Health Promotion

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

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 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).

Patient navigation programs can serve as a key approach to achieving the triple aim in cancer care by improving patient experience, improving population health, and reducing health care costs. The goal of this project is to develop a model which can be used by various cancer centers to predict costs and outcomes involved in implementing and managing a patient navigation program. Model variables will be derived from literature review and various scenarios will be built into the model for screening, diagnosis, survivorship, and end of life care. Outcome projections from the model can be used to develop a business case for implementing patient navigation programs. Dr. Prashanthinie Mohan is also a collaborator on this project. 

Abstract not available. 

The overarching aim of this study was to determine if the Nurtured Heart Approach® (NHA) can reduce the symptoms of inattentiveness, hyperactivity, and impulsivity, which are associated with attention deficit/hyperactivity disorder (AD/HD), among children ages six to eight years old. NHA is a six-week, online, behavioral intervention that trains parents on its three primary principles including: (1) completely refusing to engage in negativity, by moving toward the elimination of strong reactions such as reprimands, yelling, and hitting, (2) persistently creating and emphasizing positivity and success, and (3) being absolutely clear when using consequences and setting limits. We randomly assigned 104 parents to either the immediate or delayed NHA intervention. Data were collected and analyzed using surveys from parents at three time points. We expected NHA parent training would be associated with (1) reductions in their child’s AD/HD behaviors, (2) reductions in parental stress, and (3) improvements in parents’ sense of competency. Parents reported significantly improved AD/HD symptoms in their children as well as lower parental stress; however, improvements in parents’ sense of competency were not detected. Collaborators: Richard J. Wahl, MD Betsy C. Wertheim, MS Study Related Links: Study Infographic Study listing on ClincialTrials.gov Published study protocol U of A Alumni article

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. 

Female smokers often face unique barriers to quitting smoking. The purpose of this study is to examine how menstrual cycle/ female sex hormones may play a role in smoking outcomes. The study tests the feasibility of a menstrual-cycle timed smoking cessation program for female smokers between 18-40 years of age. Treatment consists of a six-week telephone-based behavioral counseling program along with provision of nicotine replacement therapy. Primary outcomes include determining acceptability and feasibility of the study by assessing the recruitment and retention rate and overall participant study satisfaction. Quit smoking outcomes are measured at end of the program and at 3 month follow-up. Dr. Alicia M. Allen from the Department of Family and Community Medicine is the Co-PI on this project with Dr. Nair. 

The goal of this study is to learn about how work-demands and sleep affect mood and lifestyle choices. More specifically, we are interested in understanding how pre-shift sleep and the 911 calls received effect daily emotions, activity patterns, and caffeine intake. Information from this study may be used to develop wellness programs for 911 telecommunicators. Collaborators on this project include Graciela Silva from the College of Nursing and W.D. Scott Killgore from the College of Medicine.

The purpose of this grant was to advance understanding of the chronic burden of foodborne illness, help the Food and Drug Administration (FDA) better estimate the true overall burden of foodborne illness, and act appropriately on food safety priorities. The main objectives were (1) to develop a questionnaire for use with healthcare providers to estimate incidence, duration and severity of post-infectious functional bowel disorders and reactive arthropathies in patients with evidence of prior infection with foodborne pathogens and (2) evaluate the available literature and secondary data sources to better characterize and quantify the association between specific acute foodborne infections and chronic sequelae, including functional bowel disorders and reactive joint diseases (arthropathies). This grant was supported by the FDA.  Other faculty/staff/students: Alexandra Armstrong, PhD, and McKenzie Schaefer, undergraduate student.

This randomized controlled trial test was performed in collaboration with a statewide Medicaid health plan, building on a 10-year community partnership.  It tested the effectiveness of community health worker intervention that targets preventive services utilization among newly enrolled reproductive age women health plan members. To test this, community health care workers will be trained in a personal health education program and then asked to deliver the program information to female patients recently enrolled in Medicaid.This project was funded by the Patient-Centered Outcomes Research Institute. More information about this project can be found here.

