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UC nutrition research and education aims to ease diabetes crisis

To a large extent, Spanish-speaking California Latinos are not well informed about the causes and treatment of diabetes, while many are at high risk, but have never been screened for the disease.

These findings were gathered in a series of focus groups and surveys conducted by UC Cooperative Extension and published in the January/February/March 2003 issue of California Agriculture magazine.

In a separate study, reported in the July-August 2002 issue of California Agriculture, African American adults said that food preferences, family pressure and lack of social support were obstacles to improving dietary habits in order to prevent diabetes.

Between 1990 and 1998, the prevalence of diabetes grew 67% in California, from 4.9% to 6.9% of the total population. Between 90% and 95% of all diabetes cases are type 2, which generally develops later in life but lately has been appearing at higher rates among youth, as well. Type 1 diabetes appears to be linked to an autoimmune process and usually appears during childhood.

In the United States, the prevalence of type 2 diabetes is significantly higher in Latinos, American Indians, African Americans and Asian/Pacific Islanders than in non-Latino whites. Mexican Americans are two and a half times more likely to develop diabetes than whites; African Americans one and a half times more likely.

The federally funded UC Cooperative Extension Expanded Food and Nutrition Education Program (EFNEP) has an extensive network of nutrition educators in direct contact with low-income Californians. UCCE conducted the studies to determine how these educators can develop an effective, culturally relevant approach for reaching Latinos and African Americans.

“Before we can start teaching diabetes prevention, we have to know what preconceived notions are held by California Latinos and African Americans about diabetes,” said Lucia Kaiser, community nutrition specialist in the UC Davis Department of Nutrition.

Kaiser is chair of the ANR Health Promotion Workgroup, composed of 13 UC Davis specialists and UC Cooperative Extension nutrition, family and consumer sciences advisors. Workgroup members conducted focus groups among Latino adults with diabetes in Napa, San Joaquin and Stanislaus counties. In addition, a 40-question survey was completed by 132 Latino EFNEP participants in San Joaquin and Stanislaus counties. The workgroup conducted focus group discussions with African Americans in six California counties.

The Latino focus groups revealed the belief that shock, worry, anger, sadness or an emotional event (feelings grouped as “susto,” literally “fright” in Spanish) causes diabetes. Although some were uncertain about a causal relationship, 64% had heard that susto might be related to the onset of the illness.

In fact, the major risk factors for diabetes are excess weight, lack of physical activity, advancing age and a genetic propensity for the disease. Although stress is not believed to be a direct cause of diabetes, it may act as a trigger in people who have undiagnosed diabetes and result in a worsening of the condition so that the illness becomes apparent.
Some Latino subjects had heard from family members that insulin dilutes the blood or causes blindness. One woman mentioned that she was ashamed to let others know she had the disease. Several people voiced the belief that everyone – especially Mexicans – has diabetes, but in some people the disease just develops faster.

Although the overall profile of the Latino survey participants – ethnicity, overweight, positive family history, older age, sedentary lifestyle – suggests a risk for type 2 diabetes, 44% reported never having been screened. Thirty-seven percent did not know where to be screened for diabetes and only 14% considered themselves to be at high risk.
In the study of African Americans, many participants felt that not enough information about diabetes was reaching the black community and voiced the need for culturally sensitive education delivered through community-based channels, such as churches, schools and clinics.

“You can send all the fliers you want into the black community, but if it’s not presented right, you can hang it up. They will not listen,” said a San Joaquin County participant.

A number of factors may contribute to the increased risk of diabetes and diabetes-related complications in African Americans, the experts said. In a study of 975 whites and 418 blacks, obesity accounted for 47% of the excess risk of diabetes in black women. Genetic factors are also likely to play a role, but more research is needed.

Many focus group participants knew something about the symptoms and dire consequences of diabetes, but their comments also reflected a lot of misinformation, such as that eating too much sugar causes the disease. Most of the participants said they wanted more information on causes, prevention and symptoms.

Both studies resulted in specific approaches that can be taken by educators to reduce the prevalence of diabetes in these high-risk ethnic groups. Based on the studies’ findings, the ANR Health Promotion Workgroup is planning a multi-channel educational campaign, including ethnically appropriate cooking classes and education programs that increase awareness of risk factors, inform people about the consequences of diabetes, reduce the barriers to seeking care and adopting a healthy lifestyle and increase awareness that physical activity, a low-fat diet and weight management can prevent or postpone diabetes.

(March 2003)

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