Joel S. Meister

The Impact of a Promotora on Increasing Routine Chronic Disease Prevention among Women Aged 40 and Older at the U.S.-Mexico Border

A randomized controlled intervention tested the effectiveness of a community health worker (CHW) program in increasing compliance with annual preventive exams among uninsured Hispanic women living in a rural U.S.-Mexico border area. During 1999-2000, household surveys were administered to women aged 40 and older. Uninsured women not receiving routine comprehensive preventive care were invited to participate in a free comprehensive clinical exam. Participants in the initial exam were eligible to participate in the CHW (promotora) intervention. Women were randomized to one of two intervention arms. One arm received a post-card reminder for an annual preventive exam, the other a postcard reminder and follow-up visit by a promotora. Receiving the promotora intervention was associated with a 35% increase in rescreening over the postcard-only reminder (risk ratio [RR] = 1.35, 95% confidence interval 0.95-1.92). Using promotoras to increase compliance with routine screening exams is an effective strategy for reaching this female population.

Using lay health workers: Case study of a community-based prenatal intervention

This article reports on the design and implementation of a prenatal outreach and education intervention for low income, Hispanic women living in three migrant and seasonal farmworker communities in Arizona. The program included three major elements: a Spanish language prenatal curriculum; a group of mature Hispanic women recruited from the target communities and trained as “Comienzo Sano” (healthy beginning) Promotoras (health promoters), and the organization of a support network of local health professionals. The rationale for the demonstration is reviewed, and the structure of the intervention is described. Factors which facilitated and constrained implementation of the program are identified, and guidelines are provided for other health care providers and health educators interested in developing similar programs.

EVALUATION OF A PEER HEALTH WORKER PRENATAL OUTREACH AND EDUCATION PROGRAM FOR HISPANIC FARMWORKER FAMILIES

This article contains the findings from an evaluation of a prenatal education program to Hispanic migrant farmworker families using peer health workers. The focus of the evaluation was on establishing the validity of the intervention model in the target population. Data are presented on the program setting, characteristics of the clients served, and effects of the educational program on the clients and peer health workers. The evaluation identified factors that established confidence in the program model: (1) there were existing barriers to health care and health information; (2) the program served a culturally specific and disadvantaged population; (3) the prenatal curriculum was culturally sensitive; (4) the peer workers were accepted by the target community; and (5) the model did not threaten the medical community. The directions for future research are presented.

Predictors of Cervical Cancer Screening in Mexican American Women of Reproductive Age

Several barriers impede cancer prevention in the Mexican American population. This study identified sociocultural factors that could be used to increase screening rates for cervical cancer in women of reproductive age. A survey was conducted in 1991 of 366 Mexican American women ages 18 to 40 in Tucson, Arizona, to assess current compliance with cervical cancer screening guidelines and several psychological, social, and cultural variables. Women who had never been screened (13 percent of the sample) had a knowledge deficit, no gynecological care, and no sexual activity. Women not screened annually (16 percent) lacked preventive care, imperfectly understood the Pap test, had lower selfefficacy expectations for understanding physicians, experienced higher emotional stress about the test, and were older and less acculturated. Women who have never been screened require basic education on cancer and cancer screening and policy changes increasing access to care. For women with less routine screening, preventive care, supportive attitudes, and health care skills must be encouraged.

Special Action Groups for Policy Change and Infrastructure Support to Foster Healthier Communities on the Arizona-Mexico Border:

As part of efforts to help stem the rising tide of diabetes among Hispanic Americans living in Arizona-Mexico border communities, the Border Health Strategic Initiative was launched to foster community-based approaches to diabetes prevention and control. A major thrust of the initiative was establishment of special community action groups (SAGs) to help stimulate policy change and sustain interventions designed to reduce the risk of diabetes and its complications. The SAGs met regularly for more than two years, focusing primarily on policies that encourage development of an infrastructure to support physical activity and healthier nutrition. Through involvement with planning commissions, parks and recreation, and private companies, two community development block grants were obtained to support new walking trails. The SAGs also encouraged elementary schools to improve physical education and change vending machine products, and grocery store owners and managers to allow the demonstration and promotion of healthier foods. These groups, focused on policy and infrastructure change within their communities, may be the glue needed to hold comprehensive community health promotion efforts together.

Designing an effective statewide tobacco control program‐Arizona

In this article, the author examines the creation and development of Arizonas statewide tobacco control program. In particular, he examines the three basic goals of prevention, cessation, and policy and emphasizes the need to focus equally on all to build an effective program. The need for sound theory and research to guide statewide comprehensive programs is highlighted. Cancer 1998;83:2728‐2732.