Health Disparities

Despite suffering disproportionately from many health conditions, Mexican immigrants in the United States (U.S.) have among the lowest rates of health care utilization of any U.S.-based population, even after controlling for insurance coverage and socio-demographic factors. While barriers to health care access faced by Mexican immigrants in the U.S. have been well documented, little is known about this population’s care-seeking experiences pre-migration. Yet, prior research has argued that migrant health must be evaluated as a truly transnational phenomenon, given that regular preventive medical care during childhood improves individuals’ likelihood of seeking health care as adults. Thus, Salud Sin Fronteras seeks to expand our understanding of the relationship between pre-migration barriers to care to post-migration healthcare access. We conducted a community-based survey with 300 Mexican born adults living in Southern Arizona. The survey included questions on health and disease status, insurance status, medical care utilization, lay care utilization, and migration history. Findings from Salud Sin Fronteras will inform public health campaigns and interventions designed to increase medical care access for Mexican immigrants living in the United States. Research Team: Drs. Rebecca Crocker, Daniel Martinez, and David O. Garcia Funding Agency: UArizona Hispanic Serving Institution Faculty Seed Grant

Using data from the All of Us Research Program, this project aims to examine cardiometabolic measurements across different ethnic/racial groups in order to set a foundation for future funding for All of Us research. This project was funded by the University of Arizona Office of Research, Innovation, and Impact. 

he microbiome, the microbes - bacteria, fungi, protozoa and viruses - living inside the human intestinal track, have been shown to impact both disease and health. In the last decade, there has been considerable research demonstrating that its composition is important in the development of metabolic diseases like hypertension, obesity,  heart disease, and diabetes. At the same time, studies have also shown that gut microbes vary across different populations and the composition of the microbiome is largely shaped by cultural factors like diet, nutrition, and physical activity. Researchers have noted that not only do immigrants from different countries have different microbes in their intestines, but they also have different rates of diseases impacted by the microbiome. Research for instance, has shown that some Asian immigrants have intestinal bacteria better suited to processing carbohydrates rather than meat when they arrive in the US, but these microbes are replaced over time with bacteria more common to the general US population. At the same time, rates of cardiovascular disease and diabetes also increase. This raises the question about whether lifestyle and dietary factors among immigrants might be shaping the composition of the intestinal microbe populations and protecting them against heart disease. This pilot study will compare the intestinal microbes of recent Hispanic immigrants, 2nd generation Hispanics, and non-Hispanic whites. Since first-generation Hispanics also have been shown to have lower rates of CVD, we hope to better understand whether the bacteria in their gut might be lowering their heart disease risk. This knowledge may help us to design interventions that will lower heart disease in the general population.

This research aims of this study are to estimate the number of microaggressions and hate crimes occurring statewide in Arizona amongst the college community and nationwide amongst healthcare professionals. We aim to advocate that COVID-19 is a public health crisis, which has highlighted the systematic racism inherent in the United States. As such, this problem requires long-lasting reform in order to create equality and justice. By measuring the magnitude of the racial discrimination, we can use this information to create targeted interventions to reduce and prevent microaggressions and hate crimes.   

The growing published data and literature of the COVID-19 pandemic suggest that underserved populations have been disproportionately affected when compared to their counterparts. According to the Centers for Disease Control and Prevention (CDC), Hispanic/Latino adults in the United States accounted for approximately 31.8% of all COVID-19 cases, the highest percentage in comparison to other racial/ethnic minority groups. In addition, Hispanic/Latino adults had the second-highest percentage of COVID-19 deaths among all racial/ethnic minority groups at 17.2%. Of the total Hispanic population residing in the United States, approximately 62.3% is of Mexican-origin descent. This Hispanic subgroup has higher rates of obesity-related diseases such as non-alcoholic fatty liver disease (NAFLD), type 2 diabetes, and certain forms of cancers. As stated by the CDC, individuals with underlying health conditions like obesity-related diseases are at an increased risk for developing severe symptoms associated to COVID-19, and if not treated in time, may result in death. Given the MO population is at an increased risk for obesity-related disease, there is a need to understand the impact COVID-19 has had on MO adults, a population that is often overlooked and understudied in the United States (U.S.). The aim of this project is to identify the impact of the COVID-19 pandemic on social determinants of health in a group of Mexican-origin adults previously recruited for a study focused on non-alcoholic fatty liver disease (NAFLD) and to determine participants’ preferences for recruitment strategies, health assessment screenings, and intervention strategies to inform future NAFLD research in response to the COVID-19 pandemic.  This project is funded through the Center for Health Disparities Research within the University of Arizona Health Sciences. 

