Acceptability and appropriateness of a novel parent-staff co-leadership model for childhood obesity prevention in Head Start: a qualitative interview study

Background

Peer leadership can be an effective strategy for implementing health programs, benefiting both program participants and peer leaders. To realize such benefits, the peer leader role must be appropriate for the community context. Also, peer leaders must find their role acceptable (i.e., satisfactory) to ensure their successful recruitment and retention. To date, parent peer leaders have seldom been part of early childhood obesity prevention efforts. Moreover, parents at Head Start preschools have rarely been engaged as peer leaders. The aim of this study is to evaluate the appropriateness and acceptability of an innovative model for engaging parents as peer leaders for this novel content area (early childhood obesity prevention) and setting (Head Start).

Methods

Parents Connect for Healthy Living (PConnect) is a 10-session parent program being implemented in Head Start preschools as part of the Communities for Healthy Living early childhood obesity prevention trial. PConnect is co-led by a parent peer facilitator who is paired with a Head Start staff facilitator. In the spring of 2019, 10 PConnect facilitators participated in a semi-structured interview about their experience. Interview transcripts were analyzed by two coders using an inductive-deductive hybrid analysis. Themes were identified and member-checked with two interviewees.

Results

Themes identified applied equally to parent and staff facilitators. Acceptability was high because PConnect facilitators were able to learn and teach, establish meaningful relationships, and positively impact the parents participating in their groups, although facilitators did express frustration when low attendance limited their reach. Appropriateness was also high, as PConnect provided adequate structure and support without being overly rigid, and facilitators were able to overcome most challenges they encountered.

Conclusions

The PConnect co-facilitation model was highly acceptable and appropriate for both the parent facilitators (peer leaders) and the staff facilitators. Including parents as peer leaders aligns to Head Start’s emphasis on parent engagement, making it a strong candidate for sustained implementation in Head Start. The insights gained about the drivers of peer leadership appropriateness and acceptability in this particular context may be used to inform the design and implementation of peer-led health programs elsewhere.

Trial registration

clinicaltrials.gov, NCT03334669 (7–11-17).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10159-3.

Communities for Healthy Living (CHL) A Community-based Intervention to Prevent Obesity in Low-Income Preschool Children: Process Evaluation Protocol

BACKGROUND

Process evaluation can illuminate barriers and facilitators to intervention implementation as well as the drivers of intervention outcomes. However, few obesity intervention studies have documented process evaluation methods and results. Community-based participatory research (CBPR) requires that process evaluation methods be developed to (a) prioritize community members' power to adapt the program to local needs over strict adherence to intervention protocols, (b) share process evaluation data with implementers to maximize benefit to participants, and (c) ensure partner organizations are not overburdened. Co-designed with low-income parents using CBPR, Communities for Healthy Living (CHL) is a family-centered intervention implemented within Head Start to prevent childhood obesity and promote family well-being. We are currently undertaking a randomized controlled trial to test the effectiveness of CHL in 23 Head Start centers in the greater Boston area. In this protocol paper, we outline an embedded process evaluation designed to monitor intervention adherence and adaptation, support ongoing quality improvement, and examine contextual factors that may moderate intervention implementation and/or effectiveness.

METHODS

This mixed methods process evaluation was developed using the Pérez et al. framework for evaluating adaptive interventions and is reported following guidelines outlined by Grant et al. Trained research assistants will conduct structured observations of intervention sessions. Intervention facilitators and recipients, along with Head Start staff, will complete surveys and semi-structured interviews. De-identified data for all eligible children and families will be extracted from Head Start administrative records. Qualitative data will be analyzed thematically. Quantitative and qualitative data will be integrated using triangulation methods to assess intervention adherence, monitor adaptations, and identify moderators of intervention implementation and effectiveness.

DISCUSSION

A diverse set of quantitative and qualitative data sources are employed to fully characterize CHL implementation. Simultaneously, CHL's process evaluation will provide a case study on strategies to address the challenges of process evaluation for CBPR interventions. Results from this process evaluation will help to explain variation in intervention implementation and outcomes across Head Start programs, support CHL sustainability and future scale-up, and provide guidance for future complex interventions developed using CBPR.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03334669 . Registered on October 10, 2017.

Co-designing obesity prevention interventions together with children: intervention mapping meets youth-led participatory action research

BACKGROUND

Youth-led Participatory Action Research (YPAR) involves children throughout the process of developing and implementing interventions. Combining YPAR with a structural approach for designing and planning interventions, such as Intervention Mapping (IM), may further improve implementation and effectiveness of interventions. This paper describes how YPAR and IM were combined in the Kids in Action study.

METHODS

The Kids in Action study aims to improve health behaviors of 9-12-year old children living in a low socioeconomic neighborhood in Amsterdam, by co-designing interventions with these children. At each of four schools 6-8 children (N = 18-24 total per year) and two academic researchers formed participatory groups that met weekly or every fortnight during two school years. An IM expert panel advised the participatory groups on the application of IM.

