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Turner-McGrievy GM, Wilcox S, Frongillo EA, Kim Y, Okpara N, Wilson M. Differences in dietary acceptability, restraint, disinhibition, and hunger among African American participants randomized to either a vegan or omnivorous soul food diet. Appetite 2024; 196:107280. [PMID: 38373534 PMCID: PMC10966697 DOI: 10.1016/j.appet.2024.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
The Nutritious Eating with Soul study was a 24-month, randomized behavioral nutrition intervention among African American adults. This present study, which is a secondary analysis of the NEW Soul study, examined changes in dietary acceptability, restraint, disinhibition, and hunger. Participants (n = 159; 79% female, 74% with ≥ college degree, mean age 48.4 y) were randomized to either a soul food vegan (n = 77) or soul food omnivorous (n = 82) diet and participated in a two-year behavioral nutrition intervention. Questionnaires assessing dietary acceptability (Food Acceptability Questionnaire; FAQ) and dietary restraint, disinhibition, and hunger (Three-Factor Eating Questionnaire; TFEQ) were completed at baseline, 3, 6, 12, and 24 months. Mixed models were specified with main effects (group and time) and interaction effects (group by time) to estimate mean differences in FAQ and TFEQ scores using intent-to-treat analysis. After adjusting for employment, education, food security status, sex, and age, there were no differences in any of the FAQ items, total FAQ score, dietary restraint, disinhibition, and hunger at any timepoint except for one item of the FAQ at 12 months. Participants in the vegan group reported a greater increase in satisfaction after eating a meal than the omnivorous group (mean difference 0.80 ± 0.32, 95% CI 0.18, 1.42; P = 0.01). This is one of the first studies to examine differences in dietary acceptability, hunger, and other eating factors among African American adults randomized to either a vegan or omnivorous soul food diet. The findings highlight that plant-based eating styles are equally acceptable to omnivorous eating patterns and have similar changes in hunger, restraint, and disinhibition. These results suggest that plant-based eating styles can be an acceptable dietary pattern to recommend for cardiovascular disease prevention and may result in greater post-meal satisfaction.
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Affiliation(s)
- Gabrielle M Turner-McGrievy
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene St., Columbia, SC 29208, USA; Prevention Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA.
| | - Sara Wilcox
- Prevention Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene St., Columbia, SC 29208, USA
| | - Yesil Kim
- Prevention Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Nkechi Okpara
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene St., Columbia, SC 29208, USA; Department of Psychiatry and Human Behavior, The Miriam Hospital and Warren Alpert Medical School of Brown University, Box G-M1, Providence, RI, 02912, USA
| | - Mary Wilson
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene St., Columbia, SC 29208, USA; Prevention Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
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Xia S, Takakura J, Tsuchiya K, Park C, Heneghan RF, Takahashi K. Unlocking the potential of forage fish to reduce the global burden of disease. BMJ Glob Health 2024; 9:e013511. [PMID: 38594079 PMCID: PMC11146385 DOI: 10.1136/bmjgh-2023-013511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/14/2024] [Indexed: 04/11/2024] Open
Abstract
Red meat consumption is associated with an elevated risk of mortality from non-communicable diseases (NCDs). In contrast, forage fish, as highly nutritious, environmentally friendly, affordable, and the most abundant fish species in the ocean, are receiving increasing interest from a global food system perspective. However, little research has examined the impact of replacing red meat with forage fish in the global diet on diet-related NCDs. METHODS We based our study on datasets of red meat projections in 2050 for 137 countries and forage fish catches. We replaced the red meat consumption in each country with forage fish (from marine habitats), without exceeding the potential supply of forage fish. We used a comparative risk assessment framework to investigate how such substitutions could reduce the global burden of diet-related NCDs in adults. RESULTS The results of our study show that forage fish may replace only a fraction (approximately 8%) of the world's red meat due to its limited supply, but it may increase global daily per capita fish consumption close to the recommended level. Such a substitution could avoid 0.5-0.75 million deaths and 8-15 million disability-adjusted life years, concentrated in low- and middle-income countries. Forage fish as an alternative to red meat could double (or more) the number of deaths that could be avoided by simply reducing red meat consumption. CONCLUSIONS Our analysis suggests that forage fish is a promising alternative to red meat. Policies targeting the allocation of forage fish to regions where they are needed, such as the Global South, could be more effective in maximising the potential of forage fish to reduce the global burden of disease.
