Relations Among Stress and Health Risks Among Mexican Immigrant Families

Kimberly Greder, PhD – Human Development and Family Studies, Iowa State University

Brianna Routh, PhD, MPH, RDN – Health and Human Development, Montana State University

Marian Kohut, PhD – Immunobiology/Kinesiology, Iowa State University

Elizabeth Shirtcliff, PhD - Human Development and Family Studies, Iowa State University

Margarita Teran-Garcia, MD, PhD, FTOS - University of Illinois

Overall Goal: Prevent or reduce obesity among Latino children

• Emphasize whole family approach and build on cultural traditions

• Modify and test curriculum developed at University of Illinois

• Integration of extension, research, and teaching

• California, Illinois, Iowa, Puerto Rico, and Texas

Healthier habits brought about by Abriendo Caminos intervention will …• reduce stress• reduce inflammatory factors and gene expression

of inflammation-related genes• reduce body fat, blood lipids and HbA1c

Hypothesis

Control and Intervention Groups: Adults and children 6-18 yearsControl Group: Printed materials Intervention Group: 6 workshops

• Information and activities to promote healthful eating, physical activity and family routines, and build on cultural tradition of shared family mealtimes

• Mas o menos strategy

Data Collection• Pre Intervention (1-2 weeks prior to intervention)

• Adult Survey and Body Measurements• Child Body Measurements• Hair Cortisol and Blood Lipid Panel, Inflammatory Markers at one site

• Post Intervention (1-2 weeks after intervention)• Adult Survey and Body Measurements• Child Body Measurements

• 6 month Follow Up • Adult Survey and Body Measurements• Child Body Measurements• Hair Cortisol and Blood Lipid Panel, Inflammatory Markers at one site

Year 1 Collaboration• Families• Hospital• Extension staff• Community partners• ISU students• HDFS and Kinesiology faculty

Nutrition behaviors

Physical activity

Mental health

Stress

Family routines

Family mealtimes

Acculturation

Adult Survey

Height

Weight

Waist circumference

Blood pressure

% body fat

Body Measurements

Cortisol

3 centimeters of hair (100 strands)(1 cm = ~1 month)

Cut, washed, weighed, ground before extracting cortisol

Assayed with ELISA immune assay kits

Hair Samples

Finger stick point of care: LipidsHbA1CA few droplets

Venipuncture: Inflammatory markers (monocytes)Adults - 2.5 T Children- 1.25 T

Blood Samples

Hair and Blood SamplesCohort 1 (pre and 6 mo. follow-up) Hair (n=30/61) Blood (n=35/61)

Males 8 12Females 22 23Adults (n=35; 29-69 years)

Intervention (n=19) 9 14Control (n=16) 12 8Total 21 22

Children (n=26; 7-14 years)

Intervention (n=15) 4 8Control (n=11) 5 5

Total 9 13

Hair Cortisol: Objective measure of stress response

• Cortisol: Increased risk for obesity, heart disease, type 2 diabetes, depression, anxiety, chronic pain etc.

• Cortisol is commonly not correlated with perceived stress (Shirtcliff, et al, 2014)

• Stressors such as lack of social support (Mulvaney-Day, Alegría, & Sribney, 2007), racism, and discrimination may contribute to health disparities (i.e., obesity) (Viruell-Fuentes, Miranda, & Abdulrahim, 2012)

Change in cortisol and social support over timeCortisol• There was a trend rise in cortisol among

the control group • There was a slight rise in cortisol among

the intervention group Social support• Social support significantly decreased

for the control group• Social support remained the same for

the intervention groupControl group who has low social support had the highest rise of hair cortisol. 0

5

10

15

20

25

30

Wave 1 Wave 2Ha

ir Co

rtis

ol L

evel

(pg/

mg)

Intervention Low Social SupportIntervention High Social SupportControl Low Social SupportControl High Social Support

Blood: Objective measures of current health status and future health risk

• Lipids (e.g., cholesterol levels): risk for heart disease

• HbA1C: blood glucose regulation and diabetes

OPTIMAL RANGES for

ADULTS

OPTIMAL RANGES for

YOUTH

OPTIMAL RANGES for

ADULTS

OPTIMAL RANGES for

YOUTHGlucose 70-100 80-180 HbA1C Below 5.7 Below 8

Cholesterol Below 100 Below 170 Triglycerides Below 150 Below 75/90HDL Above 60 Above 45 LDL Below 130 Below 110

Cholesterol/ HDL Ratio Between 3.5-1

Blood Results: LipidsIntervention maintained or improved:

• Larger decreases in cholesterol• Cholesterol/HDL ratios• LDL levels• Larger increases in HDL levels

35

40

45

Pre Follow Up

HDL for focal child

Intervention Control

90

100

110

120

Pre Follow Up

LDL for mothers

Intervention Control

3

3.5

4

4.5

5

Pre Follow Up

Cholesterol ratio adults and children

optimal Intervention Control

Blood Results: HbA1c

5.25.35.45.55.65.75.85.9

Pre Follow Up

HbA1C Adults and Children

Pre diabetes Intervention Control

• Inflammatory markers: Immune system response to injury, irritation, or invention

• Associated with high fat diet, limited physical activity, and excess calorie intake

• Chronic inflammation: Promote insulin resistance, reduced immune responses

Blood: Objective measures of current health status and future health risk

Blood Results: Inflammation and HbA1cInflammatory markers (monocytes) from pre-diabetics …

• produced 2-4 times more GMCSF, IFNα, IL-1β, IL-10, TNFα, CCL4 and CCL5 in response to IAV (Flu) than normal healthy subjects.

• demonstrated greater inflammasome activation, potentially contributing to further tissue damage and increased risk for secondary infection.

Decrease in HbA1c between pre and 6 month follow up associated with greater decrease of inflammatory markers.

What we learned: biomarker collection• Mexican immigrant families are interested in learning more about their health

• Mexican immigrant families are willing to have their body measurements and blood pressure taken, provide hair and blood samples, complete surveys

• Interdisciplinary data collection requires: • continual communication• time• strong coordination and organization• many volunteers• openness to learning

ImplicationsResearch:• Pilot can inform data collection from larger sample, additional time points• Explore other obesity and overall health related health outcomes

Practice:• Whole family approach, and interaction with other families and community

professionals, may create support that helps to reduce stress and promote behavior change

• Families enjoy learning together, and learning with other families• Extension staff enjoy working collaboratively across disciplines• Extension staff and community partners are critical to overall project success

This work was supported by:

Agriculture and Food Research Initiative Competitive Grant no. 2015-68001-23248 from the USDA National Institute of Food and Agriculture (NIFA) to Cooperative Extension and the Department of Human Development and Family Studies at the University of Illinois,

Urbana-Champaign

College of Human Sciences Collaborative Seed Grant, Iowa State University

Vice President Extension and Outreach Strategic Initiative, Iowa State University

Special thank you to

ISU graduate students: Shannin Moody, Greta Stuhlsatz, Wen Wang, Andrea Tountas, Neil Barnett

ISU undergraduate students: Jose Amaya, Nayely Hurtado, Jess Alley, Joshua Burdick, Olivia Robertson

ISU Extension and Outreach Staff: Rosa Gonzales, Mary Krisco, Jon Wolseth, Marisue Hartung, Juan Ramirez, Lisa Mickelson

Local hospital staff: Lupita Chavez, Justin Chapman, numerous volunteer nurses

Community partners: Angie Lopez, David Cordero, Griselda Rodriguez, Citlalic Hurtado