RESULTS

Following the IM protocol, we conducted a participatory needs assessment with children, parents and professionals, in IM-step 1. In IM-step 2, the IM expert panel constructed matrices of program objectives, and the children provided feedback. In collaboration with children programs were designed and produced using an iterative process during IM-steps 3-4. In IM-step 5, the participatory groups and professional community partners designed the implementation plan. Finally, in IM-step 6, the protocol of the process and effect evaluation - executed by academic researchers with input from children - was developed.

CONCLUSIONS

By combining YPAR and IM, several interventions have been developed and implemented, varying from a school water policy to extracurricular sports activities. Sharing responsibility with children was challenging when combining IM with YPAR. In YPAR children are given as much autonomy as possible, while traditional IM development work is primarily done by academic researchers. Strengths in combining IM and YPAR include the involvement of the end-users - children - throughout the process while at the same time developing interventions based on existing evidence. Time-management, a multidisciplinary team, and flexibility are important conditions when combining IM with YPAR. A strong community project group, with professionals who were willing to help children develop and execute their ideas, was an important success factor. This study can serve as an example to other YPAR studies developing interventions using the IM protocol.

Communities for healthy living (CHL) - A family-centered childhood obesity prevention program integrated into Head Start services: Study protocol for a pragmatic cluster randomized trial

BACKGROUND

Childhood obesity is highly prevalent and carries substantial health consequences. Childhood obesity interventions have had mixed results, which may be partially explained by the absence of theory that incorporates broader family context and methods that address implementation challenges in low-resource settings. Communities for Healthy Living (CHL) is an obesity prevention program for Head Start preschools designed with careful focus on theory and implementation. This protocol paper outlines the design, content, implementation, and evaluation of CHL.

METHODS/DESIGN

CHL integrates a parenting program co-led by Head Start staff and parents, enhanced nutrition support, and a media campaign. CHL content and implementation are informed by the Family Ecological Model, Psychological Empowerment Theory, and Organizational Empowerment Theory. The intervention is directed by community-based participatory research and implementation science principles, such as co‑leadership with parents and staff, and implementation in a real world context. CHL is evaluated in a three-year pragmatic cluster-randomized trial with a stepped wedge design. The primary outcome is change in child Body Mass Index z-score. Secondary outcomes include children's weight-related behaviors (i.e., diet, physical activity, screen use, and sleep), parenting practices targeted at these behaviors (e.g., food parenting), and parent empowerment. The evaluation capitalizes on routine health data collected by Head Start (e.g., child height and weight, diet) coupled with parent surveys completed by subsamples of families.

DISCUSSION

CHL is an innovative childhood obesity prevention program grounded in theory and implementation science principles. If successful, CHL is positioned for sustained implementation and nationwide Head Start scale-up.

Sexual risk during initial months in US among Latina young adults

Latina young adults are disproportionately at risk for sexually transmitted infections (e.g., HIV). However, little is known about social and cultural factors contributing to sexual health disparities among young adult Latina recent immigrants. The present study examined social and cultural factors contributing to sexual risk behaviors among 530 Latina women (ages 18-23) who immigrated to Miami-Dade County, Florida, approximately 12 months before assessment. At the cultural/macrosystemic level, participants who reported more sexual risk behaviors tended to (a) be less acculturated; (b) use less positive religious coping; (c) endorse to a greater extent the marianismo belief that Latinas should be the pillar of the family; and (d) endorse less of the marianismo belief that Latinas should be virtuous and chaste (i.e., abstain from premarital sex). As for individual-level factors, participants who reported more sexual risk behaviors also indicated (e) older age, (f) being married/partnered, (g) being employed, (h) living in the US longer, and (i) drinking more alcohol. Findings indicate areas for HIV/STI prevention for this underserved population.

Cultural and quality-of-life considerations when administering corticosteroids as a therapeutic strategy for African American women living with systemic lupus erythematosus

OBJECTIVE

This study investigated the association among corticosteroids, emotional health, physical health, and work/regular activities of daily living in an ethnically diverse sample of women with systemic lupus erythematosus.

METHODS

A secondary analysis of data from the Medical University of South Carolina Lupus Database was conducted between confirmed cases of lupus (n = 224) and controls (n = 60). The sample comprised 57 Caucasian Americans, 141 Gullah African Americans (a subpopulation of African Americans from the Sea Islands of South Carolina and Georgia), and 86 non-Gullah African Americans.

RESULTS

Emotional health outcomes were better for women with systemic lupus erythematosus compared with controls. High emotional health scores may be influenced by cultural factors such as masking emotion, disease-coping mechanisms, religion, and strong familial and social support. Although a significant association was not detected between emotional health and work/regular activities of daily living, relationships were significant after adjusting for corticosteroid use.

