Beverage Consumption Among Low-Income Hispanics with Uncontrolled Type 2 Diabetes

This study sought to describe beverage consumption, caloric contribution of beverages to total caloric intake, and associations between beverage consumption and metabolic factors among a sample of low-income Hispanics participating in a trial of a diabetes self-management intervention. Findings: Treatment strategies to improve glucose control and reduce diabetes complications among Hispanics are needed. There is a high consumption of calories from beverages, accounting for one-fifth of total caloric intake, among this high-risk Hispanic population. Milk, juices, fruit drinks and regular soda are particular sources of calories. Beverage consumption is associated with metabolic markers, including HbA1c, cholesterol, blood pressure, BMI and waist circumference, and may thus increase risk for diabetic and cardiovascular complications in this population. Beverage consumption among low-income Hispanics warrants further clinical and research attention, including development of interventions that target all liquid calories, not just sugar-sweetened beverages. Targeting beverage consumption through simple messages that are in line with the literacy challenges posed by this population may be feasible. The vast benefit of clarifying a single food group that can be modified to reduce risk factors of diabetes and obesity in this population cannot be overstated

Obesity Prevalence, Weight-Related Beliefs and Behaviors among Low-Income Ethnically Diverse National Job Corps Students

The obesity rates of Job Corps students, a predominantly ethnic minority and low income group of youth, are unknown. The purpose of this project was to examine obesity rates among these youth as well as their weight-related perceptions and behavior. First, medical charts (N=641) of all Job Corps students (ages 16-25) who were enrolled in the program in the past year were examined for height and weight. In the second phase of the study, 344 Job Corp students were recruited and information on weight perceptions, knowledge of obesity consequences, and weight loss behavior were examined. Almost half of the participants were overweight or obese. Overweight males were less likely to perceive themselves as being overweight than females. The majority of participants were aware of obesity-related health consequences but of those with past weight loss attempts, only 13% reported using both exercise and diet. High levels of overweight and obesity among Job Corps students are likely to impact employment and career goals. Evidence-based obesity interventions for Job Corps students are needed

Association between food insecurity and CVD risk factors is moderated by intake of fruits and vegetables in Latinos

Background: Food insecurity has been consistently associated with CVD risk factors (i.e., obesity, type 2 diabetes, hypertension and hypercholesterolemia). Consumption of fruits and vegetables may reduce CVD risk factors among food insecure Latinos. Objective: To examine the potential moderating effect of fruit and vegetable intake in the association between food insecurity and CVD risk factors in a sample of Latino men and women in the northeast U.S. Methods: A representative community sample of Latino individuals was recruited from a community health center in Lawrence, MA. Food insecurity was measured with the 6-item USDA Household Food Security Scale. Fruit and vegetable intake, was measured with Block’s Fruit and Vegetable Screener. CVD risk factors examined included: obesity assessed by body mass index (BMI), and diagnoses of type 2 diabetes, hypertension and hyperlipidemia abstracted from electronic health records. Covariates considered included: age, gender, education and BMI (except in the obesity model). Statistical analyses included multivariable logistic regression testing for interaction between food insecurity and diet. Results: Overall, 51% of the sample were women and most self-identified as Dominicans (73%). Thirty-one percent of the sample experienced food insecurity and 79% consumed less than 5 servings of fruits and vegetables per day. Twenty percent of food secure participants and 23% of food insecure individuals consumed 5 servings or more of fruits and vegetables per day (p=0.439). In adjusted models, food insecurity was positively associated with type 2 diabetes in individuals consuming less than 5 servings of fruits and vegetables per day (OR=1.79; 95% CI=1.11–2.89) but not in individuals consuming 5 servings or more of fruits and vegetables per day. Interaction analyses showed that these estimates were significantly different from each other (p=0.04). Conclusion: Among those who were food insecure, low consumption of fruits and vegetables, was associated with type 2 diabetes in this Latino sample. Studies are needed to confirm our findings. Further, longitudinal studies are needed to understand a potential causal relationship. Interventions to increase availability of fruits and vegetables among food insecure Latinos may help alleviate diabetes disparities in this vulnerable group

