for Hispanic men is largely untested.

OBJECTIVE

This single-arm pilot study examined the feasibility and acceptability of integrating mHealth technology into a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) for Hispanic men with overweight and obesity.

METHODS

A total of 18 Hispanic men (mean age 38, SD 10.9 years; mean BMI 34.3, SD 5.5 kg/m²; 10/18, 56% Spanish monolingual) received a GCSWLI, including weekly in-person individual sessions, a daily calorie goal, and prescription of ≥225 minutes of moderate-intensity physical activity per week. mHealth technology support included tailored SMS text messaging, behavior self-monitoring support using Fitbit Charge 2, and weight tracking using a Fitbit Aria Wi-Fi Smart Scale. Changes in weight from baseline to 12 weeks were estimated using a paired 2-tailed t test. Descriptive analyses characterized the use of Fitbit and smart scales. Semistructured interviews were conducted immediately after intervention to assess the participants' weight loss experiences and perspectives on mHealth technologies.

RESULTS

Of 18 participants, 16 (89%) completed the 12-week assessments; the overall attrition rate was 11.1%. The mean weight loss at week 12 was -4.7 kg (95% CI 7.1 to -2.4 kg; P<.001). Participants wore the Fitbit 71.58% (962/1344) of the intervention days and logged their body weight using the smart scale (410/1344, 30.51% of the intervention days). Participants identified barriers to the use of the technology, such as lack of technological literacy and unreliable internet access for the smart scale.

CONCLUSIONS

Although clinically significant weight loss was achieved by integrating mHealth technology into the GCSWLI, adherence to the prescribed use of technology was modest. Addressing barriers to the use of such technologies identified in our work may help to refine an mHealth intervention approach for Hispanic men.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02783521; https://clinicaltrials.gov/ct2/show/NCT02783521.

The El Valor de Nuestra Salud clustered randomized controlled trial store-based intervention to promote fruit and vegetable purchasing and consumption

Background

Modifying the environment to promote healthy foods is a population-based approach for improving diet. This study evaluated the outcome effectiveness of a food store intervention that used structural and social change strategies to promote fruits and vegetables. It was hypothesized that intervention versus control store customers would improve their consumption of fruits and vegetables at 6 months.

Trial design

Clustered randomized controlled trial

Methods

Sixteen pair-matched stores were randomized to an intervention or wait-list control condition. With the research team’s support, intervention stores modified the availability, accessibility, and promotion of fruits and vegetables, including augmenting produce displays within the store and building employees’ capacity to place and promote fruits and vegetables throughout the store (Phase 1), followed by the delivery of a customer-directed marketing campaign for 6 months (Phase 2). From months 7 to 12, stores were encouraged to maintain strategies on their own (Phase 3). Customer-reported daily fruit and vegetable consumption (cups/day) were collected by blinded research assistants at three time-points (baseline, 6 months and 12 months post-baseline) from 369 participating customers (an average of 23/store). Secondary outcomes included customer-reported fruit and vegetable purchasing and other behaviors.

Results

The study retained the 16 stores and most customers at 6 (91%) and 12 (89%) months. Although significant differences were not observed in the overall sample for vegetable consumption, male customers of intervention versus control stores consumed significantly more fruit daily at 6 months [mean (standard deviation) cups at baseline and six months; intervention: 1.6 (1.5) to 1.6 (1.5) vs. control: 1.4 (1.2) to 1.1 (0.8)]. However, this difference was not observed at 12 months, or among females. There was an overall increase in dollars spent at the targeted store in the intervention versus control condition among male versus female customers at 6 months; however, no change was observed in the percent of dollars spent on fruits and vegetables at the targeted store. Frequency of shopping at the targeted store did not modify intervention effects.

Conclusions

Structural and social change interventions can modify customers’ behavior in the short-term. Future research should consider methods for achieving longer-term changes, and potential generalizability to other products (e.g., energy-dense sweet and savory products).

Trial registration

NCT01475526

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01220-w.

An Article in Two Parts: My Dinners With Richard and Addressing Diabetes Disparities in Hispanic Populations

Editor's note: This article was adapted from the address Dr. Marrero delivered as the recipient of the American Diabetes Association's Richard R. Rubin Award for 2021. This award recognizes a behavioral researcher who has made outstanding, innovative contributions to the study and understanding of the behavioral aspects of diabetes in diverse populations. Dr. Marrero delivered the address in June 2021 at the Association's virtual 81st Scientific Sessions. A webcast of this speech is available for viewing at https://bit.ly/3HIkOpz.