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Affiliation(s)
- Shujuan Xia
- National Institute for Environmental Studies, Tsukuba, Japan
| | - Jun'ya Takakura
- National Institute for Environmental Studies, Tsukuba, Japan
| | | | - Chaeyeon Park
- National Institute for Environmental Studies, Tsukuba, Japan
- National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Ryan F Heneghan
- Queensland University of Technology, Brisbane, Queensland, Australia
- Technology and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Mattei J, Caballero-González A, Maafs-Rodríguez A, Zhang A, O’Neill HJ, Gago C. Lessons learned by adapting and implementing LUCHA: a deep-structure culturally tailored healthy eating randomized pilot intervention for ethnic-diverse Latinos. Front Public Health 2024; 11:1269390. [PMID: 38445250 PMCID: PMC10912621 DOI: 10.3389/fpubh.2023.1269390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/20/2023] [Indexed: 03/07/2024] Open
Abstract
Objectives To report the adaptation and implementation of LUCHA (Latinos United for a Culturally Healthy Alimentation), a pilot intervention to improve dietary quality and behaviors (primary outcomes) of Latinos in Massachusetts, US, and the lessons learned during the process, including disruptions during the COVID-19 pandemic, to help shape future programs. Methods The cultural adaptation process was pre-planned using a framework, grounded in the Theory of Reasoned Action/Planned Behavior, and informed by formative mixed-methods research. A projected 75 self-identifying Latino adults (25-65y) were recruited with community-wide strategies and randomized to receive, in parallel, daily healthy eating text messages for 2 months, reinforced for 2 subsequent months, to either control (i.e., surface-level messages based on USDA MyPlate in Spanish), or intervention (i.e., deep-structure messages). The intervention messages were ethnically tailored to Caribbean or non-Caribbean heritages specifically, grounded in entrenched cultural attitudes, norms, and preferences. Trained research assistants administered questionnaires and clinical measurements at baseline, 2-months, and 4-months, in person (pre-pandemic) or via online video calls (at-pandemic). Clinicaltrials.gov registration #NCT04724382. Results LUCHA faced challenges and opportunities that conveyed lessons for future cultural adaptation and implementation of healthy eating programs. Recommendations are provided to improve digital programs for diverse ethnicities, such as widening language capabilities in texting services, using familiar video call applications, and instructing participants to measure their own clinical metrics at home using guided standardized protocols. Conclusion Tailoring nutrition programs with deep-structure cultural messages is essential when promoting healthy eating in diverse Latino heritages. LUCHA can inform programs for similar ethnic groups.
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Affiliation(s)
- Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | | | - Ana Maafs-Rodríguez
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Amelia Zhang
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - H. June O’Neill
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Cristina Gago
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, United States
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Hudson EA, Burgermaster M, Isis SM, Jeans MR, Vandyousefi S, Landry MJ, Seguin-Fowler R, Chandra J, Davis J. School-based intervention impacts availability of vegetables and beverages in participants' homes. Front Nutr 2023; 10:1278125. [PMID: 38162521 PMCID: PMC10754996 DOI: 10.3389/fnut.2023.1278125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
As rates of metabolic syndrome rise, children consume too few vegetables and too much added sugar. Because children tend to eat what is available at home, the home environment plays a key role in shaping dietary habits. This secondary analysis evaluated the effects of a school-based gardening, cooking, and nutrition education intervention (TX Sprouts) compared to control on the availability of vegetables, fruit juice, and sugar-sweetened beverages (SSBs) at home. In the TX Sprouts cluster-randomized trial, 16 schools were randomized to TX Sprouts (n = 8 schools) or control (n = 8 schools) for one academic year. All schools served predominately Hispanic families with low incomes. TX Sprouts built school gardens and taught 18 lessons to all 3rd-5th grade students at intervention schools. TX Sprouts also offered monthly caregiver lessons before and/or after school. Caregivers completed questionnaires pre and post, providing demographics and information about home availability of vegetables, fruit juice, and SSBs. Summary statistics were used to describe the sociodemographic characteristics of participants. Linear regression assessed the change in scores (pre to post) for the food/ beverage availability question. The model was adjusted for the caregiver's education, employment status, child's grade, and free or reduced-price lunch eligibility. The analytic sample included 895 participants. Compared to control, the intervention positively changed the home availability of targeted foods and beverages, largely by improving the availability of vegetables and vegetable juice. This study showed that a school gardening, nutrition, and cooking program delivered to elementary children may positively influence the home food environment.
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Affiliation(s)
- Erin A. Hudson
- The University of Texas at Austin, Austin, TX, United States
| | | | - Sophia M. Isis
- The University of Texas at Austin, Austin, TX, United States
| | | | | | - Matthew J. Landry
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Joya Chandra
- Pediatrics Division, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jaimie Davis
- The University of Texas at Austin, Austin, TX, United States
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Strayhorn SM, Carter A, Harmon BE, Hébert JR. An Examination of Culturally Relevant Health Messages in African-American Churches. JOURNAL OF RELIGION AND HEALTH 2023; 62:2547-2562. [PMID: 35994186 PMCID: PMC9943804 DOI: 10.1007/s10943-022-01638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/13/2022] [Indexed: 05/07/2023]
Abstract
This quantitative study examined the presence of culturally relevant health messages for African-Americans based on a preexisting dataset from 21 African-American churches in South Carolina (USA). Content analysis served as the primary methodological approach to code printed media messages based on their cultural relevance among African-Americans (Cohen's kappa = .74). Within the dataset (n = 2166), 477 (22%) items were identified as culturally relevant. A low prevalence of culturally relevant messages was found across the three message topics, two media types, and one media source. Due to the limited presence of culturally relevant messages, researchers should collaborate with African-American churches to design health promotion messages.
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Affiliation(s)
- Shaila M Strayhorn
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, 601 S. College Road, Wilmington, NC, 28403, USA
| | - Andrew Carter
- Department of Public Health and Recreation, San José State University, One Washington Square, San José, CA, 95192, USA
| | - Brook E Harmon
- Department of Nutrition and Health Care Management, Beaver College of Health Sciences, Appalachian State University, 1179 State Farm Rd, Boone, NC, 28607, USA.
