Low-income Hispanic Adults Research Articles

Measuring Pro- and Anti-Inflammatory Biomarkers Among Low-Income Hispanic Adults: A Feasibility and Pilot Assessment

Using the Orsmond and Cohen feasibility framework, the primary aim of this study was to assess the feasibility of the implementation of recruitment strategies, data collection procedures, and managerial resources needed to assess pro- and anti-inflammatory biomarkers from low-income, younger Hispanic adults. The secondary aim of this study was to describe the relationship between discrimination stress and inflammation as pilot work for future studies. Data were collected in a Houston-area community center from self-identifying Hispanic adults (ages 21–35) (August 2018). Inflammation was evaluated from blood samples, and interviewer-administered surveys in participants’ preferred language measured discrimination stress (Hispanic Stress Inventory-2 discrimination subscale). Spearman rank-order correlations evaluated the relationships between discrimination stress and inflammatory biomarkers. The recruitment strategies, data collection strategy, and the associated resources were evaluated and found to be feasible. While 50 participants consented to donate blood, five were too dehydrated for sample collection. Among the 45 participants [Mage = 28.9 (SD = 4.4), 17.8% U.S.-born, 42.2% 1.5 generation, 40% 1.0 generation], discrimination stress was negatively correlated with proinflammatory cytokine interleukin-8 (p < 0.01). This study demonstrated feasibility using established benchmarks. The negative correlation between discrimination stress and interleukin-8 suggests discrimination stress may contribute to inflammatory dysregulation.

P83 Formative Evaluation of a Culturally Adapted Spanish Nutrition Education and Obesity Prevention Curriculum for Low-Income Hispanic Adults

<h3>Objective</h3> To conduct an exploratory formative evaluation of a culturally adapted nutrition education program for SNAP-eligible Hispanic/Latino adult Georgians <h3>Use of Theory or Research</h3> Nutrition education programs for low-income Hispanics/Latinos must be culturally tailored to be effective. <h3>Target Audience</h3> Spanish-speaking SNAP-eligible adult Georgians <h3>Program Description</h3> "Hablemos de Comida: Comida: "Por SU Salud!" (HCPSS) is a cultural adaptation of "Food Talk: Better U," an evidence-based program focusing on healthy weight management by University of Georgia SNAP-Ed. A comprehensive needs assessment informed systematic translation and cultural tailoring. The program consists of four 90-minute didactic lessons taught by bilingual paraprofessionals focusing on portion control, limiting added sugar, and making small healthy changes. The program content is interactive and features physical activity using culturally appropriate music and 6 Hispanic/Latino-inspired, low sodium recipes. <h3>Evaluation Methods</h3> A mixed-method formative evaluation was conducted using self-administered participant surveys (n = 15), program administrative data, key informant interviews with program developers and providers (n = 6), program participant focus groups (n = 3), and in-class observations (n = 10) in 1 pilot county in 2019. <h3>Results</h3> Focus group and key informant interview findings suggested acceptability and cultural appropriateness of HCPSS. Major themes from development and implementation phases emphasized the importance of attending to diversity and cultural appropriateness for target audiences and language, translation, and other interpersonal facilitator skills such as cultural competence and humility. A team-based approach was recommended to address cultural diversity, recruitment barriers, ongoing staff training needs, and other population-specific barriers regarding language, literacy, and mistrust. Administrative data and class observation data suggested high fidelity but the importance of fully bilingual paraprofessionals and additional training for physical activity. <h3>Conclusion and Implications</h3> This study found that the culturally adapted nutrition education and obesity prevention programming targeted to low-income Hispanics/Latinos and strategies to strengthen ongoing development and implementation efforts was feasible.

Examining Equitable Online Federal Food Assistance during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Case Study in 2 Regions.

ABSTRACTThe USDA Supplemental Nutrition Assistance Program (SNAP) provides food and financial assistance to food-insecure individuals and families. In the midst of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, SNAP benefits evolved. Policy changes and federal legislation expanded SNAP eligibility, raised benefit levels, and introduced program waivers that enabled online ordering to reduce participants’ exposure to community-acquired SARS-CoV-2. Although rapid expansion of SNAP benefits in the online space represents significant progress for federal food assistance, changes also introduced unforeseen partiality in how benefits and services were accessed and utilized, as illustrated by 2 populations and regions in the early months of the SARS-CoV-2 pandemic: low-income older adults in rural Alabama and low-income Hispanic adults in urban California. Opportunities exist to build on the recent progress in SNAP, while also ensuring continued inclusiveness of eligible persons. Efforts should be informed by evidence that supports equitable access to federal food assistance.