CONCLUSION

These findings suggest corticosteroid use does influence the strength of the association between emotional health and work/regular activities of daily living.

Correlates of Resource Empowerment among Parents of Children with Overweight or Obesity

BACKGROUND

Few studies have examined correlates of resource empowerment among parents of children with overweight or obesity.

METHODS

We studied baseline data of 721 parent-child pairs participating in the Connect for Health randomized trial being conducted at six pediatric practices in Massachusetts. Parents completed the child weight management subscale (n = 5 items; 4-point response scale) of the Parent Resource Empowerment Scale; items were averaged to create a summary empowerment score. We used linear regression to examine the independent effects of child (age, sex, and race/ethnicity), parent/household characteristics (age, education, annual household income, BMI category, perceived stress, and their ratings of their healthcare quality), and neighborhood median household income, on parental resource empowerment.

RESULTS

Mean (SD) child age was 7.7 years (2.9) and mean (SD) BMI z-score was 1.9 (0.5); 34% of children were white, 32% black, 22% Hispanic, 5% Asian, and 6% multiracial/other. The mean parental empowerment score was 2.95 (SD = 0.56; range = 1-4). In adjusted models, parents of older children [β -0.03 (95% CI: -0.04, -0.01)], Hispanic children [-0.14 (-0.26, -0.03)], those with annual household income less than $20,000 [-0.16 (-0.29, -0.02)], those with BMI ≥30.0 kg/m² [-0.17 (-0.28, -0.07)], and those who reported receiving lower quality of obesity-related care [-0.05 (-0.07, -0.03)] felt less empowered about resources to support their child's healthy body weight.

CONCLUSIONS

Parental resource empowerment is influenced by parent and child characteristics as well as the quality of their obesity-related care. These findings could help inform equitable, family-centered approaches to improve parental resource empowerment.

Health Perceptions of Latinos With Intellectual Disabilities: The Results of a Qualitative Pilot Study

A pilot study among Latinos with intellectual disabilities (ID) was conducted. Focus groups and Photovoice methodology were employed to explore participants' health perceptions and beliefs. Three focus groups were conducted for a total of 15 participants. An additional member check focus group was conducted to verify results of the analysis. Photovoice methodology was employed with four Latinos with ID to explore health beliefs and perceptions of the influence of the social and physical environment. Participants' perceptions of health focused on social and mental aspects of health. Latinos with ID believed that social relationships are important to health. They believed in a connection among social, mental, and physical well-being and health. Cultural beliefs related to the role of God and traditional therapies were identified. Latinos with ID reported that they believed that health was influenced by behaviors and that diet and physical activity were beneficial, but this did not necessarily translate into regular practice.

Public Reporting of Hospital-Specific Breastfeeding Measures

BACKGROUND

Establishing breastfeeding in the first days of an infant's life is important for longer term success in breastfeeding. In 2009, New York State (NYS) was the second state to require maternity care facilities to collect infant feeding information and to publicly disseminate hospital-specific infant feeding statistics. Public reporting of these statistics as performance measures is a strategy to prompt hospitals to improve breastfeeding support.

OBJECTIVE

This qualitative study sought to explore how maternity care administrators and clinical staff responded to the mandate for publicly reported performance measures and whether they used this information to improve maternity care practices.

METHODS

This study used a stratified random sample of NYS hospitals with maternity care units. Participants were recruited by email and telephone calls. A total of 25 hospitals participated in the study, and 37 hospital administrators and staff completed in-depth interviews by telephone. The interviews were analyzed using an explanatory framework in NVivo 8.

RESULTS

Publicly reported hospital-specific breastfeeding measures increased attention to breastfeeding performance. Hospital administrators and staff reported comparing their relative rankings to other hospitals in the state. Some hospitals used publicly reported breastfeeding measures to monitor performance, whereas others were prompted to generate additional measures for more frequent monitoring. Hospitals with relatively low breastfeeding statistics took certain actions to improve their maternity care practices to support breastfeeding. Limitations of the usefulness of publicly reported measures were reported by interview participants.

CONCLUSION

Publicly reported, hospital-specific breastfeeding measures may prompt hospitals to monitor and improve maternity care practices related to supporting breastfeeding.

Developing Community Health Promotion Interventions: Selecting Partners and Fostering Collaboration

Although an often desired goal, true partnership between community members and university researchers can be difficult to achieve. Strategies implemented in a diabetes prevention and control program in a Latino community may be effective in overcoming hurdles to collaborative research. The development of selection criteria can be useful for objectively choosing a community organization as a partner agency. The implementation of formal partnership principles is proposed as a strategy for building a successful partnership. Partnership principles are a powerful mechanism to assure ethical relations between collaborators. As a strategy for process evaluation, they can help organize data on the extent to which intent has translated into action. They provide a structure for project stability that can outlast individual commitments and a mechanism to keep project commitment on course and maintain active engagement.

