To evaluate a healthy eating and physical activity intervention for immigrant families, derived through community-based participatory research.
Design:
The Healthy Immigrant Families study was a randomized controlled trial with delayed intervention control group, with families as the randomization unit.
Setting:
US Midwest city.
Participants:
Participants were recruited by community partners from Hispanic, Somali, and Sudanese immigrant communities.
Intervention:
Family health promoters from participating communities delivered 6 healthy eating modules, 4 physical activity modules, and 2 modules synthesizing information in 12 home visits (60-90 minutes) within the first 6 months. Up to 12 follow-up phone calls to each participant occurred within the second 6 months.
Measures:
Primary measures were dietary quality measured with weekday 24-hour recall and reported as Healthy Eating Index score (0-100) and physical activity measured with accelerometers (14 wear days) at baseline, 6, 12, and 24 months.
Results:
In total, 151 persons (81 adolescents and 70 adults; 44 families) were randomly assigned. At 12 months, significant improvement occurred in Healthy Eating Index scores for adults in the intervention group compared with controls (change, +8.6 vs −4.4; P < .01) and persisted at 24 months (+7.4 from baseline; P < .01). No differences were observed for adolescents and no significant differences occurred between groups for physical activity.
Conclusion:
This intervention produced sustained dietary quality improvement among adults but not among adolescents. Program outcomes are relevant to communities working to decrease cardiovascular risk among immigrant populations.
PasselJSCohnD. US Population Projections: 2005-2050. Washington, DC: Pew Research Center; 2008.
2.
SinghGKSiahpushM. All-cause and cause-specific mortality of immigrants and native born in the United States. Am J Public Health. 2001;91(3):392–399.
3.
GoelMSMcCarthyEPPhillipsRSWeeCC. Obesity among US immigrant subgroups by duration of residence. JAMA. 2004;292(23):2860–2867.
4.
KaplanMSHuguetNNewsomJTMcFarlandBH. The association between length of residence and obesity among Hispanic immigrants. Am J Prev Med. 2004;27(4):323–326.
5.
KoyaDLEgedeLE. Association between length of residence and cardiovascular disease risk factors among an ethnically diverse group of United States immigrants. J Gen Intern Med. 2007;22(6):841–846.
6.
SteffenPRSmithTBLarsonMButlerL. Acculturation to Western society as a risk factor for high blood pressure: a meta-analytic review. Psychosom Med. 2006;68(3):386–397.
7.
CreatoreMIMoineddinRBoothG. Age-and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada. CMAJ. 2010;182(8):781–789.
8.
LearSAHumphriesKHHage-MoussaSChockalingamAManciniGB. Immigration presents a potential increased risk for atherosclerosis. Atherosclerosis. 2009;205(2):584–549.
9.
LutseyPLDiez RouxAVJacobsDRJr. Associations of acculturation and socioeconomic status with subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis. Am J Public Health. 2008;98(11):1963–1970.
10.
HaskellWLLeeIMPateRR; American College of Sports Medicine; American Heart Association. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1081–1093.
11.
AndersenLBHarroMSardinhaLB. Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). Lancet. 2006;368(9532):299–304.
12.
LichtensteinAHAppelLJBrandsM. American Heart Association Nutrition Committee. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114(1):82–96. Errata in: Circulation. 2006;114(23):e629. Circulation. 2006;114(1):e27.
13.
Centers for Disease Control and Prevention. Prevalence of fruit and vegetable consumption and physical activity by race/ethnicity: United States. MMWR Morb Mortal Wkly Rep. 2005;56(13):301–304.
14.
CrespoCJSmitEAndersenRECarter-PokrasOAinsworthBE. Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988-1994. Am J Prev Med. 2000;18(1):46–53.
15.
SternfeldBAinsworthBEQuesenberryCP. Physical activity patterns in a diverse population of women. Prev Med. 1999;28(3):313–323.
16.
GaddMSundquistJJohanssonSEWandellP. Do immigrants have an increased prevalence of unhealthy behaviours and risk factors for coronary heart disease?Eur J Cardiovasc Prev Rehabil. 2005;12(6):535–541.
17.
KandulaNRKerseyMLurieN. Assuring the health of immigrants: what the leading health indicators tell us. Annu Rev Public Health. 2004;25:357–376.
18.
SinghGKKoganMDYuSM. Disparities in obesity and overweight prevalence among US immigrant children and adolescents by generational status. J Community Health. 2009;34(4):271–281.
19.
DavidsonEMLiuJJBhopalRS. Consideration of ethnicity in guidelines and systematic reviews promoting lifestyle interventions: a thematic analysis. Eur J Public Health. 2014;24(3):508–513.
20.
