Portal de Periódicos da CAPES

An Introduction to Salud America!

2013; Elsevier BV; Volume: 44; Issue: 3 Linguagem: Inglês

10.1016/j.amepre.2012.12.002

1873-2607

Amelie G. Ramírez, Guadalupe X. Ayala,

Obesity and Health Practices

Calls for the prevention and control of childhood obesity in the U.S. can seem almost commonplace these days. Media outlets regularly sound alarm over new statistics showing risks to children's health from being overweight or obese. As a response, some states and cities are regulating or considering regulating sodas and sugary snacks. Restaurants are labeling menus with nutrition information, and in some cases are making changes in what they are offering. Neighborhood stores are making fruits and vegetables more accessible. And First Lady Michelle Obama launched her massive "Let's Move!" national initiative dedicated to solving the challenge of childhood obesity within a generation. Unfortunately, the limited amount of data available on U.S. Latino children and communities makes it difficult to identify effective strategies for addressing this epidemic. It is within this backdrop that Salud America! investigators were charged with identifying the best approaches for addressing the obesity epidemic within U.S. Latino communities. Addressing the obesity epidemic in the U.S. Latino community is urgent. Latino boys are among the highest at risk (44% overweight or obese), and Latino girls follow closely behind (39%), compared with an average prevalence rate of 31%. As the percentage of Latinos among U.S. children aged 18 years or younger surges (rising from 17% of U.S. children in 1998 to 22% today and a projected 30% by 2025), the impact of these prevalence rates on the healthcare system cannot be ignored. Health risks associated with childhood obesity can reverberate into adulthood and include pulmonary, orthopedic, neurologic, gastroenterologic, endocrine, and cardiovascular problems, as well as other systemic issues. Long-term health consequences include cancer, diabetes, hypertension, sleep apnea, renal failure, and even death. The psychosocial consequences of obesity also are important to consider, including problems with self-esteem, depression, verbal and physical abuse by peers, and an increased risk of discrimination. As a consequence, childhood obesity-related health outcomes place pressure on the economy and are responsible for approximately $14 billion in direct medical expenses. The need to address this epidemic is eminently clear. What is less clear is how to consider cultural nuances specific to Latino children living in the U.S. The evidence-based research published within this Salud America! supplement to the American Journal of Preventive Medicine represents a subset of the funded research studies attempting to fill this gap.1Nevarez C.R. Lafleur M.S. Schwarte L.U. Weinstin B.R. DeSilva P. Samuels S.E. Salud Tiene Sabor: a model for healthier restaurants in a Latino community.Am J Prev Med. 2013; 44: S186-S192Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 2Castro D.C. Samuels M. Harman A.E. Growing Healthy Kids: a community garden-based obesity prevention program.Am J Prev Med. 2013; 44: S193-S199Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar, 3London R.A. Gurantz O. Afterschool program participation, youth physical fitness, and overweight.Am J Prev Med. 2013; 44: S200-S207Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 4Mier N. Smith M.L. Irizarry D. et al.Bridging research and policy to address childhood obesity among border Hispanics: a pilot study.Am J Prev Med. 2013; 44: S208-S214Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 5Hannay J. Dudley R. Milan S. Leibovitz P.K. Combining Photovoice and focus groups: engaging Latina teens in community assessment.Am J Prev Med. 2013; 44: S215-S224Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar, 6Torres M.E. Meetze E.G. Smithwick-Leone J. Latina voices in childhood obesity: a pilot study using Photovoice in South Carolina.Am J Prev Med. 2013; 44: S225-S231Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 7He M. Wilmoth S. Bustos D. Jones T. Leeds J. Yin Z. Latino church leaders' perspectives on childhood obesity prevention.Am J Prev Med. 2013; 44: S232-S239Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar, 8Gao Z. Hannan P. Xiang P. Stodden D.F. Valdez V. Video game–based exercise, Latino children's physical health, and academic achievement.Am J Prev Med. 2013; 44: S240-S246Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar, 9Boudreau A.D.A. Kurowski D.S. Gonzalez W.I. Dimond M.A. Oreskovic N.M. Latino families, primary care, and childhood obesity: a randomized controlled trial.Am J Prev Med. 2013; 44: S247-S257Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar, 10Olvera N. Leung P. Kellam S.F. Smith D.W. Liu J. Summer and follow-up interventions to affect adiposity with mothers and daughters.Am J Prev Med. 2013; 44: S258-S266Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 11Cortés D.E. Millán-Ferro A. Schneider D. Vega R.R. Caballero A.E. Food purchasing selection among low-income, Spanish-speaking Latinos.Am J Prev Med. 2013; 44: S267-S273Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar, 12Rosado J.I. Bennett Johnson S. McGinnity K.A. Cuevas J.P. Obesity among Latino children within a migrant farm worker community.Am J Prev Med. 2013; 44: S274-S281Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 13Ottoson J.M. Ramirez A.G. Green L.W. Gallion K.J. Exploring potential research contributions to policy: the Salud America! experience.Am J Prev Med. 2013; 44: S282-S289Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Salud America! investigators, most of whom are of Latino descent, considered the socioecologic framework when designing their studies. The framework suggests that children's health behaviors and health outcomes are affected by factors at multiple levels of influence including society at large and elements in the community, school, and the home. Previous research has demonstrated that the socioecologic