Reducing farmworker residential pesticide exposure: evaluation of a lay health advisor intervention

The goal of this analysis is to evaluate the effectiveness of a promotora program for teaching women in Latino farmworker families about pesticide safety and increasing pesticide safety behaviors. Volunteer promotoras delivered a pesticide safety curriculum (intervention) and nutrition curriculum (control) to farmworker women residing in western North Carolina and Virginia. Pre-and postintervention interviews assessed differences in delivery of the intervention, recognition of the intervention, pesticide knowledge, pesticide exposures behaviors, and integrated pest management behaviors. Participants in the intervention group reported significantly more receipt of pesticide education and greater recognition of the key messages. However, their knowledge, pesticide exposure behaviors, and integrated pest management behaviors did not change. A more structured program is needed to be sure that the dose of interventions is large enough to overcome educational and cultural characteristics of immigrant communities. Policy changes are needed to address circumstances outside of farmworkers' control that affect pesticide exposure.     

When promotoras and technology meet: a qualitative analysis of promotoras' use of small media to increase cancer screening among South Texas Latinos

Computer-based multimedia technologies can be used to tailor health messages, but promotoras (Spanish-speaking community health workers) rarely use these tools. Promotoras delivered health messages about colorectal cancer screening to medically underserved Latinos in South Texas using two small media formats: a "low-tech" format (flipchart and video) and a "high-tech" format consisting of a tailored, interactive computer program delivered on a tablet computer. Using qualitative methods, the authors observed promotora training and intervention delivery and conducted interviews with five promotoras to compare and contrast program implementation of both formats. The authors discuss the ways each format aided or challenged promotoras' intervention delivery. Findings reveal that some aspects of both formats enhanced intervention delivery by tapping into Latino health communication preferences and facilitating interpersonal communication, whereas other aspects hindered intervention delivery. This study contributes to our understanding of how community health workers use low- and high-tech small media formats when delivering health messages to Latinos.     

Successful recruitment and retention of latino study participants

A high prevalence of risk behaviors among the rapidly growing Latino youth population in the United States adds urgency to the need to identify effective recruitment and retention strategies for research studies and prevention programs. The objectives of this study are to (a) describe the culturally responsive recruitment and retention strategies used in the Familias Fuertes-Georgia program and (b) discuss the evaluation of the relative importance of these strategies. Familias Fuertes (i.e., Strong Families) is a community-based, primary prevention program for families in Latin America with children between the ages of 10 and 14 years. The main program goal is to reduce high-risk behaviors among adolescents by strengthening family relationships and promoting self-regulation and positive conflict resolution strategies. A pilot feasibility study was conducted to determine the appropriateness of the Familias Fuertes program for Latino families living in the United States. To promote participation, 15 culturally responsive recruitment and retention strategies were developed using a three-step process. These strategies contributed to the successful recruitment and retention of Familias Fuertes-Georgia study participants. Participating parents, the community liaison, and the community leader evaluated the relative importance of the 15 culturally responsive recruitment and retention strategies. Three of the strategies emerged as more important than others: face-to-face recruitment by the community liaison; bilingual, bicultural, and experienced facilitators; and free on-site child care. Further research is needed to develop strategies promoting the participation of male caregivers/fathers.     

Constructing “Packages” of Evidence-Based Programs to Prevent Youth Violence: Processes and Illustrative Examples From the CDC’s Youth Violence Prevention Centers

This paper describes the strategic efforts of six National Centers of Excellence in Youth Violence Prevention (YVPC), funded by the U.S. Centers for Disease Control and Prevention, to work in partnership with local communities to create comprehensive evidence-based program packages to prevent youth violence. Key components of a comprehensive evidence-based approach are defined and examples are provided from a variety of community settings (rural and urban) across the nation that illustrate attempts to respond to the unique needs of the communities while maintaining a focus on evidence-based programming and practices. At each YVPC site, the process of selecting prevention and intervention programs addressed the following factors: (1) community capacity, (2) researcher and community roles in selecting programs, (3) use of data in decision-making related to program selection, and (4) reach, resources, and dosage. We describe systemic barriers to these efforts, lessons learned, and opportunities for policy and practice. Although adopting an evidence-based comprehensive approach requires significant upfront resources and investment, it offers great potential for preventing youth violence and promoting the successful development of children, families and communities.     