The empowerment of low-income parents engaged in a childhood obesity intervention

Parents influence children's obesity risk factors but are infrequently targeted for interventions. This study targeting low-income parents integrated a community-based participatory research approach with the Family Ecological Model and Empowerment Theory to develop a childhood obesity intervention. This article (1) examines pre- to postintervention changes in parents' empowerment; (2) determines the effects of intervention dose on empowerment, and (3) determines whether changes in parent empowerment mediate previous changes identified in food-, physical activity-, and screen-related parenting. The pre-post quasi-experimental design evaluation demonstrated positive changes in parent empowerment and empowerment predicted improvement in parenting practices. The integrated model applied in this study provides a means to enhance intervention relevance and guide translation to other childhood obesity and health disparities studies.

There Is More to Transparency than Meets the Eye: The Impact of Mandatory Disclosure Laws Aimed at Promoting Breastfeeding

Requiring hospitals to inform patients of clinical best practices and to disclose performance data are two common regulatory strategies for improving healthcare. Proponents of such mandatory disclosure laws--sometimes referred to as "targeted transparency "--argue that they increase patient awareness and thereby create reputational incentives for hospitals to improve their performance. Evaluation of targeted transparency typically focuses on patient responses to information and changes in hospital behavior based on reputational concerns. This standard account, however, overlooks other important ways targeted transparency can influence hospital performance. This article presents a case study of disclosure laws designed to promote breastfeeding to illustrate how targeted transparency can influence hospitals independently of its effects on patients' choice of provider or hospitals' fear of losing business. We found that mandatory disclosure laws emboldened state regulators to take a more aggressive approach to enforcement of hospital regulations, empowered nurse managers to advocate more effectively within hospitals for changes in hospital policies, and enabled nurse managers to implement verifiable performance goals for clinical staff under their supervision. These findings suggest that the study of mandatory disclosure more generally--in areas such as financial regulation, environmental protection, food labeling, and workplace safety--would benefit by analyzing not only its influence on public awareness and its reputational effects but also how regulators use transparency laws and how managers within regulated entities employ the information that the laws provide.

Social support may buffer the effect of intrafamilial stressors on preschool children's television viewing time in low-income families

BACKGROUND

Excessive television (TV) viewing in preschool children has been linked to negative outcomes during childhood, including childhood obesity. In a sample of low-income families, this study examined associations between intrafamilial factors and preschool children's TV-viewing time and the moderating effect of social support from nonfamily members on this association.

METHODS

In 2010, 129 mothers/female guardians of 2- to 5-year-old children enrolled at five Head Start centers in Rensselaer County, New York, completed a self-report survey. The survey assessed child TV-viewing time (including TV, DVDs, and videos) and intrafamilial risk factors, including maternal perceived stress, depressive symptoms, TV viewing, leisure-time physical activity (inactivity), and family functioning. Social support from nonfamily members (nonfamily social support) was also measured and examined as an effect modifier.

RESULTS

Children watched TV an average of 160 minutes per day. Moderate depressive symptoms (Personal Health Questionnaire depression scale scores ≥10), higher perceived stress, poorer family functioning, and higher maternal TV-viewing were significantly and independently associated with greater minutes of child TV viewing, controlling for covariates. In all instances, nonfamily social support moderated these associations, such that negative experiences within the family environment were linked with higher child TV-viewing time under conditions of low nonfamily social support, but not high nonfamily support.

CONCLUSIONS

Social support from nonfamily members may buffer potentially negative effects of intrafamilial factors on preschool children's TV-viewing time.

The family context of low-income parents who restrict child screen time

BACKGROUND

The American Academy of Pediatrics recommends that parents restrict child screen time to two hours per day, but many preschool-aged children exceed this viewing recommendation. Modifying children's viewing habits will require collaborating with parents, but little is known about the factors that influence parents' capacity for effective screen-related parenting. This study aimed to identify the demographic, family and community contextual factors associated with low-income parents' restriction of child screen time.

METHODS

Parents (N=146) of children (age 2-5 years) attending Head Start centers in the United States completed a self-report survey in 2010 assessing parent and child screen use (television, DVD, video, video games, and leisure-time computer use), parent restriction of child screen time, and family (parent stress, social support, and life pressures) and community (neighborhood safety and social capital) factors.

RESULTS

Children were more likely to meet the American Academy of Pediatrics screen time recommendation if their parent reported high restriction of child screen time. Parent and child demographic characteristics were not associated with parents' restriction of child screen time. In multivariate analysis, less parent screen time, fewer parent life pressures, and greater social support were associated with parents' high restriction of screen time.