Asthma prevalence among Navajo children is 2 times that of the general population and is fueled by disparities including poverty, environmental pollutants, and minimally accessible healthcare. This project on the Navajo Nation will address these disparities using a community-based intervention targeting healthcare providers, schools, parents, children, and community members. This project was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. 

In the United States, chronic diseases and conditions such as heart disease, stroke, cancer, type 2 diabetes, and obesity are among the most common, costly, and preventable of all health problems. These chronic diseases are more prevalent in underserved populations based on race/ethnicity, geographical location, and income levels. Despite these differences, engaging individuals in research and other health initiatives remains difficult. To address this concern, we are developing the Nosotros Network as a community-based outreach and engagement effort designed to work together with and through groups in Southern Arizona. Our goal is to increase health awareness in the community and provide a direct link to research and health initiatives designed to improve the health and well-being of our community. Dr. John Ruiz from the College of Psychology is also a collaborator on this project. 

This application, entitled “Student Transformative Experiences to Progress Underrepresented Professionals” (STEP-UP) for cancer prevention, is a multidisciplinary initiative led by the Cancer Prevention and Control and Health Disparities Programs’ faculty at the University of Arizona Comprehensive Cancer Center. It is uniquely designed to provide 55 undergraduate and 54 Masters’ degree seeking students with an intensive, 12-week summer research experience in cancer prevention and control. Educational pedagogy will inform on our methodology in order to assure students receive the quality research experience that not only will increase understanding, but also will motivate students toward a continued educational commitment to advance in cancer prevention and control sciences. The emphasis in training will be largely within the clinical trials to community-based participatory research end of translational research, yet offering students 2 week-long immersion opportunities to experience cancer prevention and control science across the entire continuum of basic to applied and even dissemination research. Over 35 faculty members from diverse disciplines who are funded in cancer prevention and control research are committed to this program. The program fills a gap in our web of training opportunities for underrepresented students and yet builds on a substantial foundation of purpose-driven efforts at the UA and the Arizona Cancer Center to attract and retain a diverse student body in cancer prevention and control research. Importantly, this effort leverages our international reputation in cancer prevention research. Our specific aims include: 1. Recruit undergraduate and Master’s level graduate students from URM into the STEP-UP in cancer prevention 12-week summer experiential cancer prevention and control research training; 2. Provide an integrated, innovative, multidisciplinary educational experience in cancer prevention and control research that strengthens self-efficacy and intrinsic motivation to become a cancer prevention and control scientist; 3. Support mentoring and professional relationships with scientists, research programs and community partners; 4. Conduct formative and summative evaluations to improve the program over time. The training program is centralized in Southern Arizona and offers experiential learning within our unique catchment area which is rich in diversity relative to ethnicity (30.7% Hispanic), race (5.8% Native Americans) and age (16.4% over age 65 years). This distinctive location, strong community ties, university facilities and resources for research and education, as well as committed and experienced faculty mentors and program leaders, assures a quality program that will impact the diversity, competence and commitment of the cancer prevention and control workforce of the future.

