Strategies to establish and maintain trust when working in immigrant communities.

The nursing profession has historically advocated a strong commitment to social justice. As immigration issues have become increasingly politicized, nurses are being called upon to integrate principles of social justice when caring for immigrant populations. Nurse researchers have a particular challenge in winning and maintaining trust in immigrant communities. Data from several studies suggest that erosion of trust in the health care system, due to fears of detention and deportation, is resulting in adverse health outcomes among immigrants. The purpose of this article is to discuss a variety of strategies to establish and maintain trust in immigrant communities. These strategies were developed to maintain an academic-community partnership focused around obesity prevention among Mexican immigrant families. Strategies included: (a) Conceptualize trust as a dynamic continuum; (b) recognize the scope and impact of the stressors; (c) separate fact versus fiction; (d) identify deportation-related stressors and community responses; (e) manage trust and mistrust issues; (f) build bridges; and (g) establish a positive presence. Nurses are well poised to intervene to repair the damaged trust between immigrant communities and the health care system, using community-based participatory methods.

The Impact of Social Determinants of Health on the Diagnosis of Type 2 Diabetes Mellitus (T2DM) Among Asian Indians (AIs) in New Jersey: A Secondary Analysis of the BRFSS Survey From 2013 to 2017.

INTRODUCTION: Asian Indians (AIs), the second largest immigrant population in the United States, are disproportionately affected by type 2 diabetes mellitus (T2DM) at a lower age and body mass index (BMI). The purpose of this study was to examine the relationship between social determinants of health (SDOH) and the diagnosis of T2DM among AIs in New Jersey (NJ). METHODOLOGY: This was a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) in NJ from 2013 to 2017. Statistical analyses included descriptive and inferential statistics. RESULTS: Among 1,132 AIs, 16% had T2DM or prediabetes (PDM) and 69.2% were overweight or obese. The risk for T2DM was significantly associated with internet use, older age, having medical check-ups, and having a personal doctor (p ≤ .05). DISCUSSION: These findings inform culturally congruent care by underscoring the importance of weight management, earlier screening, and provider involvement in diabetes prevention strategies for AIs.

Hispanic women and physical activity: an integrative review.

Hispanics/Latinos represent the largest, fastest growing, and youngest minority group in the United States. Although data suggest that most Hispanics/Latinos in the United States tend to be in better health than non-Hispanic Whites (the so-called "Hispanic Paradox"), these relative advantages in health status decrease markedly with the number of years of residence in the United States. Hispanic women or Latinas, in general, report less than recommended levels of physical activity (PA), putting them at greater risk for the development of cardiovascular disease (CVD) and other chronic illnesses associated with sedentary lifestyles.

Use of Adolescent "Community Researchers" to Address Obesity Among Mexican Immigrant Families.

Background: Mexican-American immigrants have a disparate prevalence of overweight/obesity, and obesogenic illness. One approach is to train immigrant adolescents as "community researchers." Aims: (1) Design a program to train community researchers to address obesity among Mexican immigrant families and (2) identify the key components of a successful program. Methods: The content included an overview of community research/citizen science; obesity and food insecurity; study design and data collection and analysis for nutrition and physical activity. The students concluded by analyzing the results of group concept mapping (GCM) activities. Results: Post-session class discussions reflected an increased understanding of weekly topics. Analysis of GCM data suggests that members of the Mexican immigrant community may use emotional eating as a way to manage structural stigma, eventually leading to truncal obesity, T2DM and increased cardiovascular risk. Conclusions: Adolescents of Mexican heritage can have a major impact in promoting healthy lifestyles in their communities.

Methods of training lay individuals in the use of evidence-based services for the management of mental and behavioral health disorders: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to describe how lay individuals have been trained in evidence-based therapies to manage mental and behavioral health disorders as defined by the International Classification of Diseases, version 11. INTRODUCTION: Health service delivery by lay individuals is common in under-resourced areas. Prior systematic reviews have examined the characteristics of lay workers, the types of services they provide, and the efficacy of their services. Our goal is to focus on the methods of training. INCLUSION CRITERIA: Participants will include lay individuals who provide services to community residents; we will exclude individuals with formal training in health service delivery. We will consider for inclusion studies that include training programs for evidence-based therapies delivered to individuals with mental and behavioral health disorders, and will exclude those involving pharmacology or focusing on cognitive defects. METHODS: We conducted a preliminary search of the literature on PubMed and CINAHL for articles related to the inclusion criteria and published in the past 10  years. Scanning the title, abstract, keywords, and MeSH terms, we generated comprehensive lists of terms and added search terms from 6 recent systematic reviews. Our search strategy will include MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and gray literature. We will also consult with experts and review the reference lists of articles selected for final inclusion. Articles published in English or Spanish between 1960 and the present will be considered for inclusion. Data analysis will use a mix of descriptive and qualitative approaches, with data presented graphically or in diagrammatic or tabular format.