Association between food insecurity and CVD risk factors is moderated by intake of fruits and vegetables in Latinos

Background: Food insecurity has been consistently associated with CVD risk factors (i.e., obesity, type 2 diabetes, hypertension and hypercholesterolemia). Consumption of fruits and vegetables may reduce CVD risk factors among food insecure Latinos. Objective: To examine the potential moderating effect of fruit and vegetable intake in the association between food insecurity and CVD risk factors in a sample of Latino men and women in the northeast U.S. Methods: A representative community sample of Latino individuals was recruited from a community health center in Lawrence, MA. Food insecurity was measured with the 6-item USDA Household Food Security Scale. Fruit and vegetable intake, was measured with Block’s Fruit and Vegetable Screener. CVD risk factors examined included: obesity assessed by body mass index (BMI), and diagnoses of type 2 diabetes, hypertension and hyperlipidemia abstracted from electronic health records. Covariates considered included: age, gender, education and BMI (except in the obesity model). Statistical analyses included multivariable logistic regression testing for interaction between food insecurity and diet. Results: Overall, 51% of the sample were women and most self-identified as Dominicans (73%). Thirty-one percent of the sample experienced food insecurity and 79% consumed less than 5 servings of fruits and vegetables per day. Twenty percent of food secure participants and 23% of food insecure individuals consumed 5 servings or more of fruits and vegetables per day (p=0.439). In adjusted models, food insecurity was positively associated with type 2 diabetes in individuals consuming less than 5 servings of fruits and vegetables per day (OR=1.79; 95% CI=1.11–2.89) but not in individuals consuming 5 servings or more of fruits and vegetables per day. Interaction analyses showed that these estimates were significantly different from each other (p=0.04). Conclusion: Among those who were food insecure, low consumption of fruits and vegetables, was associated with type 2 diabetes in this Latino sample. Studies are needed to confirm our findings. Further, longitudinal studies are needed to understand a potential causal relationship. Interventions to increase availability of fruits and vegetables among food insecure Latinos may help alleviate diabetes disparities in this vulnerable group

Women in Control: Pioneering Diabetes Self-Management Medical Group Visits in the Virtual World

Background: The current state of diabetes self-management (DSM) education and support for diabetic patients is inadequate, especially for minority women who experience disproportionately high rates of diabetes mellitus (DM) in the US. While DSM education and support enables individuals with diabetes to make positive lifestyle choices and achieve clinical goals, this type of support is difficult to deliver in medical practice settings. Virtual reality can assist DM patients and their clinical teams by providing effective educational tools in an engaging, learner-centered environment that fosters self-efficacy and skill proficiency. Methods: Our prior research demonstrated that virtual worlds are suitable for supporting DSM education. Building upon this success, we are now investigating whether DSM virtual world medical group visits lead to similarly effective health and educational outcomes compared to face-to-face medical group visits. Currently in year one of a five year randomized controlled trial, we aim to compare the effectiveness of a virtual world DSM medical group visit format versus a face-to-face DSM medical group visit format to increase physical activity and improve glucose control (HbA1c) among Black/African American and Hispanic women with uncontrolled DM. We will also conduct a qualitative study of participant engagement with the virtual world platform to characterize learners’ interactions with the technology and assess its correlation with DSM behaviors and diabetes control. Discussion: Novel methods to promote diabetes self-management are critically needed, and the use of virtual world technology to conduct medical group visits offers a unique approach to such issue. If successful, our intervention will increase access to culturally-sensitive diabetes care and improve patient engagement in online DSM learning, leading to higher uptake of DSM behaviors and better diabetes control. Importantly, the program can be easily expanded to other chronic disease areas and scaled for widespread use

Do U.S. adults living in food insecure households experience poorer cardiovascular health?