Currently 1 in 9 Arizonan has T2D. African-American, Hispanics, American Indians and Asian-Americans, that account for 40% of Arizona residents, are about twice as likely to have T2D as are Whites. In 2008, 9,883 hospitalizations in Arizona were due to diabetes that make diabetes one of most costly diseases. Treatment regime for T2D is rather complex. After failure of diet and lifestyle efforts, step-wise addition of glucose-lowering medications is the usual course of T2D therapy. The decision of prescribing subsequent medications in the best sequence after initiation of the generally agreed upon initial oral medication (metformin) is strikingly challenging due to the unclear advantages of 2, 3, 4 and 5 drug regimens and the increased potential for adverse effects. Right now, most T2D treatments guidance are designed for the average patient. But one size doesn't fit all, and treatments that are very successful for some patients don't work for others. In addition, there are also new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications and the ideal target goals for therapy.
Comparative effectiveness studies are the traditional tools to preform comparisons. However, it is impossible due to its complexity, cost and length of the study. In this proposal, we focus on developing a data-driven paradigm to understand the medication treatment heterogeneity effects of T2D and to provide an evidence-based treatment guidance that is tailored to subgroups of patients sharing similar characteristics (precision medicine). Our data-driven approach will be based on the study of Veteran Healthcare Database, using the VA Informatics and Computing Infrastructure (VINCI). The clinical data includes the longitudinal data profiles starting from the year 2000.

Midlife (45-64 yr) Mexican-American (MA) men are susceptible to future burden from cardio-metabolic diseases because of numerous factors, most notably less healthful dietary and physical activity (PA) behaviors coupled with low participation in chronic disease prevention and management efforts. Thus, there is an urgent need to understand how to promote health-enhancing diet and PA behaviors in this understudied group of the population. The objective of this application is to use a mixed-methods approach to inform the development of and pilot test a gendered- and culturally-tailored diet- and PA intervention for cardio-metabolic disease prevention among midlife MA men. This objective will be attained by addressing the following specific aims: (1) conduct qualitative research with midlife MA men and their significant others (e.g. spouse, partner, close family member), and key informants (stakeholders from the MA community) to identify: (a) knowledge, perceptions, and behaviors regarding what constitutes healthful diet and PA practices; (b) perceived barriers and enablers of dietary and PA behavior change, (c) proposed strategies to promote dietary and PA behavior change, (d) perceived resources and assets for implementing dietary and PA behavior change interventions, and (e) masculine, cultural, and social identities that interact to influence interest and engagement in healthy lifestyle behaviors; and (2) assess the initial efficacy, feasibility and acceptability of a gender-tailored and culturally-relevant diet and PA behavior change pilot intervention targeting midlife MA men. Phase I of the project will entail focus groups to identify determinants of midlife MA men’s health behaviors, existing good practices and health- promoting values and behaviors, and acceptable intervention strategies. The proposed project will use intersectionality, which examines how the blending of identities and experiences create more accurate reflection of the determinants of men’s health behaviors, within the context of the sociocultural determinants of health, as the conceptual framework. A “grassroots” approach will also explore beliefs, barriers and enablers to dietary and PA change identified by significant others and community stakeholders Information collected during Phase I will inform the development of intervention materials and processes that will be pilot-tested during Phase II. Phase II will consist of a randomized controlled trial to test the initial efficacy, feasibility and acceptability of a gender-tailored, culturally relevant dietary and PA intervention targeting midlife MA men. Innovation lies in our study being the first to apply an intersectional approach in health disparities research with midlife MA men, a severely understudied and high-risk subgroup. To date, no interventions have been developed or adequately tailored to address issues unique to MA men 45-64 yr. Thus, the proposed research is significant be- cause it addresses a critical gap and will inform the development of lifestyle-based interventions targeting mid- life MA men. The proposed project will also establish the foundation for a subsequent test of intervention efficacy, as well as future translation and dissemination in varied community settings. ASU sub-award

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. 

