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.

Effects of Auricular Acupressure on Pain Management: A Systematic Review.

OBJECTIVE: Nearly half of hospitalized patients in the United States have reported experiencing pain even while undergoing treatment for pain. Analgesic use is the most common type of treatment for pain management. Many patients who experience pain seek nonpharmacologic interventions to manage their pain, including forms of complementary or alternative medicine such as auricular acupressure (AA). DESIGN: This study conducted the first systematic review of the studies that have evaluated the effect of AA as an adjunct on pain management. DATA SOURCES: We searched PubMed, CINAHL, Embase, Google Scholar, and Wiley for randomized controlled trials on AA. REVIEW/ANALYSIS METHODS: The pain outcomes were pain severity and analgesic consumption. Methodologic quality was also evaluated. Fifteen randomized controlled trials were included in this analysis. RESULTS: Twelve studies reported statistically significant improvement in the pain outcomes of AA treatment compared with the sham or standard care groups. When methodologic quality was assessed, the selected studies had medium quality, but there was a lack of high quality. This supports that the use of AA for patients may enhance self-management for their pain. However, the small number of studies and the lack of consistent rigorous methodology across the studies preclude definitive statements regarding the effectiveness of AA. CONCLUSION: The nursing implications based on this review is that education about AA and complementary or alternative medicine therapies for health care providers may assist them in providing pain control for their patients. In addition, we need to continue research to build on evidence on the effect of AA on pain management.

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.

Relationship of Marianismo Beliefs With the Self-Care Behaviors of Mexican Women With Type 2 Diabetes Mellitus.

INTRODUCTION: Mexican women have a higher prevalence of type 2 diabetes mellitus (T2DM) and less compliance with T2DM self-care compared with Mexican men. The term marianismo refers to gender and religiocultural based beliefs that may be a barrier to self-care behaviors among Mexican women. The purpose of this study was to explore the relationship between marianismo beliefs and self-care behaviors in Mexican women with T2DM. METHODS: This was a cross-sectional study among women with T2DM who attended primary care centers in Oaxaca, Mexico during 2019. The Summary of Diabetes Self-care Activities and the Marianismo Beliefs Scale were used to measure diabetes self-care and marianismo beliefs, respectively. RESULTS: Among the 547 participants, those with higher marianismo beliefs reported significantly lower scores in diabetes self-care, (r = -.128), exercise (r = -.150), self-monitoring of blood glucose (r = -.119), foot care (r = -.093), and oral hygiene (r = -.114; all p < .01). DISCUSSION: Findings suggest that Mexican women with strong marianismo beliefs are less likely to comply with T2DM self-care behaviors. Marianismo beliefs should be considered a potential risk factor for women's health, since Mexican women may value the social recognition of maintaining these beliefs more than self-care.

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.

Getting started in CBPR: lessons in building community partnerships for new researchers.

There is a growing interest in community-based participatory research (CBPR) methods to address issues of health disparities. Although the success of CBPR is dependent upon the formation of community-researcher partnerships, new researchers as well as seasoned investigators who are transitioning to CBPR often lack the skills needed to develop and maintain these partnerships. The purpose of the article is to discuss the competencies needed by new researchers to form successful CBPR partnerships. The author presents a series of strategic steps that are useful in establishing academic-community partnerships and in initiating, maintaining and sustaining CBPR projects. These steps include suggestions regarding community engagement, selection of community advisory board members, outreach, the community's role in problem identification, selection of research methodologies, considerations related to the community setting, need for flexibility and patience, 'insider vs. outsider' conflicts, commitment and training issues, timing concerns for tenure-track faculty and the process of community empowerment. Community-based participatory research is both rewarding and time consuming, for both the researcher and members of the community. Given its promise to address health disparities, it is imperative that researchers acquire the skills needed to develop and cultivate durable community-researcher partnerships.

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.

Acculturation stress and allostatic load among Mexican immigrant women. / Estresse de aculturação e carga alostática entre mulheres imigrantes mexicanas.

OBJECTIVES: this case-control study compared levels of stress and allostatic load (AL) among Mexican women in the US ( n =19) and Mexico ( n = 40). METHOD: measures of stress included the Perceived Stress Scale (PSS) and the Hispanic Women's Social Stressor Scale (HWSSS). A composite measure of 8 indicators of AL (systolic and diastolic blood pressure, body mass index (BMI), waist-to-hip ratio, total cholesterol, glycated hemoglobin (hemoglobin A1C), triglycerides and C-reactive protein) was calculated. RESULTS: there were no significant group differences in AL between Mexican and Mexican immigrant women ( t = 1.55, p = .126). A principal component factor analysis was conducted on the 8 AL indicators; a 2-factor solution explained 57% of the variance. Group differences in the two AL factors were analyzed using MANOVA. BMI and waist-to-hip ratios were lower, but blood pressure and triglycerides were higher in the US group and were mediated by time in the US. Greater acculturation stress was significantly related to increased waist-to-hip ratio ( r = .57, p = .02). FINAL REMARKS: findings suggest some measures of AL increased with time in the US, and acculturation stress may be a significant factor.

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.

Communicating and Assessing Physical Activity: Outcomes From Cognitive Interviews With Low-Income Adults.

OBJECTIVE: This investigation sought to identify the physical activity (PA) terms and concepts that are best understood by low-income adults. DESIGN: This was a cross-sectional study using semistructured cognitive interviews that employed retrospective verbal probing techniques. SETTING: Interviews were conducted in Expanded Food and Nutrition Education Program (EFNEP) sites in New Jersey, Tennessee, and Washington. PARTICIPANTS: A convenience sample of 57 adults participating in or eligible for participation in EFNEP. PHENOMENON OF INTEREST: Participants' interpretations and conceptualizations of PA concepts and terms. ANALYSIS: Template and constant comparative analysis. RESULTS: Participants interpreted many PA terms and concepts in unintended ways. Exercise was the term that came closest to conveying moderate to vigorous PA. Terms used to describe muscle-strengthening activities were mostly understood. Intentional engagement in extra activities was difficult for participants to conceptualize despite multiple tested wordings; making small changes to be active came closest to conveying this concept. Participants' comprehension of the PA terms differed by their PA and literacy levels. CONCLUSIONS AND IMPLICATIONS: Nutrition educators should be mindful of the terminologies they used in communicating messages and assessing PA behaviors to EFNEP participants or similar populations.

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.