Category: Lifestyle

Hispanic Heritage Month: Persisting Food Deserts in Latino Communities

Observed between September 15th and October 15th every year, Hispanic Heritage Month celebrates the vast historic and cultural contributions of Hispanic/Latinos in the United States. During this time, healthcare organizations spotlight some of the many medical conditions disproportionately affecting this community and emphasize the urgency of mitigating pervasive racial health disparities which contribute to poorer outcomes in this demographic.

Food Deserts in Hispanic/Latino Populations

The association between poverty and food availability is well-documented as more than 23 million individuals – the majority of which live in low-income households – inhabit areas that lack adequate access to healthy foods. According to the latest research, neighborhood income levels are just one of many barriers to obtaining healthy food products in impoverished communities – racial composition also plays a significant role.

Neighborhoods comprised primarily of Latino/Hispanic residents frequently have limited access to healthy, affordable, and nutritious foods, especially when compared with communities of similar poverty rates. Black and Hispanic neighborhoods have fewer large supermarkets and more small grocery stores than primarily white neighborhoods; smaller stores rarely offer the healthy, whole-grain foods, dairy products, or fresh fruits and veggies that a supermarket provides.

Combined with a shortage of supply, which causes the subsequent lack of demand, and a lack of infrastructure and resources, “food deserts” are created in many Latino neighborhoods across the United States. Residents of these areas have a difficult time finding affordable, healthy food and thus, consume a poor, nutrient-deficient diet putting them at an increased risk for cardiometabolic diseases.

Access to Healthy Foods

Overall, Hispanic/Latino community residents are faced with a significantly decreased availability of fresh produce, especially in low-income areas. Current statistics indicate that over 10% of Hispanic individuals report difficulties in accessing affordable fresh produce– the highest rate among all racial/ethnic minority groups.

Although few studies have examined the contents of Latino markets, a 2018 study investigated the availability of different food types found in these stores and found that the supply of healthy foods was lacking. For many Latino individuals, transportation is an added barrier to obtaining healthy food due to a heavy reliance on public transit systems and the geographical distance that separates them from well-stocked, large-format grocers.

Clinical Implications

The clinical implications of Hispanic/Latino food deserts are multi-fold. Poor dietary patterns, limited access to healthy foods, as well as low fruit and vegetable intakes increase the risk of chronic diseases and obesity among socioeconomically disadvantaged groups, adversely affecting population health. Disparities in access greatly contribute to the prevailing health inequities among racial/ethnic groups; per data from the Centers for Disease Control and Prevention, adults obesity rates are up to 21% higher in Latino patients than their non-Hispanic white counterparts. In addition, children of Hispanic/Latino heritage are significantly more likely to be obese than their white counterparts.

In many minority communities, the food environment does not support a healthy diet. Furthermore, residents who live near supermarkets or stores selling fresh produce tend to experience lower rates of diet-related diseases. According to a report published by The Food Trust: “A multistate study found that people with access to only supermarkets or to supermarkets and grocery stores have the lowest rates of obesity and overweight and those without access to supermarkets have the highest rates.”

Latino individuals are more likely to be overweight or obese and thus, more likely to develop cardiometabolic diseases. Living in a food desert environment has been proven to increase the risk of adverse cardiovascular events and has been associated with worsened health outcomes. Not only does this environment increase the risk of weight-related health consequences, but it also heightens the likelihood of prediabetes and diabetes development.

Persisting food deserts in minority neighborhoods and their adverse health implications highlight the need for improved public health and community outreach efforts that aim to enhance access to healthy foods. Local policymakers are encouraged to better the quality of infrastructure in these communities, to bolster local businesses and incentivize them to stock more fresh produce and healthy food products. While this field of research continues to grow, further investigation is needed to fully understand the effects of food deserts and differential access on Hispanic/Latino health as well as to determine whether community-based or individual-level interventions can improve population outcomes.

For an opportunity to delve deeper into clinical techniques for patients living in limited food environments, clinicians are encouraged to attend CMHC’s upcoming pre-conference: “Impact of Ethnicity and Race in Cardiometabolic Health:Implications for Risk Assessment and Management.” During the session “How Should You Counsel Patients Who Live in Food Deserts?” led by Alanna A. Morris, MD, practitioners will learn more about the impact of ethnicity and race in cardiometabolic health risk management, specifically related to nutritional interventions in disadvantaged communities.

Tobacco Assessment and Cessation Tools for Cardiac, Pulmonary and Vascular Rehab

Partner of the Month: AACVPR

For those quitting smoking, change can be very hard. Helping someone quit smoking can save his or her life, but for health care professionals trying to spark that change within their patient, it can be difficult to know exactly how to communicate.

