Qualitative Exploration of Family Influences on Physical Activity in Hispanic Families.

BACKGROUND: Limited information exists on how the family unit aids or impedes physical activity (PA) engagement within Hispanic populations. This qualitative study explored family-level influences on PA in dyads of adult Hispanic family members (eg, parent-adult child, siblings, spouses). METHODS: In-person interviews and brief surveys were conducted together with 20 dyads lasting 1.5 hours each. Two researchers coded and analyzed text using thematic analysis in NVivo (version 11.0). They resolved discrepancies through consensus and used matrix coding analysis to examine themes by participants' demographics. RESULTS: The participants were mainly women (70%), from Mexico (61.5%), and they reported low levels of acculturation (87.5%). Themed facilitators for PA included "verbal encouragement," "help with responsibilities," "exercising with someone," and "exercising to appease children." Themed challenges included "lack of support," "challenges posed by children," "sedentary behaviors," and "competing responsibilities." Women more so than men described family-level challenges and facilitators, and dyads where both study partners were physically active provided more positive partner interaction descriptions for PA support than other dyads. CONCLUSIONS: This study suggests that leveraging family support may be an important approach to promote and sustain PA, and that family-focused interventions should integrate communication-building strategies to facilitate family members' ability to solicit support from each other.

Association of Alcohol Use and Physical Activity with Body Mass Index in Mexican-Origin Adults.

BACKGROUND: Studies across racial/ethnic groups indicate that physical activity (PA) and alcohol consumption are positively associated, and that alcohol consumption is negatively associated with body mass index (BMI), but this relationship is less often evaluated in Hispanics. The purpose of this study was to assess the relationships between alcohol consumption, PA, and BMI in Hispanic adults. METHODS: In this secondary data analysis of a Mexican-American cohort, we collected self-reported PA, alcohol consumption, and demographics, and measured height and weight. Linear regression assessed the association between PA and alcohol consumption with BMI, controlling for covariates. Total sample for analyses was n = 3897. RESULTS: We found an inverse relationship between high PA and BMI in the full sample (adjusted estimate = - 0.03, 95% CI - 0.07, - 0.01) and in females, but not males. We also found an inverse relationship between current alcohol use and BMI in the full sample (adjusted estimate = - 0.05, 95% CI - 0.09, - 0.01) and both sexes. There was no significant interaction between PA and alcohol use on BMI. CONCLUSIONS: In this study of Mexican-origin adults, current alcohol use and high PA were associated with lower BMIs, but there was no interaction between PA and alcohol use. These results can be used to inform multiple behavior change interventions in Mexican-origin adults.

The Longitudinal Relationship Between Social Support and Physical Activity in Hispanics.

PURPOSE: Social support has been identified as a determinant of physical activity (PA), but research has been primarily cross-sectional, with mixed findings for different Hispanic subgroups and limited longitudinal research with Hispanics. The purpose of this study is to assess the longitudinal associations of social support with PA in Hispanics on the Texas-Mexico Border. DESIGN AND SAMPLE: We used 2 time points of data collected from Hispanic adults in the Cameron County Hispanic Cohort (N = 588). MEASURES: We collected social support for PA and self-reported leisure-time PA. ANALYSIS: We used cross-lagged panel models to assess the association between friend support, family support, family punishment (criticizing or complaining) and PA over time. RESULTS: Although social support overall was low for PA, fully adjusted cross-lagged panel models indicated that time 1 friend support was associated with time 2 PA (adjusted rate ratio = 1.02, 95% confidence interval = 1.00 -1.04), though family support was not associated with time 2 PA. In males, time 1 friend support was inversely associated with time 2 family punishment. CONCLUSION: As expected, the directionality of the relation appears to be from social support to PA. Friend support appears to be predictive of PA in Hispanics, whereas family support is not. This should be considered in intervention development, particularly because familismo (commitment and mutual obligation to family) is considered to be a strong value in these communities.

Educating Hispanics About Clinical Trials and Biobanking.