Differences in Community Members' and Academics' Perceptions of Factors Contributing to Food Insecurity and Obesity among Mexican Immigrants: An Application of Concept Mapping.

Community-based participatory research has been identified as an approach to research where community members, organizational representatives, and academic researchers all participate in the research process. As research partners, community members and academics may find some common ground in identification of problems, but frequently differ in their perception of the cause of those problems and struggle with arriving at a "shared interpretation" of the data. Failure to account for these differences ultimately leads to issues with the design of interventions. Group concept mapping is a rigorous mixed-methods approach that lends itself well to the conduct of community-based participatory research and the results can be used to systematically compare the conceptualized models of different groups of participants. Building from a previous study, where group concept mapping was used to describe the factors felt to contribute to weight gain and obesity among Mexican immigrant families, this study described and statistically evaluated the different conceptualizations between community members and academicians. Using a Procrustean comparison approach and permutation strategy, we assessed the spatial correspondence of concept maps generated by the two independent community members and academic groups. The results indicated the conceptualized patterns, represented by the two multidimensional scaling configurations (i.e., concept maps) produced by community and academic groups, were more similar than expected by chance, although meaningful differences existed. We describe how these differences in perspective have important implications for the cooperative development of an intervention addressing the multiple factors related to the perceived causes of obesity.

The Impact of Childhood Growth Stunting and Post-Migration Dysbiosis on the Development of Metabolic Syndrome Among Indigenous Immigrant Mexican Women.

While weight gain is common following migration to a new country and Mexican Americans have a disparate prevalence of overweight and obesity. In particular, Mexican American women have one of the world's highest rates of Metabolic Syndrome (MetS), characterized by abdominal obesity, insulin resistance, hypertension, and dyslipidemia, all of which increase the risk for atherosclerotic cardiovascular disease (CVD). Although the etiology of this dilemma is not well understood, using the framework of allostatic load (AL), we posit that exposure to multiple physiologic, psychosocial and environmental stressors over the course of the lifespan may contribute to an increased risk of MetS among indigenous Mexican immigrant women. Two such frequently overlooked stressors are: 1) a history of childhood growth stunting (CGS) and 2) dietary changes post migration that result in decreased diversity of the gut microbiome (dysbiosis). To date, little is known about how migration experiences differentially affect the relationship between CGS and MetS in adulthood. The purpose of this theoretical article is to present a proposed model of how early life stressors (ELS), specifically CGS, may interact with insalubrious aspects of the immigration experience to promote an increased risk for MetS among indigenous Mexican immigrant women. This model may be used in a bi-national effort to guide intervention efforts to decrease CGS in Mexico and to prevent, monitor or delay the components of MetS post migration in the US.

Using Concept Mapping within a Community-Academic Partnership to Examine Obesity among Mexican Immigrants.

Background: Weight gain is common following migration to a new country. Mexican immigrants have a disparate prevalence of overweight/obesity and food insecurity. Social stressors, such as unemployment, discrimination, and the threat of deportation, may fuel both food insecurity and weight gain in this population. Objectives: We sought to (1) examine community-defined causes and correlates of obesity among Mexican-Americans; (2) determine how current social stressors, policies, and programs impact food insecurity and obesity; and (3) identify community-defined priorities for preventive interventions. Methods: Group concept mapping (GCM) was used in a community-academic partnership (CAP) to describe the factors contributing to weight gain and obesity among Mexican immigrant families. Activities included community brainstorming, sorting and rating, multivariate statistical analysis, and community interpretation of results. Results: Eighty statements were generated in the brainstorming sessions. These statements were sorted into nine clusters, which were organized into three regions: (1) intrapersonal factors; (2) community-level factors; and (3) social policy-related barriers. Statements reflecting the impact of immigration-related stressors were found in all three regions, addressing participants' fears of deportation, and the prioritization of resources away from healthy eating, resulting in food insecurity. Community members identified five priority areas for intervention planning: (1) lack of exercise; (2) lack of knowledge of a healthy diet; (3) expense of healthy foods; (4) "junk" food; and (5) stress management. Conclusions: Results suggest high levels of social stress are contributing to food insecurity and obesity among Mexican immigrant families. Areas identified for intervention planning reflect the need for a multifaceted approach toward obesity prevention.

A comparison of field methods to assess body composition in a diverse group of sedentary women.

