The influence of ethnicity and length of time since immigration on physical activity

Design/setting/participants

Main results

Conclusions

This study investigates whether ethnicity and length of time since immigration influence levels of leisure-time physical activity in Sweden.

This cross-sectional study analyses data from the Swedish Survey of Living Conditions from the years 1996, 1997 and 1999, which is conducted annually and is a simple, random sample drawn from the register of the total population in Sweden. The total sample was 14,485 men and women aged 20–74 years, who were categorised according to country of origin: born in Sweden, Western Europe, Finland, Southern Europe, Eastern Europe or all other countries. The multivariate analysis was performed using a logistic regression model in order to investigate the effects of possible confounding factors on physical activity.

The risk of reporting low levels of physical activity was significantly higher for men born in Finland, Southern Europe and in the category ‘all other countries’, and also for women born in Southern Europe, Eastern Europe and ‘all other countries’, compared with men and women born in Sweden. After the inclusion of the variables education, smoking, body mass index and longstanding illness or disability into the model, the relationship between ethnicity and low levels of physical activity decreased to non-significance for men born in Finland and Southern Europe, but remained significant for men born in the category ‘all other countries’. The differences in risk for women observed in the crude model remained significant even after inclusion of all other variables in the multivariate model. A positive gradient was observed between the length of time since immigration to Sweden and low levels of physical activity in women but no relationship was observed in men.

There are significant differences in levels of leisure-time physical activity between different ethnic groups living in Sweden, which could not all be explained by the confounding factors age, education, smoking, body mass index or long-term illness or disability. In women, but not in men, levels of leisure-time physical activity increased with increasing time since immigration to Sweden.     

Impact of educational interventions on primary prevention of cardiovascular disease: A systematic review with a focus on physical activity

Background: Evidence from epidemiological and experimental studies illustrates the beneficial impact of healthy lifestyle behaviours on cardiovascular risk.

Objectives: To assess the effectiveness of primary care health education interventions designed to promote healthy lifestyles on physical activity levels and cardiovascular risk.

Methods: A computer-aided search on PubMed and Scopus was performed to identify relevant studies published from January 2000 to October 2016. Two authors independently selected studies for inclusion and extracted data, including intervention characteristics and outcome measures, namely physical activity and cardiovascular risk or risk factors.

Results: Of the 212 identified studies, 15 met the inclusion criteria. The 15 studies enrolled 6727 participants; the sample size varied between 74 and 878 adults. Fourteen studies assessed physical activity by questionnaire and only one study used accelerometry. Eight of the 15 studies showed improvements in the physical activity levels after the intervention, ranging from 5% to 26% in those where significant changes between groups were detected. Most studies reported significant positive effects of the health education interventions on cardiovascular risk factors, mainly on lipid profile, blood pressure and cardiovascular risk score.

Conclusion: The health education interventions, in primary care, seem to improve daily physical activity, cardiovascular risk factors and risk score.     

Patient ethnicity and perceptions of families and friends regarding depression treatment

Objective. Black Americans are less likely than white Americans to seek professional treatment for depression. Whether treatment recommendations are sought and implemented by patients will be influenced by the role families and friends play in diagnostic acceptance and treatment decisions. We investigated the association of ethnicity with the perceived need for treatment of depression by family and friends of older primary care patients.

Design. Cross-sectional survey of 355 older adults with and without significant depressive symptoms was conducted. At the baseline visit, family and friends’ ratings of apathy and need for depression treatment were obtained on 314 of the 355 patients (88% response rate) and examined according to ethnicity. Participants were interviewed using standardized measures of chronic medical conditions, functional status, and psychological status.

Results. Older black patients compared to older white patients were less likely to be rated as needing depression treatment by their family and friends (odds ratio (OR)=0.34; 95% confidence interval (CI)=[0.18, 0.64]) adjusting for depressive symptoms, cognition, functional status, and other potentially influential characteristics.

Conclusions. Our study suggests that patient ethnicity may play a role in a family member's or friend's perceived need for depression treatment of older adults who present in the primary care setting. Further study of attitudes, expectations, and values of patients and family members or friends in primary care settings may help elucidate the interplay of physician, patient, and family member or friend.     

