Health Promotion programs and healthy lifestyle: Black males perspectives

1. Health Promotion programs and healthy lifestyle: Black males perspectives Matthew Asare, Ph.D. Northern Kentucky University

2. Presenter Disclosures <Matt Asare> < “No relationships to disclose” > (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

3. Background: Purpose • The purpose of this study wasto determine the black males’ perceptions, beliefs and attitudes about healthy lifestyle and preventive care and culturally appropriate way to promote health promotion programs among them. • Healthy lifestyle Includes: physical activity and healthy eating behaviors • Preventive care: Accessing health screening such as hypertension, hypercholesterolemia, cancer, diabetes, etc

4. Background: Black males and Chronic Diseases • The leading causes of death among black males in the US includes preventable diseases such as • cardiovascular disease, • cancer (malignant neoplasms), • cerebrovascular diseases, • cirrhosis, • chronic obstructive pulmonary disease, and • diabetes mellitus (CDC,2012)

5. Background: Risk Factors • The modifiable risk factors that contribute to most of those diseases are: • Physical inactivity, • Poor dietary habits • Misperceptions (Gadino, 2010; Bennett, 2006)

6. Background: Physical activity vs. Chronic diseases • Studies showed that physical activity • Improves energy expenditure (Jeffrey et al, 2003; Morabia & Costanza, 2004), • Decreases the rate of type 2 diabetes (Knowler, et al. 2002), • Prevents heart attack (Yusuf S, Hawken S, Ounpuu S et al, 2004; Snell, & Mitchell, 1999; Wei, Kampert, Barlow, 1999), • Reduces blood pressure (Stewart, 2002)

7. Background: Nutrition vs. Chronic Diseases • Study showed that good nutrition can help lower risk for: • heart disease, • stroke, • some cancers, • diabetes, • osteoporosis. • Increased fruits and vegetables consumption can help reduce the risk for heart disease and certain cancers (CDC, 2009)

8. Background: Health Screening vs. Chronic diseases • Studies show that Preventive care such as regular screening for colorectal cancer can reduce the number of people who die from this disease in the U.S. (Preventive Services Task Force, 2008). • When colorectal cancer is found early and treated, the 5-year relative survival rate is 90% (Ries,et al 2008) • Annual eye and foot exams can reduce vision loss and lower-extremity amputations. • Detecting and treating diabetic eye disease can reduce the development of severe vision loss by 50% to 60%.(Kung, Hoyert, Xu, & Murphy, 2008) • .

9. Background • However, studies showed • a higher physical inactivity rate among black males (Jones, et al., 1998; Marshall, et al., 2007) • Health promotion research focusing on black males has not received sufficient attention

10. Rationale • However, studies showed • a higher physical inactivity rate among black males (Jones, et al., 1998; Marshall, et al., 2007) • Black males have not given sufficient attention to some of the health promotion programs or preventive care programs (Cheatham et al., 2008; Thompson et al., 2009). • Paucity in the literature about black males perceptions about physical activity, good eating behavior and health screening behaviors

11. Methods: • An hour face-to –face interview was conducted among 50 black males • Twelve semi-structured open ended questions • Demographic information was elicited • Snowball method and Convenient sample were used • Notes were taken and the conversations were tape recorded • The conversations were transcribed • Analyzed the data to find trends

12. Results: Demographics (Country of Origin)

13. Results: Demographics (Education)

14. Results: Demographics (Employment Status)

15. Results: Demographics (BMI)

16. Results: Demographics (Annual Income)

17. Results: Physical Activity Behavior • When a question “do you consider yourself physically active, why and why not?” was asked • The majority, 78% (n= 39) of the participants indicated that they are physically active and the rest, 22% (n=11) acknowledged that they are not physically active at all. • However, a closer look at the participants’ responses about physical activity revealed three groups • First group leads sedentary lifestyle • Second group engages in occupational activities • Third group engages in physical activity/Exercise

18. Types of activity levels

19. Physical Activity behavior • Type of physical activities • 28% (n=5) of the participants indicated that they walk for at least one hour each day for five days in a week • 22% (n = 4) reported that they run more than 30 minutes each day for three days • 22% (n = 4) spend 60 to 90 minutes each day doing weight lifting for three days • 28% (n = 5) of the participants said they play soccer for at least 90 minutes once a week

20. Participants’ perception • When a question “From your experience or interaction with black males (it could be your friends, brothers, a relative, etc), do you think black males in general like to do exercise or engage in physical activity? • Majority, 70% (n = 35), of participants responded ‘NO” • One participant responded. • “No, they don’t because it is not our culture to have a schedule for exercise. In Africa, our daily activities involved exercise: we walk to almost everywhere we go. We walk to farm, walk to fetch water; in short everything we do involves exercise. I know a few friends here in the U.S. who don’t care about physical activity or exercise.”