The overall goal of this UAHS CDA is to receive mentoring and complete extensive training in precision prevention (population genetics, population health and metabolomics) to reduce cancer health disparities in Hispanic males, particularly Mexican Americans (MA).

This project will challenge current research paradigms for Hispanic males by testing a gender– and culturally–sensitive weight loss intervention and providing highly impactful formative research on recruitment strategies and desire to use novel mHealth self–monitoring technologies to facilitate dietary/physical activity behavior changes. Support for this project comes from the University of Arizona Foundation and the Dean's Canyon Ranch Center for Prevention and Health Promotion Fund. 

H3HRH00032 Barraza (PI) 06/01/2016 – 05/31/2019 HRSA Small Rural Hospital Improvement Program (AzSHIP) supports quality and performance improvement in 14 critical access hospitals (CAHs). Find more information at: AzSHIP.

 1NAVCA150222-01- 00 Derksen (PI) 09/02/15- 09/12/18 DHHS, CMS/CCIIO Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Marketplaces  Find more information at: AzCRH Navigator Consortium.

H54RH00030 Derksen (PI) 09/01/2015 – 08/31/2019 Health Resources & Services Administration (HRSA). Medicare Rural Hospital Flexibility Program (AzFlex) - supports quality, operational and performance improvement in Arizona’s 14 critical access hospitals (CAHs) and their 17 affiliated Rural Health Clinics. Find more information at: AzFlex.

Under this agreement, ASHLine will provide a tobacco cessation program. Services for Phoenix Children's Hospital include: Service Initiation and Enrollment Behavior Change Coaching Program Medication Support Follow-up Reporting The program period is defined as 90 days starting from the date of program enrollment when the employee completes an initial survey with an ASHLine enrollment specialist. Achievement of the program goal is defined as 6 completed coaching sessions during the 90 day program period. Employees may engage in additional coaching sessions beyond the set goal (six sessions) during the program period as needed.

Under this agreement, ASHLine will provide a tobacco cessation program. Services for lnsteel employees include: Service Initiation and Enrollment Behavior Change Coaching Program Medication Support Follow-up Reporting The program period is defined as 90 days starting from the date of program enrollment when the employee completes an initial survey with an ASHLine enrollment specialist. Achievement of the program goal is defined as 6 completed coaching sessions during the 90 day program period. Employees may engage in additional coaching sessions beyond the set goal (six sessions) during the program period as needed.

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

ASHline coaches for up to 30 enrollees from Southwest Diagnostic for tobacco cessation services for the 90 day program. The purpose of the Outreach Counselor, Sr for SW Diagnostic is to provide telephone-based tobacco cessation coaching to a caseload of SW Diagnostic clients to help support tobacco users to work through the quitting process while utilizing a client-directed treatment philosophy emphasizes client direction and autonomy through a personalized quit. Additionally, The Outreach Counselor, Sr position will work as part of a team of tobacco cessation coaches to develop quality coaching programs using most up-to-date, evidence-based, best practices and keep accurate records of services through collection of data and continuous quality assurance protocols for SW Diagnostic clients. The Outreach Counselor, Sr., will also provide documentation on all services and provide general information to all other calls. The Outreach Counselor Sr, is also available to provide engagement services that include explaining more detail about the coaching and medication services offered through ASHLine, preparing SW Diagnostic enrollees (clients) about the coaching experience and initiates the quit plan. The Outreach Counselor, Sr., must provide an engaging and friendly response to all calls and be attuned to real time customer feedback for SW Diagnostic clients.

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. 

Under this agreement, ASHLine will provide a tobacco cessation program with 24/7 live answer. Services for WebPT’s employees include: Service Initiation and Enrollment Behavior Change Coaching Program Medication Support Follow-Up On-site Engagement Reporting Completion of the quit program is defined as the completion of 6 coaching sessions, which must be completed during the 90 day program period. The program period is defined as 90 days starting from the date of program enrollment completion when the employee completes an initial survey with an ASHLine enrollment specialist. Employees may complete additional coaching sessions beyond the set goal (six sessions) during the program enrollment period as needed.

