Health Promotion Programs and Healthy Lifestyle: First Generation African Black Males’ Perspectives

Black males (which, when the term is used in surveillance data collection in the United States (US), refers to both native born African Americans males and foreign born black males), experience disproportionately high chronic diseases such as heart disease, type II diabetes, hypertension, etc., in the United States. While the life expectancy rate gap between black males and other ethnic groups is narrowing, it must be said that + the life expectancy rate for black males is approximately six years less than other ethnic groups [1]. The Centers of Disease Control and Prevention (CDC) [2] reported that 40% of black males are more likely to die prematurely from heart disease as compared to 21% among white males. The leading causes of death among black males in the US include preventable diseases such as: cardiovascular disease, cancer (malignant neoplasms), cerebrovascular diseases, cirrhosis, chronic obstructive pulmonary disease, and diabetes mellitus [2]. Even though this study seeks to tease out first generation African black males’ behaviors and perspectives about healthy lifestyles, there are no separate public health surveillance data sets on first generation black African males’ health status. This is because the current methodologies for surveillance data collection consider first generation Africans and native born African Americans as a monolithic whole. There is overwhelming evidence indicating high prevalence of hypertension and elevated blood pressure [3], diabetes [4,5], obesity [6,7], and Cardiovascular diseases [8] in most African countries. Based on of the aforementioned studies in Africa, it is not far from the truth to infer that first generation African black males in the US are susceptible to getting those chronic diseases as well.

The modifiable risk factors that contribute to most of those diseases are physical inactivity, poor dietary habits and misperceptions of preventable diseases [9,10]. However, healthy lifestyle such as physical activity, good eating habits, and stress management can help prevent or reduce incidence of some of the chronic diseases. For instance, Physical Activity Guidelines Advisory Committee [11] in the US recommended that “for substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.” Regular physical activity can help control: blood pressure, blood sugar level, lower bad cholesterol and increase good cholesterol, prevent type II diabetes, prevent heart diseases, and control weight. Fast walking for 15 minutes per day or slow walking for 30 minutes per day can increase physical activity behavior [12] as well as, improve ones’ overall health [13]. Studies shown physical activity can improve energy expenditure [12,14], decrease the rate of type II diabetes [15], prevent heart attacks [16-18], and reduce blood pressure [19].

A healthy diet that consists of vegetables, fruits, whole grains, fat-free or low-fat milk products, seafood, poultry, lean meats, eggs, beans, peas, seeds, and nuts has been shown to promote good health. Increased consumption of fruits and vegetables can help lower the risk for heart disease and certain cancers [20,21]. The US government recommends that for each day, an adult should eat various food groups: half of daily food intake should be whole grains, and the other half should be fruits and vegetables. The recommended daily amounts of protein for adults should be between 5 and 6 ounces and dairy product food should be 3 cups for each day [22].

Regular health screening and preventive care such as physical examination, laboratory work, x-rays, immunizations, etc., can also help early detection or prevention of an onset of certain chronic diseases. The earlier a disease is detected, the more likely it is that it can be successfully managed or treated. A study showed that preventive care such as regular screening for colorectal cancer can reduce the number of people who die from this disease in the US [23]. Ries et al., [24] reported that when colorectal cancer is detected early and treated, the 5-year relative survival rate is 90%. Again, early detection and treatment of diabetic eye disease can reduce the development of severe vision loss by 50% to 60% [25].

Over the years, efforts have been made by public health professionals to understand and help prevent some of these health problems. Their application of one-size-fits-all health promotion programs has not helped reach black males [26]. For example, studies have shown a higher physical inactivity rate among black males [27,28]. Black males have not given sufficient attention to some of the health promotion programs or preventive care programs [26-29]. However, it is unfortunate little is known about first generation African black males’ physical activity, nutritional and preventive care behaviors. Therefore, the main purpose of this study was to determine the first generation black African males’ perceptions, beliefs and attitudes about healthy lifestyle (physical activity and healthy eating behavior, and health screening behavior) and culturally appropriate way to promote healthy lifestyle among them. The secondary purpose of the study was to assess whether or not first generation African black males in the US meet the recommended guidelines for physical activity and healthy eating behavior.