21. Reasons for physical inactivity • The reasons for physical inactivity are • Cultural and acculturation influence, • lack of time, • the fear of the neighborhood, • laziness, • lack of discipline, • lack of understanding of the importance of physical activities,

22. Physical Activity: Quote 1 • “Traditionally, most of the times we do a lot of walking, somebody will walk about five miles to his farm and walk five miles back home. …. Since in our culture we don’t have specific time for exercise but exercise is always embedded in our daily lifestyle, we don’t see it as necessary to have set aside any time for exercise here in the US. For instance, I spent forty years of my life in Africa and throughout those years, I was walking back and forth to farm, fetch water, pound fufu etc. Naturally and effortlessly, Iengaged in physical activity. So when I came to the US, I found it difficult to go to gym just to do exercise because I am not used to doing that. I see it as a waste of time.”

23. Physical Activity: Quote 2 • “It is very difficult to get into a routine exercise, especially for black males. Most of the time exercise has to do with discipline… we have a culture of doing physical activities, i.e. most of the things we do in Africa involve physical activities but I believe this cultural influence has affected black males in the US in a negative way. This is because back in Africa we do it (physical activity) naturally but when we came to the US everything is opposite... We are no longer living that physical activity lifestyle any more. If you want to engage in physical activities, you have to plan your schedule well, be committed and disciplined. Unfortunately, most blacks don’t want to add that kind of burden on their already stressful lifestyle.”

24. Healthy Eating behavior • Almost all the participants, 94% (n = 47) reported that they have a healthy eating behavior. • Many of participants, 90% (n = 45) stated that they prefer to cook their own food and also like traditional African food. • However, several of them about 56% (n = 28) admitted that once in a while they eat fast food especially when they are away from home for a long time • The participants reported eating major food group such fruits, vegetables, grains, proteins etc.

25. Healthy Eating behavior • For fruits the most common ones among the participants are banana, apples, oranges and watermelon. • Among the vegetables the participants mentioned most are carrot, broccoli, spinach, corn etc. • Participants mentioned brown rice, wheat bread, white rice, etc. some of the examples of grain food they normally eat. • Many of the participants also said they eat a lot of beans and smoked fish.

26. Health Eating behavior • The most common traditional African food they mentioned includes: • Fufu(made up of powdered yam, cocoyam, cassava or plantain) with soup (prepared with vegetables), • Plantain, Yam, Rice, • Banku(made up of corn dough), • Kenkey(also made up of corn dough but has a wrapper on it), • Eba(made from cassava flour) .

27. Healthy Eating Behavior • When a question “Do you check for the nutritional components of the food you eat?” • About 80% (n = 40) of the participants reported they do not check for the nutritional components because: • culturally most of the food they eat do not have food labels. • they have been eating the same food since they were born and therefore they see no reason to bother themselves to check for what the food contains

28. Healthy Eating Behaviors • A participant stated • “No I normally don’t check. This goes back to our culture because we don’t check for the nutritional components. We also don’t have the means to check for the nutritional component because there are no food labels so we don’t check it.” • About 60% (n = 30) indicated that they don’t know the nutritional components of the food they eat. • One participant stated: • “I don’t check for the nutritional components of the food I eat and I believe most black males don’t check for them because their parents introduced them to the food and they believe it has the requisite nutrients they need. I don’t know anything about nutritional components, I just eat what my mother introduced to me and I believe they are healthy food too”

29. Healthy Eating Behavior • Factors/Problems • The amount of time needed to prepare traditional food; • The cost of African food • Lack of diverse organic African traditional food

30. Poor eating habits • The participants identified the following poor eating habits: • The big portion size of food, • Carbohydrate (Starchy) food, • Fried food, • Failure to eat three square meals • Eating the same kind food consistently

31. Preventive care: Health screening • Majority, 54% (n = 27) of the participants stated that they don’t access preventive care such as health screenings for conditions as hypertension, hypercholesterolemia, cancer, and diabetes. • However, 42% (n = 21) indicated that they access preventive at least once a year and another 4% (n = 2) said they used to access it regularly when they had insurance • Interestingly, among those who access health screening regularly about 12% (n = 6) of them have known health problem(s) and that accounts for the reason why they go for checkup

32. Preventive care • Reasons for not accessing preventive care include: • The culture and the belief system of black males, • Lack of trust in the health care system, • The fear of knowing their health status, • Expensive health care and lack of insurance • Lack of time • Ignorance and problems of navigating American health care system • Use alternative medicine such as traditional/herbs • For instance, one participant has this to say about the black males’ culture and belief system, “Back in Africa we rely on traditional medicine and it is not our culture to go for checkup until we are sick”

33. Preventive care • One participant has this to say: • “Black males don’t go for checkup because at times we go to the hospitals and doctors don’t tell us the truth. You can’t trust the system. At times when you go for checkup some of the report you get from the doctors can be so disturbing and it can hasten your death. So if you don’t know your health status you will not think about anything. When it is time for you to die you just die and go away. Doctors’ reports other people have received have discouraged many people from going to checkup.”