Technical workshop report: Working Group I: Occupational health and safety strategies for agriculture

The six workshops in this subgroup--Injuries, Respiratory Diseases, Acute Chemical Toxicity, Cancer, and Health Surveillance--competently outlined the principal health and safety issues in agriculture, documenting the increased and unacceptable morbidity and mortality in farmers and their families. It became evident that although research knowledge is just now unfolding, sufficient data exist to permit comprehensive program planning for research and prevention. It is necessary that farmers and their families be considered an occupational grouping and that specific programs aimed at ongoing risk assessment and early diagnosis are important. At the same time, a more broadly based approach to rural family life enhancement is essential, including the following: 1) education; 2) prevention; 3) family life enhancement; and 4) research. Because of the scope and nature of the problem, program development should include a multidisciplinary approach that involves the local community, state government, university (professional) resources, farm/organizations, and industry.     

Padres Preparados,Jóvenes Saludables: A Randomized Controlled Trial to Test Effects of a Community-Based Intervention on Latino Father’s Parenting Practices

Parenting practices have been associated with adolescent lifestyle behaviors and weight status. Evidence is limited regarding the efficacy of interventions to address father influences on adolescent lifestyle behaviors through availability and modeling practices. Therefore, the purpose of this study was to evaluate changes in father parenting practices after Latino families with adolescents participated in the Padres Preparados Jóvenes Saludables (Padres) program. Time-1 (baseline) and Time-2 (post-intervention) data were used from Latino father/adolescent (10–14 years) dyads enrolled in the Padres two-arm (intervention vs. delayed-treatment control group) randomized controlled trial in four community locations. The program had eight weekly, 2.5-h experiential learning sessions on food preparation, parenting practices, nutrition, and physical activity. Two types of parenting practices (role modeling and home food availability) were assessed by father report via questionnaire for each of 7 lifestyle behaviors, for a total of 14 parenting practices. Linear regression mixed models were used to evaluate the intervention effects. A total of 94 father/adolescent dyads completed both Time-1 and Time-2 evaluations. Significant positive intervention effects were found for frequencies of fruit modeling (p = 0.002) and screen time modeling (p = 0.039). Non-significant results were found for the other 12 father parenting practices.     

<Emphasis Type="Italic">Healthy Eating and Harambee</Emphasis>: Curriculum Development for a Culturally-Centered Bio-Medically Oriented Nutrition Education Program to Reach African American Women of Childbearing Age

The purpose was to develop, implement and evaluate a peer-led nutrition curriculum Healthy Eating and Harambee that addresses established objectives of maternal and infant health and to shift the stage for African American women of childbearing age in Genesee County toward healthier dietary patterns using a socio-cultural and biomedical orientation. The PEN-3 model, which frames culture in the context of health promotion interventions, was integrated with the Transtheoretical Model to guide this 13-week pre-test/post-test curriculum. Materials developed included soul food plate visuals, a micronutrient availability worksheet, a fruit stand, and gardening kits. Learning activities included affirmations, stories, case-scenarios, point-of-purchase product recognition, church health teams, and community health fairs. We investigated health-promoting dietary behaviors (consumption of more fruits and vegetables (F&V), serving more F&V to their families, and moderating dietary sodium and fat intakes), and biomedical behaviors (self-monitoring blood pressure and exercising) across five stages of change. Session attendance and program satisfaction were assessed. N = 102 women participated (mean age = 27.5 years). A majority (77%) reported adopting at least one healthy eating behavior (moderating sodium, serving more F&V to their families), 23% adopted at least two such behaviors (reading food labels for sodium; using culinary herbs/spices; serving more F&V to their families), and 45% adopted both dietary (moderating sodium; eating more fruits) and biomedical behaviors. Participants and facilitators favorably evaluated the curriculum and suggested improvements. A multi-conceptual approach coupled with cultural and biomedical tailoring has potential to promote young African American women’s movement to more advanced stages of change and improve self-efficacy for fruit and vegetable intake, dietary sodium moderation, and self-monitoring blood pressure and physical activity.     

Community Health Workers as Drivers of a Successful Community-Based Disease Management Initiative

In 2005, local leaders in New York City developed the Washington Heights/Inwood Network for Asthma Program to address the burden of asthma in their community. Bilingual community health workers based in community organizations and the local hospital provided culturally appropriate education and support to families who needed help managing asthma. Families participating in the yearlong care coordination program received comprehensive asthma education, home environmental assessments, trigger reduction strategies, and clinical and social referrals. Since 2006, 472 families have enrolled in the yearlong program. After 12 months, hospitalizations and emergency department visits decreased by more than 50%, and caregiver confidence in controlling the child''s asthma increased to nearly 100%. Key to the program''s success was the commitment and involvement of community partners from program inception to date.

