Using Qualitative Research to Explore Energy Balance Promotion within the Hmong Culture

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Using Qualitative Research to Explore Energy
Balance Promotion within the Hmong Culture

• Loan P. Kim, MS, RD
• Doctoral Student
• UCLA School of Public Health
• Loanpham_at_ucla.edu

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Acknowledgments

• Co-PIs
• Gail Harrison, PhD
• Marjorie Kagawa-Singer, PhD, MN, RN
• CAANPAC research team
• Community partners
• Hmong Womens Heritage Association
• Stone Soup
• Asian American Network for Cancer Awareness,
  Research and Training (AANCART) Department of
  Health Services, Public Health Institute
  National Cancer Institute

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API Demographics in California

• Asian1 population in CA has ? by 56 since 1999.
• 4.2 million Asian and Pacific Islanders (API)
  reside in CA 35 of the US API total.
• APIs comprise 11 of CAs population and 4 of
  total US population.
• Census projects that the national API population
  will increase to 6.2 by 2025. (http//ca.ran
  d.org/stats/popdemo/popprojUS.html)

Census data, population projections 1
Non-Hispanic, Asian alone or in combination with
one or more races http//quickfacts.census.gov/qf
d/states/06000.html
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Asian population in US and California
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Low-Income Asian Subgroups in California
Census 2000 data Target of API formative
research project
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THE HEALTH STATUS OF AAPI Obesity by
Acculturation

• Among immigrant API ? number of years in the
  
• US ? weight.
• Obesity rate doubles from first to second
  generation
• API adolescents.
• Asian children born outside the U.S. less likely
  to
• become obese than those born in US
• 1996 Medical Expenditure Survey shows Latino
• and API adolescents more overweight.
• Obese children who grow into obese adults live
• 10 20 fewer years

Haas JS, American Journal of Public Health,
2003 Popkin BM, American Society for Nutritional
Sciences, 1997
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Overweight Increased Most Sharply for California
API Low-Income Children
Percent overweight, low-income CA children
Overweight BMI gt 95th percentile. Overweight
is comparable to obesity in adults. Children 5
- gt20 years old Source California Dept. of
Health Services, Childrens Medical Services
Branch, California Pediatric Nutrition
Surveillance System
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Aggressive Marketing in API Communities
Ad campaign i am asian
Chinese Lunar New Year Celebration San
Francisco, 2004
http//www.i-am-asian.com/
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Marketing Doesnt Stop at the U.S. Border
Kentucky Fried Chicken in Japan and
China McDonalds in China
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• Japan China Korea
  Malaysia Taiwan

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Purpose of Project

• Conduct formative study among adults youths in
  the low-income Hmong communities in CA (also
  Chinese, Vietnamese)
• To inform the design of a community-wide campaign
  to promote energy balance through fruit and
  vegetable consumption and PA

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Community Partners
Hmong Womens Heritage Association
Stone Soup
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Sample Selection Criteria

• Ethnicity Hmong
• Poverty Below 185 federal poverty level
• Sites Northern CA Sacramento
• Central CA Fresno

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Distribution of Participants
Adult Age Range 25-80 years old (all 1st
generation) Youth Age Range 8-14 years old K.I.
Age Range 25-62 years old
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Study Methodology Analysis

• Methodology
• Focus Groups (4 in each community)
• 2 Adults
• 2 Youth
• Key informant interviews
• 5 in each community
• Analysis
• Transcripts translated
• Atlas 4.2 for data organization analysis

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Common Definitions of Health

• FV consumption and PA important for general
  health
• Health includes concept of harmonious family
• Yin Yang balance important consideration for
  health and food preparation
• Home-cooked meals healthier than eating out

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• Definitions of Health
• Hmong Specific

• Absence of physical disorders
• Abstinence from alcohol tobacco
• Having clean environment
• Air quality
• Free of dirt and germs

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Healthy Foods

• Fresh foods
• pesticide free
• recently picked/slaughtered
• hormone-free
• not frozen
• not canned
• Fruits and Vegetables
• Meats (fish, pork, chicken)
• Rice/noodles
• Soybean products

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Unhealthy Foods

• Dried/preserved foods
• Cured meats
• Instant noodles
• Excessive meats
• Excessive sweets (candy, sweet cereals)
• Fast foods/Fried foods
• Hamburgers, French fries, chips, fried chicken
• Foods treated with pesticides, fertilizers,
  hormones
• Frozen foods

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Healthy Unhealthy Drinks

• Healthy Drinks
• Milk
• Water
• Boba tea/slushy, smoothies
• Diet sodas
• Fruit Juice
• Gatorade
• Tea
• Unhealthy Drinks
• Soda and High Sugar Drinks

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Fruits Vegetables

• Commonly Eaten Fruits
• Most common Bananas Oranges
• Guava, mango, pineapple, kiwi
• Commonly Eaten Vegetables
• Mustard and collard greens
• Eggplant
• Squash

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Serving Size Unfamiliar Concept

• Traditional family style meals common
• Participants aware of variety but not quantity

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Fruits Vegetables

• of Respondents Who Said Children ACTUALLY Eat 5
  Or More Svgs of FV a Day
• General trends. Total number of respondents vary
  between each age and ethnic group. One serving
  equals half cup cooked vegetables, half banana or
  apple, half bowl of rice.

