+ Interventions for Ethnically Diverse Populations Chapter 7

+ Physical Activity Levels Ethnic diverse populations have the highest rates of inactivity in the United States (CDC, 2005) Sedentary behavior was (Crespo, 2000): 52% in African Americans 54% in Hispanics 46% in American Indians/Alaska Native, and 42% in Asian American/Pacific Islanders Ethnic diverse population have: Higher rates of heart disease Higher rates of obesity Higher rates of diabetes Higher rates of chronic diseases such as Asthma Higher rates of cancer

+ Physical Activity Promotion Programs for Ethnic Population Few programs exist that target ethnic populations Few studies have been conducted about Barriers Behavioral modification (interventions) Limited research results in fewer strategies to ensure successful implementation of physical activity and exercise programs for this population

+ Social-economic Status Many ethnic population come from low socieconomic status They are uninsured or under insured They are less likely to have club memberships, afford personal training, access to safe neighborhoods to walk, and less access to professional health professionals.

+ Factors related to Successful Physical Activity Interventions The number one key factor in designing and promoting successful physical activity and exercise programs for ethnically diverse populations is cultural relevancy Each ethnic groups has it: Own norms Own values Own practices Exercise leaders must consider these characteristics when promoting physical activity and exercise.

+ Factors related to Successful Physical Activity Interventions Due to prevalence of obesity, diabetes, cardiovascular disease and other chronic diseases related to inactivity, implementation of physical activity and exercise interventions must account for these conditions. Exercise leader needs to be have the knowledge about exercise prescription in people who possess these risks and chronic diseases. Due to many of them fall in the low-income group, occupational and home-based programs may be more successful than traditional PA or exercise training programs.

+ Strategies for enhancing cultural relevancy are: Recruitment & retention Location of the intervention Delivery of the intervention

+ Recruitment & Retention PFT or health professionals must earn credibility in the ethnic community. When participants have respect for the PFT than there is higher adherence rates (Yancey, Miles, and Jordan, 1999). Successful interventions usually are supported by community leaders and religious agents (e.g. church or spiritual leader). Community and religious leaders involved in leading the interventions results in higher adherence. Successful story telling or report from a member of the ethnic group about the PA intervention results in higher adherence. Ethnic mediated interventions & publications Needs to be in both English ad language of the ethnic group Media advisement should be language sensitive Incentives to exercise need to be appropriate. Free health screening Money for participating

+ Mode of Delivery Physical activity programs should have collaboration (partnerships) among variety of community based agencies County health departments, universities, hospitals, churches, etc. Community personal need to included in all phases of the program (design, implementation, evaluation, & interpretation) Personnel involved Trusted Respected Trained to work with ethnic groups Culturally appropriate Language Appeal to the ethnic group Family oriented E.g., day care centers

+ Location of Intervention Churches have been used to implement a number of PA programs in minority of communities. Church base interventions increases PA in ethnically diverse populations: Walking Aerobics Sports Occupational and home-based programs are sites that can reach this population group.

+ Barriers to Physical Activity and/or Exercise  Barriers to physical activity and exercise within various ethnic populations must be careful considered when establishing specific interventions to increase both cultural relevancy and physical activity/exercise  Evidence suggest that the major barriers to PA/exercise in Hispanic and African Americans are consistent with those of Caucasians. These are:  Lack of time,  Motivation,  Social support,  Knowledge,  Health information,  Transportation, and  Safety. (Eyler et al., 1998; Jarbe et al., 2002)  But some are reported more frequently by Hispanics and African American  Hispanic groups report “lack of time” where as African Americans report “lack of safe places to be active” more frequently.

+ Consideration for Working with Other Diverse Populations American Indians/Alaska Native Little is known about effective PA Interventions Limited access to health care and high diabetes Family unit and spirituality are key to cultural relevancy. Focus should be on the whole family to be active. PA programs should foster a higher level of spirituality and community cohesion. Asian Americans/Pacific Islanders Little is known High levels of obesity & heart disease Programs need to be developed for cultural relevancy in this group. There attitudes for PA are similar to other population groups. They do value PA in lower obesity and heart disease.

+ Successful Interventions Project walk impACT LaVida Caminando

+ Project Walk Home based media campaign involving phone and s to promote walking in ethnic minority women. They are recruited via presentations at WIC meetings (women infants and children). They are then provided staged-matched media materials (fliers, publications, newspaper, etc). Presenters are bilingual. Phoning is a form retentions. Results increased time in walking.

+ impACT ImPACT (increased motivation for physical activity) Targest low ethnic minority women. Designed to motivate women to become PA active. Health educators are matched with clients and given guidance in how to exercise or become involved in PA. They receive media stage based printed materials about PA with follow phone calls over a 10 month period. Programs used culturally tailored education skills to increase PA.

+ La Vida Caminando Designed by and for Latino families in rural cities of California. Designed to promote CDC standards of PA. Example of commuinity collaboration by adding one PA facility in each of the 4 designated California communities, involve at least 200 adults in walking clubs, and organize community based activities and events. Local advisory committee were formed to determine their PA goals (e.g., diabetes). PA programs were low cost, low impact, and family friendly. Media materials were in both Spanish and English. Once one became a member of walking club face to face interventions were provided. Results showed a increase in PA activity in the participants and decrease in the barriers to exercise.

+ Key Factors Earn credibility with community and religious leaders Build collaborations within the community Media and printed materials should be culturally relevant Use roles models to recruit for and deliver the intervention Offer culturally relevant incentives Offer programs in churches and community centers Include the family Provide day care for parents when ever possible

+ The End