The influence of ethnicity on patient satisfaction

Methods

Results

Conclusion

To investigate the influence of ethnicity on patient satisfaction with hospitalization care.

We conducted a random selection, cross-sectional study. Data were collected by telephone interviews over a three-year period utilizing a 16-question survey. Patients were excluded from the study if they were admitted for an obstetric visit, physical rehabilitation, or psychiatric illness or if we were unable to reach them by telephone. We used logistic regression to compare ethnicity with the responses for each of the 16 questions while controlling for three confounders (age, gender, and insurance status). For each question, patient responses of excellent and very good were considered satisfied. Patient responses of good, fair, and poor were considered not satisfied.

We surveyed 7,795 patients. Compared to African-Americans, non-Hispanic white Americans were significantly older, included more males, and were insured by Medicaid less often (p?

African-Americans reported significantly lower rates of satisfaction compared to non-Hispanic white Americans for six of 16 questions regarding satisfaction during hospitalization care.     

Patient ethnicity: a key predictor of cancer care satisfaction

Introduction. Research in cancer care satisfaction itself is scarce; investigation of the role of ethnicity in care satisfaction is even rarer.

Objective. The present study examined relationships between ethnicity and satisfaction with care in a sample of 759 patients diagnosed with three different types of cancer (lung, head and neck, or gynecologic) from a large tertiary cancer hospital.

Method. Respondents filled out an assessment package that consisted of demographics, the Ware Patient Satisfaction Questionnaire-III (PSQ-III), 17 additional items constructed by the research team to examine other specific areas of satisfaction, and the Psychological Screen for Cancer (PSSCAN) Part C, to measure anxiety and depression.

Results. In a multivariate analysis, being non-White emerged as the primary predictor variable (beyond patient age, gender, marital status, education, cancer site, duration of illness, and presence or absence of metastases) of several of the PSQ-III satisfaction subscales.

Conclusion. Health care systems must consider how to become more responsive to the needs of all individuals, regardless of their ethnic background and levels of acculturation.     

A comparison of respiratory conditions between multiple race adults and their single race counterparts: an analysis based on American Indian/Alaska Native and white adults

Context. Multiple race data collection/reporting are relatively new among United States federal statistical systems. Not surprisingly, very little is known about the multiple race population in the USA. It is well known that some race and ethnic groups experience some respiratory diseases (e.g., asthma) disproportionately. However, not much is known about the experience of multiple race adults. If differences exist in how single/multiple race adults experience respiratory conditions, this information could be useful in public health education.

Objective. To explore differences in respiratory conditions between single race white adults, single race American Indian/Alaska Native (AIAN) adults, and adults who are both white and AIAN (largest multiple race group of adults in the USA).

Methods. Data from the National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, were analyzed. Hispanic and black populations are oversampled. Multiple logistic regressions were performed to predict if the occurrence of each respiratory condition analyzed differed by single/multiple race reporting.

Sample. A nationally representative sample of 127,596 civilian non-institutionalized adults (≥18 years of age) from the 2000–2003 NHIS.

Outcome measure. Adults told by a doctor or other health professional that they had asthma, hay fever, sinusitis, and/or chronic obstructive pulmonary disease.

Results. Adults who are both AIAN and white generally had higher rates of respiratory conditions than did their single race counterparts. These differences persisted even after controlling for socio-demographic and health care access measures.

Conclusions. This paper presents some of the first research of how the health of some multiple race adults differs from their single race counterparts. Contrary to some previous expectations for these estimates, respiratory condition estimates for adults who are both AIAN and white do not appear to be located between those of the component single race groups.     

Anthropometric Evaluation and Functional Assessment of Patients with Pulmonary Hypertension and its Relationship with Pulmonary Circulation Parameters and Functional Performance

Objective: The objective of this study was to investigate the anthropometric and functional status in patients with pulmonary hypertension (PH) and its relationship with pulmonary circulation parameters and functional performance.

Methods: The study is cross-sectional with 34 subjects, who were evaluated in terms of anthropometric measurements, physical performance, pulmonary circulation, and regular physical activity.

Results: Subjects had a mean age of 47.0 ± 14.5 years, mean IMC 28.5 ± 7.7 kg/m² among adults, and 27.65 ± 2.68 kg/m² among elderly, with high body fat and preserved muscle mass. The sample presented the parameters of pulmonary circulation expected for PH patients and adequate performance in the physical capacity test. By linear regression analysis there was observed a negative relationship between body fat and regular physical activity.