CONCLUSION

Family contextual factors may play an important role in enabling low-income parents to restrict their children's screen time. When counseling low-income parents about the importance of restricting child screen time, practitioners should be sensitive to family contextual factors that may influence parents' capacity to implement this behavior change.

A childhood obesity intervention developed by families for families: results from a pilot study

BACKGROUND

Ineffective family interventions for the prevention of childhood obesity have, in part, been attributed to the challenges of reaching and engaging parents. With a particular focus on parent engagement, this study utilized community-based participatory research to develop and pilot test a family-centered intervention for low-income families with preschool-aged children enrolled in Head Start.

METHODS

During year 1 (2009-2010), parents played an active and equal role with the research team in planning and conducting a community assessment and using the results to design a family-centered childhood obesity intervention. During year 2 (2010-2011), parents played a leading role in implementing the intervention and worked with the research team to evaluate its results using a pre-post cohort design. Intervention components included: (1) revisions to letters sent home to families reporting child body mass index (BMI); (2) a communication campaign to raise parents' awareness of their child's weight status; (3) the integration of nutrition counseling into Head Start family engagement activities; and (4) a 6-week parent-led program to strengthen parents' communication skills, conflict resolution, resource-related empowerment for healthy lifestyles, social networks, and media literacy. A total of 423 children ages 2-5 years, from five Head Start centers in upstate New York, and their families were exposed to the intervention and 154 families participated in its evaluation. Child outcome measures included BMI z-score, accelerometer-assessed physical activity, and dietary intake assessed using 24-hour recall. Parent outcomes included food-, physical activity- and media-related parenting practices and attitudes.

RESULTS

Compared with pre intervention, children at post intervention exhibited significant improvements in their rate of obesity, light physical activity, daily TV viewing, and dietary intake (energy and macronutrient intake). Trends were observed for BMI z-score, sedentary activity and moderate activity. Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for children's physical activity. Dose effects were observed for most outcomes.

CONCLUSIONS

Empowering parents to play an equal role in intervention design and implementation is a promising approach to family-centered obesity prevention and merits further testing in a larger trial with a rigorous research design.

Evaluation of a childhood obesity awareness campaign targeting head start families: designed by parents for parents

The Communities for Healthy Living program used a community-based participatory research (CBPR) approach to empower Head Start parents in designing and pilot testing a multi-component family-centered obesity prevention program. One program component was a childhood obesity awareness campaign addressing common parental misconceptions about obesity. The campaign was designed by a community advisory board of parents to target specific issues identified within their own community. Results from pre-post intervention surveys (N=108) showed that campaign exposure was high; 92% of responding parents reported noticing the campaign. Parents also demonstrated significant increases in awareness of childhood obesity, along with decreases in obesity-related misconceptions. Findings, supported by growing literature on CBPR, suggest a CBPR approach to campaign development is an effective strategy to promote parent awareness of childhood obesity.

Family ecological predictors of physical activity parenting in low-income families

Physical activity (PA) parenting, or strategies parents use to promote PA in children, has been associated with increased PA in children of all ages, including preschool-aged children. However, little is known about the circumstances under which parents adopt such behaviors. This study examined family ecological factors associated with PA parenting. Low-income parents (N = 145) of preschool-aged children (aged 2 to 5 years) were recruited from five Head Start centers in upstate New York. Guided by the family ecological model (FEM), parents completed surveys assessing PA parenting and relevant family and community factors. Hierarchical regression analysis identified independent predictors of PA parenting. Parent depressive symptoms, life pressures that interfere with PA and perceived empowerment to access PA resources were associated with PA parenting. Community factors, including neighborhood play safety and social capital, were not independently associated with PA parenting in the multivariate model. Together, family ecological factors accounted for a large proportion of the variance in PA parenting (R (2) = .37). Findings highlight the need to look beyond cognitive predictors of PA parenting in low-income families and to examine the impact of their broader life circumstances including indicators of stress.

Social-cognitive predictors of low-income parents' restriction of screen time among preschool-aged children

Parents' rules regarding child television, DVD, video game, and computer use (screen time) have been associated with lower screen use in children. This study aimed to identify modifiable correlates of this behavior by examining social-cognitive predictors of parents' restriction of child screen time. Low-income parents (N = 147) of preschool-aged children (2-6 years) completed self-administered questionnaires examining parent and child screen time, parent restriction of screen time, self-efficacy to restrict screen time, and beliefs about screen time. Structural equation modeling results indicated that greater self-efficacy to restrict screen time (β = .29, p = .016) and greater perceived importance of restricting child screen use (β = .55, p < .001) were associated with greater restriction of child screen use, after controlling for parent screen time. Family-based interventions that consider broader attitudinal factors around child screen time may be necessary to engage parents in restricting screen use.

