Gloria D. Coronado

Community-Based Participatory Research: Lessons Learned from the Centers for Children's Environmental Health and Disease Prevention Research

Over the past several decades there has been growing evidence of the increase in incidence rates, morbidity, and mortality for a number of health problems experienced by children. The causation and aggravation of these problems are complex and multifactorial. The burden of these health problems and environmental exposures is borne disproportionately by children from low-income communities and communities of color. Researchers and funding institutions have called for increased attention to the complex issues that affect the health of children living in marginalized communities—and communities more broadly—and have suggested greater community involvement in processes that shape research and intervention approaches, for example, through community-based participatory research (CBPR) partnerships among academic, health services, public health, and community-based organizations. Centers for Children’s Environmental Health and Disease Prevention Research (Children’s Centers) funded by the National Institute of Environmental Health Sciences and U.S. Environmental Protection Agency were required to include a CBPR project. The purpose of this article is to provide a definition and set of CBPR principles, to describe the rationale for and major benefits of using this approach, to draw on the experiences of six of the Children’s Centers in using CBPR, and to provide lessons learned and recommendations for how to successfully establish and maintain CBPR partnerships aimed at enhancing our understanding and addressing the multiple determinants of children’s health.

Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study

Objective To determine the extent to which uterine leiomyomas are associated with characteristics of pregnancy, labor, and neonatal outcome recorded on birth certificates. Methods In a population-based series of women who delivered singleton live infants in Washington state from 1987–1993, we linked computerized birth certificates and hospital discharge records to investigate the relationship between uterine leiomyomas and complications in pregnancy and delivery. Subjects were 2065 women with uterine leiomyomas noted on computerized hospital discharge records. From the remaining records, a comparison group of women without uterine leiomyomas diagnoses were selected at random and frequency-matched by birth year to women with leiomyomas. We used unconditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of pregnancy or delivery complications in relation to uterine leiomyomas after multivariate adjustment. Results Women with leiomyomas were more likely than controls to be over age 35 at delivery, nulliparous, or black. We observed independent associations between uterine leiomyomas and abruptio placentae (OR 3.87, 95% CI 1.63, 9.17), first trimester bleeding (OR 1.82, 95% CI 1.05, 3.20), dysfunctional labor (OR 1.85, 95% CI 1.26, 2.72), and breech presentation (OR 3.98, 95% CI 3.07, 5.16). The risk of cesarean was also higher among women with uterine leiomyomas (OR 6.39, 95% CI 5.46, 7.50), but a portion of the excess risk might have been due to biased detection of leiomyomas at cesarean delivery. Conclusion Leiomyomas appear to increase likelihood of complications during pregnancy, labor, and delivery.

Pesticide take-home pathway among children of agricultural workers: Study design, methods, and baseline findings

Farmworkers are exposed to pesticides and may take home pesticide residues to their families. In this paper, self-reported pesticide exposure and home practices to reduce the amount of pesticide residues taken home were examined among 571 farmworkers. Urine samples from a subsample of farmworkers and children and dust samples from households and vehicles also assessed pesticide exposure. Overall, 96% of respondents reported exposure to pesticides at work. Many employers did not provide resources for hand washing. Farmworkers’ protective practices to keep pesticide residues out of the home were at a low level. In a subset of respondents, pesticide levels above the limit of quantitation were seen in the urine of children and adults and in house and vehicle dust. The results support the take-home pathway of pesticide exposure. Ways must be found to reduce this pesticide exposure among children of farmworkers.

