Qualitative Analysis of a Kinesiology Student-Led Sustainable Exercise Program Targeting Underserved Communities.

BACKGROUND: The 3 WINS Fitness is a free exercise program delivered by kinesiology students to underserved communities without external funding since 2011. The program's wins focus on reducing health inequities, increasing community health, and student professional development. The objective of this study was to conduct a qualitative evaluation of the program's value for the participant, community, and student-instructors. METHODS: We conducted 9 online focus groups (n = 51), categorized by participant role and timeline in 3 WINS: participants (4 groups), student-instructors (3 groups), and combined participants and student-instructors (2 groups). Data collection for this remote qualitative study of the 3 WINS program occurred May to June 2021. The data were analyzed to determine codes and emerging themes. RESULTS: Three main themes are presented: asset, health, and social connection. The asset theme was subdivided into subthemes: (1) professional asset for the student-instructor, (2) program asset for the student-instructor, (3) program asset to the community, and (4) program asset for the participant. The health theme was subdivided into (1) community and (2) personal health subthemes. The social connection theme was defined in any combination, as camaraderie, friendship, connections, community, and family. CONCLUSION: The program improves the individual participant's health and through role modeling for their family and friends, encourages others to follow their example thus providing a positive influence on overall community health. Concomitantly, student-instructors are developing into well-trained professionals. The 3 WINS as a student-led sustainable and replicable model can address the existing call from public health to reduce physical activity health-related diseases and inequities.

The Earliest Food Deserts: Availability of Infant and Follow-on Formula, and Lactation Support Products among Stores in Black and Non-Hispanic White Zip Codes in Los Angeles County.

OBJECTIVES: This study investigates the availability, accessibility, and product depth of in-store infant feeding and galactagogues products in majority Black and majority white zip codes in Los Angeles County. METHODS: A cross-sectional study was conducted to determine racial/ethnic neighborhood differences in the availability of infant and follow-on formula and galactagogues products in 47 retail stores in 21 zip codes. Store-level data were collected in June 2019 and an observational tool for galactagogues products and infant/follow-on formula (availability, accessibility, product depth) was employed at each store. RESULTS: Most of the stores were grocery stores (87.2%). Stores in majority Black zip codes had less availability of infant formula ready-to-use (p = 0.001), less accessibility of follow-on powder (p = 0.028), and availability of galactagogues beverages (p = 0.036) versus majority white zip codes. Product depth (number of brands sold) of stores with one or more brands of the aforementioned products was consistently higher in majority white zip codes compared to majority Black zip codes. Stores in majority Black zip codes were most likely to have lower availability of infant formula and galactagogues products, an important part of the food environment for infant feeding options, in particular, for lactation support. CONCLUSIONS FOR PRACTICE: Most studies investigating the association of the food environment and health outcomes have focused only on solid foods. However, additional food products (e.g., liquids, powders) may be contributors to extensive disparities in infant mortality between Black and white infants and may lead to health disparities beyond infant stage (e.g., children, adolescents, and adults). Lastly, for breastfeeding inequities to decrease, pregnant and postpartum Black persons need equitable access and education on safe and quality galactagogues products.

Environmentally Driven Increases in Type 2 Diabetes and Obesity in Pima Indians and Non-Pimas in Mexico Over a 15-Year Period: The Maycoba Project.

OBJECTIVE: The global epidemics of type 2 diabetes and obesity have been attributed to the interaction between lifestyle changes and genetic predisposition to these diseases. We compared the prevalences of type 2 diabetes and obesity in Mexican Pima Indians, presumed to have a high genetic predisposition to these diseases, to those in their non-Pima neighbors, both of whom over a 15-year period experienced a transition from a traditional to a more modern lifestyle. RESEARCH DESIGN AND METHODS: Prevalence of diabetes, impaired fasting glucose, impaired glucose tolerance, and obesity in Mexican Pimas (n = 359) and non-Pima Mexicans (n = 251) were determined in 2010 using methods identical to those used in 1995. RESULTS: During this 15-year period, age-adjusted diabetes prevalence was unchanged in Pima men (5.8% in 1995 vs. 6.1% in 2010) yet increased in non-Pima men from 0.0 to 8.6% (P < 0.05). Diabetes prevalence tended to increase in both Pima women (9.4 vs. 13.4%) and non-Pima women (4.8 vs. 9.5%). Age-adjusted prevalence of obesity increased significantly in all groups (6.6 vs. 15.7% in Pima men; 8.5 vs. 20.5% in non-Pima men; 18.9. vs 36.3% in Pima women; 29.5 vs. 42.9% in non-Pima women). CONCLUSIONS: Type 2 diabetes prevalence increased between 1995 and 2010 in non-Pima men, and to a lesser degree in women of both groups, but it did not increase in Pima men. Prevalence of obesity increased among Pimas and non-Pimas of both sexes. These changes occurred concomitantly with an environmental transition from a traditional to a more modernized lifestyle.

High-Risk Populations: The Pimas of Arizona and Mexico.

The purpose of this review is first, to broadly summarize the long-term commitment that began in 1965 to studying type 2 diabetes and obesity through the cooperation of the Pima Indians of Arizona, and second, to discuss the investigations with the Pima Indians of Mexico that started in 1991. The later studies emphasize gene-environment interactions in the pathogenesis of these metabolic disorders. Through the participation of both groups of Pimas, the researchers made key findings with regard to the epidemiology, physiology, clinical assessment and genetics of type 2 diabetes and obesity.