Design

Sampling

Recruitment process

Data collection and analyses

Body Mass Index (BMI)

Demographic

Participants’ physical activity behavior

Reasons for physical inactivity

Participants healthy eating behavior

Health screening behavior

The purpose of the study was to determine the first generation African black males’ perceptions, beliefs, and attitudes about healthy lifestyle, health screening or preventive care, and culturally appropriate ways to promote health promotion programs among them. The study also assessed if first generation African black males in the US meet the recommended guidelines for physical activity and healthy eating. The BMI results of the study did not only confirm obesity and overweight problems among first generation black African males [34,35] but also they revealed disturbing potential health problems for three reasons: First, most of the participants were physically inactive and with 18% of the participants being obese and over 54% being overweight, they are at risk of experiencing hypokinetic diseases. Second, since some of the participants did not want to access health screening, they might not know their health status whether or not they have any hypokinetic diseases for which they may need either early treatment or preventive care before the disease progresses to an advance stage. Finally, the poor eating behaviors of the participants may compound their health problems.

The study showed that most of the first generation black African males lead sedentary lifestyle and this lends credence to conclusions drawn by Jones et al., and Marshall et al., [27,28] that black males are physically inactive. The study also revealed that the overwhelming majority of the participant did not meet the physical activity committee [11] recommended guidelines for adults engaging in physical activity. The findings are consistent with Sahrif et al., [36] study that there is a high degree of acceptance of physical activity among first generation black African males but they sometimes mistakenly express physical activity only in terms of sporting activities. It could be one of the reasons why most of the participants indicated that they do not have enough time to participate in physical activities. Obviously, all the sporting activities demand some amount of time. So equating physical activities to sports could definitely discourage people from engaging in physical activity. It is therefore imperative to educate first generation black African males, first about time management and second about the fact that physical activity is not always the same as sporting activities and that a 30-minute brisk walking per day can improve upon their health status.

The study also revealed a subtle contradictory belief system among first generation African black males about their physical activity behaviors. In other words, the participants believe that they are physically healthy because of their past experience and their culture of being physically active in Africa, but when they were asked to critically reflect on their current physical activity behavior in the US, they realized that there is a gap between their past experience and their current behavior. It is not because they are lying or being deceptive about their physical activity behavior but they are simply oblivious to the fact that their current environment and lifestyle are gradually contradicting their ingrained belief system that Africans are physical active. Therefore, health professionals who are dealing with first generation African black males should not take it on the face value when they claim that they are physical active. Health professionals should probe very well into what they mean “by being physically active.”

The study also confirmed that environmental factors such as weather (extreme cold and hot weather), accessibility to physical activity facilities, safety concerns, convenience etc., contribute to sedentary lifestyle. Even though it is true that those environmental factors are problem for everybody in the US, it is more serious problem for first generation African black males. This is because they grew up in an environment where most of those factors were less of a problem to them. They could turn any open space as a playground and did not have to worry so much about cold weather or extremely hot weather, or safety concerns. The problem among first generation African black males in the US is worsened by convenience and easy accessibility to cars, and the fact that they are not oriented toward the culture of regime exercise and gym membership. While in their respective countries in Africa, the participants were very active, it is so unfortunately that most of them did not associate their active lifestyles to healthy living. Some of them saw those active lifestyles as necessity i.e., the only means to move from one place to another or survived, while others saw it as a lifestyle full of struggles. So when they moved to the US, they are trapped in the convenient lifestyle and they see it as a dream comes true. For some of them, any suggestion to do exercise, for example, go for a walk, may seem like asking them to go back to their former struggling lifestyle. It is therefore important to refocus first generation African black males’ attention to the health benefits that come with engaging in physical activity.