Background Twelve percent of U.S. adults live in food insecure households, putting them at risk for adverse health outcomes. Relationships between food insecurity and cardiovascular disease (CVD) risk factors range from well-established to inconsistent and understudied. Food insecurity has been positively associated with poor glycemic control, tobacco use, and poor diet. The link with unhealthy body mass index (BMI) is only observed among women. Inconsistent evidence of relationships with hypertension and dyslipidemia has been found and literature examining physical activity is sparse. The relationships between food insecurity and overall cardiovascular health metrics have not been studied in a nationally representative sample of U.S. adults. Objective To quantify the extent to which food insecurity in U.S. adults is associated with poorer cardiovascular health, as measured by the Life Simple 7 metrics, and to assess gender differences in these associations. Methods This was a cross-sectional analysis of 1,446 National Health and Nutrition Examination Survey participants (2011-2012) aged \u3e20 years. The United States Department of Agriculture Adult Food Security Module 10-item questionnaire assessed food insecurity status. Affirmative responses were summed and dichotomized as food secure (responses) or food insecure (\u3e3). An ideal cardiovascular health score was generated from the sum of American Heart Association’s (AHA) Life’s Simple 7 metrics components achieved. The metrics included three health factors (blood glucose, cholesterol, and blood pressure) and four health behaviors (non-smoking, physical activity, healthy BMI, and healthy diet) as measured by laboratory values, anthropometric measures, self-reported questionnaires, and dietary recalls. Multiple linear and logistic regressions determined the associations between food insecurity and overall ideal cardiovascular health, defined as meeting all of the AHA Life Simple 7 metrics, and individual cardiovascular health components, respectively. The interaction between food insecurity and gender and ideal cardiovascular health was tested. Results No U.S. adults met all ideal cardiovascular health components. The 15.8% of adults living in food insecure households achieved a lower ideal cardiovascular health score (adjusted β coefficient: -0.27; 95% Confidence Interval (CI): [-0.50 to -0.04]) than adults living in food secure households. Tests for gender interaction were non-significant. In analyses assessing individual cardiovascular health components, only smoking was significant; adults living in food insecure households were half as likely to be non-smokers or recent quitters relative to their food secure counterparts (adjusted Odds Ratio 0.51; 95% CI: [0.31-0.81]). Conclusion Adults living in food insecure households achieved a lower ideal cardiovascular health score, which was driven by its association with smoking status. In addition to primary and secondary prevention, primordial prevention and cardiovascular health promotion approaches are necessary to reduce CVD burden. Effective policies and health behavior interventions are prudent, specifically to improve diet quality among all U.S. adults and tobacco cessation within food insecure populations

Sedentary Behavior and Cardiovascular Disease Risk Factors among Latino Adults

Background: Compared to other racial/ethnic subgroups in the U.S., Latinos experience increased rates of cardiovascular disease (CVD) and CVD risk factors such as hypertension, inactivity, and diabetes. Sedentary behavior has also been defined as an additional risk factor for CVD, independent of physical activity participation. However, while sedentary behavior has been associated with increased risk for CVD among primarily White samples, previous studies in Latinos have shown mixed results. Purpose: To explore the relationships between sedentary behavior and CVD risk factors, including BMI, waist circumference, blood pressure, physical activity, dyslipidemia, and diabetes, among a sample of Latino adults. Methods: Cross-sectional secondary analysis of the Latino Health and Well-Being Study. Latino adults were recruited from the Greater Lawrence Family Health Center (N= 602). Surveys of sedentary behavior and physical activity were verbally administered. Anthropometric measurements included weight, height, waist circumference and blood pressure. Medical record data for diabetes and dyslipidemia were obtained. Results: This study showed that individuals in older age strata, females, and individuals with a less than high school education were more sedentary than their younger, male, and more educated counter parts. Sedentary behavior was positively associated with BMI (β = .164, p \u3c .001) and waist circumference (β = .162, p \u3c .001). There were no associations between sedentary behavior and blood pressure, high cholesterol, diabetes, or physical activity. Conclusions: There is growing evidence that sedentary behavior may have its own unique set of metabolic consequences. However, the consequences of sedentary behavior may not be uniform across subgroups. Evaluating the relationship between sedentary behavior and CVD risk is critical in identifying behaviors, like sedentariness, that contribute to the development of CVD