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Fruits Vegetables

• of Respondents Who Said Children
• SHOULD Eat 5 Or More Svgs of FV a Day
• General trends. Total number of respondents vary
  between each age and ethnic group

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Fruit Vegetable Consumption Patterns

• CONSUMPTION PATTERNS
• Fruit eaten throughout the day
• (snack or dessert)
• Vegetables usually served at
• every meal
• KNOWLEDGE of BENEFITS
• Provide energy and strength
• Prolongs life
• Prevent sickness and diseases

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Physical Activity

• Common Activities
• Sports (e.g. Baseball, Football, Volleyball,
  etc.)
• House work/cleaning, mowing the lawn, etc.
• Playing with friends
• Walking, Tai Chi
• Traditional activities
• Tulu
• Kato
• Stretching
• Meditation

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Physical Activity

• of Respondents Who Said Children ACTUALLY Do 60
  min or more of PA a Day
• General trends. Total number of respondents
  vary between each age and ethnic group

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Physical Activity

• of Respondents Who Said Children SHOULD Do 60
  min or more of PA a Day
• General trends. Total number of respondents
  vary between each age and ethnic group

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Physical Activity Pattern

• Frequency
• 3 days a week
• Location
• Backyards/home or friends home
• Neighborhood streets
• Parks and Playgrounds
• School
• Recreation facilities, YMCA
• Faith-based organizations

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Barriers to FV Consumption

• Lack of time/energy to prepare meals
• Eating at fast food restaurants
• Feeding kids what they want to eat
• Lack of financial resources to purchase FV
• Lack of land/gardens to grow certain FV
• Lack of information regarding importance of FV
  
• Lack of availability of certain FV in markets
• Poor quality and limited selection at school
• Children dislike taste of certain FV

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Concerns regarding Obesity Barriers to PA

• Substantial number of parents and children
  experienced weight gain since moving to U.S.
• Increased consumption of American food and
  decreased physical activity
• Barriers
• Distraction from academic studies
• Believe girls should NOT play aggressive sports
• Environmental safety (e.g. bad air quality,
  gangs, crime, unsafe areas)
• Lack of time and energy to participate
• Lack of community resources and access (parks
  rec facilities)
• Lack of financial resources- to expensive to
  enroll children in programs
• Language barriers
• Little information about PA programs
• Individual Safety bodily injuries

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Ways to Encourage/Maintain Individual Level

• F V Consumption
• Highlight importance of eating FV daily
• Creative cooking to include FV in every meal
• Educate parents children about proper
  nutrition
• and benefits of FV
• Have family dinners create positive eating
• environment
• Parents serve as role models
• Make FV at home
• Teach children at an early age to eat FV

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Ways to Encourage/Maintain-Individual Level

• Physical Activity
• Reinforce tradition of family activities with
• children
• Provide low-cost or free supervised physical
• activities in the community
• Improve access to parks and playgrounds

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Common Strategies Suggestions Group Level

• Educational Materials/Workshops Classes
• In-language materials
• Visual pamphlets, stickers, health videos,
• posters, book covers, key chains
• Audio Radio, incorporate music/jingle
• More pictures, less words
• Educational classes
• Locations for Education/Outreach
• Churches/temples
• Community-based agencies
• Doctors offices/clinics
• Health fairs
• Asian Supermarkets
• Schools

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Strategies and Suggestions Community Level

• Media
• In-language TV and radio
• Parents commercials/PSAs in evening
• Use networks/programs children enjoy watching
  (e.g. cartoons)
• Shock campaigns (e.g. Truth.com)
• Using animation, role models in community to
  market the message (e.g. Got Milk?)
• In-language nutrition/PA health videos to
  distribute at community health fairs

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Strategies and Suggestions

• Health Information Messengers
• Parents (mothers)
• Teachers
• Community health outreach worker/social workers
• Community religious leaders
• Doctors, Nurses, Nutritionists, Health educators
• Counselors, Friends/Peers

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Limitations of Rapid Assessment

• Cross-sectional
• Key informants were selected for their knowledge
• of the community they provided a single
  interview
• time constraint- no opportunity to check
  concepts arising in focus groups or triangulate
  data
• Focus groups were recruited in opportunistic
  convenience manner
• No formal ethnographic tasks were undertaken
• All adult focus group participants were first-
• generation immigrants

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Conclusion

• With greater numbers of years in the US,
• traditional diets and PA patterns will
• inevitably change.
• Appreciate and garner multicultural identity
• to develop A/PI 5-A-Day Campaign in CA
• 3 Goals of A/PI Campaign
• Reinforcement of healthy traditional lifestyle
  
  
• Culturally tailored messages
• Multilevel strategy

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• Than You for your Feedback!

• Loanpham_at_ucla.edu