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, University of South Carolina, 242 Discovery 1, Columbia, SC, 29208, USA
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Weerakoon SM, Chen B, Harrell MB, Vidot DC, Messiah SE. Racial and ethnic disparities in chronic disease risk in adolescence after prenatal polydrug exposure: Examination of the Hispanic paradox. J Ethn Subst Abuse 2023:1-18. [PMID: 36840527 DOI: 10.1080/15332640.2023.2181257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Racial disparities exist in fetal development which in turn can influence growth and development of chronic disease later in life. The purpose of this study was to explore potential racial and ethnic differences in chronic disease risk factors throughout the pediatric years given prenatal exposure to substance use. Data from the Maternal Lifestyle Study cohort was used for this analysis. Urine toxicology confirmed maternal substance use (y/n) and offspring height, weight, and systolic blood pressure (SBP) data at 16 years was analyzed. Linear mixed effects modeling with an interaction term for adolescent race/ethnicity and maternal drug use assessed growth trajectories (body mass index (BMI) percentile) and cardiovascular disease risk factors (elevated SBP). Of the sample (n = 1,388 mother/infant dyads), 23% (n = 319) of mothers used three substances during pregnancy and 14% (n = 200) used four or five. Controlling for BMI, Hispanic adolescents prenatally exposed to any singular substance had 13 mmHg higher SBP at age 16 than their unexposed counterparts (95% Confidence Interval [CI]: 12.24, 14.01). Prenatal exposure to >1 substance significantly lowered SBP in Hispanic adolescents only. Results here showed that Hispanic adolescents exposed to singular substance are at higher risk of elevated SBP in adolescence, but SBP decreased when exposed to >1 substance. The Hispanic paradox may play a role; future studies should continue to explore this. Additionally, barriers to prenatal care for Hispanic women should be addressed in order to prevent substance use during pregnancy which can reduce chronic disease risk in offspring adolescence.
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Affiliation(s)
- Sitara M Weerakoon
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas
| | | | | | - Denise C Vidot
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas
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Mattei J, Díaz-Alvarez CB, Alfonso C, O’Neill HJ, Ríos-Bedoya CF, Malik VS, Godoy-Vitorino F, Cheng C, Spiegelman D, Willett WC, Hu FB, Rodríguez-Orengo JF. Design and Implementation of a Culturally-Tailored Randomized Pilot Trial: Puerto Rican Optimized Mediterranean-Like Diet. Curr Dev Nutr 2023; 7:100022. [PMID: 37181130 PMCID: PMC10100940 DOI: 10.1016/j.cdnut.2022.100022] [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: 07/14/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
Background Adhering to a Mediterranean Diet (MedDiet) is associated with a healthier cardiometabolic profile. However, there are limited studies on the MedDiet benefits for non-Mediterranean racial/ethnic minorities, for whom this diet may be unfamiliar and inaccessible and who have a high risk of chronic diseases. Objectives To describe the study design of a pilot trial testing the efficacy of a MedDiet-like tailored to adults in Puerto Rico (PR). Methods The Puerto Rican Optimized Mediterranean-like Diet (PROMED) was a single-site 4-mo parallel two-arm randomized pilot trial among a projected 50 free-living adults (25-65 y) living in PR with at least two cardiometabolic risk factors (clinicaltrials.gov registration #NCT03975556). The intervention group received 1 individual nutritional counseling session on a portion-control culturally-tailored MedDiet. Daily text messages reinforced the counseling content for 2 mo, and we supplied legumes and vegetable oils. Participants in the control group received cooking utensils and one standard portion-control nutritional counseling session that was reinforced with daily texts for 2 mo. Text messages for each group were repeated for two more months. Outcome measures were assessed at baseline, 2 and 4 m. The primary outcome was a composite cardiometabolic improvement score; secondary outcomes included individual cardiometabolic factors; dietary intake, behaviors, and satisfaction; psychosocial factors; and the gut microbiome. Results PROMED was designed to be culturally appropriate, acceptable, accessible, and feasible for adults in PR. Strengths of the study include applying deep-structure cultural components, easing structural barriers, and representing a real-life setting. Limitations include difficulty with blinding and with monitoring adherence, and reduced timing and sample size. The COVID-19 pandemic influenced implementation, warranting replication. Conclusions If PROMED is proven efficacious in improving cardiometabolic health and diet quality, the findings would strengthen the evidence on the healthfulness of a culturally-appropriate MedDiet and support its wider implementation in clinical and population-wide disease-prevention programs.
