Sarah Khan Leads Project to Evaluate Nutrition in South Milwaukee

As with the general US population, obesity is a major health issue for Latinos. Nationwide, nearly 30 percent of Latino adults are obese and 64.5 percent are overweight.

There is little research, however, on Latinos' eating habits and nutritional options. That's why Sarah Khan, MS, MPH, PhD, an assistant scientist in the Department of Family Medicine's (DFM) integrative medicine program, is leading a public health research project to document the nutritional environment in one south Milwaukee neighborhood.

She is partnering with CORE/El Centro (CORE), and Aurora Walker's Point Community Clinic (AWPCC), two nonprofit clinics that provide traditional and complementary health care services to this underserved, predominantly Latino community.

Research results will help CORE and AWPCC design a future weight management pilot intervention program for the community.

Understanding Individual and Community Factors

The high prevalence of obesity can only be partly explained by individual factors, such as what and where a person eats and shops. Environmental factors, such as having access to low-cost, healthy foods, also strongly influence individual choices and behaviors.

To better understand both factors, Dr. Khan's team collected two types of data:

1) Patient data. 225 patients completed surveys during routine health care visits at the CORE and AWPCC clinics. The surveys asked patients:

1. The types of food they eat (for example, the amount of fruit, vegetables, fiber, and fat);
2. Where they usually eat (at home or at restaurants); and
3. Where they shop for food.

2) Nutritional environment data. The team used a separate survey to evaluate the availability and price of fresh and packaged food in stores in the 53204 zip code.

The team found that the majority of respondents shop at one of the three El Rey stores in the area. The top restaurants where community members choose to eat out are: McDonald's, China Buffet and Los Comales (a Mexican restaurant on Milwaukee's south side).

The research team is in the process of evaluating the food frequency questionnaires and summarizing the Nutrition Environment Surveys.

Engaging and Empowering the Community

Dr. Khan credits the project's two coordinators, Stephanie Calloway, MS, and Tatiana Maida, as "instrumental" in moving the project forward.

She also highlighted a unique aspect of this project: the participation of community health promoters (CHPs). The project's three CHPs, all Latina women, and the two project coordinators administered the patient surveys and helped with nutritional environment surveys. At the same time, they were able to talk to participants one on one, share information, and answer questions.

Through this work, and with Dr. Khan and the project coordinators' guidance, the CHPs learned more about the ins and outs of research, including the human subjects' approval process.

They also have become "ambassadors" of nutrition in their community, and as a result, are now branching out into other local research projects.

For example, the project coordinators and CHPs just held a community discussion on the immigration experience, how it influences eating habits, and how to make it easier to eat well in the community.

The two project coordinators also just convened a community focus group to learn more about the food environment challenges from community members.

In addition, CORE/AWPCC are in conversation with United Community Center about how to share the data already gathered to increase outreach. The group looks forward to finding funding for additional projects.

"What's been most powerful for me is the health promoters' transformation," said Calloway. "We've seen them recognize the environmental influence—that lean meat is more expensive than full-fat meat, or that there's not an option for baked or low-fat chips in their stores."

"We've talked about the socio-ecological model, but this is the first time I think they've actually experienced it and seen it in their neighborhood," she added.

As for Dr. Khan, this project has been about more than just research data—it's been about teaching, mentoring, and providing a place for community members to exercise their power. "My role is to create an environment of exchange and research that helps people determine on their own how they want to make their communities more healthy."

This project was supported by a Department of Family Medicine Small Grant and matching funds from Aurora Health Care®.