Deborah Parra-Medina

Pounds off with empowerment (POWER): A clinical trial of weight management strategies for black and white adults with diabetes who live in medically underserved rural communities

OBJECTIVESnWe evaluated lifestyle interventions for diabetic persons who live in rural communities.nnnMETHODSnWe conducted a 12-month randomized clinical trial (n = 152) of intensive-lifestyle (modeled after the NIH Diabetes Prevention Program) and reimbursable-lifestyle (intensive-lifestyle intervention delivered in the time allotted for Medicare reimbursement for diabetes education related to nutrition and physical activity) interventions with usual care as a control.nnnRESULTSnModest weight loss occurred by 6 months among intensive-lifestyle participants and was greater than the weight loss among usual-care participants (2.6 kg vs 0.4 kg, P<.01). At 12 months, a greater proportion of intensive-lifestyle participants had lost 2 kg or more than usual-care participants (49% vs 25%, P<.05). No differences in weight change were observed between reimbursable-lifestyle and usual-care participants. Glycated hemoglobin was reduced among all groups (P<.05) but was not different between groups.nnnCONCLUSIONSnImprovement in both weight and glycemia was attainable by lifestyle interventions designed for persons who had type 2 diabetes and lived in rural communities.

Toward a critical social theory of youth empowerment

SUMMARY This article contributes to the development of a critical social theory of youth empowerment which emphasizes collective efforts to create sociopolitical change. It draws upon analysis of four youth empowerment models, and upon findings from a participatory research study which identified key dimensions of critical youth empowerment: (1) a welcoming, safe environment, (2) meaningful participation and engagement, (3) equitable power-sharing between youth and adults, (4) engagement in critical reflection on interpersonal and sociopolitical processes, (5) participation in sociopolitical processes to affect change, and (6) integrated individual- and community-level empowerment. It concludes with discussion of the measurement of outcomes, and the challenges and opportunities for empowerment in youth organization.

Health Communication in the Latino Community: Issues and Approaches

With reference to the Communication-Persuasion model, we describe various research issues and challenges when considering the health of Latinos, and implications for designing and evaluating health communication and behavior change efforts in this population. Latinos, collectively the nations largest minority group, vary substantially in terms of socioeconomic and legal status, their country of origin and the extent of ongoing contact with that country, their region of residence within the United States, their generation status and levels of acculturation, and psychosocial factors. Health communication efforts with Latinos need to focus on family, cultural traditions, and collectivism while attending to acculturation, language, generation and national origin. The most extensive intervention topic in Latino health promotion has been the application of the lay health advisor model. This and other fundamental communication approaches, as well as audience and population characteristics, need to be considered within the context of dynamic and complex societal changes.

Factors Influencing Help-Seeking From Informal Networks Among African American Victims of Intimate Partner Violence:

The purpose of this study was to gain an understanding of the challenges African-American women in abusive relationships face when they consider seeking-help from their informal networks. Data are reported from interviews with 15 African-American women who were self-identified as having survived physical intimate partner violence. A 13-item, semi-structured interview guide was developed in order to elicit information from participants. All of the interviews were audio-recorded, transcribed, and coded for analysis. This analysis revealed emergent themes from these interviews concerning the social factors and perceptions that influence help-seeking behavior. Participants perceived their informal networks as willing to offer instrumental support. However, informal networks were not emotionally supportive. Participants also noted that the African-American community at-large believes victims of violence to be “stupid” for remaining in violent relationships. Additional results are also discussed. Results may be used to help enhance efforts to reduce the rates of intimate partner violence among African-Americans.

Predicting adolescent risk behaviors based on an ecological framework and assets.

OBJECTIVESnTo examine the relationship between an aggregate risk score (smoking, drinking, and number of sex partners) and measures of youth assets in a sample of 3439 youth aged 14-18 years.nnnMETHODSnLinear regression models for African American and white males and females predicted an aggregate risk score.nnnRESULTSnAfter adjustments, the youth asset most predictive of risk was self/peer values regarding risk behaviors. Perceived school support was also predictive.nnnCONCLUSIONSnTaking an ecological approach to the measurement of adolescent health behaviors contributes to our understanding of these risk behaviors.

Pilot study of strategies for effective weight management in type 2 diabetes: Pounds Off with Empowerment (POWER).

