Nutrition and Secondary Prevention: A public health project University of Florida Amarillys Alvarado-Sojo, Christie Champaign, Kristin Miller, Debbie Walker, Chris Weiss

1. Nutrition & Secondary
Prevention
University of Florida
Amarillys Alvarado-Sojo, Christie Champaign,
Kristin Miller, Debbie Walker, Chris Weiss

2. Health Indicator: Obesity
Epidemiology
• In the U.S., it is estimated that 1 in 3
adults are now obese: 78.6M
• 1 in 20 are considered extremely obese
• Prevalence is similar for men and
women
• Medical costs now exceed 140B
annually
• If you are obese, you will spend, on
average, $1,400 more in medical care
than a non-obese person
(CDC, 2014; WIN, 2014)

3. Most Affected
• Problem worse in rural areas with estimates around
40% of adults (Befort, Nazir, & Perri, 2012)
• Rates (prevalence) are higher among Hispanics
(78.8%), African Americans (76.7%)
Minorities are among the
fastest growing
populations in the U.S.
(CDC, 2014)

4. Health Outcomes
As a person becomes obese, their risks increase for:
6.5-13.7
life years
lost
Heart
disease
Cancer
(breast,
colon)
Stroke
Sleep
apnea
Liver
disease
Type 2
Diabetes
(Kitahara et al., 2014; Lee,
2014)

5. Health Outcomes…Bottom
Line
Compared to a non-obese SMOKER, an obese adult is
more likely to die earlier
But, this is a largely Preventable problem

6. Target Population
Low-Income Hispanic Community in
Florida

7. About Our Population
Characteristics
• Hispanics (Latinos)
• Overweight, obese
• Adults 18 and older
• Male and Female
• Low-income
• Any education level
Reason for Selection
• Highest prevalence
rates among all
minorities
Vulnerable
population
• Wages inversely
related to BMI/obesity
• This trend is higher
among Hispanics
(FRAC, 2014)
• Cultural differences

8. Gathering Information
Social
Quality of life of
individuals, families
Extent of problem
Cultural beliefs, practices
(slender physique=not
healthy vs. obese=healthy)
-Community and provider
interviews
Epidemiological
Assessment of health
condition (obesity)
Assess comorbidities
Assess SES
-US Census, NHANES,
Florida-charts

9. Gathering Information
Behavioral/Environmental
• Eating/nutritional habits
• Lack of healthy food
options
• Convenience of fast food
• Public source data,
interviews
Educational/Ecological
• Attitudes/knowledge/be
liefs about obesity
• Beliefs about eating
• Social norms of
community and culture
surrounding diseases
and importance of
health diet
• Local surveys, focus
groups

10. Levels of addressing the problem:
Applying the CDC Ecological Model
Individual:
• BMI awareness
• Know what a healthy weight is
for an individual
• Active lifestyle
• Education about nutritional
meals/ healthy living
Community:
• Communities making healthy
food options accessible
• Communities providing options
for nutritional education
• Encouraging an active lifestyle
at work
• Distributing education about the
risks of being obese and eating
poorly
Relationship:
• Families engaged in healthy Hispanic
cooking
• Encouraging an active lifestyle at home
with family members
• Education about the risks of being obese
and eating poorly
Societal:
• Implement health education
• Implement nutritional education
• Shift cultural norms
• Social policies
Normal Weight Obese

11. Variables: Individual Level
BMI (Obesity) Awareness
• Hispanics may rate themselves as ‘more attractive’ with
heavier body weights
• Acculturation in America increases this risk with more
convenient access to less healthy foods, and less healthy
foods in low-income areas (Latino Coalition for a Healthy
California, 2006)
Theory of Planned Behavior
Theory accurately
explains behavior
In this case,
individuals do not
perceive obesity as a
threat nor do their
close contacts
Results in limited
intent to act

12. Variables: Relationship Level
Hispanic Cooking
• “Family unit”
• Many meals are shared
together
• Typical Hispanic diet:
-fruits, vegetables,
beans, grains,
corn/corn products,
dairy
• Many foods are fried with
fats and oils
(Smith, 2010; Clutter & Nieto, n.d.)
These aspects of the
Hispanic culture contribute
to obesity

13. Variables: Societal Level
Cultural Norms
• Men- head of the
house
• Women- tend to
household duties
• Grandparents,
parents, and children
may live in the same
house
• Responsibility to
family

14. Model

15. Intervention
Organize a Health Fair, “Feria
de Salud para ti,” in a
Hispanic community
Provide basic screenings,
advertise cooking lessons and
trips to local grocery store

16. Nature of Intervention
Description: Intervention within the community, intent to
empower individuals and families by providing them with
knowledge and skills required to develop healthy eating habits
and learn self monitoring skills
Designed to take into consideration culturally relevant aspects
of dietary behavior, social interactions and beliefs
Assist in helping them make informed dietary choices in
accordance with individual preferences and affordability.
Levels Addressed: Individual and Relationship
Population: Hispanic community adults over age 18 and their
families

17. Intervention: Individual & Relationship
Levels
• Increase awareness, assist in choosing healthier choices
by providing healthy Latino recipes (www.Goya.com)
• Accompany individuals/families in grocery store utilizing
Camino Magico bilingual shopping list and meal planner
• Provide store tour educating consumers about options
available in every aisle that fit the Latin American Diet
Pyramid
• Display a poster of the Latin American Diet Pyramid in-store
and at Health Fair
• Educate on avoiding fast food

18. Grocery Store Tour
Partner with local grocery store to walk through
showing healthier choices, cooking demonstrations,
and samples

