Community and Global Health Works

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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.
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.
The influences of course effort and outside activities on grades in a college course
(2006-09) Svanum, Soren; Bigatti, Silvia M.
The influences of course effort and outside (family, job, social) activities on grades earned in a college course were examined for 230 urban college students. Multiple measurements of hours of work, social and family activities, and course effort were collected over a semester. Path modeling revealed that cumulative GPA and course effort had significant and independent predictive paths with grades. Outside activities did not directly influence course grade. Job activities, however, negatively influenced course grade indirectly through reduced course effort and mediated the influence GPA exerted on course grade. Thus, work demands lessened course effort and lessened GPA-indexed potential for course success. Cumulative GPA positively influenced effort, and effort mediated part of the relation between cumulative GPA and grades.
From Program to Policy: Expanding the Role of Community Coalitions
(Centers for Disease Control and Prevention, 2007) Hill, Anne; De Zapien, Jill Guernsey; Staten, Lisa K.; McClelland, Deborah Jean; Garza, Rebecca; Moore-Monroy, Martha; Elenes, JoJean; Steinfelt, Victoria; Tittelbaugh, Ila; Whitmer, Evelyn; Meister, Joel S.
Background Diabetes mortality at the United States–Mexico border is twice the national average. Type 2 diabetes mellitus is increasingly diagnosed among children and adolescents. Fragmented services and scarce resources further restrict access to health care. Increased awareness of the incidence of disease and poor health outcomes became a catalyst for creating community-based coalitions and partnerships with the University of Arizona that focused on diabetes. Context Five partnerships between the communities and the University of Arizona were formed to address these health issues. They began with health promotion as their goal and were challenged to add policy and environmental change to their objectives. Understanding the meaning of policy in the community context is the first step in the transition from program to policy. Policy participation brings different groups together, strengthening ties and building trust among community members and community organizations. Methods Data on progress and outcomes were collected from multiple sources. We used the Centers for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health (REACH) 2010 Community Change Model as the capacity-building and analytic framework for supporting and documenting the transition of coalitions from program to policy. Consequences Over 5 years, the coalitions made the transition, in varying degrees, from a programmatic focus to a policy planning and advocacy focus. The coalitions raised community awareness, built community capacity, encouraged a process of “change in change agents,” and advocated for community environmental and policy shifts to improve health behaviors. Interpretation The five coalitions made environmental and policy impacts by engaging in policy advocacy. These outcomes indicate the successful, if not consistently sustained, transition from program to policy. Whether and how these “changes in change agents” are transferable to the larger community over the long term remains to be seen.
Immigrant populations, work and health—a systematic literature review
(2007-04) Ahonen, Emily Q.; Benavides, Fernando G.; Benach, Joan; ;
Objectives This paper summarizes the information on immigrant occupational health available from recent studies, incorporating varied study designs. Methods A systematic search was carried out in PubMed employing terms of interest to the study and related terms supplied by the same search engine. Articles were selected through the following process: (i) reading the title and abstract, in English or Spanish, for the period 1990–2005, (ii) reading of the entire text of selected articles; (iii) making a manual search of the relevant citations in the selected articles; (iv) eliminating articles without a focus on the themes of central interest (immigration, work, and health), and (v) reading and analyzing the definitive article set. No quality criteria were used in the article selection. Results The location of studies was not straightforward and required careful thought about the search terms. The included 48 papers were often multifaceted and difficult to categorize. They generally came from countries historically associated with immigration and described occupational risk factors, health consequences, and the social, economic, and cultural influences on worker health. They were also based on data, surveillance, training, and preventive measures that were inadequate. Conclusions Increased migration is a reality in industrialized countries all over the world, and it has social, political, and economic consequences for migrating groups, as well as for their sending and host societies. More reliable data, targeted appropriate interventions, and enforcement of existing regulations are necessary to improve the health of immigrant workers. Furthermore, studies in sending and developing countries should be encouraged to form a more complete understanding of this complex situation.
The Words of Our Ancestors: Kinship, Tradition, and Moral Codes
(2008) Coe, Kathryn; Palmer, Craig T.
In this paper we use the cross-cultural record to identify the behavioral rules of conduct, and the system supporting those rules, that are found in traditional societies, such as tribal societies. We then draw on the historical record to identify the behavioral rules of conduct, and the system supporting those rules that were found in the early state. The proposal tested here is that in traditional societies the behavioral rules of conduct and the systems that support them (e.g., processes for identifying guilt, punishing offenders, enacting legislation, preventing conflict) are aimed at promoting enduring, cooperative relationships among individuals who are identified as kin through common ancestry. The assumption underlying this proposal is that once human females increased their investment in offspring, cultural strategies to protect those offspring became more important. A moral system, which is the term we use to refer to the early system of behavioral codes, protected offspring by turning conspecific threats into the protectors, providers, and educators of children. It did this by creating a strong kinship system, the members of which were bound by common ancestry (actual or metaphorical), thus tying individuals into enduring, cooperative relationships by using culture to encourage them to honor ongoing duties to one another. This kinship-based moral system is significantly different from that found in societies in which the majority of interactions are with non-kin, interactions often center on the exchange of good and services, and traditions have largely been broken down. We refer to this second system as a system of law and argue that this distinction between moral and legal systems has implications for attempts to explain the evolutionary basis of human cooperation.