This pilot test effort focused on weight management strategies for individuals with type 2 diabetes living in rural, medically under-served communities. Randomly selected patients from the diabetes registry of a federally funded primary care practice in a rural community were randomized to one of two 8-week interventions: intensive lifestyle (reduced fat and calorie intake and increased activity) or intensive lifestyle plus ongoing formal evaluation for continuous quality improvement. Mean weight loss was 1.15 ± 1.90 kg (96.4% African American, n = 23, p < 0.01) with no difference between groups. Among the 78% who lost weight, mean loss was 2.00 kg. Mean difference in pre- vs. postintervention fasting blood glucose was −24.23 mg/dL (n = 23, p < 0.05). In this rural, medically under-served community, the interventions were moderately successful in facilitating weight loss and improving fasting glucose concentration. For purposes of state-of-the-art weight management interventions with diabetics, the addition of formal evaluation did not result in improved outcomes.

Covariations of Adolescent Weight-Control, Health-Risk and Health-Promoting Behaviors.

OBJECTIVESnTo assess the prevalence of dieting and investigate clusters of risk behaviors among adolescents.nnnMETHODSnData were secured from a random sample of adolescents (4,636) and analyzed using bivariate methods and logistic regression.nnnRESULTSnFrom the survey sample, 19.2% adolescents were classified as extreme, 43.2% as moderate dieters, 37.2% as nondieters. Extreme dieters were more likely to use alcohol, cigarettes, and/or marijuana and to attempt suicide and less likely to practice vigorous exercise. Moderate dieters were less likely to use cigarettes, marijuana and more likely to engage in vigorous exercise, with differences across gender-race categories.nnnCONCLUSIONSnResults have relevance for developing multicomponent programs for adolescents.

A Replicable Process for Redesigning Ethnically Relevant Educational Materials

BACKGROUNDnTo serve the populations targeted by Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) effectively, healthcare providers need educational materials that are evidence based and ethnically relevant and can be easily incorporated into busy clinic settings. We describe a replicable process used to redesign and tailor physical activity and diet education materials for African American women in the southeastern United States.nnnMETHODSnThe process consists of seven phases. Quantitative and qualitative analyses were used on data gathered in 2000 from two expert panels and eight focus groups.nnnRESULTSnExpert panelists preferred materials perceived to be high quality, easy to understand, organized to facilitate use by healthcare providers, and with content relevant to African American women. Focus group participants were mostly concerned with the visual appeal and content of educational materials. They liked high-quality materials that are brief; avoid jargon and use simple language, bright colors, and photographs; and provide useful information that acknowledges the context of their lives, including their family roles.nnnCONCLUSIONSnThe redesign process can produce ethnically and culturally appropriate educational materials for use by WISEWOMAN providers and other healthcare providers in conjunction with cardiovascular (CVD) risk reduction and behavioral counseling. To be effective, materials must address the needs and concerns of both providers and patients.

Adult roles in community-based youth empowerment programs: implications for best practices.

Current literature on community-based youth empowerment programs provides few specific operational descriptions of adult roles. This research addressed that gap by exploring the perspectives and experiences of adults actively engaged with youth empowerment programs. Data were gathered through in-depth interviews, field observations, and interactive group discussions with adult program leaders. The following dimensions of adults work were identified: putting youth first; raising the bar for youth performance; creating the space and making things happen; being in relationships; exerting influence, control, and authority; and communicating and connecting with the broader community. These findings provide guidance for the development of best practices in community-based youth empowerment programs.

Societal images of youth: representations and interpretations by youth actively engaged in their communities

In this paper, the authors explore representations and interpretations of images of youth that surfaced in discussions with groups of adolescents in four community youth organizations. As part of a larger multi‐method study, adolescents created photo‐essays on the theme ‘Youth Making a Difference in the Community.’ These projects then served as triggers for small‐group discussions around the product and meaning of the exercise. In the analysis of the discussion‐group transcripts, one of the striking findings was how these youth, in the processes of creating and reflecting on their photo‐essays, perceived and challenged dominant societal images; reconstructed alternative images based on their personal and peer experiences; and valued visibility and recognition of youths contributions to the community as a way of changing the image of youth. The authors discuss implications for research and educational practices aimed at youth empowerment and recasting societal images.