The Mountain West Preparedness and Emergency Response Learning Center (MWPERLC) has worked with state, local, and tribal communities for over seven years developing emergency preparedness training.  MWPERLC proposes to build upon this experience through implementation of a three-phase nationwide program for whole community inclusive emergency planning.  Phase I will support integration of community-engaged partnerships (CEPs) in emergency management.  Online modules and regional workshops will provide skills and tools to establish, integrate, and mobilize CEPs throughout the emergency management cycle.  A series of five modules will instruct participants on the concepts and practice of organizational planning including: 1) strategies for including members of the greater community (e.g., faith-based organization, educators, business partners, service organizations, etc.) in emergency planning; 2) networking within communities to establish linkages; 3) recognizing community diversity, risks, capabilities and needs; 4) utilizing and adapting the Hazard Vulnerability Assessment (HVA)/Threat Hazard Identification Risk Assessment (THIRA) to build local capacity; and 5) integrating these partners in planning activities to promote improved disaster response and recovery operations.  During Phase II, Emergency Managers will be provided with a roadmap to engage CEPs.  The objective for this phase will be to share existing plans and begin developing and/or enhancing local CEP plans to complement the jurisdiction’s existing HVA/THIRA.  MWPERLC will facilitate this planning process through strategic guidance, webinars, and trainings aimed at the development of community-based response and recovery plans.  This approach to emergency management will incorporate the Whole Community Principles outlined in the FEMA DOC 104-008-1.  Phase III will evaluate the effectiveness of the local CEP Plans through Homeland Security Exercise and Evaluation Program (HSEEP) compliant tabletop exercises (TTXs).  MWPERLC will develop a series of TTXs, adaptable to local jurisdictions.  CEP participation in the exercise will complete the emergency management cycle, allowing for evaluation and refinement of their plans.  

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. 

Located in the Mel and Enid Zuckerman College of Public Health at the University of Arizona and funded by the state tax on tobacco products, The Arizona Smokers’ Helpline (ASHLine) is one of over 50 quitlines across the United States. Established in 1995, it is also one of the oldest and most seasoned quit lines in existence.  As a member of the North American Quitline Consortium, ASHLine is actively engaged in collaborations, research, evaluation and quality improvement to assure all Arizonans have access to high quality, evidence-based tobacco cessation services and support. Nationally, quit rates reported among North American quit lines vary, averaging around 30%.  The Arizona Smokers’ Helpline (ASHLine) has been helping people quit tobacco since its inception in 1995. We are a comprehensive quitline, offering free telephone (both reactive and proactive) and web-based quit services and four to twelve weeks Nicotine Replacement Therapy (NRT). In addition, we have fax and electronic provider referral program and provide free training and technical assistance to healthcare providers and community partners statewide. The Arizona Smokers’ Helpline (ASHLine) is a service entity well-positioned to contribute to ongoing tobacco control efforts by providing effective, evidence-based support to individuals in their effort to end tobacco use.

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  

Ryan Seltzer was a contributor on this project but has since left the University of Arizona.

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.  