The Center for Indigenous Environmental Health Research (CIEHR) is a Center of Excellence on Environmental Health Disparities Research supported by the National Institute of Health’s National Institute of Environmental Health Sciences and the Environmental Protection Agency. Learn more at https://ciehr.arizona.edu

In the U.S., Hispanic males have the highest rate of overweight and obesity when compared to males of other racial/ethnic groups. Obesity contributes to the risk for certain cancers in Hispanics. For example, obesity is associated with non-alcoholic fatty liver disease (NAFLD), which is 1.4 and 1.9 times more common in Hispanics than in Non-Hispanic Whites (NHW) and African Americans, respectively. While not all individuals with NAFLD develop liver complications, nearly 30% will develop nonalcoholic steatohepatitis (NASH) and be at risk for hepatocellular carcinoma, the most common form of liver cancer in adults. Consequently, Hispanic males have the highest rates of liver cancer incidence in the U.S., twice those of NHW men. Weight loss is considered the first line of prevention for NAFLD progression. Yet, current research is lacking to inform best practices to engage Hispanic males in weight loss and/or to promote a successful weight loss trajectory. Without this information, the health disparities associated with obesity related cancer will continue to increase. Using existing practice guidelines and evidence from our qualitative assessments in overweight/obese Hispanic males, we will test a novel intervention approach to address this knowledge gap. We propose to 1) assess the feasibility, acceptability and preliminary efficacy of a gender- and culturally-sensitive weight loss intervention in 20 overweight/obese Hispanic males ages 18-64 over 24 weeks; and 2) examine pathologic changes in the liver (NAFLD, NASH, fibrosis, or cirrhosis) in 20 overweight/obese Hispanic males ages 18-64 over 24 weeks using a non-invasive Magnetic Resonance Imaging (MRI) of the liver. This project will be the first gender and culturally-sensitive weight loss intervention of which we are aware to explicitly target Hispanic males with an emphasis on reducing body weight. In addition, the intervention will provide highly impactful formative research on the effects of a weight loss lifestyle intervention on liver histology. Given the Hispanic population is the fastest growing in the U.S., efforts to identify strategies to promote weight control among Hispanic males has potential to significantly impact obesity-related cancer health disparities.

The purpose of the study is to shed light on how obesity develops by examining daily behaviors and sleep in people who have involuntarily lost their job. If findings show that disturbances in daily routine and sleep precede weight gain, then there is solid backing for the development of a behavioral sleep prevention program targeting unemployed individuals. Since unemployment, chronic sleep restriction, and obesity are such prevalent social and public health issues, the results of this study are highly relevant to a large segment of the U.S. population. Funding for this study came from the National Heart, Lung, and Blood Institute. 

Ovarian cancer accounts for over 18,000 deaths each year in the U.S. with disease progression rates estimated at 60-70% after 4 years. The efficacy of a physical activity + dietary intervention to increase progression-free survival (PFS) in this vulnerable population is currently being tested in a hypothesis-driven, randomized, attention-control study of 1070 women with prior invasive disease [(Gynecological Oncology Group (GOG) 0225 study (Lifestyle Intervention for oVarian cancer Enhanced Survival- (LIVES) Trial]. Here, we propose to take advantage of the trial infrastructure and capacity to collect repeat blood samples to evaluate the mechanistic underpinnings that might explain any changes in health indices by treatment arm over time. The overarching hypothesis is that change in metabolic and inflammatory status of participants, that is expected to demonstrate a reduction in inflammation and metabolic deregulation in the intervention group participants more so than the attention-control group, will be associated with increased PFS. A secondary focus of the proposed work will be the interaction with central adiposity. The Specific Aims include: To determine if the LIVES intervention alters biomarkers of metabolic deregulation in women previously treated for stage II-IV ovarian cancer; Aim 2: To determine if any effect of the intervention on biomarkers is mediated by change in central adiposity; and Aim 3: To determine if any effect of the intervention on biomarkers is modified by baseline central adiposity including exploration of central adiposity using Computerized Tomography (CT) scans. Our longer term goal is to determine whether change in central adiposity, insulin/lipid metabolism or inflammation is associated with progression free survival.

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. 

