Using a household food inventory to assess the availability of traditional vegetables among resettled African refugees

A cross-sectional sequential explanatory mixed methods study was conducted among household food preparers to examine the association between home availability and consumption of traditional vegetables among resettled African refugees living in Queensland, Australia. Home availability of traditional African vegetables was associated with age, having a vegetable garden, employment status, and having a supermarket in the local neighborhood. Food preparers from homes with low vegetable availability were less likely to consume the recommended number of vegetable servings. Barriers faced in the food environment included language, lack of availability of traditional vegetables and lack of transport. All of these aspects contributed to the study findings that both individual and food environment characteristics may play a role in access to and availability of food and vegetable consumption of resettled refugees. Consumption of traditional foods among the resettled refugees continues post resettlemen

Enhancing Efficiency of the Nutrition Education for Utah Refugees

Refugees face many challenges related to obtaining and preparing adequate and culturally acceptable and desirable foods in their resettlement communities. These challenges often lead to risk of food insecurity and chronic diseases. A review of literature identified the existing delivery strategies and highlighted the need for nutrition education tailored to the refugees’ conditions. This study identified some of the barriers that refugees face, including the English language, transportation, finding items in grocery stores, availability of ingredients and equipment needed for cooking, affordability of food and budgeting. It also highlighted participants’ preference for having nutrition education. To overcome these challenges, the Create Better Health (CBH) curriculum was adapted to be culturally relevant for Somali refugees in Utah. The adapted curriculum was used to teach Somali refugees in Utah about nutrition. This nutrition education was delivered online during a 2-hour session once per week for 12 weeks by a Somali professional. Pre- and post-intervention survey data demonstrated that several nutrition-related behaviors improved among the participants after receiving the intervention. Although many nutrition-related behaviors improved, most of the participants still were not meeting recommended levels of fruits and vegetables and most of the other indicators of the five domains

Integration of Nutrition Education Classes into English as Second Language Classes for Refugees

Recently resettled refugees are at high risk for food insecurity and its health consequences. This observational study evaluated the effectiveness of integrating nutrition lessons into English as a Second Language (ESL) classes at a work-site training center for refugees. The lessons focused on making healthy choices with a limited budget. Through the assistance of ESL teachers, nutrition educator assistants (NEAs) from the Supplemental Nutrition Assistance Program (SNAP) taught nutrition lessons to 98 refugees from 17 different countries for 12 weeks. Food frequency questionnaires (FFQ) for 49 participants were matched pre and post 12 weeks of class. A Wilcoxon test was used to determine differences in intake of fruits, vegetables, meats, whole grains, refined grains, dairy, sugar, fat, and alcohol. No significant difference was found between median intake for fruit, vegetables, whole grains, refined grains, sugar, and alcohol. The median intake of meat (2.5 to 1 servings per day, p=0.006), dairy (2.5 to 1 servings per day, p=0.013), and fat (1 to 0.7 servings per day, p=0.01) significantly decreased. Food purchase receipts were gathered to evaluate feasibility of assessing food expenditures in this population. Fifty percent (49/98) of the refugees completed all 12 lessons. Receipts were collected from 59 different participants and 93% (55/59) of the participants had receipts that used SNAP funds. Receipts reflected food purchased from supermarkets and ethnic food stores by 92% (54/59) and 59% (35/59) of the participants. The model of delivering nutrition education through ESL classes addressed barriers refugees face. Further research is needed to develop culturally sensitive nutrition education and validated assessment tools for refugees

From the Democratic Republic of the Congo to North Carolina: An Examination of Chronic Disease Risk

