Border Health

The Title V legislation requires the state, as part of its Application, to carry out a statewide Needs Assessment every five years that identifies the need for preventive and primary care services for pregnant women, mothers and infants up to age one; children and adolescents; and children with special health care needs up to age 26. The University of Arizona College of Public Health is collaborating with Arizona Department of Health Services (ADHS) to contribute the qualitative components of the Title V needs assessment, including focus groups, community forums and dissemination of results to community partners. Our approach involves (i) participation at state-wide meetings; (ii) conduct of focus groups with selected communities not traditionally heard including African American, Hispanic, Refugees, LGBTQ, Farm Workers, Families with Children with Special Health Care Needs and Youth; (iii) facilitation of community forums with community members and providers to get feedback on preliminary findings; and (iv) dissemination of results to community partners. Results will feed into priority setting for Title V programming for the next five years 2020 – 2025.  This project is funded by the Arizona Department of Health Services (ADHS).

This research supplement expanded analyses of arsenic and UVR exposures to additional analyses accounting for location and time using spatial epidemiology methods including Geographic Information Systems (GIS). To accomplish this, Marvin Langston was trained in GIS technologies and spatial epidemiologic methods under the mentorship of Dr. Dennis and a co-mentor Dr. Brown (another MEZCOPH faculty with expertise in GIS, not on the parent grant). These methods will then be applied to the arsenic and UVR exposures in relationship to melanoma within this study. Marvin Langston and Charles Lynch are also contributors to this project. 

Parental deportation can have profound and long-lasting consequences for the children left behind. To our knowledge, no large-scale, longitudinal, and population-based study has examined the short- and long-term effects of parental deportation on the health and well-being of U.S. citizen children of deported immigrants. The aim of this 2-year mixed-methods pilot study is to develop and test a novel methodology to conduct such a study in the near future. This study will inform the methods of a future large cohort study to determine the impact of deportation policies on the health and well-being of U.S. citizen children of deported Mexican immigrants. Additional collaborators on this project include Ana P. Martinez-Donate from Drexel University and M. Gudelia Rangel-Gomez from the Mexico section of the US Mexico Border Health Commission.

Engaging the community and sustaining its investment in control programs is recommended as a critical component of assessing response during dengue outbreaks [1]. Evidence of the effectiveness of community engagement to impact entomological and to a lesser extent epidemiological endpoints is growing [2-5]. Both effectiveness and sustainability need to be explored as even effective programs may be unsustainable if community members lose motivation [6]. Evidence suggests that the use of theoretical frameworks such as the health belief model improves the effectiveness of public health interventions [7]. The health belief model would suggest that action is most likely taken when individuals have knowledge about Aedes mosquitoes and the viruses they carry; perceive Aedes mosquitoes to be a risk to them and their household members and that the risk is severe; perceive that the benefits of interventions outweigh the barriers to implementation; and are further motivated by self-efficacy and external cues to action such as media campaigns [8]. Indeed the best practices for communicating vector control strategies to the public have not been well defined particularly for industrialized countries where evaluation mosquito-borne disease messaging is particularly sparse. Vulnerable populations, including individuals residing in public housing, were less likely to receive information about dengue during an outbreak in Key West, FL [9]. During the West Nile outbreak in 2003 a study indicated people were most commonly getting their information from communications through newspapers, radio and TV broadcasts [10]however those that reported taking action were more likely to have gotten their information from the newspaper, word of mouth, or searching on the internet as compared to information they received from radio, TV, brochures, or health professionals perhaps due to the more active engagement associated with these sources. Some studies have indicated that mass media reports during outbreaks may not provide accurate risk information that could help individuals determine if they should take precautions [11, 12]. Leveraging mobile apps and social media as public health communication tools has become more broadly implemented for improving healthy behaviors; with most regular implementation addressing physical activity and smoking cessation [13, 14]. While mobile apps have shown variable effectiveness at increasing positive health behaviors, the potential is recognized [13].  Kidenga is a community-based surveillance and education app developed to address the increasing risk of Aedes-borne diseases in the southern United States. The Kidenga app was launched in late September 2016 and was developed through a collaborative partnership between the University of Arizona (lead institution) and CDC personnel based at the Division of Global Migration and Quarantine in San Diego, CA (www.kidenga.org). The intention of Kidenga is to both collect data on syndromes that may be consistent with Aedes-borne diseases and to provide timely and accurate risk information back to the user. As part of this work the Kidenga team will build upon existing Kidenga mobile application development to provide a “Spanish-version” for use along the Arizona and Texas borders to enhance surveillance and education for Zika, dengue and Chikungunya disease and their mosquito vector, Aedes aegypti (yellow fever mosquito). In addition, a preliminary assessment of the acceptability of Kidenga mobile application with end-user groups and a prioritization of modifications or enhancements to increase the usability and acceptability of Kidenga.  