34. Recommendations • Education • Majority 90% (n=45) recommended that black males should be reached with more educational programs • Educational programs should focus towards: • Importance of physical activity vis-à-vis physical inactivity • General benefits of physical activity • Emphasis on Physical activity as a preventive mechanism not as a cure • Time management • Promote sports like soccer • Group activity like marathon,

35. Education • Nutritional components of Blacks’ traditional food • The need to eat balanced diet • The need to reduce portion size • The need to reduce fried food • Importance preventive care

36. Approach • Cultural Competency • Majority of the participants (over 60%) indicated they can trust somebody who is culturally competent to implement educational programs in black community. • One participant stated: • “I should think somebody coming to the black community should be culturally competent to educate the black males. The person should know the culture of the person and not to look down on them and tell them what they want. Whoever is going to do it with people with different background should be culturally competent to be able to factor in the cultural issues of those people they are going to talk to. That will cause the people or allow the people or free the people to accept whatever he is going to tell them”

37. Limitations • Sampling bias • Diverse cultural background but treated as a monolithic whole • Not representative enough need to include other nationalities

38. Conclusion • Health professionals who have better understanding of black’s culture, their food and also lead healthy lifestyle themselves are the ones black males can trust for health promotion programs. • Healthy lifestyle promotion programs among black males should be based on their culture and not one-size-fits-all approach.

39. References • Marshall, S.J., et al., (2007). Race/ethnicity, social class, and leisure-time physical inactivity. Medicine and Science Sports and Exercise, 39: 44-51 • Gadino, J.D., Lepore, S.J., & Rassnick, S (2010). Relation of misperception of healthy weight to obesity in urban black men. Obesity 18, 1318–1322 • Bennett, G.G & Wolin, K.Y (2006). Satisfied or unaware? Racial differences in perceived weight status. International Journal of Behavioral Nutrition and Physical Activity 3:40 • Centers for Disease Control and Prevention (2012), Health, United States, 2011. Retrieved from http://www.cdc.gov/nchs/data/hus/hus11.pdf • Jones, D.A., et al., (1998). Moderate leisure-time physical activity: who is meeting the public health recommendations? A national cross-sectional study. Archives of Family Medicine, 7:285 - 9 • Jeffery, R.W., Wing, R.R., Sherwood, N.E et al. (2003) Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? American Journal of Clinical Nutrition 78:684-9. • Knowler, W.C., Barrett-Connor, E, Fowler SE et al., (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine 346:393-403. • Kung, H.C., Hoyert, D.L., Xu, J.Q.,& Murphy, S.L,(2008). Deaths: final data for 2005. National Vital Statistics Reports 2008;56(10). Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf • Morabia, A. & Costanza, M.C.(2004). Does walking 15 minutes per day keep the obesity epidemic away? Simulation of the efficacy of a population-wide campaign. American Journal of Public Health 94(3); 437 – 430 • Ries, L.A.G., Melbert, D., Krapcho, M., Stinchcomb, D.G., Howlader, N., Horner, M.J., et al. (2008), editors. SEER can­cer statistics review, 1975–2005 [Internet]. Bethesda, MD: National Cancer Institute; Available from: http://seer.cancer.gov/csr/1975_2005/index.html • Snell, P.G & Mitchell, J.H (1999). Physical inactivity: an easily modified risk factor? Circulation 100:2-4. • Stewart, K.J (2002). Exercise training and the cardiovascular consequences of type 2 diabetes and hypertension: plausible mechanisms for improving cardiovascular health. Journal of the American Medical Association; 288:1622-31. • U.S. Preventive Services Task Force (2008). Guide to clinical preventive services [Internet]. Rockville, MD: Agency for Healthcare Research and Quality. Available from: http://www.ahrq.gov/clinic/uspst­fix.htm • Wei, M., Kampert, J.B., Barlow CE et al. (1999). Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. Journal of the American Medical Association 282:1547-53. • Yusuf, S., Hawken, S., Ounpuu, S et al. (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364: 937-52