Role Strains and Mood in Husbands of Women with Fibromyalgia Syndrome: A Test of the Stress Process Model
(2008) Bigatti, Silvia M.; Lydon, Jennifer R.; Brothers, Brittany M.
Spouses of patients experience role strains as a result of informal caregiving, which has been associated with mood in numerous research studies. However, most research is on female caregivers, and little is known about the experience of male spouses, or of the caregiving provided to fibromyalgia patients. The Stress Process Model was used to examine mediators and moderators of the relation between role strain and mood among 135 husbands of women with fibromyalgia. Results indicated that the more activities of daily living and instrumental activities of daily living performed by the husband, the greater the role strain. Role strain was associated with worse mood. A test of the Stress Process Model supported a partial mediation model, where social support and emotion-focused coping partially mediated the relation between role strain and mood. No evidence was found for a moderation model or for problem-focused coping as a mediator. Our research suggests significant impairment and caregiving needs among this patient population, which in turn relates to the mood of the husband who is also an informal caregiver. Our findings also support the Stress Process Model in explaining the complexity of caregiving effects. The results of the study suggest avenues for intervention for individuals strained by their partners’ illness.
Sleep Disturbances in Fibromyalgia Syndrome: Relationship to Pain and Depression
(2008-07) Bigatti, Silvia M.; Hernandez, Ann Marie; Cronan, Terry A.; Rand, Kevin L.
Objective This study is an examination of sleep, pain, depression, and physical functioning at baseline and 1-year followup among patients with fibromyalgia syndrome (FMS). Although it is clear that these symptoms are prevalent among FMS patients and that they are related, the direction of the relationship is unclear. We sought to identify and report sleep problems in this population and to examine their relationship to pain, depression, and physical functioning. Methods Patients diagnosed with fibromyalgia were recruited from a Southern California health maintenance organization and evaluated according to American College of Rheumatology criteria in the research laboratory. Six hundred patients completed the baseline assessment and 492 completed the 1-year assessment. Measures included the Center for Epidemiologic Studies Depression Scale, the McGill Pain Questionnaire, the Pittsburgh Sleep Quality Index, and the Fibromyalgia Impact Questionnaire. Results The majority of the sample (96% at baseline and 94.7% at 1 year) scored within the range of problem sleepers. Path analyses examined the impact of baseline values on 1-year values for each of the 4 variables. No variable of interest predicted sleep, sleep predicted pain (β = 0.13), pain predicted physical functioning (β = −0.13), and physical functioning predicted depression (β = −0.10). Conclusion These findings highlight the high prevalence of sleep problems in this population and suggest that they play a critical role in exacerbating FMS symptoms. Furthermore, they support limited existing findings that sleep predicts subsequent pain in this population, but also extend the literature, suggesting that sleep may be related to depression through pain and physical functioning.
Academic course engagement during one semester forecasts college success: Engaged students are more likely to earn a degree, do it faster, and do it better
(2009-01) Svanum, Soren; Bigatti, Silvia M.
A qualitative study about immigrant workers´ perceptions of their working conditions in Spain
(2009-05) Ahonen, Emily Q.; Porthé, Victoria; Vázquez, María Luisa; García, Ana María; López-Jacob, María José; Ruiz-Frutos, Carlos; Pérez, Elena Ronda; Benach, Joan; Benavides, Fernando G.
Background: Spain has recently become an inward migration country. Little is known about the occupational health of immigrant workers. This study aimed to explore the perceptions that immigrant workers in Spain had of their working conditions. Methods: Qualitative, exploratory, descriptive study. Criterion sampling. Data collected between September 2006 and May 2007 through semi-structured focus groups and individual interviews, with a topic guide. One hundred and fifty-eight immigrant workers (90 men/68 women) from Colombia (n = 21), Morocco (n = 39), sub-Saharan Africa (n = 29), Romania (n = 44) and Ecuador (n = 25), who were authorised (documented) or unauthorised (undocumented) residents in five medium to large cities in Spain. Results: Participants described poor working conditions, low pay and health hazards. Perception of hazards appeared to be related to gender and job sector. Informants were highly segregated into jobs by sex, however, so this issue will need further exploration. Undocumented workers described poorer conditions than documented workers, which they attributed to their documentation status. Documented participants also felt vulnerable because of their immigrant status. Informants believed that deficient language skills, non-transferability of their education and training and, most of all, their immigrant status and economic need left them with little choice but to work under poor conditions. Conclusions: The occupational health needs of immigrant workers must be addressed at the job level, while improving the enforcement of existing health and safety regulations. The roles that documentation status and economic need played in these informants’ work experiences should be considered and how these may influence health outcomes.

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