IOM-WIC March 31, 2016 Challenges to Nutritional Health Faced by Mexican-American and Mexican Immigrant Children and Families in Texas Border Colonias Joseph R. Sharkey, PhD, MPH, RD Program for Research and Outreach-Engagement on Nutrition and Health Disparities Solutions School of Public Health Texas A&M Health Science Center 1

Game Plan Cultural appropriateness in context Appropriateness and adequacy of the 2009 food package changes and gaps Gaps in access to foods Gaps in nutrition education Participation – start and stay Missing links

Resources Nutritional Health Individual Economic Community Family Sharkey et al., BMC Pediatrics (2013)

Contextual Domains Resources Individual Economic Family Community Resources Cultural Network Personal Sociopolitical Sharkey et al., BMC Pediatrics (2013); Ashing-Giwa, Ethnicity & Disease (2005)

Cultural Appropriateness in Context Low-income and low-education populations in functionally rural areas Varied food preparation and storage Single Hispanic/Latino-targeted approach fails to meet the needs of Mexican immigrants for whom the “usual” program does not apply Locational disadvantage Reinvent tradition

Food Package Acceptance IOM-WIC March 31, 2016 Food Package Acceptance Information on changes Whole wheat (everything?) Cheese Milk Where’s the meat (and chicken and fish)?

Gaps in Locations Product availability Alternative food sources, such as pulgas

Participation Start and Stay Awareness Transportation Perception of eligibility Location Hours Limited community outreach

Gaps in Nutrition Education Package options Tailored to context Reinvent tradition Stretching meals Hands-on cooking Seasonal recipes

Missing Links Community engagement Outreach Voices of the participants Promotoras de salud