The only thing certain about life is death; and death comes in various forms. With the advances in medical science new diseases are discovered and old ones conquered. Among the numerous intractable modern diseases is heart disease, which creeps upon the unsuspecting victim. A great deal of research is being done on this “gift” of modern day stresses, and much of it focuses on specific segments of the population.
One such ongoing study has been undertaken by the Center for Family and Community Health (CFCH) (University of California Berkeley), in collaboration with the Asian and Pacific Islander American Health Forum (APIAHF). The study funded by the federal Center for Disease Control and Prevention aims to assess risk factors for heart disease among Indians in three California communities. Heart disease appears to affect Indians more than other groups based on information from other studies. Shobha Srinivasan designed the study and presently Susan L. Ivey, M.D., MHSA, Health Policy specialist, Center for family and community health, is the chief researcher working on it.
The study has three major goals: (i) To assess the community’s perception of health and cardiovascular disease; (ii) Social cultural and psychological factors of the disease; (iii) to assess the methods of reaching the community.
In order to correctly assess risk of heart disease various factors must be taken into consideration; these include cultural, social, genetic, and migration factors. A worrisome fact is that there is a different yardstick of health for Asians. Even with the same BMI (Body Mass Index) as other races, Indians are at a greater risk for heart disease.
The first phase of the heart disease project included focus groups. CFCH and Asian and Pacific Islander American Health Forum (APIAHF) conducted a total of eight focus groups (six in English and two in Punjabi) interviewing 52 men and women of South Asian heritage about diet, cooking styles, exercise, stress, and knowledge of heart disease. A total of 304 people were interviewed in which there were more women than men. Most people who participated were well educated and fairly well off. However, in the rural areas of the state people were less wealthy and less educated.
The study from CFCH was designed to look at heart disease risks and to account for different immigrant experiences. Questions asked to measure acculturation included how closely the respondents still identified with India and Indian cultural values, how frequent their visits to India were, and whether or not they had a support system in their adopted country. Other routine questions on diabetes, cholesterol, diet, and physical activity were also a part of the survey. The study tried to find out if use of ghee as a cooking medium has any association with heart disease. Another first was the use of a standard depression instrument in a survey on the Asian Indian population.
Walking and yoga were the most commonly mentioned exercises in the survey. Community meetings in Yuba City and Fremont were convened in July/August 2002 to disseminate the results of the study and to facilitate a discussion around the development of prevention interventions for South Asians who might be at risk for heart disease.
The study brought to light various stresses faced by the immigrant population in trying to make a life in a new country. Frustrations like the inability to use the same skills in the adopted country and the pressures of having to start over and get new credentials.
Across all groups, exercise levels were low but particularly so among the rural and lower income persons. Diets included a lot of fruits and vegetables but also included relatively high levels of fat. On the other hand, fast food was less likely to be a regular part of people’s diets than it is in the typical American diet. Few current smokers were identified. Low income and lower education were associated with poorer health. Rates of diabetes and high cholesterol were noted to be higher than average.
No study on heart disease can be complete without measuring the stress levels of the focus group. Some insights gained through other studies include the association of low job control with greater stress i.e. people holding jobs involving a greater adherence to schedules and less flexibility are more susceptible to heart disease as compared to people with greater control on their jobs. Also families that meet each other on a regular basis, due to religious reasons or otherwise experience comparatively less stress than those that don’t.
The men surveyed viewed their jobs as “stressful.” There were differences in stress perception between people from the urban and suburban areas. Overall, stress was related to depression, with greater stress associated with greater depression. Between English speaking and Punjabi speaking participants, it appeared that stress was lower for those speaking Punjabi, yet that has not been definitely concluded and could also be attributed to semantic differences between the two languages. Ivey hopes to confirm this with more work in other Indian languages like Hindi, Gujarati, and Telugu. Efforts should be made to keep stress within manageable levels or learn better coping skills. Researchers were better able to understand special stresses that immigrant families face, how they could modify meals when a family member has heart disease, and their attitudes about exercise.
Interpreting the present findings of the ongoing survey, Ivey found that diets and physical activity needs improvement. She stresses the need to make incremental healthy changes in lifestyle, rather than a radical overhaul. “It is hard for someone who has never exercised to start exercising five days a week, so one should start a regimen of two to three days a week and gradually take on more. Similarly, through the findings we understood that while ghee has a certain scared value attached to it, there might be some relationship of saturated fat to heart disease risk. Therefore the prudent thing would be to use it in moderation.”
“The goal is to get the word out in the communities and use them to foster lifestyle changes.” Says Ivey. “It is important that early signs be noted and prevention started for the younger generation.”
How true! Though we shall all pass away one day, it sure feels good to live healthy and well as long as we live.