Accurate assessment of body composition is essential in the evaluation of obesity. While laboratory methods are commonly used to assess fat mass, field measures (e.g., skinfold thickness [SKF] and bioelectrical impedance [BIA]) may be more practical for screening large numbers of individuals in intervention studies. In this study, a correlational design was used among 46 racially and ethnically diverse, sedentary women (mean age = 25.73 years) to (a) compare the percentage of body fat as determined by SKF and the upper body BIA and (b) examine the effects of body mass index (BMI), racial/ethnic background, age, and stage of the menstrual cycle on differences in the estimated percentage of body fat obtained using the SKF and BIA. Overall, a significant correlation between SKF and BIA (r = .98, p < .001) was found, with similar findings among Black, Hispanic and White non-Hispanic women. The mean differences between BIA and SKF were not significantly correlated with BMI, age, race/ethnicity or stage of the menstrual cycle. Data from this study suggest that BIA showed similar body fat prediction values compared with SKF and may be a viable alternative to SKF among diverse groups of healthy women. Additional testing and comparison of these field methods with the laboratory methods of hydro-densitometry or dual energy X-ray absorptiometry is recommended to further determine whether BIA devices can be routinely recommended as an alternative to the SKF.

Cultural beliefs and attitudes of Black and Hispanic college-age women toward exercise.

The purpose of this study was to examine the cultural knowledge that informs exercise behaviors among Black and Hispanic college-age women. Focus groups were conducted among 26 Black or Hispanic female college students. Questions were based on constructs from social cognitive theory. Data were analyzed using content analysis. Latinas were found to be more likely to view vigorous exercise as "unfeminine" and cited family responsibilities as barriers. Black women enjoyed the competition and camaraderie of exercise, but felt pressure to conform to White standards of beauty. There appear to be distinct differences in the cultural beliefs that inform exercise behaviors among these women.

Outcomes of a Culturally Tailored Partially Randomized Patient Preference Controlled Trial to Increase Physical Activity Among Low-Income Immigrant Latinas.

INTRODUCTION: Almost half (47.8%) of adult Latinas report they never engage in any leisure time physical activity (PA) which is an independent risk factor for the development of cardiovascular disease and other chronic illnesses. There is a pressing need to develop and test PA interventions among Latinas. Therefore, the purpose of this study was to evaluate the effects of a PA Intervention for Latinas, a culturally tailored, promotora-facilitated 12-week PA intervention. It was hypothesized that at the completion of the intervention, participants would have (a) higher daily PA levels; (b) improved aerobic fitness, muscle strength, and flexibility; and (c) lower body mass index and percentage of body fat. METHODOLOGY: A partially randomized patient preference trial design with lag group was used to test the intervention. Participants ( N = 76) attended twice weekly, low-impact aerobic/Latin dance PA classes taught by laywomen trained as promotoras. RESULTS: Significant improvements were measured in aerobic fitness, muscle strength and flexibility, and daily PA levels ( p < .001). Sixty percent of the participants attended at least 60% of the PA sessions. DISCUSSION: Findings suggest laywomen trained as promotoras can successfully facilitate the delivery of an intervention to increase PA among immigrant Latinas.

An investigation of habitual and incidental physical activity among Costa Rican and Costa Rican American teenage girls.

A comparative survey design was used to examine habitual and incidental physical activity among native Costa Rican (CR) and Costa Rican American (CRA) adolescent girls. The purposive sample included 17 girls (ages 12-19 years) living in Limon, Costa Rica (n = 11), and the metropolitan New York/New Jersey area (n = 6). Participants in the CR group had significantly higher levels of habitual (p = .04), incidental (p = .02), and combined (p = .03) physical activity as compared with those on the CRA group. Dance was a preferred form of activity for both groups. The relationship between habitual and incidental physical activity was not significant, underscoring the need to address both variables in assessment of total physical activity. The findings suggest a need to prioritize the promotion of physical activity among immigrant teenage girls using culturally valued methods.

A comparison of field methods to assess cardiorespiratory fitness among neophyte exercisers.