More than four million people with asthma live outside of urban areas, and most are seen in primary care settings where their asthma is often inadequately managed, representing a significant gap in care. Rural health disparities for children with asthma include poverty, limited access to care, and environmental challenges including high levels of outdoor and indoor particulate exposure. The Asthma Toolkit program has translated evidence-based asthma care into both rural and urban primary care practices. Although this program has produced evidence of increased guidelines-concordant care, much room exists for improvement. We believe that by deploying Asthma Toolkit training in a larger program that includes community, school, and family engagement, quality of care and health outcomes can be improved for rural children with asthma. This project will bring together investigators from the University of Arizona and National Jewish Health to 1) engage three communities on the Navajo Nation to build a successful collaboration (U34); and 2) conduct a randomized pragmatic trial of a community rural pediatric asthma program (U01). During the initial empowerment phase, we will solidify relationships with community stakeholders including patients, parents, community leaders, hospital administrators, schools, and providers. A group of stakeholder advisors will be created to inform and guide the subsequent study.  In the second (U01) phase, we will employ a step wedge, randomized trial design to test the capacity of the Community Asthma Toolkit program to improve care and outcomes.  The provider component will include comprehensive training in evidence-based pediatric asthma care. The school component will work to improve capacity to identify pediatric asthma and facilitate communication between school, family, and provider. The hospital component will help provide structured communication between hospital clinicians and primary care providers to improve outpatient management and prevent unnecessary urgent care utilization. Finally, the air quality component will assess community and provider concerns about indoor and outdoor air quality and determine potential methods to measure and reduce environmental risks to children with asthma. The final trial will be modified in accord with stakeholder input during the engagement phase. We believe that the intervention could serve as a model for implementation of strategies to improve asthma care in rural children.

The American Lung Association Airways Clinical Research Centers (ACRC) network is a network of asthma and airways experts with access to a nationwide and demographically representative study population, for the purpose of decreasing the prevalence, morbidity and mortality of asthma and COPD. The basic activities of the network and its data coordinating center include:  Developing a collective data base of well characterized patients with asthma and COPD who can serve as potential research participants;  Collecting core data from recruited participants;  Communicating information gained from network activities to local Lung Associations and the populations they serve;  Participating interactively in developing grant and contract proposals. Such proposals may be extensions of initial projects proposed in the applications of individual centers, or may involve emerging new priorities that arise as a consequence of developments within the field.  Participate in development of presentations and publications based on network research.

Asthma is a common chronic condition among children that is associated with significant morbidity. Because medication non-adherence is an important cause of excess morbidity, the National Asthma Education and Prevention Program guidelines have called for the development of more effective adherence programs.  Schools represent a logical setting where adherence programs could reach the inner-city, low-income, and ethnically diverse populations that have the highest morbidity and lowest adherence.  A recent clinical trial demonstrated that supervised therapy of daily controller medication at school increased medication adherence and asthma control among primarily African-American students in urban, low-income elementary schools.  This study aims to evaluate:  (1) the effectiveness of supervised therapy when administered by the community under real world conditions via a randomized controlled trial of 500 children with asthma in a large urban, predominantly Hispanic school system;  (2) the cost-effectiveness of supervised therapy from the societal perspective using dollars per quality-adjusted life year (QALY) gained; and 3) the program’s implementation fidelity, optimal delivery mechanisms, and construct validity via a comprehensive process evaluation.  Supervised therapy is hypothesized to be both an effective and cost-effective mechanism to improve population-level asthma control among students with asthma.  This project will provide critical information regarding the program’s value, feasibility, and sustainability within communities with large asthma burden.  In addition, it will provide important recommendations to accelerate the adoption of guideline-based care for students with asthma in urban, low-income, and ethnically diverse populations.  With this information, policymakers can optimize the use of scarce public health resources by adopting programs that efficiently maximize child health. Funding for this study came from the National Heart, Lung, and Blood Institute. Also, this study is supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp and product donation from Thayer Medical Corporation.

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.

The goal of this project is to examine the association between stress and asthma morbidity, using our preliminary work from the Children’s Respiratory Study, and within the context of an ongoing school-base randomized clinical trial, to determine to what degree variations in asthma control and morbidity are associated with chronic school stressors. Eyal Oren was a contributor on this project but has since left the University of Arizona. 

