Spirituality moderates the relationship of psychosocial stress to metabolic risk factors among Afro-Caribbean immigrants in the US Virgin Islands.

OBJECTIVE: Spirituality may contribute to the health advantage of foreign-born blacks compared to United States (US)-born blacks. The objective of this study was to test the hypothesis that spirituality attenuates the association of psychosocial stress to stress-associated metabolic risk factors among foreign-born Caribbean blacks living in a US jurisdiction. METHODS: Data on demographic factors, anthropometric measurements (height, weight and waist), fasting glucose and insulin, lifestyle behaviors (smoking and alcohol use), psychosocial stress and spirituality were collected from a population-based sample of 319 Afro-Caribbean immigrants, ages 20 and older, who were recruited between 1995 and 2000 in the Virgin Islands of the United States (USVI). Glucose and insulin measurements were used to estimate insulin resistance by the homeostasis model assessment (HOMA-IR) method. Participants were classified into three levels of spirituality, "low", "medium" and "high" based on the distribution of spirituality scores. Stepwise regression analyses were used to identify the significant predictors of waist circumference and HOMA-IR within each level of spirituality. RESULTS: The predictors of waist circumference and HOMA-IR varied across the levels of spirituality. Psychosocial stress was an independent predictor of waist and HOMA-IR only among participants with a low level of spirituality. CONCLUSION: Spirituality appears to attenuate the association of psychosocial stress to waist circumference and insulin resistance among Afro-Caribbean immigrants in the USVI.

The Association of Afro-Caribbean Immigrants' Feelings of Disconnection from the Community with the Metabolic Syndrome.

Many immigrants can feel like outsiders in their adopted country. The objective of this study was to determine if psychosocial stress associated with feelings of disconnection from the community is associated with the metabolic syndrome (Met-S) among Afro-Caribbean immigrants. The frequency of the Met-S, based on International Diabetes Federation criteria, was determined for a population-based sample of 406 English-speaking Afro-Caribbean immigrants ages twenty and older in the Virgin Islands of the United States (USVI). Feelings of disconnection were assess with Roger's Life Attitude Inventory. Logistic regression analyses showed that a high level of disconnection was significantly associated with the Met-S [Odds Ratio = 1.64 (95% CI 1.10-2.44)] after adjusting for conventional risk factors and for body mass index. Afro-Caribbean immigrants in the USVI who express a high level of disconnection from the community have an increased risk for the Met-S.

Internalized racism is associated with elevated fasting glucose in a sample of adult women but not men in Zimbabwe.

OBJECTIVES: Internalized racism (INR) is associated with metabolic abnormalities among African Caribbean women. The current study was conducted to determine if similar associations exist among Black women living in Africa. METHODS: In 2003, a stratified random sample of Black adults ages > or =18 years was drawn from four high-density suburbs of the city of Bulawayo, Zimbabwe. A total of 318 persons (90% of those recruited) participated. Face-to-face interviews were used to gather information on demographic variables, health history, internalized racism, anthropometric measurements and blood pressure. Internalized racism, the extent to which individuals agree with racist stereotypes about their race, was measured with a standardized questionnaire. A fasting blood sugar level was also measured for each participant. Persons with diagnosed diabetes or incomplete data (n=44) were excluded from analyses. RESULTS: Women (n=188) and men (n=86) did not differ significantly by age, INR score, waist circumference or fasting glucose level. The mean body mass index of women (23.6 kg/m2) was higher (P<.05) than that of men (22.3 kg/m2). INR was significantly correlated with waist circumference, diastolic blood pressure and fasting glucose among women but not among men. In multiple logistic regression analyses using the data for women, a high INR remained independently associated with abnormal fasting glucose (odds ratio=2.74, P=.0085) after adjusting for potential confounders including adiposity. CONCLUSIONS: These findings show the consistency of the association of high INR with metabolic abnormalities among Black women in the Diaspora.

The effect of health and nutrition management classes on nutrition choices: a case study on diabetics in huntsville, alabama, United States.

This study evaluated the effectiveness of a one-day nutrition education seminar utilizing a sample of 26 confirmed diabetics who had at least once before, participated in nutrition classes. The participants were exposed to a seminar that promoted, evaluated, and rewarded good nutrition choices in an effort to educate this group about coping with diabetes through nutrition management. A 24-hour food recall was used as a pre-test, meal plans constructed by trained graduate-level diet interns were used as the standard by which proper nutrition was judged, and participants' choices were used as the post-test evaluation. Significant differences were found between the 24-hour recall and the ideal meal plans in all of the three nutrient measured (energy, protein and fat). Participants showed a preference for personally constructed meal plans as opposed to those constructed by the interns. However, significant diet adjustments were shown in the short term. Discussion focused on the need for repeated involvement in diet interventions, and the challenges faced in changing diet habits of a group of middle-aged individuals who are even slightly obese.

Attitudes toward condom use among high school and university students in Zimbabwe.

Utilizing a sample of students (N = 504) from Matabeleland, Zimbabwe, Africa, this study investigated the extent to which knowledge of AIDS and two components of the Health Belief Model are related to: 1) attitude toward condom use, and 2) intentions to use a condom in future sexual encounters. Results indicated that knowledge of AIDS is not significantly related to any of the two dependent variables. However, belief in the efficacy of condoms, and lack of barriers to the use of condoms were significantly related to both dependent variables. Discussion focused on the role of religion and SES in influencing attitudes and decisions about condom use.

Cultural mistrust and use of hospice care: challenges and remedies.

Cultural mistrust is a prominent barrier to the involvement of African Americans in hospice care. While disavowing the theory that cultural mistrust has its origin in any single factor or event, it is argued that there needs only to exist the cultural construct of community for cultural mistrust to perpetuate itself among any ethnic group. The attitudes toward hospice care are advanced as illustrative of the relationship between African Americans and the health care system, and many other institutions of American society. From a perspective that accepts the existence of the phenomenon of cultural mistrust, suggestions for structuring training for cultural competence are discussed. These suggestions are relevant for workers in institutions that serve the African American community in critical health care areas in general, and administrators and staff of hospices in particular.

Effectiveness of various nutrition education teaching methods for high school students: a case study in alabama, United States.

This study examined a nutrition education program consisting of two content sessions: food-label reading, and food pyramid guide. In each session two groups of nutrition interns utilized four teaching methods: role-play/video presentation/display, grocery store tour, overhead transparency and lecture, and power point lecture, among a group of (N = 29) ninth grade, high school students. The purpose was to determine the most effective method of delivering nutrition education to high school students. Analysis using the Kruskal Wallis One-way Analysis of Variance showed that the combination method of role-playing/video presentation/visual display was most effective in the food pyramid session (χ² = 8.13, p = .04). While this method was given the highest rank in the food-label reading session it was not statistically significant. These results show that a combination of methods classified as the teacher's style, is more effective than a style that involves a single teaching method.