RESPIRA+: A culturally tailored yoga and mindfulness intervention to enhance physical activity and mental health among Latina youth
U.S. Latina adolescents between 15-18 years of age report high levels of psychological distress (i.e., high levels of anxiety, stress, and depression) and are less likely to seek professional psychiatric treatment than non-Latinx Whites (Bennett & Joe, 2015; Perreira et al., 2019; Stafford et al., 2019; Stafford & Draucker, 2020). Barriers to mental health treatment include limited treatment options, negative stigma, and costs due to lack of health insurance (Alegría, 2015; Lehman Held et al., 2020). Youth of color who do seek treatment are more likely to drop out of treatment earlier compared to non-Latinx Whites (Alegría, 2015; Ford-Paz et al., 2015). Researchers speculate dropout may be due to the lack of culturally sensitive approaches to treatment (Ford-Paz et al., 2015; Silva & Van Orden, 2018). Prolonged psychological distress without adequate treatment may have severe consequences and adverse health outcomes later in life, such as early high school dropout, social and cognitive impairments, increased risk of development of cardiovascular and metabolic diseases, substance abuse, and suicide (Vancampfort et al., 2018). There is a critical need to investigate and implement culturally tailored programs to help increase mental health among Latina youth (Silva & Van Orden, 2018). Physical activity (PA), defined as any bodily movement resulting in energy expenditure (> 1.5 METs), is associated with lower anxiety, stress, depressive symptoms, and improved quality of life (Liguori & American College of Sports Medicine, 2020, p.6). Although engagement in PA has positive mental health outcomes, 15-23% of Latinx adolescents do not engage in vigorous PA compared to 11% of non-Latinx Whites (Kim et al., 2022), with Latina youth experiencing lower levels of PA (Benes et al., 2017). Data from the Youth Risk Behavioral Surveillance System found that 20% of Latina youth did not meet PA guidelines compared to 15% of White female youth (Pontes et al., 2021). Low levels of PA may be partly due to socioenvironmental barriers including but not limited to family economic stress, discrimination, gender roles, and family-immigration stress (Benes et al., 2017; D’Alonzo, 2012; Gallo et al., 2019; Kim et al., 2022; Lopez, 2019; Lorenzo-Blanco & Unger, 2015). For example, Latina adolescents are less likely to participate in after-school extracurricular activities to help family members at home due to family economic stress and facing discrimination at school (Ford-Paz et al., 2015; McWhirter et al., 2018). Moreover, first-generation Latina adolescents living in traditional Latinx households may face acculturation barriers. For example, perceptions of self-care in traditional Latinx households may be perceived as selfish as it will take time away from family and household activities (D’Alonzo et al., 2012). Yoga is a malleable form of PA (i.e., intensity, type, time) and often consists of active bodily movements, breathing techniques, and cognitive activities such as mindfulness and meditation (Gard et al., 2014). Yoga and mindfulness reduce psychological distress and improve psychological resilience in youth (e.g., self-efficacy, coping strategies and mindfulness; (Cramer et al., 2013; James-Palmer et al., 2020)). Yoga’s top-down and bottoms-up mechanisms of self-regulation explain the improvement in physical and psychological wellbeing through the integration of high-level brain network areas improving attentional control, intention, and memory, and lower-brain network areas, through somatic sensory awareness (Gard et al., 2014). Yoga and mindfulness practicies improve musculoskeletal and cardiorespiratory functioning and reduce psychological distress (Gard et al., 2014). Limited PA interventions among youth and adolescents consider equity, and there is need to increase multidimensional programming (Love et al., 2019; Love et al., 2017), and culturally sensitive programming for Latina youth (Ford-Paz et al., 2015; Ortiz et al., 2019; Silva & Van Orden, 2018). Culturally tailoring includes surface-level strategies such as language considerations for youth and parents (e.g., flyers, consent forms, bilingual research staff; Clarke et al., 2021) and deep-level strategies such as embedding relevant cultural values (e.g., family, common topics of distress such as intergenerational cultural dissonance; (Wang-Schweig et al., 2014). Latinxs place high cultural values on family, religiosity/spirituality, and marianismo (Bopp, 2017, p. 63; Jocson et al., 2020; Sanchez et al., 2019). Additionally, recent studies have found mindfulness programs to increase PA (Yang & Conroy, 2020). However, previous yoga and mindfulness programs among Latinx did not target PA as a primary outcome and did not tailor programming to address unique cultural and gender-role-related barriers to PA/yoga (Clarke et al., 2021; Ortiz et al., 2019). Empowering Latina youth with coping strategies and ways to address barriers to yoga, mindfulness, and PA while providing a safe space to practice could increase PA. Moreover, to our knowledge, yoga and mindfulness programs are not tailored to include community-building strategies or an education component to increase PA. Embedding community strategies such as empowerment and critical consciousness may improve psychological resilience via discussions on health equity. Furthermore, as most yoga and mindfulness programs focus on psychological health outcomes rather than PA, programs do not embed discussions on facilitators and barriers to engagement in PA/Yoga. The Social Cognitive Theory (SCT) is a critical theory used in the design of PA interventions to help enhance self-efficacy (i.e., confidence and perceived ability; Young et al., 2014). Bandura (1991; 1997) explained there is an opposite reciprocal triadic association between cognitive (goal-setting, affect, beliefs), and social environmental factors (social norms, social support, barriers, facilitators) that influence PA behavior (i.e., yoga and mindfulness). Therefore, it is necessary to assess the effects of culturally tailored yoga and mindfulness program for Latina youth to increase PA. This preexperimental study has three main aims: Aim 1: Examine the feasibility of an 8-week culturally tailored yoga and mindfulness program, RESPIRA+, and workbook for Latina adolescents. Hypothesis: We hypothesize that RESPIRA+ will be feasible for Latina youth. Aim 2: Examine changes in total PA and mental health among Latina youth receiving a culturally tailored yoga and mindfulness intervention. Hypothesis 2: We hypothesize that total PA levels will increase. Additionally, we hypothesize mental health will improve (i.e., psychological distress will decrease and psychological resilience will increase) at the midpoint and post-intervention assessments. Aim 3: Qualitatively explore the perceptions of Latina youth on physical activity, mental health, and a culturally tailored yoga and mindfulness program and workbook, using focus groups and semi-structured interview guides guided by the SCT at pre and post-intervention.
Yoga Mindfulness, Health Equity, Physical Activity, Latina Youth
University of Illinois - Urbana-Champaign
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University of Illinois at Urbana-Champaign