The objective of this Interagency Service Agreement (ISA) is to work in collaboration with the University of Arizona Mel and Enid Zuckerman College of Public Health to strengthen academic institution alliances and to provide for a mechanism to direct funds that are awarded to the ADHS OBH / AZ ORO by the U.S. Department of Health and Human Services, Office of Global Affairs, to border health programs.

The primary objective of this research is to provide outreach services to the under and uninsured Latino population in Maricopa and Pima County through mobile unit sponsored and financed by the Ministry of Health of Mexico. Services include basic screening for chronic disease, health education and referral to a medical home. The University of Arizona will perform the following duties: Be the lead organization for the Program. Responsible for operating the mobile health unit. Identification of key target communities outside metropolitan areas of Phoenix, Arizona. Planning scheduled visits to selected communities. Instrumentation of database for registration activities and services and to monitor cases where it is detected that require specialized medical attention. Elaboration and implementation of capacity building programs to train health workers among residents of targeted communities who wish to participate. Recruitment of personnel: This should be bilingual, bicultural and highly trained. Elaboration of a work plan according to MOU. Daily registration of the services offered through the mobile health unit according to the corresponding electronic format. Development of reporting results according to MOU. Ensure the quality of the services at all time for users of the services. Responsible for maintaining the mobile unit in optimal conditions in order to ensure quality. By fulfilling these duties, the expected outcomes of the project are: Counsel and/or refer approximately 50% of underinsured users eligible for public benefit health insurance programs during the term of this contract. Provide medical referrals to 100% of individuals with abnormal health screening results to a primary care provider or an appropriate clinic for follow-up care during the term of this contract. Establish a medical home for approximately 50% of clients referred to community clinics and encourage users to keep appointments and use community clinic services. Provide general health consumer education sessions to individuals at the mobile health units during the term of this contract. This project was funded by The United States-Mexico Border Health Commission. 

Residents of rural communities and Latinos continue to experience significant health disparities for chronic disease such as diabetes and cardiovascular disease.  The residents in these communities have significant disparities due to multiple social determinants of health including but not limited to a lack of access to opportunities for physical activity and other resources necessary to prevent chronic disease. Bike Ajo is a community-campus coalition with diverse membership including community health. Bike Ajo’s goal is to create a sustainable cycling hub that educates, trains, provides resources, and builds health-based partnerships within the Ajo community. The asset-based coalition includes community residents, Desert Senita Community Health Center, International Sonoran Desert Institute, Ajo Chamber of Commerce, Arizona Planning Association, Mel and Enid Zuckerman College of Public Health, UA Department of Mexican American studies, Pima County Parks & Recreation, Pima County Health Department, and Pima County Department of Transportation. The Bike Ajo works to increase access to environments promoting physical activity opportunities through the creation of the1) Bike Ajo Cycling Hub (ReaCH); and 2) expanding community-clinic linkages to chronic disease prevention resources for Desert Senita Community Health Center patients.  Successes, lessons learned, and process/implementation strategies will be shared through the Arizona REACH network as well as at local and national conferences.  Digital stories will be utilized to help community members tell their own compelling stories of the personal impact of inequities in public health. This project was funded by the National Center for Chronic Disease Prevention and Health Promotion and the Arizona Chapter of the American Planning Association. 

