Lisa Staten

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https://hdl.handle.net/1805/30348

The Diabetes Impact Project: Partnering with communities and organizations to reduce diabetes burden and improve quality of life

Prior to coming to Indiana, Dr. Lisa Staten served as a faculty member at the University of Arizona where she worked with community partners along the US-Mexico border to reduce risk factors for diabetes in Latino communities. The overarching theme of Dr. Staten’s research is improving health equity through community engagement. A great deal of her work has focused on chronic disease prevention using community-based participatory research methods. More recently, she is shifting her focus to developing interventions that address the social determinants of health. Dr. Staten's current research project is the "Diabetes Impact Project – Indianapolis Neighborhoods (DIP-IN)." This a multi-year, multisector, community engaged project with a holistic approach to reducing diabetes burden in three communities of Indianapolis. Dr. Staten has published several journal articles in the areas of minority health, intervention design and evaluation, community engaged research, and coalition building. Dr. Staten's translation of research into improved quality of life for communities around the U.S. is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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Promotion and tenure for community-engaged research: An examination of promotion and tenure support for community-engaged research at three universities collaborating through a Clinical and Translational Science Award
(http://dx.doi.org/10.1111/cts.12061, 2013-06-06) Marrero, David G.; Hardwick, Emily J.; Staten, Lisa K.; Savaiano, Dennis A.; Odell, Jere D.; Frederickson, Karen; Saha, Chandan
Introduction. Community engaged health research, an approach to research which includes the participation of communities, promotes the translation of research to address and improve social determinants of health. As a way to encourage community engaged research, the National Institutes of Health required applicants to the Clinical and Translational Science Award (CTSA) to include a community engagement component. Although grant-funding may support an increase in community engaged research, faculty also respond to the rewards and demands of university promotion and tenure standards. This paper measures faculty perception of how three institutions funded by a CTSA support community engaged research in the promotion and tenure process. Methods: At three institutions funded by a CTSA, tenure track and non-tenure track faculty responded to a survey regarding perceptions of how promotion and tenure committees value community engaged research. Results: Faculty view support for community engaged research with some reserve. Only 36% agree that community engaged research is valued in the promotion and tenure process. Discussion: Encouraging community engaged scholarship requires changing the culture and values behind promotion and tenure decisions. Institutions will increase community engaged research and more faculty will adopt its principles, when it is rewarded by promotion and tenure committees.
The Enigma of the Stigma of Hair Loss: Why is Cancer-Treatment Related Alopecia so Traumatic for Women?
(2013-09) Coe, Kathryn; Staten, Lisa K.; Rosales, Cecilia; Swanson, Marie
Pasos Adelante: The Effectiveness of a Community-based Chronic Disease Prevention Program
(2005-01) Staten, Lisa K.; Scheu, Linda L.; Bronson, Dan; Peña, Veronica; Elenes, JoJean
Background Implementing programs that target primary prevention of chronic diseases is critical for at-risk populations. Pasos Adelante, or “Steps Forward,” is a curriculum aimed at preventing diabetes, cardiovascular disease, and other chronic diseases in Hispanic populations. Pasos Adelante is adapted from the National Heart, Lung, and Blood Institute’s cardiovascular disease prevention curriculum, Su Corazón, Su Vida, and includes sessions on diabetes and community advocacy and incorporates walking clubs. Context The Pasos Adelante curriculum was implemented in two Arizona, United States-Sonora, Mexico border counties. Key issues in these communities are safety, access to recreational facilities, climate, and cultural beliefs. Methods Pasos Adelante is a 12-week program facilitated by community health workers. The program includes interactive sessions on chronic disease prevention, nutrition, and physical activity. Evaluation of the program included pre-curriculum and postcurriculum questionnaires with self-reported measures of physical activity and dietary patterns. Approximately 250 people participated in the program in Yuma and Santa Cruz counties. Consequences Postprogram evaluation results demonstrate a significant increase in moderate to vigorous walking among participants and shifts in nutritional patterns. Interpretation The Pasos Adelante program demonstrates that an educational curriculum in conjunction with the support of community health workers can motivate people in Arizona/Sonora border communities to adopt healthy lifestyle behaviors.
