Search

Introduction: Latinx and Asian American communities in the U.S. face unique yet similar structural barriers to maintaining adequate diet quality, contributing to an increased burden of diabetes and non-alcoholic fatty liver disease in these groups. These inequities have been exacerbated in recent years due to overt anti-immigrant and anti-Asian sentiment during the COVID-19 pandemic, invoking fear and cultural shame for these groups, and amplifying challenges towards accessing food and economic stability. Hypothesis: Herein we describe a community-centered, multi-level approach aligned with the National Institute of Minority Health and Health Disparities Framework. We hypothesize our study will result in increased fruit and vegetable intake (self-report, measured via skin carotenoids), social cohesion and ethnic pride at the individual level and improved socioeconomic outcomes at the neighborhood level. Methods: Working collaboratively with 8 community-based and farm partners, the goal of the Building Access to Food through Systems and Solidarity (BASIS) Study is to improve diet and economic stability in Sunset Park—a neighborhood of Mexican and Chinese American families in Brooklyn, NY. This neighborhood has been hard-hit during the COVID-19 pandemic and lagged in economic recovery, and its residents are disconnected from government support. BASIS addresses food access, nutrition education, policy change, and hands-on learning (e.g., gardening, cooking) incorporating culturally appropriate values, foods, and taste preferences throughout each of these activities. Results: To date, we have held four group model-building workshops with partners to identify common priorities/goals towards improving nutrition in immigrant communities; co-developed Mexican and Chinese American-specific nutrition education materials; held eight virtual and in-person sessions with community members (n=291); conducted qualitative interviews (n=19) and quantitative data collection (n=175) amongst community residents to inform program development; and implemented a subsidized, community-supported agriculture pilot program for 20 weeks in 2022 (n=38). BASIS resources have been well-received by community members, with high engagement (90% attend weekly produce box pick-up events) and acceptance (100% indicated they would recommend the program to others). Conclusions: Planned evaluation will include mixed methods and administrative data analyses for assessment of multi-level outcomes. BASIS will expand to more participants (n=150), and will include additional program components (e.g., food policy assessment; workforce development; small business owner education). BASIS presents a powerful model to improve diet in immigrant communities applying systems thinking and community-centered best practices, lessons which may be gleaned for other immigrant communities.

Low fruit and vegetable (FV) intake and high sugar-sweetened beverage (SSB) consumption are independently associated with an increased risk of developing cardiovascular disease (CVD). Many people in New York City (NYC) have low FV intake and high SSB consumption, partly due to high cost of fresh FVs and low cost of and easy access to SSBs. A potential implementation of an SSB tax and an FV subsidy program could result in substantial public health and economic benefits. We used a validated microsimulation model for predicting CVD events to estimate the health impact and cost-effectiveness of SSB taxes, FV subsidies, and funding FV subsidies with an SSB tax in NYC. Population demographics and health profiles were estimated using data from the NYC Health and Nutrition Examination Survey. Policy effects and price elasticity were derived from recent meta-analyses. We found that funding FV subsidies with an SSB tax was projected to be the most cost-effective policy from the healthcare sector perspective. From the societal perspective, the most cost-effective policy was SSB taxes. All policy scenarios could prevent more CVD events and save more healthcare costs among men compared to women, and among Black vs. White adults. Public health practitioners and policymakers may want to consider adopting this combination of policy actions, while weighing feasibility considerations and other unintended consequences.

Background: This scoping review examines the existing literature on pregnancy and perinatal outcomes among Pacific Islander women in the United States (U.S.) and U.S.-affiliated Pacific Islands. Objective: Specifically, we aimed to identify research that disaggregated Pacific Islanders from any other population group. Search Strategy: We conducted a systematic search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid) electronic databases, and hand searched grey literature. Data collection and analysis: We extracted and synthesized data on the study characteristics and pregnancy and perinatal health outcomes. Main results: Forty-eight articles published between January 2010 and June 2020 were included in the review. The majority of studies utilized clinical record data were conducted in Hawaii. Infant outcomes (preterm birth, birth weight) were more commonly reported than maternal outcomes related to either pregnancy health or the perinatal period. Our findings highlight several limitations of the existing literature, including continued aggregation of Pacific Islanders with Asian Americans and other ethnic groups, little comparison between Pacific Islander sub-groups, lack of definition of the nationality/ethnic composition of Pacific Islander groups, a lack of hypothesis-driven primary data collection and clinical trials, and underrepresentation in population-based studies. Conclusion: Researchers and policymakers should aim to address these limitations to better understand pregnancy and perinatal outcomes among Pacific Islanders.

This scoping review examines the literature on pregnancy and perinatal outcomes among Pacific Islander women in the United States (U.S.) and U.S.-affiliated Pacific Islands. Our aim was to identify research that disaggregated Pacific Islanders from other population groups. We conducted a systematic search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid) databases and a hand-search of grey literature. Forty-eight articles published between January 2010 and June 2020 were included. The majority of studies were conducted in Hawaii and utilized clinical record data. Infant outcomes were more commonly reported than maternal outcomes. We highlighted several limitations of the existing literature that included aggregation of Pacific Islanders with Asian American and other ethnic groups; limited comparison between Pacific Islander sub-groups; inadequate definitions of the nationality and ethnic composition of Pacific Islander groups; a lack of hypothesis-driven primary data collection and clinical trials; and underrepresentation of Pacific Islanders in population-based studies. Researchers should address these limitations to improve pregnancy and perinatal outcomes among Pacific Islanders, who comprise the second fastest growing ethnic minority in the U.S.

This review describes some of the unique challenges faced by the US-Affiliated Pacific Islands (USAPIs) in addressing diabetes prevention and care and presents innovative population-level strategies that have been employed to address them. Challenges include an unhealthy food environment and a strained health care infrastructure, both compounded by geography. Innovations in addressing these challenges include attempts to modify the food environment, a focus on early life prevention, and task shifting among the health workforce. Many of the successful interventions share a focus on culture, community, and capacity building. Although the USAPIs are uniquely challenged by environmental, structural, and health system barriers, there have been a number of innovative and successful strategies employed that highlight the resilience of these island nations in addressing their current disease burden when provided with the opportunity and resources to do so. Health policies to protect, support, and promote diabetes prevention and care are essential and may be informed by the interventions described.