Conclusion: The evaluated subjects had an excess of body weight and fat, with preserved muscle mass, which does not appear to interfere in the pulmonary circulation parameters. However, elevated body fat appears to impair regular their physical activity.     

Religious and ethnic differences in health: evidence from the Health Surveys for England 1999 and 2004

Objectives. To examine the role of religion in the patterning of health inequities, and how this is related to ethnicity and socioeconomic status.

Design. Multivariate analyses using nationally representative data on self-assessed fair or poor health, longstanding limiting illness, diagnosed diabetes, diagnosed hypertension, waist–hip ratio, body mass index, current tobacco use and participating in no regular physical activity from 14,924 Christians, 4337 Muslims, 656 Sikhs, 1197 Hindus and 2682 people reporting not identifying with any religion with different ethnic backgrounds, who were interviewed as part of the Health Survey for England in either 1999 or 2004, adjusted for age, gender and socioeconomic status and periodicity.

Results. Odds ratios for general health, hypertension, diabetes, waist–hip ratio, tobacco use and physical activity speak to the importance of ethnicity in the patterning of health inequalities. But there is also evidence of an important, independent role for religion, with risks for the different health indicators varying between people with the same ethnic, but different religious, identifications. Adjusting for socioeconomic status attenuated the ethnic/religious patterning of, particularly, self-assessed health, longstanding activity-limiting illness, waist–hip ratio, body mass index and tobacco use.

Conclusions. This evidence enables greater understanding of the complexities of the relationship between ethnicity, religion and health, recognising the need to understand the heterogeneity underlying both ethnic and religious group membership and the processes producing the structural disadvantage facing certain religious and ethnic groups in the mediation of the relationship between health and ethnicity/religion.     

‘I didn't feel like any of those things were me’: results of a qualitative pilot study of race/ethnicity survey items with minority ethnic adolescents in the USA

Objective. The present study is a qualitative exploration of the thought processes of minority ethnic adolescents in responding to standard epidemiologic survey questions about racial/ethnic group membership in the USA.

Design. Fifteen minority ethnic adolescents (ages 15–21) were enrolled in a pilot qualitative study using a cognitive processing interview technique to elicit their understanding and interpretation of race/ethnicity survey items.

Results. Findings from this pilot study indicated that racial/ethnic classification survey items commonly used in the USA were susceptible to a number of item performance problems, including participant confusion, and misreported or insufficient responses. Additionally, item wording elicited intense affective reactions among participants. Results suggest the need for careful review of current US race/ethnic classifications systems, as standard survey measures are likely to provide an incomplete demographic characterization of minority ethnic adolescents.

Conclusions. Recommendations are provided for improving procedures for collecting race and ethnicity data from youth in the USA.     

Hypertension Improvement Project (HIP) Latino: results of a pilot study of lifestyle intervention for lowering blood pressure in Latino adults

Objectives. To assess the feasibility of a culturally tailored behavioral intervention for improving hypertension-related health behaviors in Hispanic/Latino adults.

Design. Feasibility pilot study in a community health center and a Latino organization in Durham, North Carolina.

Intervention. The culturally adapted behavioral intervention consisted of six weekly group sessions incorporating motivational interviewing techniques. Goals included weight loss if overweight, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, and increased physical activity. Participants were also encouraged to monitor their daily intake of fruits, vegetables, dairy and fat, and to record physical activity. Cultural adaptations included conducting the study in familiar places, using Spanish-speaking interventionist, culturally appropriate food choices, and physical activity.

Main outcomes. Systolic blood pressure (BP), weight, body mass index (BMI), exercise, and dietary pattern were measured at baseline and at 6 weeks follow-up. Qualitative evaluations of the recruitment process and the intervention were also conducted.

Results. There were 64 potential participants identified via healthcare provider referrals (33%), printed media (23%), and direct contact (44%). Seventeen participants completed the intervention and had main outcome data available. Participants ‘strongly agreed/agreed’ that the group sessions provided them with the tools they needed to achieve weight loss, BP control, and the possibility of sustaining the lifestyle changes after completing the intervention. At the end of the intervention, all physiological, diet, and exercise outcomes were more favorable, with the exception of fat. After 6 weeks, systolic BP decreased an average of ?10.4±10.6 mmHg, weight decreased 1.5±3.2 lbs, BMI decreased 0.3±0.5, and physical activity increased 40 minutes per week.