Refugees from the Democratic Republic of the Congo are one of the largest refugee groups globally and in the US, however, there is limited research with this group. Therefore, objectives of this study were to examine: 1) obesity and hypertension rates, 2) diet and lifestyle behavior changes, and 3) diet, lifestyle and social factors of obesity and hypertension risk of Congolese refugees in the US. This cross-sectional data collection utilized a survey developed specifically for this project. Clinical and anthropometric measures including height, weight and blood pressure were also obtained. Data analysis included descriptive and regression analysis. Participants (n=48, \u3e18 years, 55% female) reported consumption of a traditional diet with an emphasis on starchy foods, dark leafy greens, legumes, fish and fruit. Adverse dietary changes and reductions in physical activity were reported. Of the sample 63% were overweight or obese and 91% exhibited elevated blood pressure. Sociodemographic factors including age, sex, and changes to lifestyle (diet, physical activity) were not significantly associated with BMI or diastolic or systolic blood pressure. Findings in this study reveal both lifestyle and clinical risk factors associated with chronic disease as well as potential health care and health literacy barriers. Results from this study may be utilized by practitioners and/or researchers to tailor culturally appropriate future health promotion and/or care to address and reduce health disparities commonly experienced by African refugees

Conceptualizing and Measuring Food Security Among Resettled Refugees Living in the United States

Food security research with resettled refugees in the United States and other Global North countries has found alarmingly high rates of food insecurity, up to 85% of surveyed households. This is well above the current US average of 12.7%. However, the most common survey tool used to measure food security status in the US, the US Household Food Security Survey Module (HFSSM), has not been sufficiently validated for resettled refugee populations, leading to the risk that the HFSSM may actually be underestimating the prevalence of food insecurity among resettled refugees in the US. Though research has attempted to establish validity of the HFSSM for resettled refugees through statistical associations with other risk factors for food insecurity, no efforts have been made to first explore and establish the content validity of the HFSSM for measuring food security among resettled refugees. Content validity is an essential component of construct validity. It first requires a qualitative theoretical foundation for demonstrating the relationships of the test contents to the underlying construct (ie food security) that the test intends to measure. Our research explores these theoretical relationships through a qualitative grounded study of food insecurity and food management experiences described by resettled refugees living in Vermont. Dr. Linda Berlin and I conducted 5 semi-structured focus groups in the summer and fall of 2015 with Bhutanese (2 groups), Somali Bantu (1 group), and Iraqi (2 groups) resettled refugees. During the focus groups, we inquired about food management practices under typical circumstances and under circumstances of limited household resources, as well as difficulties participants have faced in these processes. Additionally, I conducted 18 semi-structured interviews and 1 focus group in the same time frame with service providers who have worked with resettled refugees in capacities primarily related to food, health, and household resources. These interviews provided additional data about context, household food management practices among clients, and triangulating data for the focus groups. A Grounded Theory analysis of the focus group data yielded 5 major emergent themes: 1) Past food insecurity experiences of resettled refugee participants exerted significant influence on the subjective perception of current food insecurity. 2) Barriers other than just financial resources restricted participants’ food security, especially for recently resettled refugees. 3) Preferred foods differed significantly between generations within households. 4) Common elements of quality and quantity included in the definition and measurement of food security did not translate into the languages or experiences of food insecurity among participants. 5) Strategic and adaptive food management practices prevailed among participants, highlighting the temporality and ambiguity of food security concepts. These themes present potential problems of content validity for every HFSSM question. They also reveal the importance of food security concepts that are not covered by the HFSSM, including elements of nutritional adequacy of food, food safety, social acceptability of food and of means of acquiring food, short and long term certainty of food access, and food utilization. I conclude by discussing implications of our findings for service providers and local governments in Vermont who seek to better serve resettled refugee and other New American populations

ADAPTABILITY IN A BHUTANESE REFUGEE COMMUNITY: NAVIGATING INTEGRATION AND THE IMPACTS ON NUTRITIONAL HEALTH AFTER U.S. RESETTLEMENT