A Qualitative Analysis of Mexican-Origin Men's Knowledge and Cultural Attitudes Toward Non-Alcoholic Fatty Liver Disease and Interest in Risk Reduction

Mexican-origin men are at increased risk of developing non-alcoholic fatty liver disease (NAFLD). The purpose of this qualitative research was to assess Mexican-origin men’s knowledge and cultural attitudes toward NAFLD and their interest in risk reduction. Semi-structured interviews were conducted with 11 Spanish-speaking Mexican-origin men who were considered high-risk of having NAFLD according to transient elastography (FibroScan®) continuous attenuation parameter (CAP) scores (≥280). Audio recordings of these interviews were transcribed and interpreted in their respective language to facilitate data analysis using NVivo 12. A thematic codebook was developed, from which the research team identified emerging themes. Findings demonstrated limited knowledge about NAFLD and in general chronic liver disease among Mexican-origin men. Cultural attitudes appeared to both enhance and mitigate their perceived risk for NAFLD. Interviews also revealed high interest levels for reducing NAFLD risk, with family and loved ones acting as the main motivators for engagement in healthier behaviors. Inclination toward family-based interventions was reported as a subject of interest for this high-risk population. This qualitative study suggests that the development of a NAFLD-specific intervention approach for Mexican-origin men may be feasible and should consider a familial and cultural context centered in improving lifestyle health behaviors.

Opportunities to Address Obesity Disparities Among High-Risk Latino Children and Adolescents

PURPOSE OF REVIEW

This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity.

RECENT FINDINGS

Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact health behaviors and outcomes. Our last example study demonstrates the utility of technology for engaging youth and extending the reach of prevention strategies in vulnerable communities. To address growing obesity-related disparities, there is an urgent need to develop and test these strategies among high-risk, vulnerable populations like Latino children and adolescents.

Perceptions of Family-Level Social Factors That Influence Health Behaviors in Latinx Adolescents and Young Adults at High Risk for Type 2 Diabetes

Given that health behaviors occur within the context of familial social relationships, a deeper understanding of social factors that influence health behaviors in Latinx families is needed to develop more effective diabetes prevention programming. This qualitative study identified perceived family-level social factors that influence health behaviors in Latinx adolescents (12-16 years; N = 16) and young adults (18-24 years; N = 15) with obesity and explored differences in perceptions across sex and age. Participants completed an in-depth interview that was recorded, transcribed, and coded using thematic content analysis. Emergent themes central to health behaviors included: perceived parental roles and responsibilities, perceived family social support for health behaviors, and familial social relationships. Mom's role as primary caregiver and dad's role as a hard worker were seen as barriers to engaging in health behaviors among adolescent females and young adults, males and females. Adolescents perceived receiving more support compared to young adults and males perceived receiving more support compared to females. Health behaviors in both age groups were shaped through early familial social interactions around physical activity. These insights suggest that traditional gender roles, social support, and social interaction around health behaviors are critical components for family-based diabetes prevention programs in high-risk Latinx youth and young adults.

Hispanic Male Recruitment into Obesity-Related Research: Evaluating Content Messaging Strategies, Experimental Findings, and Practical Implications

Hispanic men have the highest prevalence of overweight and obesity among men in the U.S. Current research is lacking to inform best practices to engage Hispanic men in obesity-related research. The purpose of this work was to evaluate messaging strategies to engage Hispanic men in obesity-related research. Outreach took place in an outdoor marketplace in Southern Arizona, US. Messaging strategies (fear appeal/arousal, positive masculinity, and spousal convergence) identified in formative research were utilized. Two six-foot standing banners displayed content messages and infographics in both English and Spanish. Trained bilingual and bicultural staff collected health information survey cards that elicited self-reported demographic information and health concerns. Four aspects of recruitment were evaluated: volume, efficiency, community representation, and primary health concerns. A comparative analysis was conducted in the fall of 2016 to determine the effectiveness of each messaging strategy. 387 survey cards were collected, 221 were from Hispanic men. Obesity, diabetes, and cancer were identified as the most pertinent health concerns. Fear appeal yielded 209 completed surveys, followed by 110 for positive masculinity, and 68 for spousal convergence. Fear appeal/arousal and positive masculinity content messaging were effective approaches to engage Hispanic males in research, preventive and treatment efforts. Findings warrant replication as there is potential for confounding seasonal effects.

Health and Type 2 Diabetes Perspectives of At-Risk, Mexican-Origin Males (HD-MxOM): a Qualitative Study

OBJECTIVE

To investigate perspectives of diabetes, nutrition, and health among underrepresented Mexican-origin males and elucidate on contributing factors of type 2 diabetes disparities.