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Affiliation(s)
- Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- FDI Clinical Research, San Juan, PR, USA
| | | | - Charmaine Alfonso
- College of Nutritionists and Dietitians of Puerto Rico, San Juan, PR, USA
- School of Health Sciences, Ana G. Méndez University, Gurabo Campus, Gurabo, PR, USA
| | - H June O’Neill
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Carlos F. Ríos-Bedoya
- FDI Clinical Research, San Juan, PR, USA
- McLaren Health Care, Graduate Medical Education, Grand Blanc, MI, USA
| | - Vasanti S. Malik
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada
| | - Filipa Godoy-Vitorino
- Department of Microbiology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Chao Cheng
- Department of Biostatistics and Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Donna Spiegelman
- Department of Biostatistics and Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Walter C. Willett
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Frank B. Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - José F. Rodríguez-Orengo
- FDI Clinical Research, San Juan, PR, USA
- Department of Biochemistry, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
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Tyson CC, Svetkey LP, Lin PH, Granados I, Kennedy D, Dunbar KT, Redd C, Bennett G, Boulware LE, Fish LJ. Self-Perceived Barriers and Facilitators to Dietary Approaches to Stop Hypertension Diet Adherence Among Black Americans With Chronic Kidney Disease: A Qualitative Study. J Ren Nutr 2023; 33:59-68. [PMID: 35597318 PMCID: PMC10344422 DOI: 10.1053/j.jrn.2022.05.002] [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: 11/19/2021] [Revised: 03/25/2022] [Accepted: 05/01/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The Dietary Approaches to Stop Hypertension (DASH) eating plan improves hypertension in Black individuals and is associated with favorable chronic kidney disease (CKD) outcomes. Yet, adherence to DASH is low among US adults in general, particularly among Black Americans. We assessed perceptions about DASH, its cultural compatibility, and barriers and facilitators to DASH adherence in Black adults with CKD. DESIGN AND METHODS We conducted focus groups and semistructured individual interviews involving 22 Black men and women with CKD Stages 3-4 from outpatient clinics at a US academic medical center. Transcripts of audio-recorded interviews were analyzed using thematic analysis. RESULTS Among participants (2 focus groups [N = 8 and 5] and 9 individual interviews), 13 (59%) had CKD Stage 3, 13 (59%) were female, the median age was 61 years, and 19 (90%) had hypertension. After receiving information about DASH, participants perceived it as culturally compatible based on 3 emergent themes: (1) Black individuals already eat DASH-recommended foods ("Blacks eat pretty much like this"), (2) traditional recipes (e.g., southern or soul food) can be modified into healthy versions ("you can come up with decent substitutes to make it just as good"), and ( 3) diet is not uniform among Black individuals ("I can't say that I eat traditional"). Perceived barriers to DASH adherence included unfamiliarity with serving sizes, poor cooking skills, unsupportive household members, and high cost of healthy food. Eleven (52%) reported after paying monthly bills that they "rarely" or "never" had leftover money to purchase healthy food. Perceived facilitators included having local access to healthy food, living alone or with supportive household members, and having willpower and internal/external motivation for change. CONCLUSIONS Black adults with CKD viewed DASH as a healthy, culturally compatible diet. Recognizing that diet in Black adults is not uniform, interventions should emphasize person-centered, rather than stereotypically culture-centered, approaches to DASH adherence.
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Affiliation(s)
- Crystal C Tyson
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Laura P Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Stedman Nutrition & Metabolism Center, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Pao-Hwa Lin
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Stedman Nutrition & Metabolism Center, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Isa Granados
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Kayla T Dunbar
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia Redd
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Gary Bennett
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Psychology and Neuroscience, Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Laura J Fish
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
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Development of a Nutrition Environment Assessment Tool for Latino Ethnic Stores. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031860. [PMID: 35162882 PMCID: PMC8834718 DOI: 10.3390/ijerph19031860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 12/01/2022]
Abstract
The objectives were to: (1) adapt the Nutrition Environment Measures Survey for Stores (NEMS-S) to better culturally fit small Latino grocery stores (tiendas) in Iowa; (2) assess the newly adapted Latino NEMS-S for inter-rater and test-retest reliability; and (3) compare Latino and original NEMS-S summary scores. This pilot instrument, containing culturally appropriate foods from the original NEMS-S and 2015 US Dietary Guidelines for Americans, underwent two rounds of formative evaluation. The new instrument and scoring protocol were applied to a random sample of 42 of 81 possible tiendas in Iowa. Cohen’s kappa was used to assess inter-rater and test-retest reliability for availability and quality of indicator food items (total scores and food category sub scores). There were no differences in summary scores for inter-rater or test-retest reliability using paired t-tests. Inter-rater agreement was high (range 0.82–1.00; p < 0.001). Tiendas averaged 42.0 ± 7.5 of 57 possible points on the Latino NEMS-S, but only 12.0 ± 4.6 of 54 points on the original NEMS-S (p < 0.001). The Latino NEMS-S is a reliable tool for assessing the food environment within Iowa tiendas. Culturally specific instruments can describe diverse food environments more accurately and guide public health nutrition interventions within communities.
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Hiller MB, Winham DM, Knoblauch ST, Shelley MC. Food Security Characteristics Vary for Undergraduate and Graduate Students at a Midwest University. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5730. [PMID: 34073623 PMCID: PMC8197841 DOI: 10.3390/ijerph18115730] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
The study objective was to determine prevalence of food insecurity and its associations with socioecological model (SEM) characteristics for undergraduate and graduate students. An online questionnaire was distributed to a convenience sample of students aged 18-34 at a Midwestern university. Of the 938 responses, 675 were complete for analysis. Outcome measures included demographics, food security level, housing, food access barriers, coping strategies, and food assistance program usage. Results found that predictors associated with undergraduate food insecurity included non-White race, receipt of financial aid, lower self-reported health status, living off-campus, employment, and food cost (p < 0.001). Graduate student food insecurity was associated with Asian self-identification, employment, food cost, no time to prepare foods, and lack of foods for dietary needs (p < 0.001). Students with food insecurity were more likely to buy cheap food (p < 0.001). Almost 50% of food-insecure undergraduates asked friends or family to help buy food. Food-insecure students were more likely to want information on meal preparation and budgeting. More graduate students were likely to know of and use food pantries. Overall, food insecurity was higher among undergraduate than graduate students. Universities should consider institutional and policy changes tailored to the separate populations to mitigate the prevalence of campus food insecurity.