19. Intervention Objectives
● Conduct Secondary Prevention
a. Provide health screenings, including having their
BP checked, weight, height, waist circumference and
BMI calculated to determine if they are obese or at risk
of obesity
b. Identify individuals with immediate health needs
and those who are overweight and obese, and connect
them with primary care clinic near their home or work
c. Make individuals aware of risk factors and
diseases they could develop
d. Increase consumption of fruits and vegetables
instead of less healthy food

20. Hispanic Food Pyramid
Provide Hispanic food pyramid,
with examples of portion control

21. Educational Materials
Provide a visual reminder
in Spanish - to make
healthier choices, recipes,
shopping lists and meal
planner

22. Measuring Success
Design: Quasi-experimental, pre-test/post-test
• Completion of survey at beginning of health fair
• Follow-up phone call or email (preferred
communication method) 6 weeks post
• Patient satisfaction survey with grocery store tour
• Feedback forms for identifying areas for improvement

23. Potential Barriers
1. Health Fair may have limited impact on changing
individual and family behavior
2. May be low attended
3. At risk individuals may not follow up with primary
doctor or have a doctor
However,
Could include an invitation to a series of Hispanic
cooking classes
Could partner with local health department to ensure
at-risk individuals are further evaluated

24. Summary
Secondary prevention efforts incorporating healthy
nutritional habits can impact obesity by
decreasing prevalence
Plan identified 3 variables to target within Hispanic
communities in Florida: Individual awareness,
cooking styles, cultural norms
Conducting Health Fair at local grocery store and
accompanying families/individuals during
shopping is a low-cost, first-step in increasing
healthy nutritional habits
Plan addresses key factors at multiple levels and
acknowledges areas for continued development

25. Take Home Points
1. Obesity is an epidemic within U.S.
and worse for minorities
2. Collaboration among all health
professionals, policy makers,
community officials is needed to
address this problem
3. Any plan must take into account
cultural beliefs
4. Plans must be multidimensional
and ongoing; will require funding

26. References
Ammerman, A.S., Lohr, K.N., & Hersey, J. (2002). The efficacy of behavioral interventions to modify
dietary fat and fruit and vegetable intake: A review of the evidence. The Journal of Preventive
Medicine, 35(1), 25-41. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12079438
Bautista, L., Reininger, B., Gay, J. L., Barroso, C. S., & McCormick, J. B. (2011). Perceived barriers
to exercise in Hispanic adults by level of activity. Journal of Physical Activity & Health, 8(7),
916–925.
Befort, C. A., Nazir, N., & Perri, M. G. (2012). Prevalence of obesity among adults from rural and
urban areas of the United States: Findings from NHANES (2005-2008). The Journal of Rural
Health, 28, 392-397. doi: 10.1111/j.1748-0361.2012.00411.x
Centers for Disease Control. (2014). Strategies to combat obesity. Retrieved from
http://www.cdc.gov/obesity/strategies/index.html
Centers for Disease Control. (2014). Adult obesity facts. Retrieved from
http://www.cdc.gov/obesity/data/adult.html
Clutter, A., & Nieto, R. (n.d.). Ohio State University fact sheet. Retrieved from
http://ohioline.osu.edu/hyg-fact/5000/5237.html

27. References
Dwyer, J. (2006). Starting down the right path: nutrition connections with chronic diseases of
later life. The American Journal of Clinical Nutrition, 83, 415S-420S. Retrieved from
http://ajcn.nutrition.org/content/83/2/415S.full
Food Research and Action Center. (2014). Relationship between poverty and overweight or obesity.
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Kitahara, C. M., Flint, A. J., de Gonzalez, A. B., Bernstein, L., Brotzman, M., MacInnis, R. J., Hartge,
P. (2014). Association between Class III obesity and mortality: A pooled analysis of 20
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Latino Coalition for a Healthy California. (2006). Obesity in Latino communities. Retrieved from
http://www.lchc.org/wp-content/uploads/2005_Obesity_in_Latino_Communities_NewLogo.pdf
Lee, R. (2014). Warning: Obesity is more dangerous than smoking, cuts life span by 14 years.
Retrieved from http://www.techtimes.com/articles/10033/20140711/warning-obesity-is-more-dangerous-
than-smoking-cuts-life-span-by-14-years.htm

28. References
Salud Mesoamerica. (2014). Salud campaign. Retrieved from http://www.iadb.org/en/salud-mesoamerica-
2015/sm2015/sm2015-supports-the-lac-forum-awareness-campaign-in-favor-
of-the-right-to-sexual-and-reproductive-health,9347.html
Smith, K. L. (2010). Cultural diversity: Eating in America Mexican-American. Retrieved from
http://ohioline.osu.edu/hyg-fact/500
Spanish Sabores. (2014). 8 fried foods you must try in Spain. Retrieved from
http://spanishsabores.com/2012/01/25/8-fried-foods-you-must-try-in-spain/
Urban Institute. (2010). Vulnerable populations. Retrieved from
http://www.urban.org/health_policy/vulnerable_populations/
USDA. (2011). A visual reminder to help Spanish-speaking consumers make healthier food
choices. Retrieved from:
http://www.usda.gov/wps/portal/usda/usdahome?contentid=2011/09/0428.xml
USDA. (n.d.). Choose my plate. Retrieved from http://www.choosemyplate.gov/index.htm

29. References
Weight-Control Information Network. (2014). Overweight and obesity statistics. Retrieved
from http://win.niddk.nih.gov/statistics/
Wolf, R. L., Lepore, S. J., Vandergrift, J. L., Wetmore-Arkader, L., McGinty, E., Pietrzak,
G., & Yaroch, A. L. (2008). Knowledge, barriers and stages of change as correlates
to fruity and vegetable consumption among urban and mostly immigrant black men.
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