Background and Purpose
The Obesity epidemic has staggering social and economic implications as obesity impacts quality of life, increases mortality, and drives up healthcare costs. Racial/ethnic minority groups suffer disproportionately from obesity and obesity-related disease/disability. Given that the US will be a majority minority country by mid-century, a trend largely shaped by immigration, there are serious consequences for the nation’s health. Macro factors endemic to many minority communities, such as poverty and resource deprivation, increase risk exposure through socio-environmental influences that do not promote optimal health. New immigrants in Boston are primarily from the Caribbean. Racial/ethnic minorities in the US context, immigrants settle in established Boston minority communities, and face the often less than optimal life circumstances US minorities face. Research indicates immigrants are generally healthy upon arrival in the US, but over time health deteriorates and chronic conditions such as obesity increase, which is exacerbated by structural barriers to healthy living. Mitigating obesity among new immigrants thus entails addressing the socio determinants as well improving health behaviors.
Description
Inadequate opportunities for physical activity (PA), and employment/employability were identified as priorities that contribute to obesity among new immigrants in the target communities. This project employs a community based participatory research (CBPR) approach. in partnership with a non-profit fitness center (Healthworks Community Fitness), community health center (Southern Jamaica Plain Health Center), and community based organization (Dominican Development Center), we developed a women’s obesity mitigation intervention employing an asset-based model. Set within diverse Black and Latino minority and immigrant neighborhoods in Boston, we are testing targeted job-training as a strategy to deliver a more traditional public health intervention. We hypothesized career development and employment can increase individual motivation to be physically active, improve health attitudes and behaviors, while serving as the foundation for a public health intervention to increase PA opportunities, which can increase community participation in PA. Ten women participated in the Train4Change program which included health educator training and intensive instruction to earn Group Exercise (GroupX) Certification, in order to deliver GroupX classes and lead walking groups. Participants completed an externship comprised of participating and observing GroupX classes, as well as instruction from a GroupX instructor experienced in women’s health/fitness to learn to structure and facilitate a variety of GroupX classes for diverse populations. On completion of the training in Aug 2012, participants began teaching GroupX classes and leading walking groups in the target communities. Participants will each teach up to 5 classes/week through the summer 2013. Classes are free. A community survey identified classes to offer and when.The initiative provides career development for minority women while helping them confront obesity in their communities. Certifying residents as GroupX instructors and health educators, our intervention increases career opportunities in health/fitness, while providing the wider community with new strategies to improve opportunities and increase participation in regular PA among immigrants of Caribbean origin.
Lessons Learned
80% of participants completed the training and are currently leading classes and walking groups in their communities. of these participants, 38% earned AFAA certification, the remainder are currently awaiting results of a re-take of the exam. We are collecting data on participation in the GroupX classes and walking groups. We will present results of the training program, community survey, and community participation in the GroupX classes and walking groups. We will discuss the intervention model and how the approach employed addresses individual, community and systemic factors, and increases individual and community capacity to address obesity. We will also discuss challenges, limitations, and how this approach can sustainably improve the economic and health profiles of the target communities.
Conclusions and Implications
Through this intervention we reframe employment and employability as public health issues, and economic development as integral components of obesity mitigation efforts. Efforts to address obesity in under-resourced communities could be strengthened by including efforts to increase resources and opportunities in the target communities and populations. Such a strategy also lays the groundwork for future collaborations while building community capacity to address pressing public health issues. Interventions that solely focus on behavior change are not sustainable and are of questionable efficacy, as are top-down interventions that do not meaningfully engage members of the target population. to tackle obesity diverse sectors of community life must be involved. Securing community participation in such efforts furthermore entails addressing the determinants of health and priority needs within communities.
Next Steps
A key aim of this project is to convene stakeholders to examine and share findings, and link them to broader policy or program changes. We are presently convening an Advisory Board (AB) to identify opportunities to apply study findings to existing and new programming, and develop policy strategies to address obesity in Boston communities at high risk for obesity. Chaired by Boston Mayor Thomas Menino, the AB will have representation from hospitals, community colleges, community organizations, elected officials, as well as community, health policy and workforce leaders.
Support / Funding Source
This project is funded by The Boston Foundation as part of its Healthy People in a Healthy Economy Initiative.
