RESUMO
BACKGROUND: Upon arrival, the prevalence of overweight and obesity is lower in new immigrants than their native counterparts in the U.S. With longer residency in the U.S., these differences converge over time, followed by higher prevalence among immigrants than native U.S. residents. Results from the Live Well project in the Greater Boston area demonstrate the viability of utilizing a culturally adapted, community-based participatory research (CBPR) approach to reduce weight gain among newly immigrated mother-child dyads. METHODS: Haitian, Latina, and Brazilian mother-child dyads (n = 390), new to the U.S. (fewer than 10 years) were enrolled in a one- to two-year long CBPR lifestyle intervention that targeted dietary and physical activity behaviors. Attendance was recorded to establish dose. Demographics, anthropometrics, and relevant covariates were collected from participants at baseline, 6, 12, 18, and 24 months. Body Mass Index (BMI) was calculated using objectively measured height and weight. Linear mixed regression models were used to assess change in BMI and BMI z-score of mothers and children respectively. RESULTS: At baseline, nearly 75% of mothers and 50% of children were either overweight or obese (BMI ≥ 25.0 and BMI z-score ≥ 85th percentile, respectively). Only 20% of mothers attended all 12 intervention sessions in year 1. Using intent-to-treat analyses, no significant time, intervention, or time × intervention effects were observed for weight change of mothers or children at follow-up. Mothers in the highest quantile (those who attended all 12 intervention sessions) had significant reductions in BMI at 18 months (1.76 units lower, 95%CI: -3.14, -0.37) and 24 months (2.61 units, 95%CI -3.92, -1.29) compared to mothers in the lower quantiles, including those with no exposure. Such dose effects on BMI z-scores were not noted for children. CONCLUSIONS: Findings from Live Well demonstrate the viability of utilizing a CBPR approach to address overweight and obesity among immigrant mothers. Given the higher-than-expected prevalence of overweight and obesity among mother-child dyads by ~ 6 years of U.S. residency, and lower maternal participation rates in the intervention, additional research is necessary to identify the optimal intervention length, retention strategies, and approach to jointly support healthy maternal and child weight.
Assuntos
Emigrantes e Imigrantes , Obesidade Infantil , Feminino , Humanos , Sobrepeso/epidemiologia , Sobrepeso/prevenção & controle , Haiti/epidemiologia , Obesidade/epidemiologia , Índice de Massa Corporal , Mães , Relações Mãe-Filho , Obesidade Infantil/epidemiologia , Obesidade Infantil/prevenção & controleRESUMO
BACKGROUND: This study estimates job-related risks among common low wage occupations (cleaning, construction, food service, cashier/baggers, and factory workers) held by predominantly Haitian, El Salvadorian, and Brazilian immigrants living or working in Somerville, Massachusetts. METHODS: A community-based cross-sectional survey on immigrant occupational health was conducted between 2006 and 2009 and logistic regression was used to assess the job-related risks among the most common low wage occupations. RESULTS: Construction workers reported significantly higher health risks, and lower access to occupational health services than the other occupations. Compared to cashier/baggers, the reference population in this study, cleaners reported significantly lower access to health and safety and work training and no knowledge of workers' compensation. Factory workers reported significantly lower work training compared to cashier/baggers. Food service workers reported the least access to doctors compared to the other occupations. CONCLUSION: We found significant variability in risks among different low wage immigrant occupations. The type of occupation independently contributed to varying levels of risks among these jobs. We believe our findings to be conservative and recommend additional inquiry aimed at assuring the representativeness of our findings.
Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Doenças Profissionais , Serviços de Saúde do Trabalhador/estatística & dados numéricos , Saúde Ocupacional/estatística & dados numéricos , Traumatismos Ocupacionais , Salários e Benefícios/estatística & dados numéricos , Adulto , Brasil/etnologia , Estudos Transversais , El Salvador/etnologia , Feminino , Haiti/etnologia , Humanos , Modelos Logísticos , Masculino , Massachusetts , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The goal of this paper is to describe the baseline characteristics of Live Well (intervention to prevent weight gain in recent immigrant mother-child dyads from Brazil, Haiti, and Latin America) participants, and to explore self-reported changes in diet and physical activity post-immigration. Baseline data from 383 mothers were used for this study. Dyads attended a measurement day where they completed self-administered surveys collecting information about socio-demographics, diet, physical activity, other psychosocial variables, and height and weight. Haitian mothers' socio-demographic profile differed significantly from that of Brazilians' and Latinas': they have been in the US for a shorter period of time, have higher rates of unemployment, are less likely to be married, more likely to have ≥3 children, more likely to be obese, and have immigrated for family or other reasons. In multivariate models, self-reported changes in diet and physical activity since migrating to the US were significantly associated with BMI with non-linear relationships identified. Future research is needed to understand how diet and physical activity change while acculturating to the US and explore the adoption of both healthy and unhealthy dietary changes.