RenzahoAMMellorDBoultonKSwinburnB. Effectiveness of prevention programmes for obesity and chronic diseases among immigrants to developed countries: a systematic review. Public Health Nutr. 2010;13(3):438–450.
21.
NierkensVHartmanMANicolaouM. Effectiveness of cultural adaptations of interventions aimed at smoking cessation, diet, and/or physical activity in ethnic minorities: a systematic review. PLoS One. 2013;8(10):e73373.
22.
DunnJRDyckI. Social determinants of health in Canada’s immigrant population: results from the National Population Health Survey. Soc Sci Med. 2000;51(11):1573–1593.
23.
MalmusiDBorrellCBenachJ. Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin. Soc Sci Med. 2010;71(9):1610–1619.
24.
CaperchioneCMKoltGSTennentRMummeryWK. Physical activity in culturally and linguistically diverse migrant groups to Western society: a review of barriers, enablers and experiences. Sports Med. 2009;39(3):167–177.
25.
HorowitzCRRobinsonMSeiferS. Community-based participatory research from the margin to the mainstream: are researchers prepared?. Circulation. 2009;119(19):2633–2642.
26.
ShalowitzMUIsaccoABarquinN. Community-based participatory research: a review of the literature with strategies for community engagement. J Dev Behav Pediatr. 2009;30(4):350–361.
27.
IsraelBASchulzAJParkerEABeckerAB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202.
28.
WielandMLWeisJAOlneyMW. Screening for tuberculosis at an adult education center: results of a community-based participatory process. Am J Pub Health. 2011;101(7):1264–7.
29.
WielandMLWeisJAYawnBP. Perceptions of tuberculosis among immigrants and refugees at an adult education center: a community-based participatory research approach. J Immigr Minor Health. 2012;14(1):14–22.
30.
JohnsonCEAliSAShippMP. Building community-based participatory research partnerships with a Somali refugee community. Am J Prev Med. 2009;37(6 suppl 1):S230–S236.
31.
GreggJCenturionLMaldonadoJAguillonRCelaya-AlstonRFarquharS. Interpretations of interpretations: combining community-based participatory research and interpretive inquiry to improve health. Prog Community Health Partnersh. 2010;4(2):149–154.
32.
LamTKMcPheeSJMockJ. Encouraging Vietnamese-American women to obtain Pap tests through lay health worker outreach and media education. J Gen Intern Med. 2003;18(7):516–524.
33.
CristanchoSGarcesDMPetersKEMuellerBC. Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use. Qual Health Res. 2008;18(5):633–646.
34.
MartinezILCarter-PokrasO. Assessing health concerns and barriers in a heterogeneous Latino community. J Health Care Poor Underserved. 2006;17(4):899–909.
35.
LauderdaleDSKuohungVChangSLChinMH. Identifying older Chinese immigrants at high risk for osteoporosis. J Gen Intern Med. 2003;18(7):508–515.
36.
TovarAVikreEKGuteDM. Development of the live well curriculum for recent immigrants: a community-based participatory approach. Prog Community Health Partnersh. 2012;6(2):195–204.
37.
RenzahoAMHallidayJAMellorDGreenJ. The Healthy Migrant Families Initiative: development of a culturally competent obesity prevention intervention for African migrants. BMC Public Health. 2015;15:272.
38.
Rochester Healthy Community Partnership [Internet]. www.rochesterhealthy.org. Accessed December 6, 2016.
39.
NjeruJWPattenCAHanzaMMBrockmanTARidgewayJLWeisJA. Stories for change: development of a diabetes digital storytelling intervention for refugees and immigrants to Minnesota using qualitative methods1. BMC Public Health. 2015;15:1311.
40.
WielandMLWeisJAPalmerTGoodsonMLothSOmerF. Physical activity and nutrition among immigrant and refugee women: a community-based participatory research approach. Womens Health Issues. 20123;22(2):e225–32.
41.
BanduraA. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–164.
42.
SheeshkaJDWoolcottDMMackinnonNJ. Social cognitive theory as a framework to explain intentions to practice healthy eating behaviors. J Appl Soc Psych. 1993;23(19):1547–1573.
43.
TrostSGOwenNBaumanAESallisJFBrownW. Correlates of adults’ participation in physical activity: review and update. Med Sci Sports Exerc. 2002;34(12):1996–2001.
44.
EylerAABrownsonRCDonatelleRJKingACBrownDSallisJF. Physical activity social support and middle- and older-aged minority women: results from a US survey. Soc Sci Med. 1999;49(6):781–789.
45.
TiedjeKWielandMLMeiersSJMohamedAAFormeaCMRidgewayJL. A focus group study of healthy eating knowledge, practices, and barriers among adult and adolescent immigrants and refugees in the United States. Int J Behav Nutr Phys Act. 2014516;11:63.