framework is useful for designing formative research studies, observational studies, and the design and implementation of interventions. In addition, results from a 2008 national Delphi survey by Salud America! to define an early research agenda served as a driving force to help investigators identify communities, schools, and families as priority areas. Here are some important highlights of this supplement: Whether studying the effects of menu modifications in a Los Angeles ethnic food mercado,1Nevarez C.R. Lafleur M.S. Schwarte L.U. Weinstin B.R. DeSilva P. Samuels S.E. Salud Tiene Sabor: a model for healthier restaurants in a Latino community.Am J Prev Med. 2013; 44: S186-S192Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar community gardens as a way to improve the built environment of neighborhoods,2Castro D.C. Samuels M. Harman A.E. Growing Healthy Kids: a community garden-based obesity prevention program.Am J Prev Med. 2013; 44: S193-S199Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar or examining factors associated with physical inactivity and the prevalence of obesity among Latino migrant farm worker children,3London R.A. Gurantz O. Afterschool program participation, youth physical fitness, and overweight.Am J Prev Med. 2013; 44: S200-S207Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Salud America! researchers designed contextually and culturally relevant, community-based studies to address the problem of childhood obesity. In their paper, Nevarez and colleagues1Nevarez C.R. Lafleur M.S. Schwarte L.U. Weinstin B.R. DeSilva P. Samuels S.E. Salud Tiene Sabor: a model for healthier restaurants in a Latino community.Am J Prev Med. 2013; 44: S186-S192Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar showed that owners of small, independent restaurants can improve access to healthy menu options in low-income, Latino communities. Their findings may generalize to other ethnic eateries across the nation and complement efforts being made by chain restaurants to post nutrition information on menus. Nevarez also found that patrons did, in fact, report use of calorie information posted on menus when deciding what to buy. Castro et al.2Castro D.C. Samuels M. Harman A.E. Growing Healthy Kids: a community garden-based obesity prevention program.Am J Prev Med. 2013; 44: S193-S199Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar tested whether community gardens had effects on the mostly Latino families who tended them. Their results showed that families involved in tending a garden and going to nutrition and cooking workshops improved or maintained children's BMI z-score and increased the availability of fruits and vegetables in their homes and the consumption of fruits and vegetables among low-income, Latino children. Examining the other end of the energy spectrum, London and Gurantz3London R.A. Gurantz O. Afterschool program participation, youth physical fitness, and overweight.Am J Prev Med. 2013; 44: S200-S207Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar investigated how effective fitness-focused after-school programs were in improving youth fitness and lowering obesity rates. They showed that participation in such programs was associated with an increased likelihood of subsequent fitness over a 2-year period. The study suggested that program sustainability could occur if local communities can adopt these approaches. Although all Salud America! investigators designed their research with an eye toward policy—shaping it, changing it, developing it—the research of Mier and colleagues4Mier N. Smith M.L. Irizarry D. et al.Bridging research and policy to address childhood obesity among border Hispanics: a pilot study.Am J Prev Med. 2013; 44: S208-S214Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar addressed this directly in Texas' Hidalgo County, the second poorest county in the nation. They studied physical activity needs within the U.S.–Mexico border colonias. Local stakeholders were engaged in a knowledge transfer process and Mier et al. concluded that the work would pave the way for policy development and environmental change. Within any community are potential barriers to living a healthy lifestyle. Salud America! investigators contributed studies evaluating Photovoice's ability to engage groups of Latinos in identifying barriers to physical activity where they live. Photovoice is a community-based participatory research method that involves using photography to identify important themes and then using those themes to trigger discussion, followed by action. Hannay et al.5Hannay J. Dudley R. Milan S. Leibovitz P.K. Combining Photovoice and focus groups: engaging Latina teens in community assessment.Am J Prev Med. 2013; 44: S215-S224Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar used Photovoice to evaluate an existing after-school obesity program in Connecticut. Latina teens and their parents provided feedback on barriers to exercise within their school and community and offered views on how to improve access to out-of-school activity programs. Their findings suggest that using Photovoice as a research tool warrants replication by other communities seeking to understand the root causes of obesity. In the second Photovoice study, authored by Torres et al.,6Torres M.E. Meetze E.G. Smithwick-Leone J. Latina voices in childhood obesity: a pilot study using Photovoice in South Carolina.Am J Prev Med. 2013; 44: S225-S231Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar Latina mothers documented that community barriers to transportation, language, and school communication negatively affected their family's physical activity. They concluded that the Photovoice process positively engaged Latina mothers to suggest solutions within their communities. Finally, the connection between spiritual and physical health was studied. Authors He and colleagues7He M. Wilmoth S. Bustos D. Jones T. Leeds J. Yin Z. Latino church leaders' perspectives on childhood obesity prevention.Am J Prev Med. 2013; 44: S232-S239Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar interviewed leaders from 18 San Antonio churches who reported that their religious communities could serve as conduits for obesity prevention programs. Methods to promote moderate-to-vigorous physical activity in schools are sorely needed. Gao et al.8Gao Z. Hannan P. Xiang P. Stodden D.F. Valdez V. Video game–based exercise, Latino children's physical health, and academic achievement.Am J Prev Med. 2013; 44: S240-S246Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar introduced one of the hottest active video games on the market—Dance Dance Revolution—into an urban elementary school, along with other group-based exercise. The study looked at possible effects of the game. Children regularly participating in the exercise program improved their cardiorespiratory endurance and math scores over time. This study suggests that educators can consider using active video games at schools to promote health and learning. Some Salud America! investigators focused their research on Latino families. These interventions are well received by families and often result in strengthened family relationships and family members who are better educated on the benefits of physical activity and healthy eating. Cross-sectional and formative research helps us to continue to identify important mediators to target in future interventions. The article by Boudreau et al.9Boudreau A.D.A. Kurowski D.S. Gonzalez W.I. Dimond M.A. Oreskovic N.M. Latino families, primary care, and childhood obesity: a randomized controlled trial.Am J Prev Med. 2013; 44: S247-S257Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar evaluated a family-centered healthy lifestyle intervention for Latino families delivered within a primary care setting. The study showed that families were willing to participate, but concluded that further research is needed to problem-solve barriers and to determine the needed dose for clinical benefits. The interplay of health among Latina mothers and daughters was evaluated by Olvera and colleagues.10Olvera N. Leung P. Kellam S.F. Smith D.W. Liu J. Summer and follow-up interventions to affect adiposity with mothers and daughters.Am J Prev Med. 2013; 44: S258-S266Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Latina girls came together in the summer for an intervention that included exercise, as well as nutrition education and behavioral counseling. Mothers received training in parenting strategies and how to support daughters in making healthy lifestyle choices. A follow-up program occurred in the fall, focusing on aerobic activity for mothers and daughters. The study found that the summer program, which was better attended than the fall program, resulted in a significant reduction in percent body fat and waist circumference for the girls. A main conclusion was that summer months appear most appropriate for successful obesity prevention programs for Latina girls. Latino families' grocery purchases were the main focus of an intervention conducted by Cortés et al.11Cortés D.E. Millán-Ferro A. Schneider D. Vega R.R. Caballero A.E. Food purchasing selection among low-income, Spanish-speaking Latinos.Am J Prev Med. 2013; 44: S267-S273Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Families received nutrition education about food selection, including an instructional grocery store tour. The intervention resulted in a decrease in the total number of calories per dollar spent and median grams of carbohydrates per dollar reflected in their food bills, among other changes. These results challenge arguments that purchasing healthy foods is difficult because of perceived higher costs of such foods. Finally, identification of future targets for change helps advance the field. Rosado and colleagues12Rosado J.I. Bennett Johnson S. McGinnity K.A. Cuevas J.P. Obesity among Latino children within a migrant farm worker community.Am J Prev Med. 2013; 44: S274-S281Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar looked at a typically understudied Latino community. They collected data on the prevalence of obesity among migrant farmworker children and their parents, as well as parents' perceptions of their children's weight. Almost half the children in the study were either obese or overweight. Parents most often reported that they were concerned about their children's weight if the children were obese, but they were not necessarily concerned if children were overweight, demonstrating a need for more education and prevention programs in the community, Rosado said. The final paper in the supplement represents a perfect end, because the study's main goal was to place all the investigations described above into a single frame of reference. Ottoson and the team13Ottoson J.M. Ramirez A.G. Green L.W. Gallion K.J. Exploring potential research contributions to policy: the Salud America! experience.Am J Prev Med. 2013; 44: S282-S289Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar conceptualized a framework that plotted each paper's potential influence within the policy process. The paper concludes by suggesting that by adding a policy lens to existing public health practices, investigators can engage policymakers and the public in understanding health issues, implementing solutions, and evaluating their effectiveness. The framework may serve as a tool to help researchers look beyond hypothesis testing and program efficiency, and toward possible policy contribution. We hope you enjoy this supplement by Salud America! The Robert Wood Johnson Foundation Research Network to Prevent Obesity Among Latino Children. It culminates several years of diligence, passion, and hard work in identifying and examining the most promising policy-relevant strategies to reduce and prevent obesity among Latino children. Along the way, the project helped increase the skills and experience of researchers working in the field and further expand the national Salud America! research network. The ranks of those fighting the country's obesity epidemic are getting stronger and stronger each day!