Increasing rates of overweight, obesity, and related metabolic diseases documented among refugee communities across the United States necessitate greater attention to how processes of integration impact refugee health. These nutritional health trends (e.g., increasing rates of obesity) suggest potential disconnects between refugees\u27 past environments and their conditions after re-settlement, which may contribute to adverse changes in energy balance (diet and exercise). While Bhutanese refugees were among the largest refugee groups entering the US during the five years leading up to this research, very few studies have examined how they have responded to integration and the impact of this transition on their health. Grounded in human adaptability and political economic theories, and adopting a biocultural approach, this dissertation investigates how Bhutanese refugees in “Prospect City” (pseudonym) negotiate changing and unfamiliar structural and sociocultural conditions after resettlement and the consequences for energy balance and nutritional status. The results reveal high rates of overweight and obesity compared to US averages. Age and caste related differences in nutritional status were also found. High rates of overweight and obesity corresponded with an energy imbalance due to over consumption of energy dense traditional foods and limited understanding of the importance of regular exercise. Over consumption of energy dense traditional foods stemmed from several interrelated factors: the abundance of foods in the US, prior experiences with food deprivation, a history of political exile that reinforced desires to preserve cultural food preferences, and joint family efforts to accommodate work-related time constraints by increasing food production and availability. Decreases in exercise appeared to stem from more sedentary lifestyles in the US as a result of work environments and available transportation, coupled with a lack of health knowledge regarding health benefits of physical activity. This dissertation’s findings are being reported to Prospect City’s Bhutanese Community Organization to help develop strategies for improving nutritional health in the community

A Participatory, Transformational Approach to Urban Food Security Research

abstract: Contemporary urban food security in the US is influenced by complex, multidimensional, and multi-scale factors. However, most assessment methods and intervention efforts in food security research are: 1) narrowly focused on environmental factors (i.e. the presence or absence of quality food outlets), 2) divorced from the human dimension and, 3) ultimately disempower communities to affect change at the local level. New approaches are needed to capture the lived experiences and unique perspectives of people potentially most vulnerable to food insecurity, while also empowering people to become change agents in their lives and in the wider community. This thesis argues that sustainability problem solving frameworks such as transformational sustainability research (TSR), and community-based participatory research (CBPR) provide promising bases from which to address these deficiencies. Through interactive workshops with youth in Canyon Corridor, a neighborhood in Phoenix, Arizona, I demonstrate the potential of concept mapping, sketch mapping, and intervention mapping methods that prioritize participation and co-production of knowledge to: 1) better understand the contextual, community-identified factors that contribute to food security or food insecurity, 2) identify and adapt interventions for the local context and, 3) promote community agency and action. Workshop outcomes suggest the relevance of these frameworks and methods, and the potential for more people- and place-based approaches to food security research.Dissertation/ThesisM.A. Sustainability 201

The Potential of Refugee Seed Systems to Promote Contemporary Adaptation in Traditional Crops: A Case Study of African Maize in New England

There are many mechanisms by which landraces evolve in a contemporary agricultural setting; however, the influence of forced human migration on landrace redistribution and evolution has received little attention in comparison to the stochastic effects of drift, mutation, and gene flow in the centers of origin. Although the seed systems of forcedly-displaced people remain poorly understood, evidence suggests that refugees often continue to grow traditional crops after resettlement. From a genetics perspective, the crops that are transported to highly disparate environments provide an interesting opportunity to study adaptation. This research addresses how forced human migration has impacted contemporary landrace evolution in a specific case study of African maize being grown by new American farmers in Vermont and New Hampshire. We utilize a whole genome sequencing approach and methods in population genetics to investigate the origin, genetic diversity, and potential adaptation in these crops. Our findings suggest that maize grown by new American farmers in the study does in fact originate from Africa and that each farmer is growing a genetically distinct crop, although we are unable to link origin of the crop to immigration history of the farmer. We also found that genetic diversity is remarkably high across all samples, even compared to landrace panels assembled from the U.S. National Plant Germplasm System. Lastly, we found numerous signatures of positive selection across all farmer samples, and through Gene Ontology analysis, we identified two significant biological processes enriched by positive selection, (1) cinnamoyl-CoA reductase biosynthesis and (2) glutathione synthase activity, that may indicate recent adaptation and be correlated to increased cold tolerance. Overall, through this case study we show a specific example of how forced human migration has affected landrace redistribution, subsequent evolution, and potential adaptation to a disparate environment. We believe these findings hold interesting implications towards agrobiodiversity conservation and suggest the potential of refugee seed systems to promote contemporary adaptation in traditional crops