The goal of this project is to determine whether texting can serve as a low cost technology for improving low LTBI adherence rates. This work is being completed in partnership with the Pima County Health Department TB Clinic in Tucson, AZ. Specifically, the project will focus on these aims: Aim 1. To determine the effectiveness of text reminders for improving adherence in latent TB patients using a randomized controlled single blinded trial. Aim 2. To establish the costs associated with text messaging. Aim 3. To determine patient experiences with the texting intervention. You can learn more about TXT4MED and its progress at http://txt4med.arl.arizona.edu  

The goal of this project is to evaluate the role of Helicobacter pylori infection and gastric diseases in the southwestern United States to identify interventions to reduce disease. This private foundation-sponsored work has resulted manuscripts and multiple poster presentations, as well as numerous engaged students and faculty. In addition we are using this work as a springboard to apply for additional funding to investigate infectious causes of chronic diseases.

A five year REACH (Racial and Ethnic Approaches to Community Health) cooperative agreement\subcontract to help reduce health disparities and improve health through community efforts in six States. This project began November 1, 2012. We are partnering with Hidalgo Medical Services, University of Texas and the Northwest Regional Primary Care Association in the REACH: Su Comunidad Consortium to address health disparities in nutrition, physical activity and healthy weight among Hispanics/Latinos in six states. The four organizations have developed the REACH: Su Comunidad Consortium to address health disparities in nutrition, physical activity and healthy weight among Hispanics/Latinos in the six states.  The Consortium will sub-award funds to fifteen sub-recipient communities and provide intensive training and technical assistance. Using a Community Health Worker (CHW) model, the Consortium will help sub-recipient communities to develop or expand multi-sector community leadership teams, conduct community assessments and develop and implement community action plans that utilize relevant policy, systems and environmental (PSE) strategies to promote nutrition, physical activity and healthy weight.   A five year REACH (Racial and Ethnic Approaches to Community Health) cooperative agreement\subcontract to help reduce health disparities and improve health through community efforts in six States. This project began November 1, 2012. We are partnering with Hidalgo Medical Services, University of Texas and the Northwest Regional Primary Care Association in the REACH: Su Comunidad Consortium to address health disparities in nutrition, physical activity and healthy weight among Hispanics/Latinos in six states. The four organizations have developed the REACH: Su Comunidad Consortium to address health disparities in nutrition, physical activity and healthy weight among Hispanics/Latinos in the six states.  The Consortium will sub-award funds to fifteen sub-recipient communities and provide intensive training and technical assistance. Using a Community Health Worker (CHW) model, the Consortium will help sub-recipient communities to develop or expand multi-sector community leadership teams, conduct community assessments and develop and implement community action plans that utilize relevant policy, systems and environmental (PSE) strategies to promote nutrition, physical activity and healthy weight.  

AIs suffer disproportionately from diabetes, substance abuse, unintentional injuries/motor vehicle accidents and suicides. Applying deficient approach to health challenges discourages AI students and communities and leaves AI populations conflicted about health research. CAIRs RTE Core will specifically address the need for a clear educational pathway to develop necessary research skills that address health disparities.

I will obtain publically available data from several studies in different ethnic/racial groups, and use data mining procedures to develop prediction models of type-2 diabetes risk from genetic markers. Career Development - This K01 grant also has a major career development component for which I am taking courses, going to workshops and conferences, and attending research seminars.

This center involves innovative and current models of research, service, and training within Arizona, and is part of a national network of Prevention Research Centers funded by the CDC. There is focused research in 4 border counties but the PRC community action board reflects statewide (including tribal) issues. This research project, Unidos: Linking Individuals’ to Social Determinant and Community Health Services will result in a model intervention to improve overall health and quality of life among predominantly Mexican-origin Latinos in Arizona. Principal Investigator: Scott CarvajalDeputy Director: Maia Ingram

Pima County was awarded a $16 million grant by the CDC to address obesity. MEZCOPH is responsible for evaluation of coalition activities to impact obesity through environmental and policy changes in Pima County with a focus on health disparity. This has involved working across the University with the College of Architecture Drachman Institute and the College of Nutritional Sciences as well as with a number of community agencies that include the Tucson Community Food Bank, the United Way, the YMCA and Carondelet Health Network.  CPPW interventions focus on schools, worksites, health and human services, faith-based organizations, and communities.