An Evaluation of Digital Health Tools for Diabetes Self-Management in Hispanic Adults: Exploratory Study

BackgroundAlthough multiple self-monitoring technologies for type 2 diabetes mellitus (T2DM) show promise for improving T2DM self-care behaviors and clinical outcomes, they have been understudied in Hispanic adult populations who suffer disproportionately from T2DM.ObjectiveThe objective of this study was to evaluate the acceptability, feasibility, and potential integration of wearable sensors for diabetes self-monitoring among Hispanic adults with self-reported T2DM.MethodsWe conducted a pilot study of T2DM self-monitoring technologies among Hispanic adults with self-reported T2DM. Participants (n=21) received a real-time continuous glucose monitor (RT-CGM), a wrist-worn physical activity (PA) tracker, and a tablet-based digital food diary to self-monitor blood glucose, PA, and food intake, respectively, for 1 week. The RT-CGM captured viewable blood glucose concentration (mg/dL) and PA trackers collected accelerometer-based data, viewable on the device or an associated tablet app. After 1 week of use, we conducted a semistructured interview with each participant to understand experiences and thoughts on integration of the data from the devices into a technology-facilitated T2DM self-management intervention. We also conducted a brief written questionnaire to understand participants’ self-reported T2DM history and past experience using digital health tools for T2DM self-management. Feasibility was measured by device utilization and objective RT-CGM, PA tracker, and diet logging data. Acceptability and potential integration were evaluated through thematic analysis of verbatim interview transcripts.ResultsParticipants (n=21, 76% female, 50.4 [SD 11] years) had a mean self-reported hemoglobin A1c of 7.4 [SD 1.8] mg/dL and had been diagnosed with T2DM for 7.4 [SD 5.2] years (range: 1-16 years). Most (89%) were treated with oral medications, whereas the others self-managed through diet and exercise. Nearly all participants (n=20) used both the RT-CGM and PA tracker, and 52% (11/21) logged at least one meal, with 33% (7/21) logging meals for 4 or more days. Of the 8 possible days, PA data were recorded for 7.1 [SD 1.8] days (range: 2-8), and participants averaged 7822 [SD 3984] steps per day. Interview transcripts revealed that participants felt most positive about the RT-CGM as it unveiled previously unknown relationships between lifestyle and health and contributed to changes in T2DM-related thoughts and behaviors. Participants felt generally positive about incorporating the wearable sensors and mobile apps into a future intervention if support were provided by a health coach or health care provider, device training were provided, apps were tailored to their language and culture, and content were both actionable and delivered on a single platform.ConclusionsSensor-based tools for facilitating T2DM self-monitoring appear to be a feasible and acceptable technology among low-income Hispanic adults. We identified barriers to acceptability and highlighted preferences for wearable sensor integration in a community-based intervention. These findings have implications for the design of T2DM interventions targeting Hispanic adults.

P100 How Various Epoch Lengths and Activity Cut-Points Influence Physical Activity Estimates for Low-Income Hispanic Adults Under Free-Living Conditions

Background Accelerometers are popular, objective physical activity (PA) measures. However, when using accelerometry, data processing decisions must be made regarding sampling intervals (i.e., epoch lengths (EL)) and PA intensity cut-points. Objective To examine how different epoch lengths (EL) and intensity cut-points influence PA estimates among free-living, low-income Hispanic adults. Study Design, Settings, Participants This study was cross-sectional. Low-income Hispanic adults (n = 35) recruited from Expanded Food and Nutrition Education Program in five states, were asked to wear an accelerometer (ActiGraph GT3X+) for seven consecutive days. Measurable Outcome/Analysis Only data from participants with > 4 valid days (i.e., > 10 hour of wear time) were analyzed. Downloaded data were reintegrated into 1-, 10-, 30-, and 60-second ELs. Within each EL, PA cut-points were classified as either: a) sedentary; b) light; c) moderate; or d) vigorous, using two widely-accepted algorithms (Freedson and Matthews). Total moderate to vigorous PA (MVPA) was also calculated. Since the data were not normally distributed, Kruskal-Wallis analysis was used to compare the time spent in different PA intensity levels, by aforementioned ELs, for each intensity cut-point. Results The participants were mostly female (88.6%), with a mean age of 36.5 ± 11.0. Using the Freedson cut-points, the mean rank of time spent in light PA was higher for longer ELs (H = 90.7, P P P P P Conclusion This study's findings suggest that PA estimates vary by EL regardless of the cut-points used, thus validity studies should be done to compare accelerometer results with indirect calorimetry to generate the optimal EL for estimating low-income Hispanic adults’ true PA levels. Funding NIFA.

Informing the Adaptation and Implementation of a Lifestyle Modification Program in Hispanics: A Qualitative Study Among Low-Income Hispanic Adults.