There is evidence to suggest that aerobic fitness levels among adults have declined markedly over the past 2 to 3 decades. Submaximal field measures of aerobic fitness, such as step tests, may now be seen as aversive by contemporary neophyte exercisers. In this study, a single-factor within-subjects (repeated measures) factorial design was used to compare three field measures of cardiorespiratory fitness among sedentary women: (a) the Queen's College step test (QCST), (b) the Rockport 1-mile walk (RW), and (c) a nonexercise estimation of VO(2) max (NE). The sample consisted of 31 racially and ethnically diverse female college students (mean age of 24.8 years). No significant within-subjects differences were found in the three measures of V0(2) max (F = 1.89, p = .17) among Black, Hispanic, White non-Hispanic, or Asian women, but relative perceived exertion scores were significantly higher for the QCST than for the RW (t = 9.79, p < .001) for all groups. The mean calculated VO(2) max for the QCST was 35.90 ml/kg/min for the subset of women ages 18 to 25 and 31.85 for those ages 26 to 46. These values represent a "poor" to "below average" score for aerobic capacity among women in both age groups. Data from this preliminary study suggest that both the RW test and the NE test are comparable to the QCST as valid and reliable field measures of aerobic fitness and appear to be good alternatives to step testing among sedentary individuals.

The Johnson-Neyman procedure as an alternative to ANCOVA.

ANCOVA is a widely used statistical procedure that is particularly useful in analyzing data from experimental designs. There are, however, a number of assumptions that must be tested before proceeding with the ANCOVA. Of particular concern is the assumption of homogeneity of regression slopes (HOS). When the HOS assumption has been violated, the researcher needs to look for an alternative approach to the ANCOVA. The Johnson-Neyman procedure (J-N) is presented as such an alternative. Although the calculations for the procedure are somewhat tedious and are not currently a standard feature of statistical software packages, an alternative approach using SAS syntax codes is presented.

Social Factors Contributing to the Development of Allostatic Load in Older Adults: A Correlational-Predictive Study / Factores sociales que contribuyen al desarrollo de la carga alostática en adultos mayores: un estudio correlacional-predictivo / Fatores sociais que contribuem para o desenvolvimento da carga alostática em idosos: um estudo preditivo correlacional

ABSTRACT Objective: To determine if social factors, such as housing conditions, satisfaction with one's house, neighborhood characteristics, social support, family relations and church attendance affect allostatic load in older adults. Materials and method: A correlational-predictive, cross-sectional study was conducted. The instruments used were sociodemographic data, the perceived family relationships instrument, the Medical Outcomes Study-Social Support Survey and the abbreviated version of the Neighborhood Environment Walkability Scale. The allostatic load biomarkers used were: systolic and diastolic blood pressure, body mass index, waist circumference, waist-hip ratio, total cholesterol, high density lipoprotein, glycated hemoglobin, fibrinogen, and C-reactive protein. Sample size was estimated to contrast the no relation (R2= 0) hypotheis in a multiple lineal regression model with 11 covariables, with a significance level of .05, power of 90% (.90), when coefficient of determination (R2) is .15, resulting in a sample of 131 older adults. The statistical analysis included descriptive measures and generalized linear models. Results: The participants had either medium- or high-risk allostatic load. Multivariate linear regression model analysis showed that better housing conditions, satisfaction with own house, presence of dead-end streets, and church attendance reduce allostatic load, while dangerous traffic increases allostatic load. Conclusions: There are several social factors contributing to the development of allostatic load in older adults. It is necessary to create nursing care strategies toward the social environment to decrease allostatic load in older adults.

RESUMEN Objetivo: determinar si factores sociales como las condiciones de vivienda, la satisfacción con la casa, las características del vecindario, el apoyo social, las relaciones familiares y la asistencia a la iglesia contribuyen al desarrollo de la carga alostática en los adultos mayores. Materiales y método: se realizó un estudio correlacional y predictivo de corte transversal. Los instrumentos utilizados fueron una hoja de datos sociodemográficos, el instrumento de relaciones familiares percibidas, el cuestionario de Apoyo Social y la Escala de Movilidad Activa en el Entorno Comunitario, versión corta. Los biomarcadores de carga alostática utilizados fueron: presión arterial sistólica y diastólica, índice de masa corporal, circunferencia de la cintura, relación cintura-cadera, colesterol total, lipoproteína de alta densidad, hemoglobina glicosilada, fibrinógeno y proteína C-Reactiva. La muestra se calculó para para el contraste de la hipótesis de no relación (R2= 0), en un modelo de regresión lineal múltiple con 11 covariables, con un nivel de significancia del .05 y una potencia del 90 % (.90), cuando el coeficinete de determinación poblacional (R2) es .15, tamaño de muestra que resultó en 131 adultos mayores. El análisis estadístico incluyó medidas descriptivas y modelos lineales generalizados. Resultados: los participantes tenían un riesgo medio o alto de carga alostática. El análisis del modelo de regresión lineal multivariante mostró que las mejores condiciones de vivienda, la satisfacción con la propia casa, la presencia de calles sin salida y la asistencia a la iglesia reducen la carga alostática y que el tráfico peligroso aumenta la carga alostática. Conclusiones: existen varios factores sociales que contribuyen al desarrollo de la carga alostática en adultos mayores. Es necesario crear estrategias de cuidado de enfermería hacia el entorno social para disminuir la carga alostática en el adulto mayor.

