Transcript Understanding diabetes risk among Latinos in eastern North

Understanding diabetes risk among
Latinos in eastern North Carolina:
perceptions regarding nutrition and
physical activity
Shahna Arps, East Carolina University; Ricardo
Contreras, East Carolina University; Luci Fernandez,
East Carolina University
Photos: AMEXCAN’s “Festival de la Raza”, 2007, http://www.amexcannc.org
Diabetes currently represents an urgent
health issue among Latinos
• According to national statistics, 10.4% of Hispanics 20 years or
older have been diagnosed with diabetes
• Rates among Mexican Americans
are nearly 2 times as high as
among non-Hispanic White adults
• Hispanics are 1.6 times more
likely to die from diabetes than
non-Hispanic Whites
Source: CDC. 2007. National diabetes fact sheet: general information
and national estimates on diabetes in the United States.
Latinos suffer disproportionately from health
problems, because they lack access to education,
information, & health services
• Only 1 in 3 Hispanics in the US may know he/she has the disease
(National Alliance for Hispanic Health)
• Obesity & lack of physical activity are the leading risk factors for
diabetes among Latinos
• Many cases of diabetes could be prevented or delayed if these
risk factors were addressed by public health interventions
• Designing effective health programs that promote behavioral
changes depends on understanding beliefs, values, customs, &
constraints among individuals in the target population
Perceptions of diabetes, nutrition, &
physical activity among Latino immigrants
Goals:
• Identify factors that contribute to obesity & physical
inactivity
• Develop culturally-appropriate strategies to prevent
diabetes
In collaboration with AMEXCAN
(Asociación de Mexicanos en Carolina del
Norte) which has developed a diabetes
awareness program in Pitt County, NC
Methods
• Focus group discussions with adults (various ages)
attending AMEXCAN’s diabetes awareness workshops
• Held in a local church (n=11) & community center (n=12)
• Discussions were conducted in Spanish
• Most participants were from Mexico
• Open-ended questions about diabetes, nutrition, &
physical activity
– Differences in diet & physical activity since migrating to the US
• Responses transcribed during the discussions & later
translated into English for analysis
Results
What is diabetes?
•
•
•
•
•
“Terrible illness”
“Incurable illness” (?)
“It is easy to get”
“It is very dangerous”
“Diabetes can cause death”
Diabetes, cont.
Symptoms
• Thirst
• The need to urinate
often
• Disturbed sleep
• Blurred vision
Causes
• Poor nutrition
• Being overweight
• Not doing physical
activities/exercising
• Eating sugar
• Genetics/heredity
Diabetes, cont.
Prevention
• Need more
information about
diabetes
• Exercise
• Eat vegetables &
fruits
• Lower stress
• Get health exams
Treatment
• Do the same as you
would to prevent it
• Take medicine
How is diet related
to diabetes?
• Food is important,
eating healthy
• Many people get
diabetes because
they eat poorly
– EX: Fast food,
hamburgers, sweets,
French fries, bread,
high fat foods, fried
foods, pizza
How is physical
activity related to
diabetes?
• Exercise can regulate
sugar
• It is important to
control your weight
• Exercise is good for
health
Physical activities
What kind of
physical activities
do you do?
• Women: Work in the
home (housework
only)
• Men: physical
activities at work (Ex:
brickmasons)
Benefits of physical
activity?
• It is important to be
active
• It makes you healthier
• It makes you more
active
• Good conditioning/
physique
• Healthy metabolism,
circulation, strong
heart & lungs
Have your physical activity levels changed
since you came to the US? How?
• “There is a huge change!”
• More sedentary
• Walked more in Mexico, “Now we walk to the
refrigerator”
• “Before I walked every day to school and other
places and biked, too”
• “I walked all the time”
• “[In the US] you don’t go anywhere if you don’t have
a car, you are stuck at home”
• “Here if we go to the park we walk, but there is even
food at the park”
• “I walk at work but not for exercise, it’s different”
• “Washing clothes by hand was a good workout”, use
machines now (also, vacuum cleaners)
What are the barriers to doing
more physical activity?
• There is not enough time to exercise
– Work
• Too tired to exercise after working long
hours
• Cold
– “When it is cold I don’t walk or like to go outside”
– “It is cold now so we don’t do too much in terms
of exercise”
• Safety (?)
– “I am afraid to walk in my neighborhood because
there are many dogs”
Nutrition
What is a healthy diet?
• Low in fat
• Low in bread
• High in fruit
• Plenty of fruits &
vegetables
• drinking water
• Eating grains, beans
• “Corn is very nutritious”
Benefits of good
nutrition?
• If eat well, less
illnesses and
disease
Has your diet changed since you
came to the US? How?
• Ate better in Mexico, more nutritious diet
• Eat fewer vegetables & fruit now
• Vegetables & fruit are different here than in Mexico
• Food has more fat and grease in the US
– “Here they sell a lot of things with fat”
– Eat more fast foods
• Not as fresh, healthy, less flavor
– “Meat is old because it’s frozen and shipped”
– Meat is “injected” - has a different taste
– “Before we could grow many things like corn, lettuce, tomatoes, cabbage,
garlic, and peppers on our own land”
– “Food was from the country, not bought”
– “We ate more grains and meat”
– Food in the US isn’t “original”
• Men & women have gained weight, health has declined
Barriers to eating healthier?
• Time constraints (to cook and eat)
• “It is our custom to spend a lot of time cooking and eating, but
it is not possible because we do not have time”
– Work
• Eat fast food now because of time constraints at work
• 30 minutes to eat at work
– Eating is organized around children’s schedules and husband’s
schedules
• “I buy fresh fruit and vegetables but I don’t have time to prepare them
before they go bad and I need to throw them away”
• Buy more canned food (not accustomed to canned food)
• Children refuse to eat traditional Mexican food, “they are picky
and want American food like pizza”
– Too difficult to prepare two kinds of food (American & traditional
Mexican)
• Customs
– Don’t eat many vegetables, not in traditional diet, cook with lard
• Money is not a barrier to eating healthier, can buy cheaper food
Discussion
• Emphasized seriousness of diabetes
• Importance of nutrition & physical activity/exercise
• But described barriers that specifically relate to life
in the US
– Had more nutritious diets & active lifestyles in Mexico
– In the US, less fresh food, more high fat, convenient food
– More sedentary, depend on cars, washing machines, don’t
walk as much
– Lead busy lives with insufficient time for cooking traditional
meals & exercising
Conclusions
• Lifestyle changes described can help us understand
the factors that promote obesity & physical inactivity
(the major risk factors for diabetes)
• Results have applied dimensions for designing
diabetes prevention programs
• Some issues that need to be addressed:
–
–
–
–
time constraints (work, children’s schedules)
children’s changing dietary preferences
cold temperatures prevent outdoor activities
customs (eating few vegetables, cooking with lard)
• Community health initiatives must use culturally
appropriate strategies that deal with these barriers in
order to successfully prevent diabetes in the Latino
community
Acknowledgments
• We would like to thank AMEXCAN for
collaborating with us on this project,
especially Juvencio Rocha Peralta,
AMEXCAN President & Juan Pablo
Servin Ramírez, AMEXCAN Coordinator