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Affiliation(s)
- Molly B. Hiller
- Department of Food Science & Human Nutrition, Iowa State University, Ames, IA 50010, USA; (M.B.H.); (S.T.K.)
| | - Donna M. Winham
- Department of Food Science & Human Nutrition, Iowa State University, Ames, IA 50010, USA; (M.B.H.); (S.T.K.)
| | - Simon T. Knoblauch
- Department of Food Science & Human Nutrition, Iowa State University, Ames, IA 50010, USA; (M.B.H.); (S.T.K.)
| | - Mack C. Shelley
- Department of Political Science, and Department of Statistics, Iowa State University, Ames, IA 50010, USA;
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Putting Knowledge into Practice: Low-Income Women Talk about Food Choice Decisions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145092. [PMID: 32679700 PMCID: PMC7400203 DOI: 10.3390/ijerph17145092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022]
Abstract
Insights into barriers and facilitators for healthy eating are needed to improve low-income women's diets and to decrease disease risk. The study objectives were to explore women's qualitative perceptions of influences on their food choices such as food security, their knowledge of nutrition-related health risk factors and self-efficacy for diet change, and their dietary intakes in practice. Thirty-six women, aged 19-50, who were eligible to receive income-based assistance were recruited in central Iowa. Focus group discussions on defining healthy foods, influences on food choice, and nutrition information sources were analyzed using a socioecological model framework. Demographics, nutrient intake estimates, food security status, health behaviors, and self-efficacy for nutrition behavior change were collected by survey. Most participants were White (61%), single (69%), food insecure (69%), and living with children (67%). Few women met dietary recommendations. Barriers to healthy eating include cost, convenience/preparation time, family taste preferences, and limitations of federal food assistance programs. Facilitators are high self-efficacy for nutrition change and health knowledge on average. These results challenge the strategy of using nutrition education to improve healthy eating and instead show that intervention messaging should focus on limited, achievable steps to improve dietary choices that fit within cost, convenience, and taste constraints.
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Der Ananian C, Winham DM, Thompson SV, Tisue ME. Perceptions of Heart-Healthy Behaviors among African American Adults: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112433. [PMID: 30388803 PMCID: PMC6265893 DOI: 10.3390/ijerph15112433] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/22/2022]
Abstract
African Americans have a disproportionately higher risk of chronic conditions such as cardiovascular disease (CVD), type 2 diabetes, and hypertension than other ethnic or racial groups. Data regarding CVD-related perceptions and beliefs among African Americans are limited, particularly in the Southwest US. Assessment of current views regarding health and health behaviors is needed to tailor interventions to meet the unique needs of specific populations. We sought to examine knowledge, attitudes, and perceptions of African Americans living in Arizona toward CVD and etiological factors associated with health behaviors and chronic disease development to inform state health agency program development. Transcripts from 14 focus groups (n = 103) were analyzed using Grounded Theory for perceived disease risk, knowledge of CVD risk factors, nutrition, preventative behaviors, and barriers and motivators to behavior change. Participants identified CVD, stroke, and diabetes as leading health concerns among African-Americans but were less certain about the physiological consequences of these diseases. Diet, stress, low physical activity, family history, hypertension, and stroke were described as key CVD risk factors, but overweight and obesity were mentioned rarely. Participants described low socio-economic status and limited access to healthy foods as contributors to disease risk. Focus group members were open to modifying health behaviors if changes incorporated their input and were culturally acceptable. Respondents were 41% male and 59% female with a mean age of 46 years. This study provides insight into CVD and associated disease-related perceptions, knowledge, and attitudes among African Americans in the Southwest and recommendations for interventions to reduce CVD risk.
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Affiliation(s)
- Cheryl Der Ananian
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA.
| | - Donna M Winham
- Food Science & Human Nutrition, Iowa State University, Ames, IA 50010, USA.
| | - Sharon V Thompson
- Division of Nutritional Sciences, University of Illinois at Urbana Champaign, Urbana, IL 61801, USA.
| | - Megan E Tisue
- Food Science & Human Nutrition, Iowa State University, Ames, IA 50010, USA.
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Culture and food security. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2018. [DOI: 10.1016/j.gfs.2018.02.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Boatemaa S, Badasu DM, de-Graft Aikins A. Food beliefs and practices in urban poor communities in Accra: implications for health interventions. BMC Public Health 2018; 18:434. [PMID: 29609589 PMCID: PMC5880073 DOI: 10.1186/s12889-018-5336-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/19/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Poor communities in low and middle income countries are reported to experience a higher burden of chronic non-communicable diseases (NCDs) and nutrition-related NCDs. Interventions that build on lay perspectives of risk are recommended. The objective of this study was to examine lay understanding of healthy and unhealthy food practices, factors that influence food choices and the implications for developing population health interventions in three urban poor communities in Accra, Ghana. METHODS Thirty lay adults were recruited and interviewed in two poor urban communities in Accra. The interviews were audio-taped, transcribed and analysed thematically. The analysis was guided by the socio-ecological model which focuses on the intrapersonal, interpersonal, community, structural and policy levels of social organisation. RESULTS Food was perceived as an edible natural resource, and healthy in its raw state. A food item retained its natural, healthy properties or became unhealthy depending on how it was prepared (e.g. frying vs boiling) and consumed (e.g. early or late in the day). These food beliefs reflected broader social food norms in the community and incorporated ideas aligned with standard expert dietary guidelines. Healthy cooking was perceived as the ability to select good ingredients, use appropriate cooking methods, and maintain food hygiene. Healthy eating was defined in three ways: 1) eating the right meals; 2) eating the right quantity; and 3) eating at the right time. Factors that influenced food choice included finances, physical and psychological state, significant others and community resources. CONCLUSIONS The findings suggest that beliefs about healthy and unhealthy food practices are rooted in multi-level factors, including individual experience, family dynamics and community factors. The factors influencing food choices are also multilevel. The implications of the findings for the design and content of dietary and health interventions are discussed.