The study found that first generation African black males did not meet the daily recommended guideline for eating the major food groups (whole grains, vegetables, fruits, proteins, and dairy). The participants’ responses showed that they have tendency to eat similar type of food almost every day. For example, some of the participants indicated fufu or rice form greater percentage of their daily food and that they hardly eat different food groups as recommended. This eating behavior goes back to the African culture where staple food for dinner, for instance, is always a similar kind of food for most people. Having said that, it must be added that, as the study revealed, most first generation African black males eat various food groups like grains, fruits, vegetables, and proteins but they do not make conscious decision to eat balanced food daily. For instance, they eat fruits as to when they feel like eating and for the most part the emphasis is on taste or/and on getting full and not worrying so much about obtaining right amount of various nutritional values. Effort should be made to educate first generation African black males to eat balanced diet instead of eating similar food almost every day. The study showed that the first generation African black males relish the idea that they used to eat healthy food in Africa and that they continue to eat traditional African food in the US. Those findings of the current study support Oniang’o, Mutuku, and Malaba, [37] assertion that “Food habits are slow and difficult to change because food has important psychological associations with the family and the community. Familiar food is satisfying and reassuring, particularly the traditional foods of childhood, which evoke a deep-seated emotional response.”

Since food evokes emotion, has psychological association, and is culturally driven, it is important for health professionals to know and understand eating behavior and the types of food first generation African black males eat before they offer any suggestions to change their eating behaviors. As one participant bluntly puts “I eat what my mother gave to me when I was growing up and I know it is good so I don’t need to know what it contains and I don’t need to change anything.” Therefore to influence such an individual’s eating behavior, efforts should be made to understand the person’s culture. 

Another eating behavior about the participants in the study worth discussing is the amount of portion size the participants eat. The concern with first generation African black males eating behavior is that most of them do not follow any defined mealtime and/or they skip meals. Consequently, they tend to eat large portion size to make up for whatever they lost and that eaten behavior had been found to be unhealthy [38]. Some of the participants’ behaviors of skipping meals and not following regular meal time are commonplace in most African countries because of poverty some cannot afford three square meals and having regular meal time are not part of some African culture. Finally, another eating behavior that the study reveals about African black males is that greater percentage of the meal is made up of carbohydrate. They also use trans-fat or saturated fat in preparing most of their food. Study has found that eating food prepared with trans-fat is not good for one’s health [39] but unfortunately the current study shows that first generation African black males eat a lot of fried food prepared with saturated fat and at times trans-fat.

The result of the study indicates that most of the participants do not access routine health screenings. This finding is consistent with similar conclusions drawn by Chokunonga et al., [40] that most Africans do not access health screening and it is not a common practice for most people in Africa to access health care checkups. The current study results also support Frost’s study [41], in most cases an African will go to see a doctor or go to a hospital only when he is seriously ill. At best an African will buy an over-the-counter medicine to treat himself or will use traditional medicine. This study reveals that some of the participants still rely on traditional medicines for their health care regimen. The concept of somebody going for physical examination is not a common practice in most African countries. This behavior continues for most black African males who have migrated to the US, as the study reveals. Some of the African males in the study are suspicious about American health care system because most of them believe the health care system is not fair to them. One participant said, “there is an unspoken belief among Africans in the US that so long as you are black and have accent you will not receive proper attention from healthcare professionals as would a white person receive.” This kind of mistrust is difficult to explain but believe it or not it discourages some first generation African black males from accessing health screening or health care in general. Many of the participants do not want to know their health status, because of the fear of the unknown.

Limitations: The first limitation of the study is the method of recruitment. The use of snowball methods may skew the responses to a particular group of people. Since the researcher relied on personal contacts and referrals, the participants may not be representative enough and this may account for the reason why most of the participants were Ghanaians. Future studies should strive to include more other nationalities to make the study representative. Second, time factor was another limitation on this study. Since the interview time lasted for one hour, some of the participants decided not to take part in the study because they indicated that they did not have time to be interviewed even though they were willing to participate in the study.

Third, the study relied only on personal accounts, honesty, and integrity of the participants since there were no means to verify the truthfulness or inaccuracies of the information provided. Nevertheless, the accurateness of the information provided by the participants was to a greater degree validated by the uniformity of the answers provided by the respondents. Fourth, the study was predicated on the assumption that the first generation African black males have the same culture but in reality there are cultural differences across the African continent and within each African country. For instance, the type of food produced in West Africa is different from the food produced in East Africa [37]. However, the study tried to piece together the commonalities among African culture. Future studies can be done separately based on where in Africa participants are from originally: West Africa, East Africa, North Africa or Southern Africa. 