Mayo Clinic Rochester Shawn Leth, M.Ed, CEP, and Kathy Zarling, MS, APRN, CTTS, both of the Mayo Clinic in Rochester, Mn., recently hosted an AACVPR webinar about using motivational interviewing as a tool to help smoking cessation. Health care providers need to understand how to ask the right questions to dig deeper into what their patients need in order to quit using tobacco for good.

“As we all know, smoking cessation is a challenging process for both the smoker and those trying to help them quit,” Leth said. “Motivational interviewing and coaching have been shown to be the most effective method to use during interventions.”

Motivational interviewing can be done in a variety of ways, but the goal remains the same. By partnering with clients in understanding their goals and motivations to quit using tobacco, health care professionals can facilitate a care plan to help them get there. Most importantly, it’s vital for those helping patients to quit be non-judgmental and empathetic in a person’s journey to quit.

While there are many methods to motivational interviewing, Zarling said it’s important to remember that no one way is the best. Health care professionals should feel empowered to use these tools in combination with one another if they find one resonates more with a patient than another does.

“Motivational interviewing is always a dance,” Zarling said. “It’s collaborative, it’s partnership, it’s working directly with the patient and walking alongside them to make that change.”

The OARS Method

There are several different methods to do this. The first is OARS.

  • Open-ended questions
  • Affirmations
  • Reflections
  • Summarize

Upon intake, professionals should ask open-ended questions. Instead of asking “Did you smoke last night?” try asking, “What challenges did you face that made you want to smoke last night?”

Asking these questions results in more robust questions and gives you an opportunity to learn more about your patient. It also helps you dig into whether they’re feeling confident about their cessation attempts. Maybe a person didn’t smoke the previous night, but hearing why they struggled with that can help dig deeper into what they’re facing.

Which leads into affirmations. If a person who is struggling was successful, be sure to recognize what they’ve been able to do, Leth said.

“Don’t we all appreciate being recognized for something we’re working on? Our patients are no different,” she said.

Help a patient reflect on their experiences, their successes and their failures by actively listening. If they feel they’re being heard—and what they’re saying is important to you—they’re more likely to trust. And lastly, summarize these conversations.

The DARN-CATS Method

Like the OARS Method, DARN-CATS is aimed at using change talk to highlight why a person would want to stop using tobacco, and what tools a person needs to get there.

  • Desire to Change
  • Ability to Change
  • Reason to Change
  • Need to Change
  • Commitment
  • Activation
  • Taking Steps

Again, this method is based on a value-based approach that uses non-judgmental questions to help someone quit tobacco.

The first part of DARN-CATs (the DARN) looks at what a patient feels about their tobacco use. It gauges their desire to change, what they need to do to start making those changes, and identifies reasons and needs for smoking cessation. Listening to a patient’s story helps the health care professional to find the patient’s values and goals.

“It’s walking along side our patients—and just a little behind them—so they lead in telling us their stories and telling us what their motivations and goals are,” Zarling said. “It also explores their values, strengths and desires in moving forward their goal of tobacco cessation.”

Once you understand where they’re coming from, you can help them build a plan. CATS helps move that needle forward. What does a patient think they can do to be successful? What are some small steps they can start on their own time when they’re ready to change?

Elicit-Provide-Elicit Method

Like the others, the Elicit-Provide-Elicit Method is predicated on what a patient is experiencing. This method specifically focuses on the patient experience through asking questions and using those answers to determine what information is applicable to the paitent.

Once you understand how a patient feels—and what questions and reservations they have about quitting—a health care professional should ask their patient if it is okay to make recommendations.

“Provide information in a neutral, non-judgmental way by asking permission first, respecting them and asking if it’s okay to intervene,” she said. “We don’t judge the patient, we meet them where they’re at.”

The Five A’s

While motivational interviewing is key to understanding a patient’s needs and desires, when you start moving into actually creating a plan for care. The Five A’s can create a roadmap for health care professionals to follow.

  • Ask patients about tobacco use every visit
  • Advise all patients who use tobacco to quit
  • Access the patient’s willingness to quit
  • Assist the quit attempt with counseling and/or medication
  • Arrange a follow up

Using motivational interviewing at each step of the process during this time is beneficial for not only the patient, but the health care professional as well. It can help you ask the right questions, help reinforce with the patient their own personal goals for quitting and allow everyone to get on the same page.

During those follow-up conversations—whether they’re in person or not—health care professionals should continue using motivational interviewing to build confidence in a patient.

“Change takes time,” Leth said. “It’s not going to happen overnight.”

Want to learn more about motivational interviewing? Leth and Zarling’s full webinar will be available on AACVPR’s website.