RESUMO Objetivo: determinar se fatores sociais, como as condições de moradia, a satisfação com a casa, as características do bairro, o apoio social, as relações familiares e a freqüência à igreja afetam a carga alostática em idosos. Materiais e método: um estudo de correlação transversal e preditivo foi realizado. Os instrumentos utilizados foram dados sociodemográficos, o instrumento de relações familiares percebido, o Medical Outcomes Study-Social Support Survey e a Abbreviated Neighborhood Environment Walkability Scale. Os biomarcadores de carga alostática utilizados foram: pressão arterial sistólica e diastólica, índice de massa corporal, circunferência da cintura, relação cintura-quadril, colesterol total, lipoproteína de alta densidade, hemoglobina glicada, fibrinogênio e proteína C-reativa. A amostra foi calculada para o contraste do hipóseo de nenhuma relação (R2 = 0), em um modelo de regresión múltiple linear con 11 covariáveis, com um nível de significância de 0.05 e uma potencia de 90% (0.90), quando o coeficiente de determinação populacional (R2) es .15, o tamanho da amostra resultou em 131 idosos. A análise estatística incluiu medidas descritivas e modelos lineares generalizados. Resultados: os participantes tinham risco médio ou alto de carga alostática. A análise multivariada do modelo de regressão linear mostrou que melhores condições de moradia, satisfação com a casa própria, presença de ruas sem saída e freqüência à igreja reduzem a carga alostática e o tráfego perigoso aumenta a carga alostática. Conclusões: existem vários fatores sociais que contribuem para o desenvolvimento da carga alostática em idosos. É necessário criar estratégias de cuidados de enfermagem em direção ao ambiente social para diminuir a carga alostática no idoso.

The influence of marianismo beliefs on physical activity of immigrant Latinas.

PURPOSE: To verify and explicate the impact of marianismo beliefs on the physical activity behaviors of immigrant Latinas. DESIGN: Twenty-eight immigrant Latinas, aged 18 to 40 years, were recruited to participate in two focus group interviews. Data collection and analysis were driven by Spradley's Developmental Research Sequence. RESULTS: Two domain terms were identified: "Life is too fast here" and "The woman is the center of the family." Six included terms and five cultural themes were specified. DISCUSSION: A combination of marianismo beliefs, acculturation stress, loss of social support, and conflicts between collectivist and individualist values combine to adversely influence physical activity behaviors of immigrant Latinas. IMPLICATIONS: Physical activity interventions for Hispanic women should capitalize on the strengths of the marianista, address factors leading to acculturation stress among women and their families, and establish bridges of social support among new groups of immigrants.

A biobehavioral approach to understanding obesity and the development of obesogenic illnesses among Latino immigrants in the United States.

The prevalence of obesity and obesity-related illnesses is higher among Hispanics (Latinos) than other racial and ethnic groups, and rates increase exponentially with the number of years living in the United States. Mounting evidence suggests that the origins of many chronic illnesses among disadvantaged minority groups may lie with cumulative exposure to chronic psychological and physiological stressors through the biobehavioral process of allostatic load (AL). Among immigrant Latinos, acculturation stress may contribute to an increase in AL and thus may be an independent risk factor for the development of obesity and obesogenic illnesses. The purpose of this theoretical article is to present a proposed model of the effects of acculturation stress on AL and obesity among Latino immigrants. Such a model can be useful to guide intervention efforts to decrease obesity among immigrant Latinos by adding education, skill building, and social integration strategies to healthy eating and physical activity to reduce the deleterious impact of acculturation stress.

Evaluation and revision of questionnaires for use among low-literacy immigrant Latinos.

As more Spanish speaking immigrants participate in and become the focus of research studies, questions arise about the appropriateness of existing research tools. Questionnaires have often been adapted from English language instruments and tested among college-educated Hispanic-Americans. Little has been written regarding the testing and evaluation of research tools among less educated Latino immigrants. The purpose of this study was to evaluate and revise a battery of Spanish-language questionnaires for an intervention among immigrant Hispanic women. A three-step process was used to evaluate, adapt and test Spanish versions of the Self-Efficacy and Exercise Habits Survey, an abbreviated version of the Hispanic Stress Inventory-Immigrant version and the Latina Values Scale. The revised tools demonstrated acceptable validity and reliability. The adaptations improved the readability of the tools, resulting in a higher response rate, less missing data and fewer extreme responses. Psychometric limitations to the adaptation of Likert scales are discussed.