Refugees are resettled into the Tucson metropolitan area of Pima County at a rate of between 600-800 persons annually. They come from every continent and diverse backgrounds, speak a range of languages, including Arabic, Kirundi, Somali, Mai Mai, Nepali, Burmese and Swahili, and all of them hold in common the need to learn to navigate an unfamiliar and complex primary health care delivery system. The challenges they face in this process, and the challenges encountered by health and human service agencies in providing optimal services to them have been documented anecdotally in Pima County, but as yet, have not been closely examined qualitatively. This project included a primary care service needs assessment focusing on the population of refugees in Tucson, as well as a service delivery and training needs assessment of primary care providers in Pima County. Using a model of community-based, participatory research, I formed a Refugee Primary Care Work Group who guided the development and implementaion of a survey among a multidisciplinary universe of service providers to identify the range of refugees’ priority and unmet needs, and the challenges they currently face in serving new refugees (cultural, linguistic, economic, among others). Once the provider survey was complete, we employed the same participatory model to develop and conduct group and individual interviews with refugees from at least six different language groups, to elicit health concerns, barriers to accessing services, and recommendations for improvement of outreach and services. An interdisciplinary team of graduate students from the disciplines of public health, nursing, and information resources and library science were involved, under my supervision and guidance, in development, implementation, data collection and management, analysis and community reporting of the findings. Diverse agencies including Arizona Health Sciences Library, refugee resettlement agencies, urgent care facilities, primary health care providers, Pima County Health Department Public Health Nurses and Pima County Public Library assisted in this process in an advisory capacity. Findings and recommendations have been utilized by RISP-Net and PCCHTF to take steps to respond to identified needs and recommendations, to include fundraising and program modification wherever indicated and possible, and will assist in dissemination of findings through local, state and national networks. The work group has continued with my leadership, unfunded, beyond March 2010, and I presented findings at the APHA Annual Meeting in Denver in November 2010.

The purpose of this community assessment is to begin to describe the provider system-based reasons for low rates of pediatric visits in young children enrolled in University Family Care (UFC) in Pima County, and to identify optimal mechanisms to improve these members’ access to UPH providers.  The quality measures of interest are:1)   well-baby visits, where children should be having 6 well baby visits by 15 months of age, and 2) children having at least one wellness visit between age 3 and 6 years.D. Jean McClelland, of the University of Arizona Mel and Enid Zuckerman College of Public Health, Division of Health Promotion Sciences (HPS), will lead a Quality Improvement (QI) Team composed of HPS Maternal and Child Health concentration (MCH) faculty and students, UPH Department of Pediatrics personnel and UPH Health Plans personnel to perform a provider system community assessment and collaborate with the QI Team to develop a proposal for improving quality of preventive care in the population of UFC members age 0-6.  Ms. McClelland will be responsible for convening the QI Team, instrument and database development, oversight of MCH students assisting in the best practices review, conducting key informant interviews, reporting on findings, and facilitating recommendations. 

This evaluation contract is now in its 3rd and final year in 2012.  The Center for Well- Beings goal is to provide behavioral health providers with a more comprehensive view of refugee mental health issues, and identify trends within cultural groups and genders. This information will be used to revise assessment tools used to screen refugees and inform referral protocols. Core activities include, but are not limited to the following: 1. Baseline Assessment: Compile baseline information regarding the types and prevalence of mental health issues presented by various refugee groups, including Iraqi, Burmese, Bhutanese, Somali and Burundians. This will be accomplished by creating a questionnaire and surveying service providers. 2. Focus Groups: The compiled baseline information will be augmented by gathering information on the cultural perspectives of refugee groups about the causes of mental health issues and their appropriate treatment. Refugee perspectives will be ascertained by holding small focus groups and interviewing the In-Home Well-Being Promoters. 3. Impact Measurement: Develop a pre- and post-test model to determine Refugee Well Being Project participants knowledge of key concepts and information delivered through in-home instruction; Develop a survey to determine Well-Being Project participants confidence regarding advocacy for themselves and others.