Conclusion. Our findings suggest that lifestyle interventions for preventing and treating hypertension are feasible and potentially effective in the Hispanic/Latino population.     

Gender and ethnic differences in the co-occurrence of adolescent risk behaviors

Design

Results

Conclusion

We consider gender and ethnic differences in the co-occurrence of adolescent behaviors related to health and well-being.

Using a nationally representative sample of adolescents in the National Longitudinal Survey of Youth (1997–2000), we examine behavior among students as well as school drop-outs. We use latent class models (LCMs) to identify subpopulations of adolescents with similar patterns of co-occurring behaviors. The generalizability of the findings for African American adolescents in the 1970s is considered using a sample of inner-city youth from the Pathways to Adulthood Survey.

For all ethnic groups, we find a subpopulation with ‘problem behavior’ characteristics (in which early sexual initiation, alcohol use, smoking, marijuana use, and truancy are all highly prevalent). This cluster is most common among European American adolescents and among young men. A subpopulation characterized by behaviors often leading to poor social outcomes (e.g. truancy, early sexual initiation and fighting) is most common for African American adolescents, especially young African American men.

Our findings suggest that multi-factorial interventions which address the interrelationships between all of the behaviors are relevant regardless of gender or ethnicity. However, the ethnic and gender differences in the likelihood of specific patterns of interrelationships highlight the importance of considering the ethnic and gender composition of a population when developing future research and interventions.     

The dragon and the snake: health practices among Chinese in the UK from an inter-disciplinary perspective

Objectives. This paper explores how ethnicity has been represented in research on the health practices of Chinese populations in the UK and suggests ways in which such research might be enriched by adopting an interdisciplinary approach.

Design. A systematic literature review of studies was conducted on research with ‘Chinese’ in the UK.

Results. The review highlighted that research with Chinese populations is frequently grounded in assumptions about the homogeneity of Chinese ethnic and cultural identities, and health practices, which undermines the generalizability of findings and conclusions.

Conclusions. There was a lack of clarity surrounding the term ‘Chinese’ as an ethnic and national label that can lead to racialised constructions of ethnicity. An interdisciplinary approach is a valuable tool for enriching understandings of culturally-specific accounts of health and illness, and to address ways in which Chinese populations negotiate different health care systems and models of health.     

The Mediterranean diet and age-related cognitive functioning: A systematic review of study findings and neuropsychological assessment methodology

Objectives: The primary aims of this review were to identify studies investigating the association between the MedDiet pattern and age-related cognitive function, to determine the current status of knowledge, and to ascertain whether a lack of standardization with the operationalization of age-related cognitive function and differences in the chosen neuropsychological assessment methodology impacted on the results and findings.

Methods: The systematic review protocol for this paper was carried out following the statement and general principles of PRISMA and the UK Centre for Reviews and Dissemination (CRD).

Results: A systematic search of electronic databases yielded two cross-sectional studies, two cross-sectional/prospective studies, and 11 prospective studies for inclusion. Among this group of studies, conflicting results and conclusions regarding the efficacy of the MedDiet as a therapeutic approach for age-related cognitive function were found. Of importance, clear differences among studies in relation to neuropsychological assessment methodology were identified. Such disparity appeared to be one plausible factor contributing to the lack of consensus among study findings.

Discussion: One of the important challenges for future research will be to aim toward some kind of standardized neuropsychological assessment criteria. This type of endeavor will enable the ability to validate with greater confidence, whether or not adherence to a MedDiet does promote benefit for age-related cognitive function.     

Meanings of food,eating and health among African Nova Scotians: ‘certain things aren't meant for Black folk'

Objective. Most research on food, ethnicity and health in Canada is focused on the dietary acculturation of first of second generation migrants. ‘Failure’ to adopt nutritional guidelines for healthy eating is generally understood as lack of education or persistence of cultural barriers. In this study we explore the meanings of food, health, and well-being embedded in the food practices of African Nova Scotians, a population with a 400-year history in Canada.

