Angela Bermudez-Millan

Impact of peer nutrition education on dietary behaviors and health outcomes among Latinos: a systematic literature review.

OBJECTIVE This systematic review assesses the impact of peer education/counseling on nutrition and health outcomes among Latinos and identifies future research needs. DESIGN A systematic literature search was conducted by: (1) searching Internet databases; (2) conducting backward searches from reference lists of articles of interest; (3) manually reviewing the archives of the Center for Eliminating Health Disparities among Latinos; (4) searching the Journal of Nutrition Education and Behavior; and (5) directly contacting researchers in the field. The authors reviewed 22 articles derived from experimental or quasi-experimental studies. OUTCOME MEASURES Type 2 diabetes behavioral and metabolic outcomes, breastfeeding, nutrition knowledge, attitudes and behaviors. RESULTS Peer nutrition education has a positive influence on diabetes self-management and breastfeeding outcomes, as well as on general nutrition knowledge and dietary intake behaviors among Latinos. CONCLUSIONS AND IMPLICATIONS There is a need for longitudinal randomized trials testing the impact of peer nutrition education interventions grounded on goal setting and culturally appropriate behavioral change theories. Inclusion of reliable scales and the construct of acculturation are needed to further advance knowledge in this promising field. Operational research is also needed to identify the optimal peer educator characteristics, the type of training that they should receive, the client loads and dosage (ie, frequency and amount of contact needed between peer educator and client), and the best educational approaches and delivery settings.

Household food insecurity is associated with depressive symptoms among low-income pregnant Latinas.

Latinas experience high rates of poverty, household food insecurity and prenatal depression. To date, only one USA study has examined the relationship between household food insecurity and prenatal depression, yet it focused primarily on non-Latina white and non-Latina black populations. Therefore, this study examined the independent association of household food insecurity with depressive symptoms among low-income pregnant Latinas. This cross-sectional study included 135 low income pregnant Latinas living in Hartford, Connecticut. Women were assessed at enrolment for household food security during pregnancy using an adapted and validated version of the US Household Food Security Survey Module. Prenatal depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. A cut-off of ≥21 was used to indicate elevated levels of prenatal depressive symptoms (EPDS). Multivariate backwards stepwise logistic regression was used to identify risk factors for EPDS. Almost one third of participants had EPDS. Women who were food insecure were more likely to experience EPDS compared to food secure women (OR = 2.59; 95% CI = 1.03-6.52). Being primiparous, experiencing heartburn and reporting poor/fair health during pregnancy, as well as having a history of depression were also independent risk factors for experiencing EPDS. Findings from this study suggest the importance of assessing household food insecurity when evaluating depression risk among pregnant Latinas.

Breastfeeding Education and Support Trial for Overweight and Obese Women: A Randomized Trial

OBJECTIVE: To evaluate a specialized breastfeeding peer counseling (SBFPC) intervention promoting exclusive breastfeeding (EBF) among overweight/obese, low-income women. METHODS: We recruited 206 pregnant, overweight/obese, low-income women and randomly assigned them to receive SBFPC or standard care (controls) at a Baby-Friendly hospital. SBFPC included 3 prenatal visits, daily in-hospital support, and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers. Standard care involved routine access to breastfeeding support from hospital personnel, including staff peer counselors. Data collection included an in-hospital interview, medical record review, and monthly telephone calls through 6 months postpartum to assess infant feeding practices, demographics, and health outcomes. Bivariate and logistic regression analyses were conducted. RESULTS: The intervention had no impact on EBF or breastfeeding continuation at 1, 3, or 6 months postpartum. In adjusted posthoc analyses, at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding (adjusted odds ratio [aOR]: 3.76 [95% confidence interval (CI): 1.07–13.22]), and giving at least 50% of feedings as breast milk (aOR: 4.47 [95% CI: 1.38–14.5]), compared with controls. Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth (aOR: 0.24 [95% CI: 0.07–0.86]). CONCLUSIONS: In a Baby-Friendly hospital setting, SBFPC targeting overweight/obese women did not impact EBF practices but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth.