Despite dramatic improvements, malaria remains a significant health problem in many regions of the world. As malaria programs move from control to elimination, there is an urgent need to understand barriers to and facilitators of the use of control measures. In this proposal, we focus on the most widely used control measure; bednets in a highland/low transmission and a lowland/high transmission. Our preliminary results indicate that in Kenya roughly 1 in 4 children under 5, the group most vulnerable to malaria, live in households that do not own a bednet. Additionally, even in net owning homes, 1 in 6 children under 5, do not sleep under a net. As Kenya and other programs expand their scope to distribute enough nets to cover all household members, much effort needs to go into understanding the prevalence of and factors related to disuse. The objective of the following proposal is to use qualitative and quantitative methods to determine the prevalence of ownership, misuse and disuse of bednets under field conditions and to identify modifiable risk factors. We will use an ecological approach to assess not only individual level factors that drive bednet ownership and use but the social and environmental context in which these decisions are being made. Following focus group discussions with community members and key informant interviews with health clinic staff, government vector control staff and village and community leaders, we will conduct a cross-sectional survey that examines 1) perceived susceptibility to malaria 2) perceived severity of malaria 3) perceived benefits of ITN use 4) perceived barriers to ITN use 5) cues to action such as health promotion programs and 6) confidence in the subject’s self-efficacy with regard to obtaining an ITN and its proper use. We will use remotely-sensed images and GIS to determine how these perceptions and practices vary geographically and if they correspond with actual risk as determined through parallel parasite prevalence surveys and pyrethrum spray catches of Anopheles. From the cross-sectional participants we will identify positive deviants, community members who own and use bednets regularly despite experiencing at least 75% of the factors associated with not owning or using a bednet. In-depth interviews will be conducted to determine their solutions and personal motivators that may be used to improve community bednet ownership and compliance. Our approach is unique in its combination of rich qualitative data and the rigor and generalizability of established epidemiologic methods. Identifying what is already working in a community is more likely to be successfully implemented as a larger intervention. We expect that we will find that individuals who have personal loss due to malaria, have identified solutions to logistical issues with hanging bednets, have a higher perception of risk and who have greater access to household resources will be more likely to own and use a bednet. This research will help drive the development of targeted community-based interventions that should improve ITN ownership and use and ultimately reduce malaria transmission. Service: Worked with community to identify strategy to disseminate bednets that would provide equitable coverage for the area.

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.

Collaborative Center with NAU and Dine College supporting 2 research projects, a community outreach component and education/training activities with Native communities and students. Advisory boards represent Indian Health Service, American Indian senior researchers at 5 different universities (nationally) and Arizona based tribal health departments.

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.   

The goal of this project was to respond to the data request regarding healthcare workforce information. Research for this project was conducted through survey design and implementation, data cleaning/scrubbing, data manipulation, statistical analysis, data reporting. This project trained public health graduate students in health care workforce analysis. This project received 90% FTE from July 2012 to June 2013. Joe Tabor was a contributor on this project but has since left the University of Arizona.

Maia Ingram provided evaluation expertise to Mariposa Community Health Center for a USDA Community Food Grant designed to improve the sustainable food system in Santa Cruz County. Activities included community food mapping and photovoice.

This project was to provide training, technical support and evaluation of a new curriculum developed by CDC focusing on hypertension and stroke.  We provided training to two community based organizations--Regional Center for Border Health and Sunset Community Health Center and produced an evaluation of the curriculum.   The research portion is the evaluation piece, the training portion is the training of the promotoras in the curriculum and the service portion is the technical assistance provided to all of the partners

Honoring Your Gift is a pilot collaboration between the University of Arizona Mel and Enid Zuckerman College of Public Health, Freedoms Gate Ministries, and Ministerios Getsemani.  The project offers a program of health promotion strategies targeting specific modifiable risk factors for heart disease in multiethnic southwest Tucson. Freedoms Gate Ministries and Ministerios Getsemani will provide the supportive environment for the intervention.  This church-based intervention addresses the common heart risk factors shared by residents of this community across ethnic groups: physical inactivity, poor nutrition, diabetes, and high blood pressure.  Residents of this community will be recruited into the program, regardless of their church or religious affiliations.  Family participation will be encouraged. African American, American Indian, and Latino American ethnic groups are experiencing increasing incidence and prevalence of heart disease. Honoring Your Gift will center on the risk factors of heart disease, which is the number one cause of death for all population groups in the United States. The program, Honoring Your Gift, teaches the value of taking care of ones body and preventing heart disease through a twelve week intervention for changing eating behavior,  increasing physical activity and managing stress through health instruction, demonstrations and applications of food preparation, walking and dance, prayer and meditation. Program aims are: To conduct a baseline assessment designed to describe the health indices and health behaviors related to modifiable risk factors for heart disease among multi-ethnic study participants in a southwest Tucson church-based program. To assist program participants in achieving healthful modifications in behaviors that are associated with heart health through a culturally relevant church-based To explore changes in health indices such as blood pressure, cholesterol, blood sugar, and health behaviors (diet, physical activity, and stress management) among the Honoring Your Gift program participants.