Mental health and family functioning as correlates of a sedentary lifestyle among low-income women with young children

The authors in this cross-sectional study examined mental health and family environmental factors related to a sedentary lifestyle, including lack of leisure-time physical activity and high levels of television viewing, among low-income mothers/female guardians of preschool-aged children. A self-administered questionnaire was completed by 131 mothers in 2010. Primary outcome measures included television viewing time (minutes/day) and leisure-time physical activity (<150 versus ≥150 minutes per week). Independent variables included depressive symptoms, perceived stress, and family functioning. Demographic factors (age, marriage, work status, education, number of children in the household, and race/ethnicity) were examined as potential covariates. Participating women watched television on average 186.1 minutes/day (i.e., >3 hours). Additionally, 36% of women engaged in less than the recommended 150-minute leisure-time physical activity per week. Hierarchical multiple regression analyses indicated that greater depressive symptoms (B = 76.4, p < 0.01) and lower family functioning (B = 33.0, p < 0.05) were independently related to greater television viewing when controlling for other variables. No independent factors were identified for lack of leisure-time physical activity when controlling for other covariates. Findings suggest that health promotion efforts to promote an active lifestyle among low-income women with young children should address mental health and family functioning factors, especially depressive symptoms.

Latino Women's Spiritual Beliefs Related to Health

PURPOSE

This study employed qualitative research to describe the relationship between spirituality and overall health among a sample of Latino women. A framework is presented for understanding this complex relationship.

DESIGN

Findings are presented from a qualitative analysis of six 1.5-hour focus group sessions.

SETTING

The research was conducted among Latino women living in Chicago, Illinois, and Northeastern New York communities. We employed a community-based participatory research approach in which community members were active participants throughout the research process.

SUBJECTS

Subjects were 47 Latino women 31 to 81 years, all of whom were Christian and the majority (43%) of whom had less than a high school education. Twenty-seven percent reported having high school diplomas, and the same percentage reported at least some college. Of the women who answered the questions, one did not have health insurance, 69% had public health insurance, and 29% had private health insurance.

MEASURES

Grounded theory using selective coding was employed to understand the relationship between spirituality and health and to develop the conceptual framework.

RESULTS

Spirituality was expressed as a vital component of health, and the belief in a need for balance of physical, mental, and spiritual health was described. An active and a passive relationship between spirituality and health emerged, with active being most common. Asking God for help or faith as a coping strategy were subdomains of the active relationship, and God responsible for health fell under the passive domain. These relationship types influenced beliefs about participation in one's own health.

CONCLUSION

The findings that emerged contribute to an understanding of how spirituality plays a role in health beliefs among Latino women, which has implications for health promotion research and program development for addressing health disparities.

Assessing the health of migrant and seasonal farmworkers in New York State: statewide data 2003-2005

OBJECTIVES

New York State data were used to document demographic characteristics and identify the top five most prevalent disease conditions among migrant and seasonal farmworkers and their families working in the state from 2003 to 2005.

METHODS

Prevalence estimates were derived using enumeration and diagnosis data provided by New York State Department of Health contractors. The sample totals ranged from 6,500 to 8,000 migrant and seasonal farmworkers and their families.

RESULTS

The majority of migrant and seasonal farmworkers were Hispanic with New York or Mexico the most frequently reported migrant home. Infections, muscular skeletal problems, respiratory disease, hypertension, and diabetes were the five most prevalent diseases identified.

CONCLUSION

Migrant and seasonal farmworkers in New York State experienced health conditions common among agricultural workers. Additional research and surveillance are necessary for understanding and serving their health needs.

Selected cultural factors associated with physical activity among Latino women

BACKGROUND

In the United States, Latinos are the largest ethnic group after non-Hispanic whites. Latinos currently represent 15% of the U.S. population and their numbers are growing in nontraditional areas. Latino women (Latinas) disproportionately experience chronic disease risk factors and report low levels of leisure time physical activity. This study examined cultural factors associated with leisure time physical activity among Latinas living in a new Latino destination in northeastern New York.

METHODS

Community-based participatory research, a collaborative approach in which community members are equitably and actively involved in the research process, was employed for this study. The Latina Health Survey was administered in Spanish and English to 289 Latina adults through snowball sampling.

RESULTS

Women reported that their national origin was predominantly Puerto Rican (58.7%) or Dominican (18.2%). Only 6.6% of women met American College of Sports Medicine's physical activity recommendations of exercising 5 days a week; 25% participated in physical activity two or more times per week. Acculturation and religious service attendance at least once a week was positively associated and fast food consumption one or more times a week was negatively associated with physical activity.

DISCUSSION

This study implicates the need for physical activity promotion efforts among Latinas who are culturally responsive and that address fast food consumption. In addition to acculturation, other, more specific cultural factors need to be examined to understand physical activity correlates among Latinas. Research among Latinas living in new Latino destinations is important for understanding behavior and tailoring health interventions among Latinos living in nontraditional areas.