The use of BMI has limitations. First, BMI can overestimate or underestimate the “fatness” of very tall or very short people, as well as underestimate “fatness” in those with a small amount of muscle mass (or lean mass). Second, there is a potential problem with the participants reporting their weight and height. Height can decrease in older age, due to spinal changes. Additionally, often overweight people do not weigh themselves frequently (unless they are trying to lose weight).

Finally, the dearth of scientific studies about first generation African black males’ healthy lifestyle in the US made it difficult to support or refute the findings of the current study. Since this study is exploratory in nature, it brings to the forefront an aspect of minority health which has long been neglected. More studies need to be done on diverse and larger African population to verify the validity of the results of this study.

Implications for practice: Notwithstanding the above limitations, this research study contributes to the understanding of first generation African black males’ physical activity, nutritional and health screening behaviors in the US. The first implication is most of the participants are either being obese or overweight. Yet, most of them lead sedentary lifestyles, have the tendency to engage in unhealthy eating behaviors, and do not want to access health screenings. Therefore, health professionals should continue their efforts to educate first generation African black males. The study reveals that the majority 90% (n=45) of the participants recommended that black males should be reached with more educational programs. The participants indicated that health educational programs targeting African black males should focus on: 

• Importance of physical activity, vis-à-vis physical inactivity
• Emphasis on physical activity as a preventive mechanism, not only as a means to cure diseases
• Time management
• Promoting group physical activity through sporting activities like soccer, running, marathon
• Nutritional components of Blacks’ traditional food
• Reduction of Carbohydrate (Starchy) food
• The need to eat balanced diet
• The need to reduce portion size
• The need to reduce trans-fat and saturated fat used in preparing food
• Importance of health screening and preventive care

Second implication for practice is that health professional working with African black males should build trust among African black males. To build trust, the participants recommended that health professional should be culturally competent, be a role model, and knowledgeable about their profession. For instance, majority of the participants (over 60%) indicated they can trust somebody who is culturally competent to implement educational programs in black community. 

The third implication is that the participants’ physical inactivity behaviors, poor eating habits and avoidant health screening behaviors were shaped by their respective cultural backgrounds. Having a better understanding of those cultural influences can help the health professional to develop targeted educational programs.

Policy implications: The findings of the study revealed that policy makers can provide incentives such as free gym membership so as to promote physical activity among first generation black males. Concerns for neighborhood safety means that more efforts should be made by community members and policy maker to promote safety in their neighborhood. The traditional African food should be required to have food labels on the imported tropical food. Incentives and resources should be made available to promote health screening at relatively low cost so that those who do not have health insurance can continue to access early health screening.

Summary: Chronic diseases are prevalent among black males but physical activity, healthy eating behavior and regular health screening can help control some of those chronic diseases. However, little is known about first generation African black males’ physical activity, eating behaviors, and health screening behaviors. Therefore, after the protocol of the study was approved by Northern Kentucky University Institutional Review Board, face to face interviews were conducted among 50 first generation black males to elicit information about first generation black males’ physical activity, eating and health screening behaviors. The study reveals that most of the participants reported sedentary behavior. The majority of participants indicated they prepared African food in homes but they have unhealthy eating behaviors. They indicated that preventative care is expensive and the fear of knowing their health status deters them from accessing preventive care. They indicated health professionals, who have a better understanding of their culture; their food; and also lead healthy lifestyle themselves, are the professionals they trust for health promotion programing. 

In conclusion, traditionally most first generation African black males had been exposed to and experience daily physical activity in their respective African countries. Due to the convenient lifestyle and environmental factors in the US, most of them are now leading sedentary lifestyles. On healthy eating, the first generation African black males’ eating behaviors in the US are still rooted in their traditional and culture upbringing. With respect to accessing routine health screening behavior, African black males are struggling to come to terms with this behavior, because it is a new culture to them. It is important for health care professionals to better understand black’s native culture and their food culture. This will aide in the development of trust for African black males for health promotion programs. Healthy lifestyle promotion programs which focus on first generation African black males’ culture stand a better chance to have a greater impact with this targeted population as opposed to a “one-size-fits-all” approach.

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