Social support and strain and emotional distress among Latinos in the northeastern United States

BACKGROUND: US Latinos report high levels of emotional distress. Having positive familial and friend social support buffers emotional distress among US Latinos, but thus far no research has been done on social support and ataque de nervios in that population, or on social strain and emotional distress. METHODS: This paper assesses social support and strain across three relationship types (partner, family, and friends) with three measures of emotional distress (depression, anxiety, and ataque de nervios). The sample for partner, family, and friend support included 508 Latino adults 21 and older. Multivariate logistic regression models were used to assess the association of social support and strain with each outcome. RESULTS: As all social support types increased, the odds of emotional distress symptoms decreased. Conversely, as each unit of partner and family strain increased, the odds of emotional distress symptoms increased. Increased friend strain was associated with greater odds of depressive and anxiety symptoms only. CONCLUSION: Social support in all three network types (partner, family, and friend) was associated with a decrease in the odds of emotional distress, assessed as symptoms of depression, anxiety, and ataque de nervios

Emotional Eating is Associated with Intake of Energy-dense Foods in Latinos

Background: Latinos experience profound health disparities in diet-related chronic conditions. Emotional eating (EE) has been positively associated with such conditions, however, little is known about the relationship between EE and energy-dense food intake that may influence risk for developing these conditions. Objective: To examine associations between EE and energy-dense food intake in Latino men and women. Methods: Latino individuals were recruited from a community health center in Lawrence, MA. Participants completed standardized assessments. EE was measured with the Three Factor Eating Behavior Questionnaire R18-V2. Dietary intake was measured with a culturally tailored Food Frequency Questionnaire. Energy-dense food groups defined as food groups exceeding 225calories per 100 grams were identified. Covariates considered in this analysis included: age, sex, education, employment status and BMI. Statistical analysis consisted of multivariable logistic regression. Results: A total of 201 participants were included in this analysis (53.7% female, 68.1% Dominicans). After adjusting for covariates, EE was significantly associated with high intake of sweet and/or fatty foods, namely dairy desserts (i.e., ice-cream, sherbet and frozen yogurt) (OR=1.55; 95%CI=1.08, 2.21; p=0.017), oleaginous fruits (i.e., nuts and seeds) (OR=1.44; 95%CI=1.01, 2.05; p=0.046) and baked goods (i.e., cakes, cookies, pies, doughnuts and muffins) (OR=1.54; 95%CI=1.07, 2.20; p=0.020). Conclusion: EE was positively associated with consumption of energy-dense foods in this Latino sample. Future studies should examine longitudinal associations between EE, intake of energy-dense foods and risk of chronic health conditions. Understanding these associations can unveil potential intervention targets for Latinos at high risk of diet-related chronic health conditions. Also presented at the Experimental Biology 2017 Annual Conference, Chicago, IL

Inclusion of evidence-based healthy eating policies in Community Health Improvement Plans: Findings from a national probability survey of US local health departments

Introduction: Evidence-based healthy eating (HE) policies can increase opportunities to engage in a healthy diet. The adoption of evidence-based policies into practice is limited and no study reports the status of HE policies nationally. Community Health Improvement Plans (CHIPs) strategically address health priorities, steer evidence-based strategy selection and implementation, and require collaboration. Local health departments (LHDs) are often key stakeholders. We aimed to determine the proportion of LHDs with a CHIP having evidence-based HE policies. Methods:A national probability survey of US LHDs serving populations of Results: 44.1% (95%CI: 34.7-54.0%) of US LHDs with a CHIP reported at least one evidence-based HE policy. The proportion of specific HE policies ranged from 28.9% for school district nutrition/procurement/vending policies to 1.3% for sugar-sweetened beverage tax. Conclusions: Increased implementation of evidence-based HE policy approaches are needed within communities