46.
WielandMLTiedjeKMeiersSJMohamedAAFormeaCMRidgewayJL. Perspectives on physical activity among immigrants and refugees to a small urban community in Minnesota. J Immigr Minor Health. 20152;17(1):263–75.
47.
MohamedAAHassanAMWeisJASiaIGWielandML. Physical activity among Somali men in Minnesota: barriers, facilitators, and recommendations. Am J Mens Health. 20141;8(1):35–44.
48.
HanzaMMGoodsonMOsmanAPorrazCapetillo MDHaredANigonJA. Erratum to: Lessons learned from community-led recruitment of immigrants and refugee participants for a randomized, community-based participatory research study. J Immigr Minor Health. 201610;18(5):1246.
49.
WielandMLWeisJAHanzaMMMeiersSJPattenCAClarkMM. Healthy immigrant families: participatory development and baseline characteristics of a community-based physical activity and nutrition intervention. Contemp Clin Trials. 20163;47:22–31.
50.
MorrisonEJClarkMMWielandMLWeisJAHanzaMMMeiersSJ. Relationship between negative mood and health behaviors in an immigrant and refugee population. J Immigr Minor Health. 20176;19(3):655–64. Epub 2016 Sep 26.
51.
BronarsCAHanzaMMMeiersSJPattenCAClarkMMNigonJA. Treatment fidelity among family health promoters delivering a physical activity and nutrition intervention to immigrant and refugee families. Health Educ Behav. 20174;44(2):262–70. Epub 2016 Jul 9.
52.
HawleyNCWielandMLWeisJASiaIG. Perceived impact of human subjects’ protection training on community partners in community-based participatory research. Prog Community Health Partnersh. 2014Summer;8(2):241–8.
53.
BlairSNDunnALMarcusBHCarpenterRAJaretP. Active Living Every Day. 2nd ed. Champaign, IL: Human Kinetics; 2011.
54.
BrownellKD. The LEARN Program for Weight Management. 10th ed. Dallas, TX: American Health Publishing Company; 2004.
National Cancer Institute. [Internet] ASA24: Automated Self-Administered 24-hour dietary assessment tool. http://appliedresearch.cancer.gov/asa24. Updated December 6, 2016. Accessed December 9, 2016.
57.
KirkpatrickSISubarAFDouglassD. Performance of the automated self-administered 24-hour recall relative to a measure of true intakes and to an interviewer-administered 24-h recall. Am J Clin Nutr. 2014;100(1):233–240.
58.
ThompsonFEDixit-JoshiSPotischmanN. Comparison of interviewer-administered and automated self-administered 24-hour dietary recalls in 3 diverse integrated health systems. Am J Epidemiol. 2015;181(12):970–978.
59.
GuentherPMKirkpatrickSIReedyJ. The healthy eating index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans. J Nutr. 2014;144(3):399–407.
60.
RedfieldMMAnstromKJLevineJA; NHLBI Heart Failure Clinical Research Network. Isosorbide mononitrate in heart failure with preserved ejection fraction. N Engl J Med. 2015;373(24):2314–2324.
61.
ZakeriRLevineJAKoeppGA; Nitrate’s effect on activity tolerance in heart failure with preserved ejection fraction trial: rationale and design. Circ Heart Fail. 2015;8(1):221–228.
62.
Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. Geneva, Switzerland: World Health Organization; 1995. WHO Technical Report Series No. 854.
63.
DietzWHBellizziMC. Introduction: the use of body mass index to assess obesity in children. Am J Clin Nutr. 1999;70(1):123S–125S.
64.
ChobanianAVBakrisGLBlackHR. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. . The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–2572. Erratum in: JAMA. 2003;290(2):197.
65.
SinghJASateleDPattabasavaiahSBucknerJCSloanJA. Normative data and clinically significant effect sizes for single-item numerical linear analogue self-assessment (LASA) scales. Health Qual Life Outcomes. 2014;12:187.
66.
CohenJ. Statistical Power Analysis for the Behavioral Sciences. New York, NY: Academic Press; 1969.
67.
HamSAAinsworthBE. Disparities in data on healthy people 2010 physical activity objectives collected by accelerometry and self-report. Am J Public Health. 2010;100(suppl 1):S263–S268.
68.
Whitt-GloverMCTaylorWCFloydMFYoreMMYanceyAKMatthewsCE. Disparities in physical activity and sedentary behaviors among US children and adolescents: prevalence, correlates, and intervention implications. J Public Health Policy. 2009;30(suppl 1):S309–S334.
69.
HunterRFMcAneneyHDavisMTullyMAValenteTWKeeF. “Hidden” social networks in behavior change interventions. Am J Public Health. 2015;105(3):513–516.
