Hispanic Health

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 project will help to explain the types of stress that may cause health problems among adults in a low-income, predominantly Mexican-origin border community. Guided by a community-based participatory research, this project explores how stress is defined and how community members respond to stress. The findings will inform strategies to lower stress and promote Latinos’ health. This project is receiving federal funding. 

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.

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. 

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

This research will establish prevalence data of nonalcoholic fatty liver disease (NAFLD) and the frequency of a specific indicator of genetic risk, the PNPLA3 allele, in Tucson, AZ. This project will accomplish this by assessing relationships between the PNPLA3 genotype, liver fat, and dietary behaviors in Mexican-origin adults, and evaluating the knowledge, attitudes, and beliefs of NAFLD risk, including genetic risk, held by Mexican-origin men and women. This project is funded by the American Cancer Society through its Institutional Cancer Research Center Grant. 

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. 

Saludable is a prevention intervention tackling the linkages of toxic stress and pediatric obesity in Latino youth populations. The Saludable curriculum focuses on three domains of health and well-being: (1) nutrition, (2) physical activity, and (3) mindfulness based stress reduction. The intervention is being delivered at community sites in both rural and urban contexts across Pima and Maricopa Counties.

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

The objective of this pilot study was to assess the feasibility and acceptability of a randomized, controlled beverage intervention in 50 obese Hispanic adults ages 18–64 over 8-weeks. Eligible participants were classified as obese, between the ages 18–64, self-identified as Hispanic, and were able to speak, read, and write in either English and/or Spanish. Study recruitment was completed August 2017. Upon the completion of baseline assessments, participants were randomized to either Mediterranean lemonade, Green Tea, or flavored water control. After completing a 2-week washout period, participants were asked to consume 32 oz. per day of study beverage for 6-weeks while avoiding all other sources of tea, lemonade, citrus, juice, and other sweetened beverages. Water was permissible. Primary outcomes were recruitment, retention, and acceptability of the intervention strategies. Our study also evaluated participant-reported tolerance and as an exploratory aim, assessed safety/toxicity-related to renal and/or liver function. Fasting blood samples were collected at baseline and 8-week intervals to assess the primary efficacy outcomes: total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Secondary outcomes include fasting glucose, hemoglobin A1c (HbA1c), and high-sensitivity C-reactive protein (hs-CRP). This project was sponsored by the University of Arizona Foundation Diabetes Development Fund.   

The NIH funded research focuses on the prevention of cardiovascular disease (CVD) and its complications among adults with diabetes in Northern Mexico. We are conducting a cluster-randomized trial among adult patients with diabetes recruited from 20 Secretaría de Salud (Secretary of Health)-operated health centers in Sonora. Ten of these health centers randomized to the intervention. Existing community health workers at the ten health centers randomized to the intervention trained on the adapted CVD prevention curriculum. To evaluate the intervention, psychosocial (e.g., knowledge, attitudes, and beliefs) and behavioral (e.g., smoking, healthy eating) risk factors for cardiovascular disease will be assessed at baseline, 3 months after, and at a 12 month follow up. Clinical risk factors (i.e., BMI, blood pressure, lipids, blood sugar) are collected at the health centers for these same time periods. Changes in the intervention clinic will be compared to changes over the same time among adult patients with diabetes in each of ten health centers randomized to the control condition, the usual standard of care.

While inhaled corticosteroids (ICS) are recommended for children with asthma, our experience suggests that Hispanic patients, particularly those of Mexican-origin, may be less responsive to ICS than non-Hispanic whites. To investigate this question, we used data from three Childhood Asthma Research and Education Network (CARE) multi-center trials that used ICS as a primary intervention, enrolled pre-school children with asthma-like symptoms, particularly severe wheeze, and whose Hispanic population was predominately of Mexican-origin. We harmonized data from three clinical trials by using the original data to construct comparable variables across the 3 studies. Data were available from 332 non-Hispanic white and 136 Hispanic white children. Our primary outcome variable, obtained from study diaries, was the fraction of asthma episode days.  The results of this analysis will help inform the treatment of pre-school children with asthma-like symptoms. This project was sponsored by the University of Arizona Health Sciences Health Data and Analytics Program. 

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. 

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. 

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.

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. 

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  

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.  

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

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.

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

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

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

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

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

The Arizona Cancer Center in collaboration with other institutions has been awarded an NCI-Avon grant which will assess whether changing social and cultural factors influence clinical, histological, and molecular patterns of breast cancer in women of Mexican descent.  Maria Elena Martinez was a contributor on this project but has since left the University of Arizona.

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

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