Provider Counseling, Health Education, and Community Health Workers: The Arizona WISEWOMAN Project
(2004-08) Staten, Lisa K.; Gregory-Mercado, Karen Y.; Ranger-Moore, James; Will, Julie C.; Giulliano, Anna R.; Ford, Earl S.; Marshall, James
Background: The Arizona Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project used provider counseling, health education, and community health workers (CHWs) to target chronic disease risk factors in uninsured, primarily Hispanic women over age 50. Methods: Participants were recruited from two Tucson clinics participating in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Women were randomly assigned into one of three intervention groups: (1) provider counseling, (2) provider counseling and health education, or (3) provider counseling, health education, and CHW support. At baseline and 12 months (1998–2000), participants were measured for height, weight, waist and hip circumference, and blood pressure. Blood tests were conducted to check blood glucose, cholesterol, and triglyceride levels. At each time point, participants also completed 24-hour dietary recalls and questionnaires focusing on their physical activity levels. Results: A total of 217 women participated in baseline and 12-month follow-up. Three fourths were Hispanic. All three intervention groups showed an increase in self-reported weekly minutes of moderate-to-vigorous physical activity, with no significant differences between the groups. Significantly more women who received the comprehensive intervention of provider counseling, health education, and CHW support progressed to eating five fruits and vegetables per day, compared with participants who received only provider counseling or provider counseling plus health education. Conclusions: All three interventions increased moderate-to-vigorous physical activity but not fruit and vegetable consumption. The intervention group with provider counseling, health education, and CHW support significantly increased the number of women meeting national recommendations for fruit and vegetable consumption.
The Role of Online Social Support in Supporting and Educating Parents of Young Children With Special Health Care Needs in the United States: A Scoping Review
(JMIR Publications, 2016) DeHoff, Beth A.; Staten, Lisa K.; Rodgers, Rylin Christine; Denne, Scott C.; Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health
Background: When parents of young children with special health care needs (CSHCN) receive their child’s diagnosis, they encounter information they may not understand, emotions they may not know how to cope with, and questions about their child’s immediate and long-term future that frequently lack answers. The challenge of health care providers is how to prepare parents for caring for their CSHCN, for coping with any resulting challenges, and for accessing the systems and services that can assist them. Objective: The purpose of this work was to review evidence of the information and support needs of parents of young CSHCN and to determine whether online social support can serve as an avenue for learning and empowerment for these parents. Methods: A scoping review identified the challenges, coping mechanisms, and support needs among parents of CSHCN, and the reach and effectiveness of digital technologies with these families and health care providers. We also conducted interviews with professionals serving parents of CSHCN. Results: The literature review and interviews suggested that parents best learn the information they need, and cope with the emotional challenges of raising a CSHCN, with support from other parents of CSHCN, and that young parents in recent years have most often been finding this parent-to-parent support through digital media, particularly social media, consistent with the theory of online social support. Evidence also shows that social media, particularly Facebook, is used by nearly all women aged 18-29 years across racial and socioeconomic lines in the United States. Conclusions: Parents of young CSHCN experience significant stress but gain understanding, receive support, and develop the ability to care for and be advocates for their child through parent-to-parent emotional and informational social support. Online social support is most effective with young adults of childbearing age, with social media and apps being the most useful within the theoretical framework of social support. This opens new opportunities to effectively educate and support parents of young CSHCN. Providers seeking to inform, educate, and support families of CSHCN should develop strategies to help parents find and use social support through digital resources to facilitate their emotional adjustment and practical abilities to care for and access services for their child. [J Med Internet Res 2016;18(12):e333]
Perspectives on a US–Mexico Border Community’s Diabetes and “Health-Care” Access Mobilization Efforts and Comparative Analysis of Community Health Needs over 12 Years
(Frontiers, 2017-07-10) Rosales, Cecilia Ballesteros; de Zapien, Jill Eileen Guernsey; Chang, Jean; Ingram, Maia; Fernandez, Maria L.; Carvajal, Scott C.; Staten, Lisa K.; Health Policy and Management, School of Public Health
This paper describes a community coalition-university partnership to address health needs in an underserved US-Mexico border, community. For approximately 15 years, this coalition engaged in community-based participatory research with community organizations, state/local health departments, and the state's only accredited college of public health. Notable efforts include the systematic collection of health-relevant data 12 years apart and data that spawned numerous health promotion activities. The latter includes specific evidence-based chronic disease-preventive interventions, including one that is now disseminated and replicated in Latino communities in the US and Mexico, and policy-level changes. Survey data to evaluate changes in a range of health problems and needs, with a specific focus on those related to diabetes and access to health-care issues-identified early on in the coalition as critical health problems affecting the community-are presented. Next steps for this community and lessons learned that may be applicable to other communities are discussed.
Evidence for Long-Term Impact of Pasos Adelante: Using a Community-Wide Survey to Evaluate Chronic Disease Risk Modification in Prior Program Participants
(MDPI, 2013-10) Carvajal, Scott C.; Miesfeld, Noelle; Chang, Jean; Reinschmidt, Kerstin M.; de Zapien, Jill Guernsey; Fernandez, Maria L.; Rosales, Cecilia; Staten, Lisa K.; Social and Behavioral Sciences, School of Public Health
Effective community-level chronic disease prevention is critical to population health within developed and developing nations. Pasos Adelante is a preventive intervention that aims to reduce chronic disease risk with evidence of effectiveness in US-Mexico residing, Mexican origin, participants. This intervention and related ones also implemented with community health workers have been shown to improve clinical, behavioral and quality of life indicators; though most evidence is from shorter-term evaluations and/or lack comparison groups. The current study examines the impact of this program using secondary data collected in the community 3–6 years after all participants completed the program. A proportional household survey (N = 708) was used that included 48 respondents who indicated they had participated in Pasos. Using propensity score matching to account for differences in program participants versus other community residents (the program targeted those with diabetes and associated risk factors), 148 natural controls were identified for 37 matched Pasos participants. Testing a range of behavioral and clinical indicators of chronic disease risk, logistic regression models accounting for selection bias showed two significant findings; Pasos participants were more physically active and drank less whole milk. These findings add to the evidence of the effectiveness of Pasos Adalente and related interventions in reducing chronic disease risk in Mexican-origin populations, and illustrate the use of innovative techniques for using secondary, community-level data to complement prior evaluation research.