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Affiliation(s)
- Sandra Boatemaa
- Regional Institute for Population Studies, University of Ghana, Accra-Legon, Ghana
| | | | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra-Legon, Ghana.
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Winham DM, Hutchins AM, Thompson SV, Dougherty MK. Arizona Registered Dietitians Show Gaps in Knowledge of Bean Health Benefits. Nutrients 2018; 10:E52. [PMID: 29316699 PMCID: PMC5793280 DOI: 10.3390/nu10010052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 12/21/2017] [Accepted: 01/05/2018] [Indexed: 12/21/2022] Open
Abstract
Registered Dietitians (RDs) promote nutrition practices and policies and can influence food consumption patterns to include nutrient dense foods such as beans. Although many evidence-based health benefits of bean consumption (e.g., cholesterol reduction, glycemic control) have been demonstrated, there is limited research on the knowledge, attitudes, and perceptions of RDs regarding the inclusion of beans in a healthy diet. To fill this existing research gap, this cross-sectional survey explored the perceptions, knowledge, and attitudes of 296 RDs in Arizona, USA, toward beans. The RDs largely held positive attitudes toward the healthfulness of beans and were aware of many health benefits. Some gaps in awareness were evident, including effect on cancer risk, intestinal health benefits, folate content, and application with celiac disease patients. RDs with greater personal bean consumption had significantly higher bean health benefit knowledge. Twenty-nine percent of the RDs did not know the meaning of 'legume', and over two-thirds could not define the term 'pulse'. It is essential that RDs have up-to-date, evidence-based information regarding bean benefits to provide appropriate education to patients, clients, and the public.
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Affiliation(s)
- Donna M Winham
- Department of Food Science & Human Nutrition, Iowa State University, Ames, IA 50011, USA.
| | - Andrea M Hutchins
- Department of Health Sciences, University of Colorado, Colorado Springs, CO 80918, USA.
| | - Sharon V Thompson
- Division of Nutritional Sciences, University of Illinois at Urbana Champaign, Urbana, IL 61801, USA.
| | - Mariah K Dougherty
- Department of Pharmaceutical & Nutrition Care, University of Nebraska Medical Center, Omaha, NE 68198, USA.
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Mayén AL, Stringhini S, Ford ND, Martorell R, Stein AD, Paccaud F, Marques-Vidal P. Socioeconomic predictors of dietary patterns among Guatemalan adults. Int J Public Health 2016; 61:1069-1077. [PMID: 27421467 DOI: 10.1007/s00038-016-0863-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/04/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES We aimed to assess the associations of socioeconomic factors with dietary patterns in a Guatemalan population. METHODS Cross-sectional data of 1076 participants (42 % men, mean age 32.6 ± 4.2 years) collected between 2002 and 2004 in four rural villages in Guatemala. Dietary patterns were derived using principal component analysis. Chi-square and Poisson regression models were used to assess associations between socioeconomic factors and dietary patterns. RESULTS Three dietary patterns were identified: "Western" (high in processed foods), "traditional" (high in traditional foods) and "coffee and sugar", explaining 11, 7 and 6 % of the variance, respectively. Annual expenditures were associated with a higher adherence to the "Western" pattern: prevalence ratios [(PR) (95 % confidence interval)] 1.92 (1.17-3.15) for the highest vs. lowest expenditure group in men and 8.99 (3.57-22.64) in women. A borderline significant (p = 0.06) negative association was found between the "traditional" pattern and higher household expenditures [0.71 (0.49-1.02) in men] and with schooling [0.23 (0.05-1.02)] in women (p = 0.05). CONCLUSIONS Dietary patterns in Guatemala are predicted by socioeconomic factors. In particular, high annual expenditures are associated with a more westernized, less traditional diet.
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Affiliation(s)
- Ana-Lucia Mayén
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Nicole D Ford
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Fred Paccaud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
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Low-Income US Women Under-informed of the Specific Health Benefits of Consuming Beans. PLoS One 2016; 11:e0147592. [PMID: 26820889 PMCID: PMC4731067 DOI: 10.1371/journal.pone.0147592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/06/2016] [Indexed: 02/04/2023] Open
Abstract
Background Bean consumption can reduce chronic disease risk and improve nutrition status. Consumer knowledge of bean health benefits could lead to increased intakes. Low-income women have poorer health and nutrition, but their level of knowledge about bean health benefits is unknown. Beans are a familiar food of reasonable cost in most settings and are cultural staples for Hispanics and other ethnicities. Study objectives were to assess awareness of bean health benefits among low-income women, and to evaluate any differences by acculturation status for Hispanic women in the Southwestern United States. Methods A convenience sample of 406 primarily Mexican-origin (70%) low-income women completed a survey on knowledge of bean health benefits and general food behaviors. Principal components analysis of responses identified two summary scale constructs representing “bean health benefits” and “food behaviors.” Acculturation level was the main independent variable in chi-square or ANOVA. Results The survey completion rate was 86% (406/471). Most women agreed or strongly agreed that beans improved nutrition (65%) and were satiating (62%). Over 50% answered ‘neutral’ to statements that beans could lower LDL cholesterol (52%), control blood glucose (56%) or reduce cancer risk (56%), indicating indifference or possible lack of knowledge about bean health benefits. There were significant differences by acculturation for beliefs that beans aid weight loss and intestinal health. Scores on the bean health benefits scale, but not the food behavior scale, also differed by acculturation. Conclusions Limited resource women have a favorable view of the nutrition value of beans, but the majority did not agree or disagreed with statements about bean health benefits. Greater efforts to educate low-income women about bean health benefits may increase consumption and improve nutrition.