Low-income Hispanics are a hard to reach population that face unique challenges in achieving behavior change. Understanding such challenges can inform the adaptation of lifestyle behavioral interventions and increase participant engagement. This descriptive qualitative study aimed to (1) inform lifestyle modification programs focused on improving the physical activity and healthy eating of low-income Hispanic adults and (2) explore potential gender differences necessary for consideration. Five gender-specific focus groups were conducted with Hispanic adults from a free community clinic (n = 45, 64% women, 53.1 ± 10.1 years). Sessions were audio-recorded, transcribed, and coded using a general inductive approach. The qualitative software program Dedoose was used to perform a content analysis. Emergent themes included topics of interest, methods of increasing engagement in healthy behaviors, and the delivery of lifestyle modification programs. Men expressed greater interest in physical activity, while women desired to learn about healthy eating. Men described the importance of physician communication, while women focused on the role of social support as facilitators for participating in such programs. Both genders described education as key to behavior change and viewed text messaging as a valuable complement. Results from this study can inform the adaptation of lifestyle modification programs and increase the engagement of low-income Hispanic populations.

Integrating CHWs as Part of the Team Leading Diabetes Group Visits: A Randomized Controlled Feasibility Study.

Purpose The purpose of the study was to evaluate the feasibility of integrating Community Health Workers (CHWs) as part of the team leading diabetes group visits. Methods This was a randomized controlled study that integrated CHWs as part of the team leading diabetes group visits for low-income Hispanic adults (n = 50). Group visits met for 3 hours each month for a 6-month duration. Main measures included baseline and 6-month clinical outcomes (ie, A1C, lipids), concordance with 8 standard of care guidelines (ie, screens for cervical, breast, and colon cancer) from the US Preventive Task Force and American Diabetes Association, and participant acceptability. Results Compared to control participants, the intervention group resulted in significantly better clinical outcomes or guideline concordance for the following areas: target A1C levels, retinal eye exams, diabetes foot exams, mammograms, and urine microalbumin. Significantly more individuals in the control group gained weight, whereas a greater number of participants in the intervention group lost weight. Intervention participants found the group visits highly acceptable. Conclusions Integrating CHWs as part a comprehensive diabetes group visit program is a feasible and effective system-level intervention to improve glycemic control and achieve guideline concordance.

Examining the Role of Income Inequality and Neighborhood Walkability on Obesity and Physical Activity among Low-Income Hispanic Adults.

Obesity is a major public health issue affecting rising medical costs and contributing to morbidity and premature mortality. We aimed to identify factors that may play a role in obesity and physical activity at the individual and environmental/neighborhood levels. We analyzed data from an adult sample who were parents of students enrolled in a school-based health and wellness program. The sample was restricted to those who were Hispanic and whose children were on free/reduced lunch (n = 377). Dependent variables: body mass index (BMI); neighborhood walkability. Walk Score® was used to assess neighborhood walkability. Overall, 46% of participants were obese and 31% were overweight. The median age of respondents was 34years, and the majority were female (88%) and married (59%). Participants who resided in a census tract with a higher relative income inequality (high, OR 2.54, 90% CI 1.154-5.601; moderate-high OR 2.527, 90% CI 1.324-4.821) and those who were unmarried (OR 1.807, 90% CI 1.119-2.917) were more likely to be obese versus normal weight. Overweight individuals that resided in areas that were walkable versus car-dependent averaged more days engaging in walking for at least 30-min (p <.05). Identifying individual and neighborhood factors associated with obesity can inform more targeted approaches to combat obesity at multiple ecological levels. The importance of understanding how neighborhood characteristics influence health-related and behavioral outcomes is further reinforced with the current findings. Identifying effective strategies to engage communities and organizations in creating, implementing, adopting, evaluating, and sustaining policy and/or environmental interventions will be needed to combat the obesity epidemic.

Cost-effectiveness analysis of a community health worker intervention for low-income Hispanic adults with diabetes.

IntroductionThe objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes.MethodsWe forecasted disease outcomes, quality-adjusted life years (QALYs) gained, and lifetime costs associated with attaining different hemoglobin A1c (A1c) levels. Outcomes were projected 20 years into the future and discounted at a 3.0% rate. Sensitivity analyses were conducted to assess the extent to which our results were dependent on assumptions related to program effectiveness, projected years, discount rates, and costs.ResultsThe incremental cost-effectiveness ratio of the intervention ranged from $10,995 to $33,319 per QALY gained when compared with usual care. The intervention was particularly cost-effective for adults with high glycemic levels (A1c > 9%). The results are robust to changes in multiple parameters.ConclusionThe CHW program was cost-effective. This study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, particularly among those with high A1c levels.

Physical Activity, Obesity, Nutritional Health and Quality of Life in Low-Income Hispanic Adults With Diabetes

The study examined relationships among age, body mass index (BMI), physical activity, nutritional health, quality of life, and health-related quality of life in Hispanic adults with diabetes (N = 59) using the PRECEDE-PROCEED planning model as a framework. Data were collected through face-to-face interviews at clinics and communities. A regression model with predisposing factors (age, BMI), and behavior (nutritional health and physical activity) significantly predicted quality of life (R 2 = 0.21, F = 3.63, p < .05) explaining 21% of variance. Physical activity and nutrition were the strongest predictors. Culturally competent intervention strategies must include factors that improve and enhance quality of life.