South Texas Border Health Disparities Center November 6, 2009 Alliance for a Healthy Border: Overview of Program & Data Set Cynthia J. Brown, PhD Donna Jackson Violeta Diaz Suad Ghaddar, PhD

Outline  Alliance for a Healthy Border (AHB) Overview of the initiative Objectives Participating community health centers Timeline of the initiative  Description of programs  Survey instrument  Variables  Focus groups  Research

Alliance for a Healthy Border  A chronic disease prevention program that funds nutrition and physical activity education programs at 12 federally-qualified community health centers (CHCs) located along the U.S.-Mexico border in Texas, New Mexico, Arizona and California

Objectives of AHB  To reduce modifiable risk factors associated with diabetes and cardiovascular disease  To establish and/or expand existing diabetes and cardiovascular disease prevention programs targeting the Hispanic and Latino population  To identify and promote best practices in the prevention of these diseases

Participating Community Health Centers CenterCountyState Ben Archer Health CenterLunaNM Centro de Salud Familiar La FeEl PasoTX Clinicas de Salud del PuebloImperialCA El Rio CHCPimaAZ Family Health CentersSan DiegoCA La Maestra CHCSan DiegoCA San Ysidro Health CenterSan DiegoCA Gateway Health CenterWebbTX La Clinica de FamiliaDoña AnaNM Mariposa CHCSanta CruzAZ Nuestra Clinica del ValleHidalgoTX United Medical Centers MaverickTX

Select Border County Characteristics Percent of Population CountyHispanicsFamilies below poverty level UninsuredForeign- born Speak language ≠ English Pima, AZ Santa Cruz, AZ Imperial, CA San Diego, CA Doña Ana, NM Luna, NM El Paso, TX Hidalgo, TX Maverick, TX Webb, TX U.S AHB sample Sources: U.S. Census Bureau: Census 2000, American Community Survey, 2006 Small Area Health Insurance Estimates, AHB data set

Time Line  Phase 1 12 CHCs April 2006 – December 2007  Phase 2 8 CHCs January 2008 – December 2008

Sample  Data collection points: baseline, program- end, 6-months post program-end  Baseline sample 4,047 individuals  Program-end sample 2,596 individuals  Six-month post program-end sample 2,134 individuals

Programs  Program lengths vary between 4 weeks and 6 months  Culturally-sensitive curriculum Existing programs (e.g., Pasos Adelante) Modification of existing curriculum (e.g., Salud para Su Corazon) Center-developed initiatives (e.g., Medir para Vivir)  Education settings vary Group sessions held in CHCs or community locations Individual sessions held in CHCs or participants’ homes  Unique participation criteria Diagnosed diabetics among CHC patients At-risk CHC patients Self-enrollment through community outreach activities

Survey Instrument  Survey instrument based on Behavioral Risk Factor Surveillance System (BRFSS) Community Tracking Study Household Survey  Anthropometric measures (weight, waist to hip ratio, heart rate, blood pressure, glucose, HbA1c, and cholesterol)

Survey Sections  Sociodemographic information  Health  Health care  Tobacco use & alcohol consumption  Diabetes  Hypertension awareness  Cholesterol awareness  Cardiovascular disease  Exercise & physical activity  Diet

Constructed Variables - Behavioral  Exercise & physical activity Meeting Healthy People 2010 physical activity recommendations  moderate-intensity physical activity for at least 30 minutes, 5-7 days a week, or  vigorous-intensity physical activity for at least 20 minutes, 3-7 days a week  Dietary habits Fruit & vegetable servings per week Healthy habits scale  Fat/cholesterol intake  Salt/sodium intake  General healthy habits (nutrition labels, portions, etc.)

Constructed Variables – HRQOL  Health-related quality of life ≥ 14 unhealthy days (physical) ≥ 14 unhealthy days (mental) ≥ 14 unhealthy days (physical or mental) ≥ 14 activity limitation days

Constructed Variables – Success  Weight reduction success Normal BMI  any reduction is success Overweight/obese BMI  5% reduction is success  Glycemic success (HbA1c reduction) HbA1c < 6  maintenance is success 6 ≤ HbA1c < 7.1  5% or more reduction is success 7.1 ≤ HbA1c < 7.6  10% or more reduction is success HbA1c ≥ 7.6, 15% or more reduction is success

Constructed Variables – Success  Dietary success If weekly FVF* ≥ 35  maintenance is success If weekly FVF* < 35  meeting 5-a-day recommendation is success Score on Healthy Habits scale improved by at least one point on at least six items  success  Physical activity success Met HP 2010 recommendations  maintenance is success Did not meet HP 2010 recommendations  meeting is success *FVF: fruit and vegetable frequency

Constructed Variables - Other  Body Mass Index  Cardiac risk ratio  Acculturation  Diagnosed with diabetes Glycemic control: HbA1c < 8% Diabetes duration

Focus Groups  Held October & November of 2007 July & August of 2008  Sample: 224 participants  Recordings and transcripts are in Spanish

Focus Groups: Questions  What are some of the things you learned since you started the program?  What did you change in your diet and in your physical activity  What specific activity made the biggest impression on you and made you change?  Were there any barriers that made these changes difficult?  Do you think you will continue with this learned behavior after finishing the program?  What would you modify from the program?

Research  Evaluation of AHB USMBHA, South Padre Island, May 2007 AcademyHealth, Orlando, June 2007 USMBHA, Hermosillo, MX, May 2008  Predictors of success in prevention programs AcademyHealth, Washington DC, June 2008  Health-related quality of life and success in prevention programs APHA, San Diego, October 2008  Effectiveness of culturally-sensitive interventions Texas Dietetic Association, Austin, April 2009

Research (cont’d)  Qualitative evaluation (focus groups) USMBHA, El Paso, June 2009  Acculturation and healthy lifestyle habits Border Health Forum, San Diego, July 2009 Publication: E-Border Health  Acculturation and diabetes self- management practices APHA, Philadelphia, November 2009  Education programs & disparities in glycemic control APHA, Philadelphia, November 2009

Untapped Research Areas  Smoking  Mental health  Cardiovascular disease

Logistics  Timeline Proposal submission: December 1 st Funding decision: December 15 th Journal submission: August 2010  Abstract: 1,000 word limit, excluding list of publication outlets and research timeline.  IRB form

Questions