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

1. 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

2. 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.

3. 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

4. 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

5. 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

6. Results What is diabetes? • “Terrible illness” • “Incurable illness” (?) • “It is easy to get” • “It is very dangerous” • “Diabetes can cause death”

7. 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

8. 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

9. 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

10. 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)

11. 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)

12. 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”

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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