Latina self-reported mental health and delay in health care in a new Latino destination

Understanding how depression and/or anxiety affects use of health care among Latinas in rapidly growing new Latino destinations, population where the growth rate of the Latino population exceeds the national average, may enhance community engagement efforts. Using community-based participatory research, a questionnaire assessing health care use was administered to 289 Latinas. Most (70%) reported delaying healthcare, and self-reported depression/anxiety was associated with a 3.1 fold (95% CI: 1.6-5.9) increase in delay, after adjusting for current health status, acculturation, age, education, and place of birth. Mental health disparities exist among Latinas, which are related to delays in use of health care. A gap exists regarding health education interventions for Latinas. More research is needed to identify successful models, especially in new Latino destinations as they may be particularly vulnerable to delay care.

Impact of a multimedia campaign to increase intention to call 9-1-1 for stroke symptoms, upstate New York, 2006-2007

INTRODUCTION

Many people are not aware of stroke symptoms, the need for emergency care for those symptoms, and that calling 9-1-1 is recommended. The New York State Department of Health developed and implemented a multimedia campaign to increase stroke symptom awareness and awareness of the need to call 9-1-1.

METHODS

The evaluation of the campaign's impact was a pre/post intervention matched comparison design. A random-digit-dialed list-assisted telephone survey was administered to measure reach of the campaign and change in intention to seek emergency care for stroke by calling 9-1-1 in response to 4 signs or symptoms.

RESULTS

A larger proportion of respondents in the intervention region than in the comparison region reported seeing a stroke advertisement and reported the advertisement's message was to call 9-1-1. There was a significant increase between baseline and follow-up in intention to call 9-1-1 for the 4 stroke symptoms. These increases were greater in the intervention region than the comparison region. The differences between intervention and comparison groups in the increases in intention to call 9-1-1 ranged from 9% to 12% for specific stroke symptoms identified in oneself and from 4% to 12% for symptoms identified in another person.

CONCLUSION

This multimedia campaign effectively increased intention to call 9-1-1 for stroke symptoms in the intervention region compared with a region matched for demographics and stroke rates. Multimedia campaigns are effective in increasing awareness of stroke symptoms and intention to immediately call 9-1-1.

Sociocultural factors influencing delay in seeking routine health care among Latinas: a community-based participatory research study

OBJECTIVES

To assess sociocultural factors associated with delaying routine healthcare among Latinas.

METHODS

Using community-based participatory research; we interviewed 287 Latinas from the Capital District, NY. The Andersen model of healthcare utilization was used to assess predisposing, enabling and need factors influencing delay in seeking care. Modified Poisson regression was used to estimate prevalence risk ratios (PRR) and 95% confidence intervals.

RESULTS

Overall 70% of women reported delaying care. After controlling for other factors, women who were not married (PRR 1.21), had chronic disease (PRR 1.24), preferred a Latino doctor (PRR 1.18), used alternative medicine (PRR 1.28), were uninsured (PRR 1.29), or had faced discrimination during earlier health care visits (PRR 1.23), were significantly more likely to delay care.

CONCLUSIONS

Delay in seeking care among Latinas is determined by cultural and social factors that need to be incorporated in interventions aimed at improving access.

Awareness of necessity to call 9-1-1 for stroke symptoms, upstate New York

INTRODUCTION

Stroke is the third leading cause of death and a leading cause of disability in New York State. A New York study determined that only 19.9% of patients arrived at a designated stroke center within 3 hours of symptom onset. Yet, receiving treatment within 90 minutes of stroke symptom onset is optimal for improved outcomes. Delay in recognition of stroke symptoms and their severity contributes to treatment delay.

METHODS

A random-digit-dialed, list-assisted telephone survey about stroke knowledge was administered to 1789 adults aged 30 years or older in upstate New York in 2006. Bivariate and regression analysis were used to examine factors associated with intent to call 9-1-1 for symptoms of stroke.

RESULTS

The largest proportion of respondents (72.4%; 95% confidence interval [CI], 69.9%-74.8%) reported they would call 9-1-1 if they noticed they or someone else had difficulty speaking, and the fewest (33.3%; 95% CI, 30.7%-36.0%) respondents reported they would call 9-1-1 for trouble seeing or double vision. Multivariate analysis found that those who had a history of delay in getting medical care in the past 6 months had decreased odds of intending to call 9-1-1 for stroke symptoms (difficulty speaking: adjusted odds ratio [AOR], 0.76; 95% CI, 0.58-1.00; trouble seeing: AOR, 0.69; 95% CI, 0.53-0.91; facial droop: AOR, 0.85; 95% CI, 0.65-1.11; arm weakness: AOR, 0.80; 95% CI, 0.63-1.03). Age, education, and history of a stroke or heart event were not consistently associated with intent to call 9-1-1.