KEY FINDINGS

• ▪Community health workers who are based in local community-based organizations and have strong ties to the community that they serve are uniquely positioned to initiate and nurture trusting partnerships with program participants.
• ▪Community health workers can move fluidly between the community and the health care settings, bridging gaps in care, providing culturally appropriate education and services, and connecting families to the clinical and social resources they desperately need.
• ▪The strength and success of the Washington Heights/Inwood Network (WIN) for Asthma Program is based in large part on the commitment and active involvement of community partners from program inception to date as well as the frequent exchange of program information and ideas among all partners and staff.
• ▪This hospital–community care coordination model is applicable to other populations and disease areas because of its customizable, culturally sensitive, and holistic approach to education and support.

     

Understanding the success of promotoras in increasing chronic diseases screening

The purpose of this qualitative study was to elicit information on why a promotora (or, community health worker (CHW)) increased adherence to chronic disease screening among women along the U.S.-Mexico border. After completion of the intervention, women and clinic staff who participated in the promotora phase of a randomized, controlled study answered structured, open-ended questionnaires. Clinicians from two non-participating clinics were also interviewed. Content analysis found that the promotora's roles included health education and the facilitation of routine and follow-up care. Clients appreciated the promotora's socio-cultural characteristics, as well as her personal skills and qualities, and described her as a trained, natural helper whose personalized support removed barriers to health care and helped women to take care of themselves. Most clinicians recommended working with a CHW to increase adherence to chronic disease prevention practices. A CHW can play a crucial role on a health care team and interventions should tap into this resource.     

Ecological strategies to promote healthy body image among children

Background: Personal habits of children and adolescents related to healthy body image (BI) are influenced by various determinants in the micro‐ and macroenvironment. These include attitudes and behaviors about eating; exercise and physical appearance modeled by parents, teachers, and peers; as well as opportunities to learn new habits and social praise for healthy choices. The coordinated school health program (CSHP) is compatible with the 5 levels of an ecological approach to developing new health behaviors. Methods: Authors systematically applied the ecological model to all 8 components of coordinated school health. Next, strategies for each of the components were developed using the professional literature as well as author expertise in the areas of health education, exercise science, and dietetics. Results: For each strategy, applicable health and physical education standards, as well as goals for each strategy and additional Web resources, were provided to assist educators and administrators in supporting healthy BI among students. Conclusions: Educators may effectively use a coordinated approach to guide multiple intervention activities aimed at increasing healthy habits among adolescents and their families. The strength of the CSHP is its collaborative nature with active participation by students, faculty members, family caregivers, agency professionals, community residents, and health care providers.     

Evaluation of a Childhood Obesity Prevention Online Training Certificate Program for Community Family Educators

Community family educators have the opportunity to incorporate childhood obesity prevention concepts in their programming with families of young children, but often lack formal health and nutrition education. The purpose of this feasibility study was to create an online training certificate program for community family educators and assess the program’s effectiveness at improving participant’s knowledge, attitudes, and intended and actual behaviors related to healthy lifestyles. Community family educators (n = 68) completed an online pretest, viewed 13 brief videos (8–15 min) focused on childhood obesity related topics and took mini-knowledge self-checks after each video followed by an online posttest. At posttest, paired t tests showed participants’ childhood obesity prevention related knowledge (i.e., nutrition, physical activity, screen time and sleep) improved significantly (p < 0.001). Participants’ attitudes toward parenting behaviors related to feeding practices, family meals, physical activity, screen time control and parent modeling significantly (p < 0.05) improved. Improvements also were seen in participants’ intentions to promote obesity prevention behaviors (i.e., age appropriate portions sizes, adequate physically active, and parental role modeling). Furthermore, changes in personal health behaviors at posttest revealed participants had significantly (p < 0.05) greater dietary restraint, improvements in sleep quality, and reductions of use of electronic devices during meals and snacks. Overall, participants were very satisfied with the training program, felt comfortable with skills acquired, and enjoyed the program. Findings suggest this online training program is a feasible and effective method for improving community family educators’ knowledge, attitudes, and intentions for obesity-prevention related parenting practices.     