Hispanics are under-represented in clinical research. To ensure that the Hispanic population benefits from advances in public health and medicine, including personalized medicine, there is a need to increase their participation in clinical trials and biobanking. There is a great need for improving awareness and addressing concerns individuals may have about participation. The purpose of this study was to adapt, implement, and evaluate educational materials about clinical trials and biobanking for Hispanic individuals. We adapted existing materials based on focus group data. We then trained four promotoras de salud to deliver education to Hispanic adults in community settings in Houston, TX. The promotoras educated 101 Hispanic adults, 51 on biobanking and 50 on clinical trials. Study staff administered brief pre- and post-test questionnaires that measured benefits, barriers, norms, self-efficacy, and intention to participate in either clinical trials or biobanking. Our sample was predominately female (83%) and Spanish-speaking (69%) and made less than $25,000 a year (87%). This intervention increased perceived benefits of participating in biobanking and clinical trials, self-efficacy for donating biospecimens, and intention to participate in biobanking if invited. Perceived barriers to participating declined. This study demonstrated that brief education can result in improved perceptions and attitudes related to participation in biobanking and clinical trials, and could increase participation. Researchers and practitioners could use these educational materials to educate Hispanic community members on clinical research potentially increasing participation rates in the future.

Process evaluation of health fairs promoting cancer screenings.

BACKGROUND: Low income and uninsured individuals often have lower adherence to cancer screening for breast, cervical and colorectal cancer. Health fairs are a common community outreach strategy used to provide cancer-related health education and services. METHODS: This study was a process evaluation of seven health fairs focused on cancer screening across the U.S. We conducted key-informant interviews with the fair coordinator and conducted baseline and follow-up surveys with fair participants to describe characteristics of participants as well as their experiences. We collected baseline data with participants at the health fairs and telephone follow-up surveys 6 months following the fair. RESULTS: Attendance across the seven health fairs ranged from 41 to 212 participants. Most fairs provided group or individual education, print materials and cancer screening during the event. Overall, participants rated health fairs as very good and participants reported that the staff was knowledgeable and that they liked the materials distributed. After the fairs, about 60% of participants, who were reached at follow-up, had read the materials provided and had conversations with others about cancer screening, and 41% talked to their doctors about screening. Based on findings from evaluation including participant data and coordinator interviews, we describe 6 areas in planning for health fairs that may increase their effectiveness. These include: 1) use of a theoretical framework for health promotion to guide educational content and activities provided, 2) considering the community characteristics, 3) choosing a relevant setting, 4) promotion of the event, 5) considerations of the types of services to deliver, and 6) evaluation of the health fair. CONCLUSIONS: The events reported varied in reach and the participants represented diverse races and lower income populations overall. Most health fairs offered education, print materials and onsite cancer screening. Participants reported general satisfaction with these events and were motivated through their participation to read educational materials or discuss screening with providers. Public health professionals can benefit from this process evaluation and recommendations for designing and evaluating health fairs.

Exposure to a community-wide campaign is associated with physical activity and sedentary behavior among Hispanic adults on the Texas-Mexico border.

BACKGROUND: Despite evidence for the use of community-wide campaigns to promote physical activity, few evaluations of community-wide campaigns in Hispanic communities exist. This study assessed the associations of exposure to a community-wide campaign with physical activity and sedentary behavior among Hispanic adults living on the Texas-Mexico border. METHODS: The intervention, Tu Salud ¡Si Cuenta! (Your Health Matters!; TSSC), included a newsletter, community health worker discussion, TV and radio segments, which were conducted from 2005 to 2010. We matched an intervention (N = 399) and a control community (N = 400) on demographics and used a cross-sectional assessment in 2010 with randomly sampled adults from both communities. We collected exposure to the campaign, as well as physical activity and sedentary behavior with the International Physical Activity Questionnaire. We conducted bivariate analyses and multivariable logistic regression models to assess the association of TSSC exposure and its components with meeting moderate-to-vigorous intensity physical activity (MVPA) guidelines and exhibiting excessive sedentary behavior, controlling for covariates. RESULTS: As compared to the control community, the intervention community has 3 times the odds of meeting MVPA guidelines (Adjusted OR [AOR] = 3.01, 95% CI = 1.85-4.88, p < .05) and 2 times lower odds of excessive sedentary behavior ((AOR = 0.46, 95% CI = 0.30-0.70, p < .05). Exposure in the intervention group to any component was associated with five times the odds of meeting MVPA guidelines (AOR = 5.10, 95% CI 2.88-9.03, p < .001) and 3 times lower odds of excessive sedentary behavior (AOR = 0.32, 95% CI 0.17-0.60, p < .001), compared with those unexposed in the control community. Exposure to newsletters, CHW discussions and TV segments were associated with significantly lower odds of excessive sedentary behavior and higher odds of meeting MVPA guidelines. Exposure to radio segments was only associated with a significantly higher odds of meeting MVPA guidelines (AOR = 4.21, 95% CI = 1.17-15.09). CONCLUSIONS: This study provides some evidence of the association of community-wide campaigns and its components in Hispanic communities with higher levels of MVPA and lower levels of excessive sedentary behavior. TRIAL REGISTRATION NUMBER: NCT00788879 Date: November 11, 2008.