CONCLUSION

Survey respondents do not interpret some stroke symptoms as urgent enough to activate the emergency medical system. History of delaying care is a behavioral pattern that influenced intent to call 9-1-1.

Photovoice as participatory action research tool for engaging people with intellectual disabilities in research and program development

People with intellectual disabilities have few opportunities to actively participate in research affecting programs and policies. Employment of participatory action research has been recommended. Although use of this approach with people who have intellectual disabilities is growing, articles on specific participatory research methods are rare. Photovoice is a participatory method often used with underrepresented groups and is effective for engaging people with intellectual disabilities in research or program development. A literature review is presented for use with this population as is a description of Photovoice as a participatory research tool for engaging people with intellectual disabilities. An example of a participatory study among people with intellectual disabilities is provided. Benefits and challenges of employing Photovoice with this population are discussed.

Awareness of genetic testing for cancer among United States Hispanics: the role of acculturation

BACKGROUND

The purpose of this study was to determine how acculturation affected awareness of genetic testing for cancer among Hispanic Americans.

METHODS

Subjects were 10,883 Hispanic respondents from the 2000 and 2005 National Health Interview Surveys. Acculturation was measured with language use and the length of time subjects had lived in the US. Weighted logistic regression was used to determine subjects' awareness of genetic susceptibility testing.

RESULTS

Greater use of English (adjusted odds ratio, OR = 1.25, 95% confidence interval, CI = 1.15-1.36) was associated with increased awareness of genetic testing. Residence in the US for less than 5 years (adjusted OR = 0.55, 95% CI 0.36-0.83) was associated with lower awareness of testing.

CONCLUSIONS

To better inform diverse American groups about genetic testing, intercultural variations and language skills must be taken into account.

Photovoice With Vulnerable Populations: Addressing Disparities in Health Promotion Among People With Intellectual Disabilities

Cardiovascular diseases (CVD) are the leading causes of death among Mexican American adults living in the United States. Using data from a modified Behavioral Risk Factor Surveillance Survey and guided by the Anderson model, this study examined the effect of nativity on CVD screening practices among 423 Mexican American adults in Chicago. Dependent variables included having had a blood pressure and cholesterol screening and a routine checkup in the past 2 years. Multivariate analyses were used to control for sociodemographic factors while accounting for complex sampling design. Compared to those born in Mexico, U.S.-born Mexican Americans had greater odds of obtaining blood pressure (OR = 5.61) and cholesterol screenings (OR = 1.60) and having a routine checkup (OR = 2.69) in the past 2 years. Health professionals wishing to increase screenings for CVD risk factors among Mexican Americans in northern cities should understand the impact of nativity on screening practices.

Nativity and cardiovascular disease screening practices

Cardiovascular diseases (CVD) are the leading causes of death among Mexican American adults living in the United States. Using data from a modified Behavioral Risk Factor Surveillance Survey and guided by the Anderson Model, this study examined the effect of nativity on CVD screening practices among 423 Mexican American adults living in Chicago. Dependent variables included having had a blood pressure and cholesterol screening and a routine check up in the past 2 years. Multivariate analyses were used to control for sociodemographic factors, while accounting for complex sampling design. Compared to those born in Mexico, US-born Mexican Americans had significantly greater odds of obtaining blood pressure (OR=5.61), and cholesterol screenings (OR=1.60) and having a routine checkup (OR=2.69) in the past 2 years. Health professionals with an agenda to increase screenings for CVD risk factors among Mexican Americans living in northern cities should understand the impact of nativity on screening practices.

Acculturation and cardiovascular disease screening practices among Mexican Americans living in Chicago

OBJECTIVE

To examine acculturation as a correlate of cardiovascular disease screening practices among Mexican Americans.

METHODS

A modified Behavioral Risk Factor Surveillance System (BRFSS) survey was administered to adults age 18 and older in four Chicago neighborhoods during the winter of 2000 (N=435).

RESULTS

Regression analyses that accounted for complex sampling design found that Mexican Americans who were acculturated, were female, and had healthcare coverage were more likely to have been screened after controlling for age, healthcare coverage, education, and marital status. Acculturated Mexican Americans were 4.97 times more likely to have had blood cholesterol screening, 3.4 times more likely to have had blood pressure screening, and 7.99 times more likely to have had a routine checkup in the preceding two years when compared to unacculturated Mexican Americans. Mexican Americans with healthcare coverage were more likely to have had their blood pressure checked and to have obtained a routine check-up than did those without coverage. Women were more likely to have had a blood pressure screening and have obtained a routine check-up in the past two years.

CONCLUSIONS

The results suggest that more acculturated Mexican Americans, as well as those who are female and who have healthcare coverage, are more likely to obtain cardiovascular disease (CVD)-related screenings. The findings indicate a need for promoting CVD-related screenings among Mexican Americans and underscores the need for Spanish-speaking health professionals.