Investigating Social Ecological Contributors to Diabetes within Hispanics in an Underserved U.S.-Mexico Border Community
(MDPI, 2013-08) Chang, Jean; Guy, Mignonne C.; Rosales, Cecilia; de Zapien, Jill G.; Staten, Lisa K.; Fernandez, Maria L.; Carvajal, Scott C.; Social and Behavioral Sciences, School of Public Health
Hispanics bear a disproportionate burden of diabetes in the United States, yet relations of structural, socio-cultural and behavioral factors linked to diabetes are not fully understood across all of their communities. The current study examines disparities and factors associated with diabetes in adult Hispanics of Mexican-descent (N = 648) participating in a population survey of an underserved rural U.S.-Mexico border community. The overall rate of diabetes prevalence rate in the sample, based on self-report and a glucose testing, was 21%; much higher than rates reported for U.S. adults overall, for all Hispanic adults, or for Mexican American adults specifically. Acculturation markers and social determinants of health indicators were only significantly related to diabetes in models not accounting for age. Older age, greater BMI (>30), greater waist-to-hip ratio as well as lower fruit and vegetable consumption were significantly related to increased likelihood of diabetes when all structural, cultural, behavioral, and biological factors were considered. Models with sets of behavioral factors and biological factors each significantly improved explanation of diabetes relative to prior social ecological theory-guided models. The findings show a critical need for diabetes prevention efforts in this community and suggest that health promotion efforts should particularly focus on increasing fruit and vegetable consumption.
The Purdue Extension and Indiana CTSI's Community Health Partnerships collaboration: An innovative, generalizable, state-wide model to help communities build a culture of health
(Cambridge University Press, 2017-10) Savaiano, Dennis A.; Lynch, Krystal H.; Vandergraff, Donna J.; Wiehe, Sarah E.; Staten, Lisa K.; Miller, Douglas K.; Pediatrics, School of Medicine
The Indiana Clinical and Translational Sciences Institute's Community Engagement Partners-Purdue Extension collaborative model demonstrates tremendous potential for creating state-wide programmatic efforts and improvements in both the health culture and status of Indiana residents across the state. It can serve as a prototype not only for others interested in pursuing wide geographic health improvements through Clinical and Translational Sciences Award-Cooperative Extension partnerships but also for broader collaborations among United States Department of Agriculture, National Institutes of Health, Centers for Disease Control and Prevention, state and local health departments, and health foundation efforts to improve population health.
The School Health Index as an Impetus for Change
(Centers for Disease Control and Prevention, 2005-01) Staten, Lisa K.; Teufel-Shone, Nicolette I.; Steinfelt, Victoria E.; Ortega, Nohemi; Halverson, Karen; Flores, Carmen; Lebowitz, Michael D.
Background The increase in childhood obesity and prevalence of chronic disease risk factors demonstrate the importance of creating healthy school environments. As part of the Border Health Strategic Initiative, the School Health Index was implemented in public schools in two counties along the Arizona, United States-Sonora, Mexico border. Developed in 2000 by the Centers for Disease Control and Prevention, the School Health Index offers a guide to assist schools in evaluating and improving opportunities for physical activity and good nutrition for their students. Context Between 2000 and 2003, a total of 13 schools from five school districts in two counties participated in the School Health Index project despite academic pressures and limited resources. Methods The Border Health Strategic Initiative supported the hiring and training of an external coordinator in each county who was not part of the school system but who was an employee in an established community-based organization. The coordinators worked with the schools to implement the School Health Index, to develop action plans, and to monitor progress toward these goals. Consequences The School Health Index process and school team participation varied from school to school. Individual plans were different but all focused on reducing in-school access to unhealthy foods, identified as high-fat and/or of low nutritional value. Ideas for acting on this focus ranged from changing the content of school lunches to discontinuing the use of nonnutritious foods as classroom rewards. All plans included recommendations that could be implemented immediately as well as those that would require planning and perhaps the formation and assistance of a subcommittee (e.g., for developing or adopting a districtwide health curriculum). Interpretation After working with the School Health Index, most schools made at least one immediate change in their school environments. The external coordinator was essential to keeping the School Health Index results and action plans on the agendas of school administrators, especially during periods of staff turnover. Staff turnover, lack of time, and limited resources resulted in few schools achieving longer term policy changes.

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