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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.

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Understanding diabetes risk among Latinos in eastern North Carolina: perceptions regarding nutrition and physical activity

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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 physical activity related to diabetes?

  • Exercise can regulate

  • sugar

  • It is important to

  • control your weight

  • Exercise is good for

  • health

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


Physical activities

  • 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

What kind of

physical activities

do you do?

  • Women: Work in the home (housework only)

  • Men: physical activities at work (Ex: brickmasons)


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


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