A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability

BACKGROUND The recent proliferation of studies describing factors associated with HPV vaccine acceptability could inform health care providers in improving vaccine coverage and support future research. This review examined measures of HPV and HPV-vaccine knowledge, attitudes, beliefs and acceptability, described psychometric characteristics, and provided recommendations about their use. METHODS A systematic search of Medline, CINAHL, PsychoInfo, and ERIC through May 2008 for English language reports of quantitative data from parents, young adults or adolescents yielded 79 studies. RESULTS The majority of studies were cross-sectional surveys (87%), self-administered (67%), conducted before prophylactic vaccines were publicly available (67%) and utilized convenience samples (65%). Most measured knowledge (80%), general attitudes about HPV vaccination (40%), and willingness to vaccinate ones daughter (26%). Two-thirds did not report reliability or validity of measures. The majority did not specify a theoretical framework. CONCLUSIONS Use of a theoretical framework, consistent labeling of constructs, more rigorous validation of measures, and testing of measures in more diverse samples are needed to yield measurement instruments that will produce findings to guide practitioners in developing successful community and clinical interventions.

A low-glycemic load diet reduces serum C-reactive protein and modestly increases adiponectin in overweight and obese adults.

Low-glycemic load (GL) diets improve insulin resistance and glucose homeostasis in individuals with diabetes. Less is known about whether low-GL diets, independent of weight loss, improve the health profile for persons without diabetes or other preexisting conditions. We conducted a randomized, cross-over feeding study testing low- compared to High-GL diets on biomarkers of inflammation and adiposity in healthy adults. Eighty participants (n = 40 with BMI 18.5-24.9 kg/m²; n = 40 with BMI 28.0-40.0 kg/m²) completed two 28-d feeding periods in random order where one period was a high-GL diet (mean GL/d = 250) and the other a low-GL diet (mean GL/d = 125). Diets were isocaloric with identical macronutrient content (as percent energy). All food was provided and participants maintained weight and usual physical activity. Height, weight, and DXA were measured at study entry and weight assessed again thrice per week. Blood was drawn from fasting participants at the beginning and end of each feeding period and serum concentrations of high-sensitivity CRP, serum amyloid A, IL-6, leptin, and adiponectin were measured. Linear mixed models tested the intervention effect on the biomarkers; models were adjusted for baseline biomarker concentrations, diet sequence, feeding period, age, sex, and body fat mass. Among participants with high-body fat mass (>32.0% for males and >25.0% for females), the low-GL diet reduced CRP (P = 0.02) and marginally increased adiponectin (P = 0.06). In conclusion, carbohydrate quality, independent of energy, is important. Dietary patterns emphasizing low-GL foods may improve the inflammatory and adipokine profiles of overweight and obese individuals.

Cancer prevention behaviors and socioeconomic status among Hispanics and non-Hispanic whites in a rural population in the United States.

OBJECTIVES: Socioeconomic status is explored as a predictor of differences between Hispanics and non-Hispanic Whites in cancer prevention behavior.METHODS: In a cross-sectional study, in-person interviews (n = 1795) were conducted in a population-based random sample of adults in 20 communities with a high proportion of Hispanics.RESULTS: Hispanics were significantly less likely than non-Hispanic Whites to ever have had cervical (p < 0.001), breast (p = 0.007), or colorectal cancer (FOBT p = 0.008; sigmoidoscopy/colonoscopy p < 0.002) screening. After adjusting for socioeconomic status (education and having health insurance), only differences in cervical cancer remained significant (p = 0.024). After adjusting for socioeconomic status, Hispanics had a significantly higher intake of fruits and vegetables per day (4.84 servings) than non-Hispanic Whites (3.84 servings) (p < 0.001); and fat behavior score was marginally significant after adjustment for socioeconomic status (p = 0.053). Significantly fewer Hispanics were current smokers than non-Hispanic Whites (p < 0.001).CONCLUSIONS: There is only limited support for the hypothesis that socioeconomic status is a major determinant of some cancer-related behaviors; specifically, socioeconomic status is related to mammography and colorectal screening, but not cervical cancer, dietary behavior, or smoking.