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Oli N, Vaidya A, Subedi M, Eiben G, Krettek A. Diet and physical activity for children's health: a qualitative study of Nepalese mothers' perceptions. BMJ Open 2015; 5:e008197. [PMID: 26351183 PMCID: PMC4563228 DOI: 10.1136/bmjopen-2015-008197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 08/04/2015] [Accepted: 08/12/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Non-communicable diseases account for 50% of all deaths in Nepal and 25% result from cardiovascular diseases. Previous studies in Nepal indicate a high burden of behavioural cardiovascular risk factors, suggesting a low level of knowledge, attitude and practice/behaviour regarding cardiovascular health. The behavioural foundation for a healthy lifestyle begins in early childhood, when mothers play a key role in their children's lives. This qualitative study, conducted in a Nepalese peri-urban community, aimed to explore mothers' perception of their children's diet and physical activity. DESIGN We notated, tape-recorded and transcribed all data collected from six focus group discussions, and used qualitative content analysis for evaluation and interpretation. SETTING The study was conducted in the Jhaukhel-Duwakot Health Demographic Surveillance Site in the Bhaktapur district of Nepal. PARTICIPANTS Local health workers helped recruit 61 women with children aged 5-10 years. We distributed participants among six different groups according to educational status. RESULTS Although participants understood the importance of healthy food, they misunderstood its composition, perceiving it as unappetising and appropriate only for sick people. Furthermore, participants did not prioritise their children's physical activities. Moreover, mothers believed they had limited control over their children's dietary habits and physical activity. Finally, they opined that health educational programmes would help mothers and recommended various intervention strategies to increase knowledge regarding a healthy lifestyle. CONCLUSIONS Our data reveal that mothers of young children in a peri-urban community of Nepal lack adequate and accurate understanding about the impact of a healthy diet and physical activity. Therefore, to prevent future cardiovascular disease and other non-communicable diseases among children, Nepal needs health education programmes to improve mothers' cardiovascular health knowledge, attitude and behaviour.
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Affiliation(s)
- Natalia Oli
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Madhusudan Subedi
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Gabriele Eiben
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Alexandra Krettek
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Biomedicine and Public Health, School of Health and Education, University of Skövde, Skövde, Sweden
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
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The Healthy Migrant Families Initiative: development of a culturally competent obesity prevention intervention for African migrants. BMC Public Health 2015; 15:272. [PMID: 25881105 PMCID: PMC4372278 DOI: 10.1186/s12889-015-1628-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 03/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background Although obesity among immigrants remains an important area of study given the increasing migrant population in Australia and other developed countries, research on factors amenable to intervention is sparse. The aim of the study was to develop a culturally-competent obesity prevention program for sub-Saharan African (SSA) families with children aged 12–17 years using a community-partnered participatory approach. Methods A community-partnered participatory approach that allowed the intervention to be developed in collaborative partnership with communities was used. Three pilot studies were carried out in 2008 and 2009 which included focus groups, interviews, and workshops with SSA parents, teenagers and health professionals, and emerging themes were used to inform the intervention content. A cultural competence framework containing 10 strategies was developed to inform the development of the program. Using findings from our scoping research, together with community consultations through the African Review Panel, a draft program outline (skeleton) was developed and presented in two separate community forums with SSA community members and health professionals working with SSA communities in Melbourne. Results The ‘Healthy Migrant Families Initiative (HMFI): Challenges and Choices’ program was developed and designed to assist African families in their transition to life in a new country. The program consists of nine sessions, each approximately 1 1/2 hours in length, which are divided into two modules based on the topic. The first module ‘Healthy lifestyles in a new culture’ (5 sessions) focuses on healthy eating, active living and healthy body weight. The second module ‘Healthy families in a new culture’ (4 sessions) focuses on parenting, communication and problem solving. The sessions are designed for a group setting (6–12 people per group), as many of the program activities are discussion-based, supported by session materials and program resources. Conclusion Strong partnerships and participation by SSA migrant communities enabled the design of a culturally competent and evidence-based intervention that addresses obesity prevention through a focus on healthy lifestyles and healthy families. Program implementation and evaluation will further inform obesity prevention interventions for ethnic minorities and disadvantaged communities.