The goal of this project is to 1) to demonstrate utility and feasibility of detection of LTBI among migrant farmworkers, and to compare outcomes in the US and Mexico and; 2)To assess follow-up of workers detected with LTBI and ability to link individuals to care. Through additional funding, we have been able to expand the work to include further care for participating migrant farmworkers in conjunction with the Migrant clinicians Network.

This research project is under the umbrella of the Arizona Prevention Research Center and is adapting our Pasos Adelante curriculum for northern Sonora and an urban population, i.e. Hermosillo.  The project research question focuses on the viability of behavioral interventions designed for border populations in the U.S. to be appropriate in Mexico.  The Service component includes the actual technical assistance that we provide to our Mexican counterparts on the model.  The training component includes training the community health workers in Mexico on the model.  

Support for this curriculum came from the Healthy Gente / Healthy Border 2010 Mini-Grants provided by the Arizona Department of Health Services and U.S.-Mexico Border Health Commission. Kerstin Muller Reinschmidt was a contributor on this project but has since left the University of Arizona.   

Description: An increasingly militarized border region has deeply embedded immigration enforcement policy into the daily lives of residents, including farmworkers living and working in the region. Objective: The institutionalization of ethno-racial profiling in immigration and local law enforcement, and the sanctioned use of Mexican appearance as probable cause for citizen inspection is a potential structural determinant of health yet to be explored.  Research:  data manipulation including conducting qualitative ad quantitative data analysis, results generation and manuscript development. Samantha Sabo was a contributor on this project but has since left the University of Arizona.

This project is focused on the development of a farmworker promotor curriculum to be utilized with agricultural workers in Sonora as well as a pilot implementation of the curriculum and an evaluation of its impact.  The project is also providing technical assistance in infrastructure and systems changes that move the agricultural industry in Sonora to be more socially responsible.   The research component is both the curriculum testing in terms of relevance and the evaluation of the impact.  The service component of the project includes the technical assistance for the curriculum development and the implementation as well as the technical assistance for infrastructure and systems change.  The training component is the skill building of local promotores on the farm. We have been recently awarded a new PIMSA grant for continuation of our work.  The new award will begin in April.  

This project is a small/pilot project program with the Southern California NIOSH Education and Research Center. This project was funded by University of California, Los Angeles (UCLA) through the CDC and NIOSH. For this project, I am serving as Ms. Sugeng's primary sponsor.

Developed research methodology to conduct a language services assessment, based on Joint Commission and CMS standards, conducted at a Critical Access Hospital that serves a U.S.-Mexico border community in southern Arizona. Focus Group conducted at AZ-CAH (May 2011). Provider survey created for pilot (Dec 2011). Kevin Driesen was a contributor on this project but has since left the University of Arizona. 

  Research: The objectives of this project are to determine if there is a difference in water quality between publically supplied tap water and the actual drinking water used by families in Nogales, AZ and understand the risk perception these families have about their publically-supplied tap water and alternative drinking water sources. Service: We are served the community by providing low-income families with analyses of their water supplies. Training: We provided training to promotoras at Mariposa Community Health Center, who are assisting with recruitment and data collection. This project forms the basis of Kerton Victory's dissertation and has provided him with training in project management, data and laboratory analyses, human subject research and risk communication. Research: The objectives of this project are to determine if there is a difference in water quality between publically supplied tap water and the actual drinking water used by families in Nogales, AZ and understand the risk perception these families have about their publically-supplied tap water and alternative drinking water sources. Service: We are served the community by providing low-income families with analyses of their water supplies. Training: We provided training to promotoras at Mariposa Community Health Center, who are assisting with recruitment and data collection. This project forms the basis of Kerton Victory's dissertation and has provided him with training in project management, data and laboratory analyses, human subject research and risk communication.  

