Breaking down the barriers: a look at “ Por la Salud de Nuestros Ninos ”

1. Por la Salud de Nuestros Ninos Breaking down the barriers: a look at “Por la Salud de NuestrosNinos” Suzanne E. Walker-Pacheco, Ph.D. MSU Dept of Sociology and Anthropology Tracy Cleveland, MS, PA-C MSU Physician Assistant Program Deborah Piland, PhD, RD/LD College of the Ozarks Dietetics Program A diabetes and obesity prevention program for Latino children

2. The Problem: Obesity • Obesity, a growing “epidemic” for all ages • Recent focus on healthy lifestyles • Pediatric obesity: U.S. obesity rate in 6-19 yr-olds more than tripled • Pediatric obesity: current and future problems • First U.S. generation destined to have shorter life span than its predecessor

3. The Problem: Disparities • Disparities in rates of pediatric obesity • Overall risk of obesity-related illness higher in U.S. minorities • Immigrant families face barriers while adapting to life in United States • U.S. Latinos: high incidence of children 2-19 yrs old overweight/obese

5. Comorbidities

6. Diabetes: Prevalence, Some Facts • Diabetes • Metabolic disorder • Ineffective use of insulin leads to high blood glucose • Total # of people with diabetes worldwide projected to rise from 171 million in 2000 to 366 million in 2030 • Over 18 million people in U.S. have diabetes • ~ 41 million have “pre-diabetes” • Leading cause of heart disease, stroke, kidney disease, blindness, and amputations • Prevalence decreases w higher education levels • Overall prevalence among Latinos almost twice that of non-Hispanic whites (9.8% vs. 5%) • Latinos susceptible at younger ages than non-Hispanic whites

7. Type 2Diabetes: CausesGenetic Basis • “Thrifty gene” hypothesis and alternatives • Some gene variants increase susceptibility to type 2 diabetes • Familial aggregation • Twin studies • Prevalence varies by ethnic group • Variants of the TCF7L2 gene

8. Type 2Diabetes: Causes Environment Lack of physical activity Dietary correlates High intake of fats & sweeteners Low intake of fruits, vegetables, & whole grains

9. Who are the Latinos? • Race concept: social construct • Shared ancestry • Affinities with Native Americans; Asian roots • Diverse • Shared cultural aspects • Hispanic vs. Latino

10. Why high rates of obesity & diabetes in Latinos? Combination of: • Genetic risk • Environmental factors • Immigration process & resulting changes in diet and physical activity • Relatively low socioeconomic status Results in high rates & susceptibility at young age

11. ~ Por la Salud de Nuestros Ninos Purpose of Study: Por la Salud de Nuestros Niños • To reduce obesity and prevent type 2 diabetes in a group of Latino children in Springfield, MO • To arm members of this population with tools to improve overall health and decrease the need for future medical care • To serve as a model for those interested in implementing applied programs, and academic and medical communities • Since health education programs aimed at children and that encourage family participation have documented success, parents and other family members would also be educated and receive similar benefits • To contribute to the incomplete database concerning health issues among Missouri’s Latinos

12. Objectives Comprehensive survey including: family health history, demographics, preventive healthcare, knowledge about diabetes, and information on the children’s daily activities and diet Identify children at risk for developing diabetes through medical and anthropomorphic indicators Promote and increase awareness of healthy lifestyle habits via weekly interactive health education program targeting proper nutrition and exercise habits Collect comparative data in Central Mexico on health status, diet and activity level, and physical health indicators

13. Methods: Location and Study Group • Local church, convenience sample • Study group: 64 Latino children, 3-9 yrs old (avg 5.3) • Multidisciplinary team • Holistic, multifaceted approach

14. Methods: Procedures • Quantitative & qualitative data collection • Comprehensive caregiver & child surveys, 24-hour recall nutritional assessments • Focus group • Weekly interactive health education program • Nutrition and exercise education • Information for caregivers • Daily nutritional intake and physical activity as reported by caregivers • Monthly physical measurements

15. Methods: Physical Measurements • Variables • Height • Weight • BMI calculated • Blood pressure • Waist circumference • Triceps skinfold thickness • N=56 (N=38 for early & late in study) • Aged 3-9 (average 5.3 yrs) • Time between 1st and last meas avgd 8.3 mos