Comparison between self-reported and observed food handling behaviors among Latinas.

The study was conducted to compare and identify the magnitude of differences between self-reported and observed food safety behaviors among women preparing a chicken and salad dish at home. The observed food safety practices also were compared according to sociodemographic variables and prior food safety education. Sixty Puerto Rican women who were the main meal preparers for their households were recruited in Hartford, Conn. Three household visits were made to (i) deliver food ingredients to prepare the chicken and salad meal, (ii) conduct household observation, and (iii) conduct a self-reported survey. The difference between self-reported and observed behaviors varied across food handling and sanitation behaviors. There was a high level of inaccuracy for socially desirable behaviors such as hand washing; the vast majority of participants reported practicing these behaviors but they were not observed doing so. Cutting board washing also was considerably overreported, questioning the validity of these self-reported data for regression analyses. There was a significant association (P < 0.05) between proper thawing method and prior food safety education, use of cutting board and higher income, and washing tomatoes and having a positive attitude towards food safety. Results revealed that overreporting errors must be considered when analyzing and/or interpreting data derived from self-reported food safety consumer surveys and that food safety education and positive food safety attitudes are associated with recommended food safety behaviors.

Food safety knowledge, attitudes, and behaviors among Puerto Rican caretakers living in Hartford, Connecticut.

Household food safety education is needed to minimize the risk of exposure to foodborne pathogens. The Latino population in the United States is growing at a fast rate and has become the largest minority group in this country. However, little research has been done to identify the food safety behavioral risks faced by Puerto Ricans. Ten in-depth household observations and a quantitative survey on food safety knowledge, attitudes, and behaviors (n = 100) were conducted to understand food-handling techniques among Puerto Rican caretakers of young children. This was followed by two focus groups (n = 12) to further characterize food safety knowledge, attitudes, and behaviors and the proper media channels for the delivery of food safety education. Even though 97% of survey participants reported washing their hands with soap and water before preparing foods, only 1 of the 10 participants in the household observations actually did it. About 60% of the household participants washed the cutting boards with soap and water compared with 89% of survey participants who claimed to do it. In the survey, 5% reported to know the meaning of cross-contamination, and 71% (n = 80) to use the same cutting board for meats and vegetables. Overall, 96% of survey participants did not use a thermometer to check if meats were cooked properly and only 10% defrosted their meats in the refrigerator. Statistically significant relationships (P < 0.05) were found between speaking English and knowing the meaning of cross-contamination and how to use a meat thermometer. Employed individuals and those with higher education were also more likely to be familiar with the term pasteurization. These results fully justify the delivery of culturally appropriate food safety education in this community.

Stress and the Social Determinants of Maternal Health among Puerto Rican Women: A CBPR Approach

This qualitative research project explores how poverty, the built environment, education, working conditions, health care access, food insecurity and perceived discrimination are experienced by Puerto Rican Latinas through the course of their lives. Five focus groups were conducted with the primary objective of documenting community experiences and perspectives regarding: 1) stress, including perceived discrimination based on race/ethnicity (racism); 2) the impact of stress on Puerto Rican women of reproductive age, their families, and/or their community; and 3) stressors that affect maternal health. Focus groups were conducted in English and Spanish in the two cities with the highest rates of premature birth and low infant birthweight in the state of Connecticut. Focus group findings indicate that participants perceived poverty, food insecurity, lack of access to quality education, and unsafe environments as significant life stressors affecting maternal and child health.

A randomized, controlled trial of a stress management intervention for Latinos with type 2 diabetes delivered by community health workers: Outcomes for psychological wellbeing, glycemic control, and cortisol.