Assuntos
Dieta , Emigrantes e Imigrantes/estatística & dados numéricos , Promoção da Saúde/organização & administração , Estilo de Vida , Atividade Motora/fisiologia , Aculturação , Adulto , Fatores Etários , Brasil/etnologia , Etnicidade/estatística & dados numéricos , Comportamento Alimentar/etnologia , Feminino , Haiti/etnologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Obesidade/prevenção & controle , Participação do Paciente/estatística & dados numéricos , Autorrelato , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Estados UnidosRESUMO
This study examines the burden of occupational health risks among a convenience sample of three immigrant worker populations (Brazilian, Haitian, and El Salvadoran) in Somerville, Massachusetts. In this community based research initiative (n = 346), logistic regression is used to analyze immigrant occupational health survey data collected from 2006 to 2009. In this study, injuries at work were significantly associated with lower English proficiency (OR = 1.8, 95 % CI 1.1-3.0), workers between the ages of 46 and 65 (OR = 2.7, 95 % CI 1.0-7.0), service workers (OR = 13.8, 95 % CI 1.8-105.2), production workers (OR = 10.8, 95 % CI 1.3-90.1), construction workers (OR: 21.7, 95 % CI 2.8-170.9) and immigrants with no health insurance (OR = 1.8, 95 % CI 1.0-3.1). Injuries were negatively associated with years in the US with more established immigrants in the US >15 years reporting more injuries at work. Older immigrants who have been in the US longer but are less proficient in English, and are still employed in low-wage occupations with no health insurance suffered more injuries than recent immigrants. Further validation of this result is required.
Assuntos
Emigrantes e Imigrantes , Saúde Ocupacional/etnologia , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Adulto , Idoso , Brasil/etnologia , Pesquisa Participativa Baseada na Comunidade , Intervalos de Confiança , El Salvador/etnologia , Arquitetura de Instituições de Saúde , Feminino , Haiti/etnologia , Acessibilidade aos Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Massachusetts , Pessoa de Meia-Idade , Razão de Chances , Identificação Social , Adulto JovemRESUMO
Our goal was to explore the perceived determinants of obesity in Brazilian, Latin American and Haitian women. This is part of an ongoing community-based participatory intervention. Focus groups by immigrant group were conducted and themes extracted. Women expressed differences in beliefs, attitudes, and barriers regarding diet and physical activity in the US versus their home country. Participants thought food in the US is "less natural," there is less time for preparation, and there is more variety. The weather is a barrier to physical activity in the US and work is more physically demanding. Job-related efforts were not considered physical activity. They reported higher levels of stress, less control of their time and less social support in the US. Providing immigrants with appropriate support and education early in the acculturation process has the potential to help prevent obesity.
Assuntos
Estilo de Vida , Obesidade/etiologia , Adulto , Brasil , Dieta , Feminino , Grupos Focais , Haiti , Humanos , América Latina , Pessoa de Meia-Idade , Estresse Fisiológico , Estresse Psicológico , Estados Unidos , Adulto JovemRESUMO
In this community based research initiative, we employed a survey instrument predominately developed and administered by Teen Educators to assess occupational health risks for Haitian, Salvadoran, and Brazilian immigrants (n = 405) in Somerville, MA, USA. We demonstrate that a combined analysis of ethnicity, years in the US, and English proficiency better characterized the occupational experience of immigrant workers than considering these variables individually. While years in the US (negatively) and English proficiency (positively) explained the occurrence of health risks, the country of origin identified the most vulnerable populations in the community. Brazilians, Salvadorans, and other Hispanic, all of whom who have been in the US varying length of time, with varying proficiency in English language had twice the odds of reporting injuries due to work compared to other immigrants. Although this observation was not significant it indicates that years in the US and English proficiency alone do not predict health risks among this population. We recommend the initiation of larger studies employing c community based participatory research methods to confirm these differences and to further explore work and health issues of immigrant populations. This study is one of the small number of research efforts to utilize a contemporaneous assessment of occupational health problems in three distinct immigrant populations at the community level within a specific Environmental Justice context and social milieu.