Design

Design. Qualitative interviews were conducted with 2 or 3 members of each of 13 families who identified as African Nova Scotian. Interviews asked about eating patterns; the influence of food preferences, health concerns, cost, and culture; perceptions of healthy eating and good eating; how food decisions were made; and changes over time. In addition, research assistants observed a ‘typical’ grocery shopping trip and one family meal.

Results

Results. Participants readily identified what they perceived to be distinctively ‘Black ways of eating.’ Beyond mainstream nutrition discourses about reduction of chronic disease risk, participants identified three ways of thinking about food, health, and well-being: physical well-being, emphasizing stamina, energy and strength; family and community well-being; and cultural or racial well-being, emphasizing cultural identity maintenance, but also resistance to racism.

Conclusion

Conclusion. While culturally traditional eating patterns are often understood as costly in terms of health, it is equally important to understand that adopting healthy eating has costs in terms of family, community, and cultural identity. Dietary change unavoidably entails cultural loss, thus resisting healthy eating guidelines may signify resistance to racism or cultural dominance. Several suggestions are offered regarding how community strengths and beliefs, as well as cultural meanings of food and health, might inform effective healthy eating interventions.     

Cognitive screening tools for primary care settings: examining the ‘Test Your Memory’ and ‘General Practitioner assessment of Cognition’ tools in a rural aging population in Greece

Background: Under conditions of high demand for primary care services in a setting of low financial resources, there is need for brief, easily administered cognitive screening tools for use in the primary care setting, especially in rural areas. However, interpretation of these cognitive tests’ results requires knowledge on their susceptibility to cultural, educational and demographic patient characteristics.

Objectives: To assess the clinical validity of the ‘Test Your Memory’ (TYM) and ‘General Practitioner assessment of Cognition’ (GPCog) which was specifically designed for primary care practice, in a rural primary care setting in Greece, utilizing the ‘Mini Mental State Examination’ (MMSE) as a reference standard.

Methods: The MMSE, TYM, and GPCog were administered to a random sample of 319 community dwelling Greek adults aged 60 to 89 years in 11 rural Primary Healthcare Centres of the Prefecture of Heraklion on the island of Crete, Greece. Analyses examined (a) The association of each instrument with demographic factors and MMSE and (b) optimal cut-off scores, sensitivity and specificity against MMSE-based cognitive impairment risk using ROC analyses with the MMSE 23/24 point cut-off as a reference standard.

Results: We found a sensitivity of 80% and a specificity of 77% for TYM (35/36 or 38/39 cut-off, depending on education). Corresponding values were 89% and 61% for GPCog (7/8 cut-off), respectively.

Conclusion: The TYM and GPCog instruments appear to be suitable for routine use in the primary care setting as tools for cognitive impairment risk detection in elderly rural populations.     

Evaluation of Barley's Beta-glucan Food Fortification through Investigation of Intestinal Permeability in Healthy Adults

Objective: Intestinal permeability is an index of the adequate function of the intestinal barrier and its modification is associated with intestinal diseases. The aim of the study is to investigate the hypothesis that barley's beta-glucan can inhibit the alteration of intestinal permeability and maintain intestinal integrity after a period of consumption of a carbohydrate snack (cake) rich in sugars.

Methods and Design: Volunteers participated in a placebo-controlled intervention study for 1 month. In this double-blind methodology, they were randomly assigned to (1) the intervention group (daily consumption of one portion of cake fortified with barley's beta-glucan) or (2) the placebo group (daily consumption of the same cake without the enrichment). Intestinal permeability was assessed using the lactulose/mannitol test.

Setting: Athens, Greece.

Subjects: Twenty-three healthy volunteers (age > 40 years).

Results: Intestinal permeability did not differ between the 2 groups, both at the beginning and at the end of the intervention. In addition, the intestinal permeability was not significantly modified at the end of the intervention in each group.

Conclusions: The results of the lactulose/mannitol test for the intervention and placebo groups were comparable. For healthy adults, the daily consumption of a simple cake (placebo) and the consumption of the cake fortified with barley's beta-glucan resulted in similar impact for intestinal permeability; thus, beta-glucans did not exert a protective role in intestinal permeability of healthy adults.     

