The Food Habits of Black Older Adults in New York City: Are There Differences between African Americans and Caribbean-Born Immigrants?
Lyons, Beverly P., Speakes-Lewis, Amandia, Upadhyay, Ruchi, Forum on Public Policy: A Journal of the Oxford Round Table
Introduction and Background
The extent to which healthcare practitioners fully understand the relationship between food habits relative to cultural health beliefs, health behaviors and the personal health status of older adults is extremely important to the provision of appropriate successful client-centered nutrition education intervention strategies. It has been well established that certain foods have beneficial nutritive and disease preventing effects on life-threatening health conditions (i.e., the leading causes of death: heart disease, cancer, stroke, diabetes). Cross-racial studies of U.S. populations indicate that Blacks (1) older adults have a disproportionately high prevalence of the afore-mentioned health conditions. (2) Yet, few if any gerontological studies have been done exploring whether Black older adults are aware of the relationship between their health conditions and their food consumption patterns. A study examining 265 nutrition education intervention research studies indicate that among the intervention studies with adults over 65 years of age, only one study measured health outcome expectations and a very few measured nutrition knowledge relative to food consumption. (3) None of these studies were cross-cultural examining differences among Black older adults.
The U.S. Census data indicate that adults 65 years of age and older are the fastest growing segment of the U.S. population. Changing immigration patterns contribute to the graying of the U.S. society in general and in urban areas such as New York City (NYC) specifically. New York City is home to the largest population of foreign-born persons living in the U.S. (4) Currently, 35% of immigrants residing in NYC are from the Caribbean. Census data also indicate that 40% of seniors in New York State (NYS) reside in NYC. Many Black elders tend to live in large urban areas including NYC. Even though these data have existed for a long time, there are few inter- and intra-cultural studies examining cultural and/or ethnic differences among Black elders. (5) This is due, in part, to the fact that there is a persistent myth that Blacks in the U.S., particularly in NYC, are a homogeneous group, void of differences in traditions and customs. (6) As such, many healthcare institutions and practitioners providing services to Black older adults in urban areas such as NYC use a generic approach to gathering nutrition data prior to and during nutrition education intervention, which bypasses important cultural nuances. Indeed, there are cultural and ethnic differences (including food habits, (7) health status (8) and cultural health beliefs (9) among subgroups of Black older adults in the U.S. that can affect their health status.
An insight into the previously stated differences relative to health status is essential to the development of culturally appropriate nutrition interventions aimed at promoting health and preventing disease among these important and growing segments of the U.S. population. The problem of imbalanced nutrition is especially salient to many NYC Black older adults because of their relatively poor health, economic disadvantage and limited access to good quality supermarkets. (10) Also salient is the fact that the consumption patterns of African Americans (AAs) are different from those consumed by Caribbean-born (CA) elders-who might be maintaining lifelong ethnic foods habits to preserve cultural identity. Today, many CA elders have access to an abundance of ethnic foods in NYC that facilitate the perpetuation of these habits, some of which are good while others might need to be modified. Very little has been done within the context of public health research even though there have been speculations that some foods, indigenous to the Caribbean, are linked to the very high rate of specific health conditions including certain cancers. For example, certain foods grown only on the Island of Jamaica, are believed to be linked to the very high rate--04/100,000--f prostate cancer among Jamaican men who have the highest rate of prostate cancer in the world. (11)
Given the multiple factors already acknowledged, any attempt to improve health conditions through the influence of nutritional intervention aimed at older Black New Yorkers must consider the peculiarities associated with AA older adults and their immigrant peers. As such, this gerontological cross-cultural nutrition pilot study (funded by an intramural grant from Long Island University, Brooklyn, NY) is an initial step in gathering data from AA and CA elders to: 1) explore their normal food habits; 2) determine their awareness about nutrition; 3) examine the influence of their personal health conditions on their food habits; 4) investigate whether participants have been the recipients of separate and specific practitioner-initiated personalized nutrition intervention; and, 5) determine if there are differences.
A qualitative descriptive research method (involving focus groups) was used because it is appropriate for exploring participants' perceptions and behaviors. Focus groups are cost-effective/time-efficient group-interviews that stimulate conversations among the participants thereby generating useful information. This process of encouraging participants to engage in discussions about the topics facilitates self-disclosure revealing their behavior, awareness and experience. (12,13) This technique has been used in nutrition studies, (14,15) and works well with older populations.
Instrument or Guide
A moderator guide, developed from a review of the literature, was used thematically to guide and facilitate the unstructured group discussion. The themes included normal food habits; awareness about nutrition; the influence of personal health conditions on food habits; and, separate and specific practitioner-initiated personalized nutrition intervention. The guide was pre-tested with middle to older aged Black professionals of AA and CA ancestry with geriatric and health care working experiences. Following pre-testing, the guide was revised to improve the clarity and flow of the questions and to reduce the focus group duration from two hours to one hour per session to minimize potential elder fatigue.
The participants (N=50) were NYC community-dwelling elders consisting of 36 AA and 14 CA older adults average age 73 years, 80% of whom were women, 36% reported less than a high school education, more than one-half reported living alone and 68% had an annual personal income in excess of $10,000.
Four focus group sessions were conducted among a convenience sample …
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Publication information: Article title: The Food Habits of Black Older Adults in New York City: Are There Differences between African Americans and Caribbean-Born Immigrants?. Contributors: Lyons, Beverly P. - Author, Speakes-Lewis, Amandia - Author, Upadhyay, Ruchi - Author. Journal title: Forum on Public Policy: A Journal of the Oxford Round Table. Publication date: Summer 2007. Page number: Not available. © 2008 Forum on Public Policy. COPYRIGHT 2007 Gale Group.
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