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Lee-Kwan SH, Goedkoop S, Yong R, Batorsky B, Hoffman V, Jeffries J, Hamouda M, Gittelsohn J. Development and implementation of the Baltimore healthy carry-outs feasibility trial: process evaluation results. BMC Public Health 2013; 13:638. [PMID: 23837722 PMCID: PMC3716976 DOI: 10.1186/1471-2458-13-638] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 06/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prepared food sources, including fast food restaurants and carry-outs, are common in low-income urban areas. These establishments provide foods high in calories, sugar, fat, and sodium. The aims of the study were to (1) describe the development and implementation of a carry-out intervention to provide and promote healthy food choices in prepared food sources, and (2) to assess its feasibility through a process evaluation. METHODS To promote healthy eating in this setting, a culturally appropriate intervention was developed based on formative research from direct observation, interviews and focus groups. We implemented a 7-month feasibility trial in 8 carry-outs (4 intervention and 4 comparison) in low-income neighborhoods in Baltimore, MD. The trial included three phases: 1) Improving menu boards and labeling to promote healthier items; 2) Promoting healthy sides and beverages and introducing new items; and 3) Introducing affordable healthier combo meals and improving food preparation methods. A process evaluation was conducted to assess intervention reach, dose received, and fidelity using sales receipts, carry-out visit observations, and an intervention exposure assessment. RESULTS On average, Baltimore Healthy Carry-outs (BHC) increased customer reach at intervention carry-outs; purchases increased by 36.8% at the end of the study compared to baseline. Additionally, menu boards and labels were seen by 100.0% and 84.2% of individuals (n = 101), respectively, at study completion compared to baseline. Customers reported purchasing specific foods due to the presence of a photo on the menu board (65.3%) or menu labeling (42.6%), suggesting moderate to high dose received. Promoted entrée availability and revised menu and poster presence all demonstrated high fidelity and feasibility. CONCLUSIONS The results suggest that BHC is a culturally acceptable intervention. The program was also immediately adopted by the Baltimore City Food Policy Initiative as a city-wide intervention in its public markets.
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Affiliation(s)
- Seung Hee Lee-Kwan
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonja Goedkoop
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachel Yong
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin Batorsky
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vanessa Hoffman
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jayne Jeffries
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mohamed Hamouda
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joel Gittelsohn
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Lemacks J, Wells BA, Ilich JZ, Ralston PA. Interventions for improving nutrition and physical activity behaviors in adult African American populations: a systematic review, January 2000 through December 2011. Prev Chronic Dis 2013; 10:E99. [PMID: 23786910 PMCID: PMC3690829 DOI: 10.5888/pcd10.120256] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The incidence of preventable chronic diseases is disproportionally high among African Americans and could be reduced through diet and physical activity interventions. Our objective was to systematically review the literature on clinical outcomes of diet and physical activity interventions conducted among adult African American populations in the United States. Methods We used the Preferred Reporting Items for Systematic Review and Meta Analysis construct in our review. We searched Medline (PubMed and Ovid), Cochrane, and DARE databases and restricted our search to articles published in English from January 2000 through December 2011. We included studies of educational interventions with clinically relevant outcomes and excluded studies that dealt with nonadult populations or populations with pre-existing catabolic or other complicated disorders, that did not focus on African Americans, that provided no quantitative baseline or follow-up data, or that included no diet or physical activity education or intervention. We report retention and attendance rates, study setting, program sustainability, behavior theory, and education components. Results Nineteen studies were eligible for closer analysis. These studies described interventions for improving diet or physical activity as indicators of health promotion and disease prevention and that reported significant improvement in clinical outcomes. Conclusion Our review suggests that nutrition and physical activity educational interventions can be successful in improving clinically relevant outcomes among African Americans in the United States. Further research is needed to study the cost and sustainability of lifestyle interventions. Further studies should also include serum biochemical parameters to substantiate more specifically the effect of interventions on preventing chronic disease and reducing its incidence and prevalence.
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Abstract
Lifestyle-related chronic diseases such as cancer and cardiovascular disease are the greatest public health concerns. Evidence shows Japanese immigrants to a westernized environment have higher incidence of lifestyle-related diseases. However, little is known about lifestyle characteristics related to chronic diseases for Japanese in a westernized environment. This study is examining the gap in lifestyle by comparing the lifestyle prevalence for Japanese in the US with the Japanese National Data (the National Health and Nutrition Survey in Japan, J-NHANS) as well as the Japan National Health Promotion in the twenty-first Century (HJ21) goals. Japanese adults were surveyed in Pittsburgh, USA, regarding their lifestyle (e.g., diet, exercise, smoking, stress, alcohol, and oral hygiene). The prevalence was compared with J-NHANS and HJ21 goals. Ninety-three responded (response rate; 97.9%). Japanese men (n = 38) and women (n = 55) in Pittsburgh smoke less than Japanese in Japan (P < 0.001 for both genders). Japanese in Pittsburgh perform less physical activity in daily life and have lower prevalence of walking more than 1 h per day (P < 0.001 for both genders). Japanese women in Pittsburgh have significantly higher prevalence of stress than in Japan (P = 0.004). Japanese men in Pittsburgh do not reach HJ21 goal in weight management, BMI, use of medicine or alcohol to sleep, and sleep quality. Japanese women in Pittsburgh do not reach HJ21 goal in weight management and sleep quality. In conclusion, healthy lifestyle promotion including exercise and physical activity intervention for Japanese living in a westernized environment is warranted.
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Ainsworth BE, Gabriel KP. The Building Healthy Lifestyles Conference: Modifying Lifestyles to Enhance Physical Activity, Diet, and Reduce Cardiovascular Disease: Summary and Conclusions. Am J Lifestyle Med 2009; 3:6S-10S. [PMID: 20401338 PMCID: PMC2855200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- Barbara E. Ainsworth
- Healthy Lifestyles Research Center and Program in Exercise and Wellness; College of Nursing and Health Innovation, Arizona State University; Mesa, AZ 85212
| | - Kelley Pettee Gabriel
- Department of Health Promotion, Social & Behavioral Health; University of Nebraska Medical Center; Omaha, NE 68198-6075
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