Professional perspectives on physical activity screening practices: Shifting the paradigm

Context: This was a qualitative study with focus groups that included researchers and health care providers with expertise in exercise and physical activities with adults.

Objective: The purpose of this study was to explore professional perspectives on current practices and beliefs about screening of older adults prior to having them initiate a structured or independent physical activity program appropriate for their physical ability and interests.

Design and setting: This qualitative study included five different focus groups held at four national professional meetings based on a standard interview guide.

Participants: Forty-two practitioners and researchers participated in these focus groups. These individuals were selected for participation based on their expertise in aging, primary care, exercise science, or behavioral science.

Results: The focus groups revealed professional perspectives articulating advantages and disadvantages of pre-exercise screening. Four major themes were identified: (1) rationale for physical activity screening; (2) rationale for no screening prior to physical activity; (3) knowledge gaps and research needs; and (4) recommendations for new screening guidelines.

Conclusions: Results suggested there was a need for a paradigm shift in screening from an ‘exclusions’ focus to an emphasis on individualized physical activity programs that would result in optimal benefits while preventing rare but possible activity-induced adverse events. Future research needs were delineated and focused on gaining a better understanding of the effectiveness and use of screening measures in identifying cardiovascular and musculoskeletal problems associated with specific physical activities and exercise.     

Increased training of general practitioners in Ireland may increase the frequency of exercise counselling in patients with chronic illness: A cross-sectional study

Background: Recent systematic reviews have established that brief interventions in primary care are effective and economic at promoting physical activity. Lack of training has previously been identified as a barrier to lifestyle counselling in Ireland.

Objectives: This study evaluates frequency of exercise counselling (EC), in patients with six chronic illnesses (type 2 diabetes mellitus, stable coronary heart disease, hypertension, depression, obesity, osteoarthritis) and healthy adults, by general practitioners (GPs) in the mid-west of Ireland, as well as, whether training in EC influences the frequency of EC.

Methods: A questionnaire survey of GPs based in the mid-west of Ireland was conducted during February and March 2012. The questionnaire was distributed to 39 GPs at two continuing medical education meetings and posted to 120 other GPs in the area. The questionnaire assessed the frequency of EC, use of written advice and frequency of recommending resistance exercise in the above patient groups. It also assessed training in EC.

Results: 64% of GPs responded (n = 102). Frequency of EC varied among the chronic illnesses evaluated. Use of written advice and advice on resistance exercise in EC was low. Only 17% of GPs had previous training in EC. If available, 94% of GPs would use guidelines to prescribe exercise in chronic illness. The association of previous training in EC with frequency of EC was variable, with significantly higher counselling rates found in T2DM, obesity and healthy adults.

Conclusion: Improved training of GPs and development of guidelines may increase the frequency of EC in Ireland.     

Effect of the Shaping Healthy Choices Program,a Multicomponent,School-Based Nutrition Intervention,on Physical Activity Intensity

Objective: Physical activity has been shown to have a wide range of beneficial health effects, yet few youth meet the United States physical activity recommendation of 60 minutes of moderate-to-vigorous physical activity (MVPA) everyday. The objective of this study was to determine whether physical activity patterns improved in a subsample of fourth-graders participating in the multicomponent intervention, the Shaping Healthy Choices Program (SHCP).

Methods: At pre- and post-intervention assessments, youth at the control and intervention schools wore a Polar Active monitor on their nondominant wrist 24 h/d for at least 2 consecutive days. Multiple linear regression was used to evaluate change in physical activity by adjusting for covariates and other potential confounders, including ethnicity/race, household income, and sex. Statistical significance was set at p < 0.05.

Results: Mean minutes of MVPA significantly increased at the intervention school (22.3 + 37.8; p = 0.01) and at the control school (29.1 + 49.5; p = 0.01). There were no significant differences in the change in MVPA between the schools. Youth at the intervention school significantly decreased mean minutes in sedentary activity compared to the controls (p = 0.02).

Conclusions: Youth who participated in the SHCP decreased time spent in sedentary activity and increased very vigorous physical activity from pre- to post-intervention, while these changes were not observed at the control school. The overall small physical activity intensity pattern shift supports that physical activity is an important area to target within a multicomponent nutrition intervention aimed at preventing childhood obesity.