1. Prevention of type two diabetes Among East African Immigrants By Zahra Abdalla MPH 515 -SPRING 2015 Professor. Hartigan

2. Prevalence of Diabetes in U.S According to Healthy people 2020, about 23.6 million people have diabetes in the U.S, and it is the seventh leading cause of death. Once diagnosed diabetes affects longevity, increase the chance of heart disease by two times and can cause kidney failure and blindness. Healthy People, (2020). Without lifestyle change including weight loss and increase of physical activity about 15 to 30 percent of individuals with pre-diabetes will develop type two diabetes within five years (CDC 2014).

3. Prevention of type two diabetes Typically people who are diagnosed with two diabetes are either obese or overweight. Since type two diabetes is tied to obesity, the best way to prevent is through physical activity, and healthy diet (Tate (2014).

4. Who are East African Immigrants? East African (Somali) refugees are the fast growing refugee entering the United States, between 2003 and 2007 more than 40,000 enter the United States fleeing their homeland country Jefferys (2006). About 77,000 Somalis (East Africa) are living in State of Minnesota alone. People Country Flag

5. Why east African are at risk of developing type two diabetes? Back home in Somalia walking and exercising was part of everyday life for East African (Somalis). Many people did not have access to transportation plus hot weather enable people to move a lot. People did not have availability of phone to communicate with friends and family. People walk to visiting friends, family and to buying grocery. East African (Somalis) develop diabetes within five years in the United States.

6. Why east African are at risk of developing type two diabetes? Cont. Most of the East African community experience weight gain and were told by their doctor that they are on the borderline for chronic disease East African community report their physical activity is lessened since moving to U.S because they have adapted the western lifestyle (Guer, Diiriye, Corrigan and Guerin 2003). Many East African have reported they consume high-calorie foods, and sedentary lifestyle have made gained weight. Reason not physical activity is due the cold weather or fear falling in the snow and fear of getting hurt because their neighborhood is not safe place to walk.

7. Application of the PRECEDE-PROCEED Model Phase 1: In this phase it is important to have the community involvement. The focus on this step is to go out in community setting: adult day care, child care, religious places, and do community survey and questionnaires to determine if pre-diabetes is health concern for the East African community. Phase 2: At this stage it is crucial to identify behavior and environmental risk factors associated with pre-diabetic Ex. Environmental risk: Many East African community complained of not getting enough exercise, due to fear of falling in the snow, cold weather and/or living unsafe neighborhood.

8. Application of the PRECEDE-PROCEED Model Phase 3: Educational and ecological assessment: It is essential to consider this community’s attitudes about being healthy, cultural norms, and knowledge about nutrition. Ex. When addressing effect of diabetes on this community, first they need to be educating about nutrition, physical activity in relation prevention of type two diabetes. Phase 4: administrative and policy assessment and intervention alignment. Ex. Considering obstacles that prevent the intervention to be successful, by change of policies in public and private sectors that will influence program’s fund.

9. Program Implementation Being on the borderline for type diabetes pose a threat to the East African community (immigrant) and type two diabetes prevention with physical activity, and healthy eating will bring changes to this community.

10. Program Implementation The health promotion program will consist of nutrition class Demonstration of physical activity people can do at home Weekly weigh- ins, weekly attendance (receives gift cards if no absence). A 16-weeks weight management program will be implemented for the individuals who are the at borderline for type two diabetes Back home (Somalia) people did not count calories and not to measure foods intake. So it is important that this community learns how high calorie- intake is relevant to weight gain, and consuming foods that contain saturated fat is bad for your health.

11. Program Implementation NEXT STEP The next step of the health promotion program will be collaborating with the community leaders, developing video that is culturally and religiously appropriate to enhance the community’s knowledge about healthy eating and physical activity. The video will address eating healthy: portion size, healthy versus unhealthy foods. Demonstration of exercises people can do at home and in the community. And culturally sensitive health education about diabetes.

12. CONCLUSION As health educator who is aware of the culture and the background of the this particular community; it is critical addressing barriers, cultural belief, culturally oriented diabetes care education, and research programs to meet their needs and improve quality of life.

13. Reference HealthyPoeple2020. (2014). Diabetes. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/diabetes http://www.healthypeople.gov/2020/topics-objectives/topic/diabetes Center for Disease Control and Prevention (2014). Pre-diabetes. Retrieved from http://www.cdc.gov/diabetes/basics/prediabetes.htmlhttp://www.cdc.gov/diabetes/basics/prediabetes.html Guerin PB, Diiriye RO, Corrigan C, Guerin B (2003). Physical activity programs for refugee Somali women: working out in a new country. Women Health. Jefferys K. (2006). Annual flow report: refugees and asylees: Washington: Department of Homeland Security, Office of Immigration Statistics (US). Tate, B. (2014). Preventing diabetes. McClatchy - Tribune Business News