A Capacity Building Approach to Increase Sports Participation in Disadvantaged Urban Communities: A Multilevel Analysis

Recent evidence showed that community capacity building is one of the key methods to reach health improvements within disadvantaged communities. Physical activity and sports participation are important means to reach health improvements. This study investigates a capacity building method which aims at increasing sports participation in the community, especially for individuals at higher risk of sports deprivation. The main aims of the present study, are the following: (1) to examine differences in sports participation between individuals living in communities implementing a sports-based capacity building program and individuals living in communities without such capacity building program and (2) to investigate if the community sports program reaches the individuals known to experience higher barriers to engage in sports. In Flanders, Belgium, five disadvantaged urban communities implementing the community capacity building program (program communities) and four without (control communities) were selected based on similarity of sociodemographic and environmental characteristics. Two hundred adults (aged 18–56 years) per community were randomly selected and visited at home to fill out a questionnaire on sociodemographics, sports participation, and the community sports program. A sample of 414 adults participated in the study. Results showed that adults from program communities reported on average 96 min/week more participation in sports than their counterparts living in control communities. Furthermore, 61.3 % of the individuals of program communities indicated to engage in sports, whereas in control communities, this was only 42.4 %. Respondents at higher risk of sports deprivation also engaged in significantly more sports participation in program communities than those in control communities. This difference was also noted for groups that are not related with sports deprivation. These results are promising and plead for a community capacity building approach to increase sports participation in disadvantaged communities.     

The Effects of City-Wide Implementation of “Second Step” on Elementary School Students’ Prosocial and Aggressive Behaviors

This study examined the impact of implementing Second Step, a violence prevention program, using a comprehensive, city-wide approach. The evaluation included 741 3rd–5th graders in six schools. Student surveys, behavioral observations, and discipline referrals were used to assess aggressive-antisocial and prosocial behaviors. We found significant improvements in positive approach-coping, caring-cooperative behavior, suppression of aggression, and consideration of others, but no changes in aggressive-antisocial behaviors. Behavioral observations and disciplinary referrals showed no significant changes. The program was implemented with high fidelity and engaged a wide range of participants from the community. Editors’ Strategic Implications: Key implementation issues are presented for a cross-site, city-wide evaluation on “Second Step.” School and community officials will benefit from these lessons, as well as the authors’ recommendations for further longitudinal study with appropriate comparison groups.     

Delivering Comprehensive Health Education Programs for Farmers in a Primary Care Setting*

ABSTRACT: A comprehensive health education series was provided for a group of farmers from a small farming community in western North Carolina. At one year after the program, the participants were surveyed. Between 70 and 100 percent of them felt that they learned something useful from each of the four sessions. The participants also noted behavior changes since the program; from 26.3 percent based on the pulmonary program to 90.9 percent based on the skin protection program. The retention of information and level of impact on health-related behaviors warrants further development and testing of this approach to agricultural occupational health education.     

Detecting Selection Effects in Community Implementations of Family-Based Substance Abuse Prevention Programs

To calculate valid estimates of the costs and benefits of substance abuse prevention programs, selection effects must be identified and corrected. A supplemental comparison sample is typically used for this purpose, but in community-based program implementations, such a sample is often not available. We present an evaluation design and analytic approach that can be used in program evaluations of real-world implementations to identify selection effects, which in turn can help inform recruitment strategies, pinpoint possible selection influences on measured program outcomes, and refine estimates of program costs and benefits. We illustrate our approach with data from a multisite implementation of a popular substance abuse prevention program. Our results indicate that the program''s participants differed significantly from the population at large.Federal, state, and local agencies increasingly require that funds for substance abuse prevention be spent on programs that have been found efficacious in randomized controlled trials (RCTs). However, community-based implementations may reach a population that is noncomparable to that of the RCT for a variety of reasons, including differences in recruiting, self-selection among program participants, differential attrition, or a different base population. The present study was designed to determine the nature of selection effects among participants attending a universal family-strengthening substance abuse prevention program called the Strengthening Families Program for Parents and Youth 10–14 (SFP). First, we briefly review the literature on selection effects in community-based prevention programs. Such programs are often delivered to families and focus on enhancing family strengths (e.g., parents'' involvement with children and parental monitoring). Family interventions of this type have been shown to prevent substance abuse, delinquency, and other risky behaviors.¹We then describe an evaluation design and analytic method that together enable detection of selection effects, even when the primary evaluation sample contains observations only on program participants, as is the case in many real-world implementations. Finally, we apply the technique to a community-driven multisite evaluation of SFP, a successful and widely disseminated prevention program,² and we discuss the results. Specifically, we use pretest data to examine the risk status of adolescent children of families who self-selected into SFP, to determine whether the probability of program participation was related to risk and protective factors. We then discuss the evaluation design in terms of its implications for assessment of program benefits, and we provide recommendations for translational research on preventive interventions in community settings.     