Study design of the Maycoba Project: obesity and diabetes in Mexican Pimas.

OBJECTIVE: To focus on the rationale and methods of the Maycoba Project. METHODS: Study population included Mexican Pima Indians (MPI) and Blancos aged ≥20-years, living in the village of Maycoba and surrounding area. Surveys in 1995 and 2010 included a medical history, biochemical and anthropomet- ric measurements. Additionally, socio- economic, physical activity, and dietary interviews were conducted. The 2010 study incorporated investigations on type 2 diabetes (T2D) and obesity-associated genetic alleles and human-envi- ronment changes. RESULTS: The study results are limited to demographic data and description of the eligible and ex- amined sample. CONCLUSIONS: This study may yield important information on T2D and obesity etiology in a traditional population exposed to environmental changes.

Fifteen years of change in the food environment in a rural Mexican community: the Maycoba project.

INTRODUCTION: Indigenous populations worldwide who are shifting to a westernized lifestyle experience high rates of type 2 diabetes and obesity. These conditions are commonly the result of genetic predisposition and environmental factors that promote excess energy intake and decreased energy expenditure. The purpose of this study was to examine changes in the food environment, specifically looking at retail and subsistence-food availability, and food-acquisition behaviors in the rural Mexican town of Maycoba and surrounding communities between 1995 and 2010. The population in this area includes indigenous Pima, genetically-related to the Pima Indians in Arizona who have the highest documented rates of diabetes, and non-Pima Mexican (ie non indigenous and other indigenous). An initial study in 1995 compared the prevalence of diabetes and obesity in the Maycoba population with that of Pima Indians of Arizona and found a dramatically lower type 2 diabetes prevalence in the Maycoba region due to the protective effect of a traditional lifestyle despite a genetic predisposition to diabetes. METHODS: The 2010 follow-up study was undertaken to determine the prevalence of obesity and type 2 diabetes as well as to examine lifestyle changes over the 15 year time span, following changes to housing and the local environment. This study focused on the food environment, examining changes in food acquisition behaviors in the retail and subsistence aspects. The study included a household survey (n=71), two focus group discussions, and participant-observation. To determine changes in retail food availability, seven stores throughout the study region were audited. RESULTS: The main findings were an increasing presence and use of retail stores for food: an expansion in the selection of processed foods, their prominent placement, and refrigeration allowing more perishable foods to be available to the local population. Subsistence activities remained significant, although some aspects of specific subsistence activities are in decline, such as the area allocated to home gardens and a reduction in the variety of crops cultivated in them. CONCLUSION: Although there have been a number of changes in the food environment during the 15 year period, a traditional subsistence-based lifestyle prevails.

Land-use and land-cover assessment for the study of lifestyle change in a rural Mexican community: the Maycoba project.

BACKGROUND: In 1995, a study was conducted to identify the effects of traditional and westernized environments on the prevalence of type 2 diabetes in Pima Indians (Pimas) in Mexico and the United States. The study concluded that the more traditional lifestyle in Mexico had a protective effect against this metabolic disorder. In the ensuing 15 years, the environmental circumstances of the Mexican Pimas changed, and a follow-up study was conducted to determine the role environmental change plays in the development of diabetes in this genetically susceptible population. A major element of environmental transition relates to land-use and land-cover (LULC) changes that could affect physical activity and promote an obesogenic environment. This study examined changes in the region's LULC to determine whether there have been transitions in agricultural land use and urbanization that would be consistent with a more sedentary lifestyle. Changes were assessed from 1994 aerial photographs and 2007 satellite images. RESULTS: The land-cover analysis showed that mixed vegetation and dense trees cover most of the study area. It suggested a rural environment that includes a low percentage of impermeable areas, and it indicated that the area experiencing human intervention covers 7% of the total area. The land-use-change findings showed a decrease or no change in agricultural or ranching areas and a decrease in farmland due to reforestation or revegetation. Three variables from the land-use-change analysis were examined as proxies for lifestyle change: urban development, dwelling-unit density, and variation in the road network. Two of the measures -the amount of urbanization and the number and density of dwelling units-showed increases, most notably in the town of Maycoba. There were only minor changes in the road network: most of the road segments are short and concentrated in Maycoba where most of the buildings, points of interest (e.g., church, stores), and cars are located. CONCLUSIONS: The LULC in Maycoba and surrounding settlements had changed during the study period. LULC change was used as a proxy to examine lifestyle changes that can affect levels of physical activity.

An Exploration of Gardens in Maycoba, Mexico: Change in the Environment of a Population Genetically Prone to Diabetes.

Gardens are an important part of the environment as they play multiple roles and are central to the lifestyle and economy of many communities. The investigators use qualitative methods to explore patterns and perceptions about changes in gardening and cultivation in the community of Maycoba, Mexico. Maycoba is home to a large community of Pima Indians, an Indigenous population genetically prone to diabetes. Pima Indians living in the United States have been shown to have an extremely high prevalence of diabetes, but the genetically comparable Pimas in Maycoba, Mexico, were found to have little diabetes in the early 1990s. The authors examine home gardens and other cultivation in the area as an element of a changing environment and lifestyle during the past 15 years. Methods include interviews and focus groups. Preliminary findings are presented in this paper.