RESEARCH DESIGN

Audio-recorded, semi-structured interviews were conducted with 15 native Spanish-speaking, Mexican-origin males. Men were between the ages of 40 and 64 and at risk for type 2 diabetes-defined as > 40 years of age, BMI > 25, and sedentary over the last 3 months. Data collected included clinical measures (height, weight, waist circumference, blood pressure) and demographic characteristics (years living in the U.S., marital status, employment, occupational physical activity, income, educational attainment, and average physical activity levels). The audio recordings, each lasting approximately 60 min, were transcribed verbatim and underwent three-cycle coding with analysis for codebook formation, categorization, and thematic extraction.

RESULTS

Barriers to engaging in health behaviors among Mexican-origin males include poor understanding of diabetes and nutrition, unreliable sources of health information, and socioeconomic status. Enablers of health neglect include intense perceptions of diabetes severity and a reactive health culture rooted in medical machismo and valemadrismo. Perspectives of personal responsibility and the desire to learn through culturally specific recommendations detail potential facilitators of health behaviors.

CONCLUSION

The data convey a network of sociocultural factors that inhibit health prioritization and promote disease misconceptions among Mexican-origin males. Pragmatic, culturally tailored education represents serviceable strategies for health promotion and diabetes prevention. These findings explicate cultural considerations for educators and clinicians seeking optimization of programs and clinical interactions with Mexican-origin men.

Mexican Origin Hispanic Men's Perspectives of Physical Activity-Related Health Behaviors

Approximately 83% of Hispanic men of Mexican origin are overweight or obese, which are both associated with increased risk of chronic disease and all-cause mortality. Consequently, men of Mexican origin have some of the highest prevalence rates of obesity-related comorbidities. Physical activity (PA) may be an important strategy for Hispanic men of Mexican origin in reducing incidence and risk factors of lifestyle diseases. The current study engaged Spanish-speaking, Hispanic men of Mexican origin aged 24–64 years with overweight/obesity to examine perspectives of health behaviors related to PA. A total of 14 in-depth semistructured individual interviews were completed between September and November of 2015 and data analyzed using an iterative deductive–inductive thematic assessment strategy. The men suggested that their PA was hindered by (a) work-related energy and time constraints, (b) socioeconomic status (SES) and the need to prioritize work, (c) adaptations to majority population lifestyle norms, and (d) perceived lack of suitable access to PA-promoting spaces. The men provided valuable insight for strategies to improve PA interventions such as (a) accurately accounting for current PA levels of participants, including occupational and transportation PA, (b) considerations of family dynamics that influence PA-based behavior change, and (c) considerations of economic and geographical constraints that can be remediated. To improve effectiveness, future PA-related intervention research with Hispanic men of Mexican origin should consider methods that (a) account for transportation and occupational PA to better tailor PA to individual needs, (b) consider sociocultural and socioeconomic influences, (c) account for social support and accountability, and (d) consider economic and geographical constraints.

Developing a "Tailor-Made" Precision Lifestyle Medicine Intervention for Weight Control among Middle-aged Latino Men

Objective

To identify what is important to middle-aged Latino men and their personal goals and values as foundations for a future precision lifestyle medicine intervention that is rooted in Self-Determination Theory.

Design

We used a phenomenological, thematic approach to analyze data from 20 semi-structured, individual interviews with Latino men aged 35-60 years.

Setting

Community-based settings between November 2017 and May 2018 in South Florida.

Participants

Latino or Hispanic men who were aged 35-60 years. The mean age of the men was 49.8 years.

Results

Two key themes emerged: a) the characteristics that these men say define what it means to be a man; and b) the characteristics that these men say define what is important to them. "What defines a man" includes three primary subthemes: a) the attributes, characteristics and behaviors that participants understood to be ideals that a man should embody and the roles he should fulfill; b) lessons learned growing up about what it means to be a man; and c) how Latino men relate to the ideal of machismo. "What defines me" includes the subthemes: a) comparing themselves with the ideal of machismo; b) caring for family and others; and c) supporting and modeling positive behavior for their children.

Conclusions

We found key candidate mechanisms that may be novel yet critical foundations on which to build a precision lifestyle medicine intervention for Latino men. We identified actionable psychosocial factors that map onto motivational constructs that can shape behaviors that are essential for weight control and be a useful foundation for improving the health of middle-aged Latino men.

A Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men: Results From the Animo Pilot Randomized Controlled Trial

Background. Hispanic males have the highest rates of overweight and obesity compared with men of all other racial/ethnic groups. While weight loss can significantly reduce obesity-related health risks, there is limited research examining effective gender- and culturally tailored behavioral weight loss programs for Hispanic men. Objective. To assess the feasibility and preliminary efficacy of a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) as compared with a waist-list control (WLC) in sedentary, Hispanic males with overweight/obesity. Method. Fifty Hispanic males (age: 43 years [SD = 11]; BMI: 34 ± 5 kg/m²; 58% Spanish monolingual) were randomized to one of two groups: GCSWLI (n = 25) or WLC (n = 25). GCSWLI participants attended weekly in-person individual sessions with a bilingual, bicultural Hispanic male lifestyle coach, and were prescribed a daily reduced calorie goal and 225 minutes of moderate-intensity physical activity per week. The WLC were asked to maintain their usual diet and physical activity habits for 12 weeks. GCSWLI participants continued with 12 additional weeks of follow-up including biweekly phone calls with lifestyle coaches. Results. At Week 12, the mean weight loss in the GCSWLI was -6.3 kg (95% confidence interval [CI; -8.1, -4.4]) compared with -0.8 kg (95% CI [-2.5, 0.9]) for the WLC (difference = -5.5 kg, 95% CI [-8.0, -2.9], p < .01). At Week 24, weight loss in the GCSWLI was maintained. Conclusions. The GCSWLI appears to be a feasible strategy to engage Hispanic males in short-term weight loss. Our pilot study indicates preliminary evidence of efficacy, though confirmation of these findings is needed in a larger study.

Physical Activity Interventions With African American or Latino Men: A Systematic Review

Relatively little is known about what helps increase physical activity in African American men, and even less is known about promoting physical activity among Latino men. This systematic review aimed to address the key questions: (a) what is the state of the evidence on health-related behavior change interventions targeting physical activity among African American or Latino men? and (b) What factors facilitate physical activity for these men? For this review, nine electronic databases were searched to identify peer-reviewed articles published between 2011–2017 that reported interventions to promote physical activity among African American or Latino men. Following PRISMA guidelines, nine articles representing seven studies that met our criteria were identified: six published studies that provided data for African American men, and one published study provided data for Latino men. Consistent with previous reviews, more research is needed to better understand how gender can be incorporated in physical activity interventions for African American and Latino men. Future interventions should explore how being an adult male and a man of color shapes motivations, attitudes, and preferences to be physically active. Studies should consider how race and ethnicity intersect with notions of masculinity, manhood and Machismo to enhance the effectiveness of physical activity interventions for these populations. Despite the health benefits of physical activity, rates of these behaviors remain low among African American and Latino men. It is essential to determine how best to increase the motivation and salience for these men to overcome the obesogenic environments and contexts in which they often live.

A gender- and culturally-sensitive weight loss intervention for Hispanic males: The ANIMO randomized controlled trial pilot study protocol and recruitment methods

Hispanic men have the highest rates of overweight and obesity when compared to men of other racial/ethnic groups, placing them at increased risk for obesity-related disease. Yet, Hispanic men are grossly underrepresented in weight loss research. Tailored intervention strategies to improve obesity treatment programs for this vulnerable racial/ethnic subgroup are needed. This manuscript describes recruitment strategies, methodology, and participant characteristics of the ANIMO study, a 24-week randomized controlled pilot trial testing the effects of a gender- and culturally-sensitive weight loss intervention (GCSWLI) on body weight in Hispanic men compared to a wait-list control condition. The ANIMO study included two phases. The first phase was a 12-week GCSWLI. Participants attended weekly in-person individual sessions guided by a trained bilingual Hispanic male lifestyle coach, were prescribed a daily reduced calorie goal, and 225 min of moderate-intensity physical activity per week. In the second phase, GCSWLI participants received bi-weekly phone calls across a 12-week follow-up. Wait-list control (WLC) participants from phase 1 received the GCSWLI plus mobile health technology support. Recruitment strategies included face-to-face efforts at a swap meet (outdoor marketplace), family/friend referrals, printed advertisements and social media. Recruitment, screening, and participant enrollment occurred over three months. Overall, 143 men expressed interest in participation. Of these, 115 were screened and 78% (n = 90) were eligible to participate; 45% of enrolled participants (n = 52) completed baseline assessments and 43% (n = 50) were randomized (mean age of 43.3 ± 11.4 years; BMI: 34.1 ± 5.3 kg/m²; 58% Spanish monolingual). Parameter estimates from ANIMO will support future adequately powered trials for this health disparate population.

Trial registration

ClinicalTrials.gov: NCT02783521.