16. Methods: Focus Group • 22 parents & grandparents • Purpose: • Investigate factors contributing to childhood obesity in study group • Receive feedback on program • Discussion included: • Caregivers’ knowledge about nutrition, diabetes, obesity • Impact of program • Physical activity • Barriers to a healthy lifestyle

17. Specific Questions

18. Results: Diet and NutritionNew Foods Survey

19. Results: Diet and Nutrition Nutrition Assessments • 21 assessments completed for children ages 3 to 10 • 24% consumed adequate servings of fruits and vegetables • General Dietary Tendencies • High in added sugars, particularly in beverages • High in fat and saturated fat • High in sodium • Not much soda consumption • Low in whole grains and fiber

20. Results: Diet and NutritionPost-Study Nutrition Survey

21. Results: Focus Group

22. Results: Focus Group Children increased physical activity Program Successes • Increased Caregiver Awareness on Child’s Health • Incentive charts identified deficits • Children eating more vegetables and less sugary foods and drinks • Consuming less soda and juice • Trying a variety of foods • Children showed increased interest in foods being purchased • Made lists of veggies for purchase

23. Parent Quotes “They also share what they learn… And it makes me conscious and when I’m buying groceries they will make sure that I try and buy healthier foods” “By filling out the charts I started to notice what foods my child was lacking” “We all participate because were trying to improve our kids diet” “Really nice to get a tip on mixing vegetables with their favorite foods” “Your program has helped my kids not want to eat as much candy as they used to” “I cooked a whole lot more in my country of origin. Back there you sometimes cook three times a day. Here you only cook once a day usually.”

24. Results: Changes in Physical Data Beginning BMI Percentile N=38

25. Ending BMI Percentile N = 38

26. Results: Mexico and Springfield Study Groups

27. Results: Mexico and Springfield Study Groups (BMI Percentile) Mexico Urban BMI higher than rural Impoverished urban lower BMI than wealthier Boys more overwt than girls

29. Which picture depicts a healthy body form for a boy?Which picture depicts a healthy body form for a girl? Results: Cultural Considerations 10% 19% 38% 33% Χ2 = 9.34 p<0.01 df=2 N=42 19% 24% 50% 7%

30. Results: Cultural Considerations Parents’ perceptions of child’s body form Is my child’s body form (height, weight) • Normal? • Too heavy? • Too light? Χ2=12.82 df=6 p<0.05 N=42

31. Effects of Immigration • Assimilation: increased overweight with more time in U.S. (individuals and populations) • Dietary differences in U.S. vs. native country • Differences in physical activity

32. Summary Nutrition Only ¼ appeared to consume enough fruits/veggies Diet high sugar, high fat, high sodium, low whole grains Most children tried new foods, recognized healthy foods Focus Group Identified… Barriers= cost and cultural/immigration issues Successes = increased awareness of healthy diets and importance of physical activity BMI Decreased over course of study for Springfield study group Springfield study group > Mexico study group Mexico urban > Mexico rural Body Form Boys more overweight than girls More parents rated heavier body form as healthier for boys than girls Many parents underestimated child’s body weight

33. Recommendations Family Centered Healthcare Family involvement Provide facts to parents Empower families with appropriate tools and skill development opportunities Provide simple tips on nutrition & exercise Identify Community Partners Develop health information delivery strategies Incorporate cultural perceptions of health Start ‘em young! • Our material will be made available (suzannewalker@missouristate.edu)

34. Acknowledgments • Funded by Missouri State University Provost’s Incentive and Dean’s Incentive grants • The participating families • Sacred Heart Catholic Church • Dr. Linda Vaught • Abe Ledezma • Trevor Schunemann • Todd Daniels

35. References • Childhood Overweight and Obesity, CDC Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/obesity/childhood/index.html • Das SK, Elbien SC (2006) The Genetic Basis of Type 2 Diabetes. Cellscience 2(4):100-131. • National Health and Nutrition Examination Survey http://www.cdc.gov/nchs/nhanes.htm • National Diabetes InformationClearinghouse (NDIC), U.S. Department of Health and Human Services http://diabetes.niddk.nih.gov/dm/pubs/causes/#what