This project implemented by Campesinso Sin Fronteras utilizes the promotora model to conduct health outreach and education to farmworker community in South Yuma County. I am overseeing the process of participatory evaluation which focuses on several activities. A core activity is the delivery of the Su Corazon Su Vida curriculum with an enhanced focus on the role of stress and depression on health behaviors. In addition, a leadership curriculum seeks to teach parents to advocate for their children in the school. The project also seeks to improve the cultural competency of the Sunset Community Health Center through provider and staff training. Evaluation of SCHC efforts focuses on patient satisfaction and knowledge of cultural competency among staff. MPH students who have served as graduate assistants on this project receive a community based experience and training in participatory evaluation.

I facilitated a process of participatory evaluation with Mariposa Community Health Center on a program entitled Salud Si, a health promotion project targeting Latinas of child bearing age that was originally funded in 2000 and developed with our collaboration. Salud Si utilized CHWs to provides weekly nutrition classes, physical activity opportunities, and emotional support as strategies to improve nutrition and physical activity behavior. Coping with stress is also addressed. The contract included a study of the maintenance of behavioral and health outcomes that had been established through prior evaluation.Analysis of 5 years of pre/post questionnaires was being complemented with qualitative data collected by the program director and myself with a sample of women who graduated at least one year prior to the time of interview. A final report was submitted to Mariposa and the results of this evaluaiton guided decisions to sustain the program within Mariposa. A collaborative manuscript was prepared and submitted on evaluation findings.

This project is a contract with the Arizona Governor's Office to work with communities on the Border to develop task forces designed to address the needs of battered immigrant women. The specific role of MEZCOPH is to use a participatory framework to provide technical assistance to project partners in seven Southern Arizona counties. Activities have included implementation of a needs assessment with community providers, technical assistance to community coordinators in the development of task forces, and interviews with battered immigrant women who have self petitioned through the Violence Against Women Act. In the past year, we completed an online interactive tool on developing a community protocol to help immigrant women apply for VAWA and we have submitted the product to peer review on CCPH CES-4 Health.

This AHEC funded needs and assets assessment was completed in April 2010 and provided to the AHEC Health Sciences Advisory Committee and to the Regional Center for Border Health.

This contract is the introductory piece to the larger Centers of Excellence Grant that we will be working on next year.  This small contract produced a written report which summarizes  Community Health Worker Programs that focus on chronic disease prevention at the U.S.-Mexico border. Samantha Sabo was a contributor on this project but has since left the University of Arizona. 

Since summer of 2000 the state of Arizona has begun addressing the needs of battered immigrant women in terms of safety and access to crucial legal, health and human services, to ensure that they will be met as mandated under the Violence Against Women Act (VAWA). Since 2002 the "Southern Arizona Battered Immigrant Women Project" has been funded through the US Department of Justice Violence Against Women Office to lay the groundwork for:1) education, outreach, information and awareness, 2) training, 3) improved services, and 4)resource development. The first phase began when Pima, Cochise and Santa Cruz Counties each formed a Battered Immigrant Women Task Force charged with developing a multidisciplinary training curriculum for law enforcement, legal services, victim services and other health and human service agencies and organizations. In 2004 the project expanded to include Pinal, Yuma, Graham and Greenlee Counties.  During the life of this project I have continued to act as a Co-PI,  contracted project consultant, for the Governor's Division for Prevention of Family Violence (GDPFV) through funding from the U.S. Department of Justice Rural Domestic Violence and Child Victimization Grant. I have provided technical assistance to county Battered Immigrant Women Task Forces, implemented service provider training needs assessments, in addition to developing and implementing in-depth interviews for women who have attempted to obtain their VAWA approval letters with the intent of providing feedback to key service providers for quality improvement and training recommendations, and the subsequent development of a model protocol toolkit for coordinated community response to immigrant victims of violence.  In 2011 the toolkit went live on the Center for Rural Health website.   