Service:   This project has developed a curriculum for community based prevention focusing on nutrition and physical activity  with young families which was implemented in Pima County and in Douglas with Head Start Programs, Family Literacy Programs. We have now finalized the curriclum and it will be posted on the AzPRC web site and the Canyon Ranch Center for Prevention and Health Promotion web site for community organizations to utilize.

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.  

Limonene is a major component in the essential oils of citrus fruits. It has demonstrated promising breast cancer preventive and therapeutic effects in preclinical model systems. This goal of this study is to evaluate the distribution of limonene to the breast tissue and its associated biological activities after 2 to 6 weeks of limonene dosing in women with a recent diagnosis of breast carcinoma in situ or atypical ductal hyperplasia scheduled to undergo definitive surgery by conducting an early phase clinical trial. This study will help evaluate the potentials of developing limonene as a breast cancer preventive agent. The long-term goals are to conduct long-term intervention trials to determine the breast cancer preventive activity of d-limonene and to conduct translational clinical research in understanding the effect of d-limonene on arresting/inhibiting/reversing the breast cancer carcinogenesis process. This project was funded by the National Institutes of Health.

The study started in 1993 to evaluate health outcomes in aging postmenopausal women and to identify factors associated with healthy aging. Between 1993 and 1998, more than 161,000 women between 50 and 79 years of age joined the WHI. Beginning in October 2004, participants were consented for sequential 5-year WHI Extension Studies (ES). The research team continues to collect self-reported as well as medical record adjudicated health and mortality data. A team of junior investigators are engaged with data analysis in an effort to advance the dissemination of WHI research findings. Arizona research team members have published over 45 manuscripts in the past 8 years using this well-characterized and robust phenotypic information.

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.

This project was an evaluation subcontract for part of a $16 million CDC-funded cooperative agreement awarded to Pima County Health Dept. to focus on policy and environmental strategies to prevent obesity. Evaluation teams included the following roles: Co-PI, Sr. Research Specialist, Sr. Program Coordinator, Research Specialist, 2 GRAs, and data input specialist. Maia Ingram served as the Co-PI for this subcontract, and co-lead team in primary and secondary data collection activities. She also served as Youth Risk Behavior Survey Coordinator for the project. This project successfully obtained weighted YRBS data for Pima County by surveying over 1300 students in 21 high schools. 

This program focused on texting intervention among youth in middle-schools of Tucson. Focus groups consisted of teens. Prior to enrollment of students, all students had completed Project Students Are Sun Safe (Project SASS), a community service from the College of Public Health to schools. 

This project conducted with the support of an MCH training grant fellow. The project abstract is not available. 

Abstract not available. 

The Canyon Ranch Center for Prevention and Health Promotion (CRCPHP) is dedicated to helping people achieve and maintain healthy lives by providing a variety of opportunities that facilitate and support growth in all aspects of health and well-being: physical, social, mental, spiritual, environmental, and emotional. The CRCPHP fosters the collaboration of academic, community and public health stakeholders by using research, education, advocacy, awareness, and service delivery to improve the health and well-being of the Tucson community by facilitating the practical application of strategies that can assist individuals, communities, and societies in adopting and maintaining healthy lifestyles. The Center houses diverse projects and activities that have been guided by community-based participatory action research to focus on the prevention of chronic disease in the border region. Each project within the Center relies on extensive community involvement and outreach. The Center houses the Arizona Prevention Research Center, which is funded by the CDC's Prevention Research Center (PRC) Program. The PRC Program is comprised of 37 academic institutions and is an interdependent network of community, academic, and public health partners that conduct prevention research and promote practices proven to promote good health.

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.