AIMS To test the efficacy of a community health worker (CHW) delivered stress management (SM) intervention on psychosocial, glycemic, and cortisol outcomes among U.S. Latinos with type 2 diabetes. METHODS A randomized, controlled trial compared CHW-delivered diabetes education (DE; one group session) to DE plus CHW-delivered SM (DE+SM; 8 group sessions). Psychosocial variables and urinary cortisol were measured at baseline and posttreatment. HbA1c was measured at baseline, posttreatment, and 3-month follow-up. RESULTS In intent to treat analysis, compared to DE (n=46), DE+SM (n=61) showed significantly improved symptoms of depression, anxiety, and self-reported health status. There were no significant group effects for HbA1c, diabetes distress, or urinary cortisol. However, there was a dose response effect for HbA1c and diabetes distress; increasing attendance at SM sessions was associated with greater improvements in HbA1c and diabetes distress. CONCLUSIONS This is the first randomized, controlled trial demonstrating that CHWs can improve psychological symptoms and self-reported health among Latinos with type 2 diabetes. Efforts to increase intervention attendance may improve HbA1c and diabetes distress.

Community health workers assisting Latinos manage stress and diabetes (CALMS-D): rationale, intervention design, implementation, and process outcomes.

Latinos have high rates of diabetes and mental distress, but lack appropriate services. A study was designed to compare enhanced standard diabetes care with enhanced standard care plus community health worker (CHW) delivered stress management for Latinos with type 2 diabetes. This paper reports intervention design and process outcomes. A formative process was used to develop and implement an eight-session, group stress management intervention. One hundred twenty-one participants completed baseline assessments; n = 107 attended diabetes education and were then randomized. Recruits reported high credibility and treatment expectancies. Treatment fidelity was high. Participants reported high treatment satisfaction and therapeutic alliance and their diabetes knowledge and affect improved over the short term. Retention and attendance at group sessions was challenging but successful relative to similar trials. This comprehensive and culturally sensitive stress management intervention, delivered by a well-trained CHW, was successfully implemented.

Nutrient and food intakes differ among Latina subgroups during pregnancy.

OBJECTIVE To document nutrient and food group serving intakes from food sources among Latina subgroups living in the same geographical area. DESIGN A cross-sectional study. Nutrient and food group serving intakes were assessed by means of a 24 h recall administered immediately after a prenatal survey. SETTING Hartford, CT, USA. SUBJECTS A total of 233 low-income pregnant Latinas. For analyses, Latinas were classified into two groups on the basis of self-reported ethnic identity: Puerto Ricans and non-Puerto Rican Latinas. RESULTS Puerto Rican Latinas were more likely than non-Puerto Rican Latinas to be more acculturated and to consume foods (i.e. processed meat, cheese, soft drinks) and higher levels of nutrients (i.e. fat, SFA, MUFA, trans fatty acids) that have been implicated in the development of chronic diseases. By contrast, non-Puerto Rican Latinas were more likely to consume foods (i.e. fruits, dark green/yellow vegetables, tomatoes, non-starchy vegetables) and higher levels of nutrients (i.e. fibre, vegetable protein, folate, β-carotene) that promote health when compared with Puerto Rican Latinas. CONCLUSIONS Findings suggest that acculturation may play a role in dietary intake. Clinicians and dietitians need to be aware of these differences to encourage healthy eating patterns among more acculturated pregnant Latina clients.

Behavioral reactivity to acute stress among Black and White women with type 2 diabetes: The roles of income and racial discrimination

This study investigated relationships of income and self-reported racial discrimination to diabetes health behaviors following an acute stressor. A total of 77 diabetic women (51% Black, 49% White) completed a laboratory public speaking stressor. That evening, participants reported same-day eating, alcohol consumption, and medication adherence; physical activity was measured with actigraphy, and the next morning participants reported sleep quality. Measures were repeated on a counterbalanced control day. There was no mean level difference in health behaviors between stressor and control days. On stressor day, lower income predicted lower physical activity, sleep quality, and medication adherence, and higher racial discrimination predicted more eating and alcohol consumed, even after accounting confounders including race and control day behaviors.