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.

Preventing youths' high-risk sexual behaviors represent some of the most difficult and important challenges for social and behavioral scientists. Adolescent sexual risk-taking behaviors are major causes of premature death and disability in the US as well as lead to unplanned pregnancies. Despite evidence suggesting differing patterns of sexual behaviors between and within ethnic groups, the role of socio-cultural factors within comprehensive theory-guided models of the determinants of high-risk sexual behaviors have been relatively untested. This study will identify factors contributing to youths' high-risk sexual behaviors and their disparities. The objectives involve testing a causal model of sexual behaviors guided by the theory of triadic influence, a model well-tested in predicting other adolescent risk behaviors that specifies the operation of key proximal factors as well as more distal factors. Proximal factors will include self-efficacy, attitudes, and social norms. Distal factors include global positive expectancies, depressive symptoms, parental relatedness, and academic orientation. Finally, potentially vital socio-cultural influences will be tested as ultimate (most distal) factors in the model. Global expectancies and cultural orientation in Latinos are two important factors of emphasis in the model that are understudied within comprehensive models of adolescents' sexual behaviors. The objectives will be accomplished through secondary analyses of Add Health data (National Longitudinal Study of Adolescent Health) collected from 1994-2002. Behavioral outcomes of focus at follow-ups include reported early intercourse, unprotected sexual intercourse, and number of sexual partners. Additionally, reported unintended pregnancies, reported STDs, and positive tests on STD assays at Wave III will be included to validate the behavioral reports and to provide further testing of the model's predictive efficacy. By clarifying the causal paths leading to these behaviors and identifying which specific protective or risk factors are most critical for adolescent groups where disparities are apparent, the proposed project may aid in the development of more effective sexual-risk reduction programs designed for diverse adolescent populations. By clarifying such factors like cultural orientation within such a theoretical model, this study will assist preventive programs in their efforts to address the most critical sexual risk-taking deterrence factors for diverse adolescent groups. The project was completed January 31, 2011. The project report was provided to the funder, National Institutes of Health, on April 1, 2011.

This grant provides funds for some rural health research and evaluation activities. The following were conducted in 2012 and some are continuing into 2013.Each activitie is identified as research, service, or training. RESEARCH: Conducted an Investigation of Rural Women's Health Literacy Levels and Preferred Sources of Health Information - IRB approval was secured early in 2012, data was collected from 350 subjects between February and May 2012, data analysis was conducted from August to December 2012, and data analysis is still ongoing. RESEARCH: Evaluation of the impact of the MEZCOP Arizona Rural Health Professions Program's rurally-based week-long, intensive service-learning courses on public health graduate students subsequent career plans and choices related to rural practice. Planning of this research project began in November 2012, and the IRB application will be submitted by the end of February 2013. The project will survey all MEZCOPH current students and alumni who have participated in any of the rural or underserved area Service-Learning Institutes since they began in 2008. The purpose of the survey will be to determine if the goal of the Rural Health Professions Program - to increase the numbers of public health students who practice in rural and underserved communities in the state of Arizona - is being achieved. SERVICE: Conducted two Community Conversations on Health Care - one in Marana and one in Ajo - to collect community health needs assessment data, and document the findings through a report for each event provided to the community and published on the Center for Rural Health Website. This research project will continue throughout 2013. SERVICE: Performed additional collection, analysis, and publication on the Center for Rural Health Website of existing health-related data resources for the border counties of Cochise, Santa Cruz and Yuma in the in the "Arizona Border Region Data Resources and Virtual Library." This project will continue throughout 2013. SERVICE: Planned and conducted a community needs assessment project for Mohave County Health Department and Kingman Regional Medical Center in Kingmam, Lak Havasu, and Bullhead City. Reports documenting findings were prepared for each site and delivered to the Mohave County Health Department. Project is still ongoing. TRAINING: Provided Community Health Needs Assessment skills training to selected staff of the Mohave and Navajo County Health Departments. Training for others is planned for 2013.