Assuntos
Emigrantes e Imigrantes , Disparidades nos Níveis de Saúde , Idioma , Saúde Ocupacional , Adulto , Análise de Variância , Brasil/etnologia , Estudos Transversais , El Salvador/etnologia , Etnicidade , Haiti/etnologia , Humanos , Modelos Logísticos , Massachusetts , Saúde Ocupacional/estatística & dados numéricos , Razão de Chances , Inquéritos e Questionários , Fatores de TempoRESUMO
BACKGROUND: Identifying risk factors that affect excess weight gain during pregnancy is critical, especially among women who are at a higher risk for obesity. The goal of this study was to determine if acculturation, a possible risk factor, was associated with gestational weight gain in a predominantly Puerto Rican population. METHODS: We utilized data from Proyecto Buena Salud, a prospective cohort study of Hispanic women in Western Massachusetts, United States. Height, weight and gestational age were abstracted from medical records among participants with full-term pregnancies (n=952). Gestational weight gain was calculated as the difference between delivery and prepregnancy weight. Acculturation (measured via a psychological acculturation scale, generation in the US, place of birth and spoken language preference) was assessed in early pregnancy. RESULTS: Adjusting for age, parity, perceived stress, gestational age, and prepregnancy weight, women who had at least one parent born in Puerto Rico/Dominican Republic (PR/DR) and both grandparents born in PR/DR had a significantly higher mean total gestational weight gain (0.9 kg for at least one parent born in PR/DR and 2.2 kg for grandparents born in PR/DR) and rate of weight gain (0.03 kg/wk for at least one parent born in PR/DR and 0.06 kg/wk for grandparents born in PR/DR) vs. women who were of PR/DR born. Similarly, women born in the US had significantly higher mean total gestational weight gain (1.0 kg) and rate of weight gain (0.03 kg/wk) vs. women who were PR/ DR born. Spoken language preference and psychological acculturation were not significantly associated with total or rate of pregnancy weight gain. CONCLUSION: We found that psychological acculturation was not associated with gestational weight gain while place of birth and higher generation in the US were significantly associated with higher gestational weight gain. We interpret these findings to suggest the potential importance of the US "obesogenic" environment in influencing unhealthy pregnancy weight gains over specific aspects of psychological acculturation.
Assuntos
Aculturação , Hispânico ou Latino/estatística & dados numéricos , Obesidade/etnologia , Sobrepeso/etnologia , Complicações na Gravidez/etnologia , Aumento de Peso , Adolescente , Adulto , Estudos de Coortes , República Dominicana/etnologia , Feminino , Idade Gestacional , Hispânico ou Latino/psicologia , Humanos , Massachusetts/epidemiologia , Obesidade/complicações , Sobrepeso/complicações , Gravidez , Estudos Prospectivos , Porto Rico/etnologia , Características de Residência/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Research has shown that parental feeding styles may influence children's food consumption, energy intake, and ultimately, weight status. We examine this relationship, among recent immigrants to the US. Given that immigrant parents and children are at greater risk for becoming overweight/obese with increased time in the US, identification of risk factors for weight gain is critical. METHODS: Baseline data was collected on 383 mother-child dyads enrolled in Live Well, a community-based, participatory, randomized controlled lifestyle intervention to prevent weight gain in recent immigrant mothers. Socio-demographic information together with heights and weights were collected for both mother and child. Acculturation, behavioral data, and responses to the Caregiver's Feeding Styles Questionnaire (CFSQ) were also obtained from the mother. RESULTS: The children's average age was 6.2 ± 2.7 years, 58% male. Mothers had been in the country for an average of 6.0 ± 3.3 years, and are Brazilian (36%), Haitian (34%) and Latino (30%). Seventy-two percent of the mothers were overweight/obese, while 43% of the children were overweight/obese. Fifteen percent of mothers reported their feeding style as being high demanding/high responsive; 32% as being high demanding/low responsive; 34% as being low demanding/high responsive and 18% as being low demanding/low responsive. In bivariate analyses, feeding styles significantly differed by child BMIz-score, ethnic group, and mother's perceived stress. In multiple linear regression, a low demanding/high responsive feeding style was found to be positively associated (ß = 0.56) with a higher child weight as compared to high demanding/high responsive, controlling for known covariates (p = 0.01). CONCLUSIONS: Most mothers report having a low demanding/high responsive feeding style, which is associated with higher child weight status in this diverse immigrant population. This finding adds to the growing literature that suggests this type of feeding style may be a risk factor for childhood obesity. Further research is needed to help understand the larger socio-cultural context and its influence on feeding dynamics among immigrant families and families of lower incomes. How parents establish a certain feeding style in their home country compared to when they move to the US "obesogenic" environment, should also be explored.
Assuntos
Emigrantes e Imigrantes , Comportamento Alimentar , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Obesidade/etnologia , Poder Familiar/etnologia , Aumento de Peso , Índice de Massa Corporal , Brasil/etnologia , Criança , Pré-Escolar , Estudos Transversais , Ingestão de Energia , Feminino , Haiti/etnologia , Humanos , América Latina/etnologia , Estilo de Vida , Modelos Lineares , Masculino , Mães , Pobreza , Fatores de Risco , Meio Social , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
Pregnancy weight gain may be a risk factor for the development of obesity highlighting the importance of identifying psychosocial risk factors for pregnancy weight gain. The goal of this qualitative pilot study was to evaluate knowledge, attitudes and beliefs regarding weight gain during pregnancy among predominantly Puerto Rican women, a group with higher rates of obesity as compared to non-Hispanic white women. We conducted four focus groups stratified by level of acculturation and BMI. Women reported receiving advice about pregnancy weight gain predominantly from nutritionists and family members rather than from their physicians. The majority of overweight/obese women reported that they had not received any recommendations for weight gain during pregnancy from physicians. Pregnancy weight gain advice was not consistent with the 1990 Institute of Medicine Guidelines. Overall, attitudes towards weight gain recommendations differed by weight status, whereas feelings and dietary beliefs about weight gain differed according to level of acculturation. Our findings inform behavior change strategies for meeting pregnancy weight gain recommendations.