Integrating Community-Engagement and a Multiphase Optimization Strategy Framework: Adapting Substance Use Prevention for American Indian Families

Initiation of substance use often occurs earlier among American Indian (AI) youth than among other youth in the USA, bringing increased risk for a variety of poor health and developmental outcomes. Effective prevention strategies are needed, but the evidence base remains thin for this population. Research makes clear that prevention strategies need to be culturally coherent; programs with an evidence base in one population cannot be assumed to be effective in another. However, guidance on effective adaptation is lacking. This paper reports on cultural adaptation of an evidence-based program utilizing the multiphase optimization strategy (MOST) framework embedded within a community-engaged process to evaluate intervention components. The Strengthening Families Program for Parents and Youth 10-14 was adapted to become the Thiwáhe Gluwá?’akapi Program for American Indian youth and families. Three program components were evaluated for their effectiveness with regard to outcomes (youth substance use, theoretical mediators of program effects on substance use, and program attendance) in a sample of 98 families (122 youth and 137 adults). Consistent with the MOST framework, the value of components was also evaluated with regard to efficiency, economy, and scalability. Expanding on the MOST framework for cultural adaptation, we also considered the results of the MOST findings regarding the acceptability of each component from the perspectives of community members and participants. The promise of a strategic component-based approach to adapting evidence-based interventions is discussed, including the benefits of engaging community to ensure relevance and considering both cultural and scientific rationale for each component to enhance impact.

     

21st century community learning centers--improving the academic performance of at-risk students: a Bronx tale

The authors of this article report on an intervention designed to improve the academic component of an extended after-school program. The agency involved in this intervention was a non-profit community action group (CAG) agency whose mission is to improve the socio-economic well-being of the residents of Upper Manhattan, the Bronx, and New York City. The agency has a staff of 200 that serve high school students. The intervention program was designed to (1) improve the working relationship between teachers, families, and students in the after-school program, (2) develop new and innovative ways to improve the academic curricula of the after-school program, and (3) provide continuous education to stakeholders to the after-school program. Improvements in student performance relating to attendance, academic work, discipline and social behaviors were reported. The intervention reported in this article has the potential of supporting learning and developmental outcomes over time.     

Parent–child mealtime interactions in racially/ethnically diverse families with preschool-age children

Family meals may improve diet and weight outcomes in children; however, results from nationally representative samples suggest that these relationships vary by race/ethnicity. Observing parent–child mealtime interactions may lend insight to why racial/ethnic differences exist. In this pilot study, a multi-ethnic sample of low-income families (n = 30) with a preschool-age child was videotaped during a dinner in their home. A global coding scheme was used to assess the following: ‘Action’ (behaviors that divert attention from eating), ‘Behavior Control’ (behaviors intended to modify another person’s behavior), and ‘Communication’ (i.e., meal-oriented, interpersonal, and critical). All families spent a significant amount of time in ‘action’ oriented behaviors that diverted their attention from eating. We also observed racial/ethnic differences in communication (i.e. critical) and behavior patterns (i.e. behavior control). This study demonstrated that this approach for observing parent–child mealtime interactions in a naturalistic setting among a diverse study sample was feasible; however, future studies should address how these patterns relate to dietary intake and weight status.     

Families of the deceased in the hospital: A multi-disciplinary approach to intervention

An intervention program for families whose loved ones have died during hospitalization is presented. Collaboration and cooperation among all members of the professional team—doctor, nurse, and medical social worker—provide a systematic primary prevention approach for the surviving family members and helps prevent pathological grief.A model for such multi-disciplinary care-giving has been operating effectively for a number of years within the Department of Cardiothoracic Surgery of Carmel Hospital, Haifa, Israel. Emotional and practical assistance, as well as referrals to community resources, is provided by the team from its first admission meeting with the families of patients. Cases are presented to illustrate the main points of the program.