Tu Salud ¡Sí Cuenta! Your Health Matters! A Community-wide Campaign in a Hispanic Border Community in Texas.

OBJECTIVE: To evaluate a community-wide campaign, Tu Salud ¡Si Cuenta! (TSSC), in improving eating behaviors and anthropometric outcomes in Hispanic border communities. DESIGN: A quasi-experimental study with matched intervention and comparison communities. Cross-sectional assessments with randomly sampled adults, examined by actual exposure and site (unexposed intervention, exposed intervention, and unexposed comparison). SETTING AND PARTICIPANTS: Predominately Mexican Americans located in Brownsville, TX (intervention) and Laredo, TX (control). INTERVENTION: The TSSC campaign included television and radio segments, community health worker discussions, and newsletters delivered in Brownsville from 2005 to 2010. MAIN OUTCOME MEASURES: Healthy and unhealthy eating indices and average hip and waist circumferences. ANALYSIS: Univariable and multivariable regression models. RESULTS: The sample (n = 799; 400 comparison and 399 intervention) was 98% of Mexican origin; 54% had completed grade 9 or higher. Exposure to any TSSC component was associated with a lower rate of unhealthy food consumption. Compared with the unexposed intervention group, the exposed intervention for the newsletter had a higher rate of healthy eating (adjusted rate ratio = 1.18; P < .01). Compared with the unexposed intervention, the exposed intervention for the community health worker discussion had a smaller hip circumference (adjusted mean difference = -5.77 cm; P < .05) and a smaller waist circumference (adjusted mean difference = -5.25 cm; P < .05). CONCLUSIONS AND IMPLICATIONS: This study provides evidence for the use of community-wide campaigns for nutrition and obesity-related outcomes in Hispanic communities.

Community Perceptions of Biobanking Participation: A Qualitative Study among Mexican-Americans in Three Texas Cities.

BACKGROUND: Most biospecimens in the US are collected from non-Hispanic Whites, limiting the generalizability of findings. There is a need to increase participation in biobanking among ethnic and racial minorities. The purpose of this study was to use qualitative methods to identify factors that may influence Mexican-American individuals' willingness to participate in biobanking. METHODS: We conducted 15 focus groups in three Texas cities with Mexican-American individuals, in both Spanish and English. RESULTS: Lack of knowledge about medical research and biobanks, lack of information about the specifics of biobanking participation, lack of communication of the results, fear of pain or harm, and distrust of the healthcare system or health research were identified as barriers to biobanking participation. Facilitators to participation were altruism, safety, understanding biobanking procedures and purposes, perceived benefits to participation, and culturally appropriate recruitment strategies. Although Mexican-Americans living in Texas are willing to donate biospecimens for altruistic reasons, such as helping society or advancing science, they want more information about what biobanking entails. They want to be assured that participation will not cause them harm and that the research is conducted with good intentions. CONCLUSION: Results from this study can inform educational materials or interventions to increase Hispanic participation in biobanking.

Perspectives of Mexican-origin smokers on healthy eating and physical activity.

Key modifiable risk behaviors such as smoking, poor diet and physical inactivity often cluster and may have multiplicative adverse effects on health. This study investigated barriers and facilitators to healthy eating and physical activity (PA) in overweight Mexican-origin smokers to inform the adaptation of an evidence-based smoking cessation program into a multiple health behavior change intervention. Five focus groups were conducted with overweight Mexican-origin men (n = 9) and women (n = 21) who smoked. Barriers and facilitators of healthy eating and PA were identified, and gender differences were assessed. Participants expressed some motivation to eat healthfully and identified strategies for doing so, yet many women experienced difficulties related to personal, family and work-related circumstances. Barriers to healthy eating among men were related to food preferences and lack of familiarity with fruits and vegetables. Participants performed PA primarily within the context of work and domestic responsibilities. Stress/depressed mood, lack of motivation and concern for physical well-being limited further PA engagement. Routines involving eating, PA and smoking highlight how these behaviors may be intertwined. Findings emphasize the importance of social, structural and cultural contexts and call for additional investigation into how to integrate healthy eating and PA into smoking cessation interventions for overweight Mexican-origin smokers.