Transcript perceptions regarding nutrition and physical activity

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
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
• Although 1 in 10 Hispanics in the United States is
living with diabetes, only 1 in 3 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, and constraints among individuals in
the target population
Perceptions of diabetes, nutrition, and
physical activity among Latino immigrants
Goals:
• To examine factors that contribute to obesity &
physical inactivity
• To 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 of 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 and
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 less vegetables and fruit now
Vegetables and 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 healthy)
• “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 with work
• 30 minutes to eat at work
– Eating is organized around children’s schedules (coming home
from school) and husband coming home from work
• “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 and 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 and 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