Dissertation research will measure corporate social responsibility (CSR) impact on proximal health and safety of migrant farmworkers employed in one socially responsible agribusiness located in Sonora, Mexico; and explore distal relationships of CSR on selected social determinants of health (SDH) among migrant farmworker households migrating from Chiapas to the Sonora study farm.  A community-based participatory research approach will engage agribusiness owners, health/social service providers, and farmworker stakeholders.  PIMSA will support two critical phases of research; (1) Key informant interviews to synthesize emerging and competing discourse and policies concerning the role of CSR on SDH and how this information is circulated, and understood by stakeholders and; (2) Retrospective case-control study to compare acute and chronic health indicators, including work-related illness and injury among regularly returning farm workers (cases) to those who do not regularly return to the same farm (controls). Study farm employee medical records for years 2004-2009 will be reviewed.  Case employees are expected to have less acute and chronic health issues and decreased work-related illness/injury compared to controls.  Budget will cover travel, per diem, and lodging.

Community-based participatory methods support building both professional and organizational capacity were used to develop a web-based database to enhance the capacity of Mariposa Community Health Center to address disparities in perinatal health in Santa Cruz County.  Fundamental to this evaluation contract is building a team-based culture of work in a multi-cultural, bilingual environment that contributes to consensus building and empowerment among internal and external partners.

The goal of this project was to establish a "social business" to build and repair low-cost wheelchairs in Nogales, Sonora. This project was funded by the International Rotary. 

We've used this grant to raise additional funding and develop the Leaders across Borders Program, an action-learning leadership development program for public health officials on both sides of the US-MX border region.  We'll soon be reviewing applications for our first class, which starts in March 2010.  All Leaders across Borders participants have the option of taking additional online training and receiving a Diplomado from the Instituto Nacional de Salud Publica.

Provide a mechanism to direct funds awarded to the Arizona Outreach Office by the US Department of Health and Human Services, Office of Global Health Affairs, to fund border health programs and binational workforce development in public health in the Arizona-Sonora region.     

The overall purpose of this proposal is to strengthen an interdisciplinary, inter-institutional working group to build a Transborder Observatory for Health at the U.S. Mexico Border and develop a model of guiding principles to define a place-based regional approach for public health research and evaluation of best practices to impact policy decisions in the border region.

This Center of Excellence, named The Center for Health Promotion of Northern Mexico, was part of 11 Center of Excellence around the world. The specific aims of project work done at this center were threefold: to conduct a scoping review of community health worker-based chronic disease primary prevention programs on the U.S.-Mexico border region; to look specifically at promising and evidenced-based interventions identified from our review of the literature, and focus on a community health promotion intervention based on social cognitive theory and the socio-ecological model. The methods used to evaluate the different types of intervention employed a quasi-experimental pre-test, post-test study, with follow-up measures of physiological changes among low-income participants residing in an urban setting in northern Mexico.

The Early Warning Infectious Disease Surveillance (EWIDS) program works to achieve cross-border early warning detection of infectious disease health threats and events, and overall situational awareness of infectious and emerging disease activity, within the broader context of the Pandemic and All-Hazards Preparedness Act (PAHPA), the Security and Prosperity Partnership of North America (SPP),and the World Health Organization’s revised 2005 International Health Regulations (IHRs). The AZCPHP will collaborate with local, state and tribal health departments to develop and provide a GIS Workshop and Epidemiology Training. This project was sponsored by the U.S.-Mexico Border Health Commission. 

This was a cross-sectional study that assess the four U.S. border states community health worker training needs. The assessment used SurveyMonkey as the data collection method. Employers of community health workers located in the four U.S. border states were included in the study. There were three follow-ups used to increase the response rate. The study obtained University of Arizona Human Subject approval.  This project was completed in December 2011.

This is a cross-sectional study of U.S.-Mexico border health research conducted in the U.S.-Mexico Border Region. The assessment uses SurveyMonkey as the data collection method. Both U.S. and Mexician border health researchers are included in the study. There are three follow-ups used to increase the response rate. The study has obtained University of Arizona Human Subject approval. The study subjects include individuals who conducted research in the U.S.-Mexico border health region. The research areas examine in the study includes the health areas addressed in Healthy Border 2010.