Organophosphate Pesticide Exposure and Work in Pome Fruit: Evidence for the Take-Home Pesticide Pathway

Organophosphate (OP) pesticides are commonly used in the United States, and farmworkers are at risk for chronic exposure. Using a sample of 218 farmworkers in 24 communities and labor camps in eastern Washington State, we examined the association between agricultural crop and OP pesticide metabolite concentrations in urine samples of adult farmworkers and their children and OP pesticide residues in house and vehicle dust samples. Commonly reported crops were apples (71.6%), cherries (59.6%), pears (37.2%), grapes (27.1%), hops (22.9%), and peaches (12.4%). Crops were grouped into two main categories: pome fruits (apples and pears) and non-pome fruits. Farmworkers who worked in the pome fruits had significantly higher concentrations of dimethyl pesticide metabolites in their urine and elevated azinphos-methyl concentrations in their homes and vehicles than workers who did not work in these crops. Among pome-fruit workers, those who worked in both apples and pears had higher urinary metabolites concentrations and pesticide residue concentrations in dust than did those who worked in a single pome fruit. Children living in households with pome-fruit workers were found to have higher concentrations of urinary dimethyl metabolites than did children of non-pome-fruit workers. Adult urinary concentrations showed significant correlations with both the vehicle and house-dust azinphos-methyl concentrations, and child urinary concentrations were correlated significantly with adult urinary concentrations and with the house-dust azinphos-methyl concentration. The results provide support for the take-home pathway of pesticide exposure and show an association between measures of pesticide exposure and the number of pome-fruit crops worked by farmworkers.

Barriers and facilitators related to mammography use among lower educated Mexican women in the USA

This study explores barriers to and facilitators of breast cancer screening and how people in a womans social network influence these screening behaviors. A total of 40 semi-structured qualitative interviews were conducted in rural Washington State (USA) among Mexican women aged 50 and over. Eligible women reported either having had a mammogram within the last two years, over two years ago, or never. We found that lack of health insurance, the perception that the mammogram is painful, and fear of finding cancer were cited as barriers to participation in mammography screening. Women who had lived in the US for a shorter period were more likely to report never having had a mammogram than women who had lived in the US for a longer period. Women often cited daughters and female friends as those from whom they received advice or encouragement to receive a mammogram. Few differences were found related to network size and mammography use among the groups. These findings may be useful in designing interventions to promote mammography use. Including daughters in intervention activities may help facilitate mammography use among Mexican women.

AMIGAS: A Multicity, Multicomponent Cervical Cancer Prevention Trial Among Mexican American Women

Considerable efforts have been undertaken in the United States to reduce cervical cancer incidence and mortality by increasing screening; however, disparities in screening rates continue to exist among certain racial and ethnic minority groups. The objective of the current study was to determine the effectiveness of a lay health worker‐delivered intervention—AMIGAS (Ayudando a las Mujeres con Informacion, Guia, y Amor para su Salud [helping women with information, guidance, and love for their health])—to increase Papanicolaou (Pap) test screening among 3 populations of women of Mexican origin.

Prevalence and Characteristics of Smokers at 30 Pacific Northwest Colleges and Universities

College is an important transition period during which young adults explore tobacco use. Few large-scale studies have been conducted among college students regarding tobacco use. We initiated a study examining tobacco use in 30 colleges and universities in the Pacific Northwest. We conducted a baseline survey among students. Sample size varied by the school size; for the 14 largest schools, we drew a random sample of all students, oversampling freshmen (n approximately 750) so that we could recruit and follow a cohort to assess smoking onset during the college years. Of the remaining students, we sampled equivalent numbers of sophomores, juniors, and seniors (n = 200 each). For the 16 schools with fewer than 1,350 students, we surveyed all students. We found overall smoking rates of 17.2%. Males (18.6%) were more likely to smoke than females (16.6%; p = .03), and public college students were more likely to smoke (20.5%) than those who attended private independent schools (18.9%; p = .61), whose rates were higher than those of private religious schools (11.6%; p = .001). Overall, college students are light smokers who do not smoke every day of the month. Further, they tend not to be highly dependent on tobacco, do not consider themselves regular smokers, and plan to quit before they graduate (56.8%). School type should be considered when estimating smoking rates among 4-year college students. Data indicate that college smokers wish and plan to quit before graduation, suggesting that efforts to assist smokers in quitting during the college years may be fruitful.