Julie St. John

Using direct observations on multiple occasions to measure household food availability among low-income Mexicano residents in Texas colonias

BackgroundIt has been recognized that the availability of foods in the home are important to nutritional health, and may influence the dietary behavior of children, adolescents, and adults. It is therefore important to understand food choices in the context of the household setting. Considering their importance, the measurement of household food resources becomes critical.Because most studies use a single point of data collection to determine the types of foods that are present in the home, which can miss the change in availability within a month and when resources are not available, the primary objective of this pilot study was to examine the feasibility and value of conducting weekly in-home assessments of household food resources over the course of one month among low-income Mexicano families in Texas colonias.MethodsWe conducted five in-home household food inventories over a thirty-day period in a small convenience sample; determined the frequency that food items were present in the participating households; and compared a one-time measurement with multiple measurements.After the development and pre-testing of the 252-item culturally and linguistically- appropriate household food inventory instrument that used direct observation to determine the presence and amount of food and beverage items in the home (refrigerator, freezer, pantry, elsewhere), two trained promotoras recruited a convenience sample of 6 households; administered a baseline questionnaire (personal info, shopping habits, and food security); conducted 5 in-home assessments (7-day interval) over a 30-day period; and documented grocery shopping and other food-related activities within the previous week of each in-home assessment. All data were collected in Spanish. Descriptive statistics were calculated for mean and frequency of sample characteristics, food-related activities, food security, and the presence of individual food items. Due to the small sample size of the pilot data, the Friedman Test and Kendalls W were used to assess the consistency of household food supplies across multiple observations.ResultsComplete data were collected from all 6 Mexicano women (33.2y ± 3.3; 6.5 ± 1.5 adults/children in household (HH); 5 HH received weekly income; and all were food insecure. All households purchased groceries within a week of at least four of the five assessments. The weekly presence and amounts of fresh and processed fruits and vegetables, dairy, meats, breads, cereals, beverages, and oils and fats varied. Further, the results revealed the inadequacy of a one-time measurement of household food resources, compared with multiple measures. The first household food inventory as a one-time measure would have mistakenly identified at least one-half of the participant households without fresh fruit, canned vegetables, dairy, protein foods, grains, chips, and sugar-sweetened beverages.ConclusionsThis study highlights the value of documenting weekly household food supplies, especially in households where income resources may be more volatile. Clearly, the data show that a single HFI may miss the changes in availability - presence and amount - that occur among low-income Mexicano households who face challenges that require frequent purchase of foods and beverages. Use of multiple household food inventories can inform the development and implementation of nutrition-related policies and culturally sensitive nutrition education programs.

Promotoras as Research Partners to Engage Health Disparity Communities

There is an urgent need to improve nutritional health in health disparity communities, such as the growing Hispanic and Latino populations. However, efforts focused on complex nutritional health issues, such as obesity and food insecurity, can be more difficult in underserved and at risk communities, such as Mexican-origin residents living in communities along the Texas-Mexico border.(blinded for review) Some of these challenges include: Establishing trust and rapport with community residents who are markedly different from the university-based research team; Working with communities to recruit from a specified sampling frame and to minimize attrition over the life course of a study; Adapting data collection protocol and instruments to culturally appropriate and reliable measures of dietary and environmental exposures; Accommodating logistical challenges of study participants (e.g., family, social, employment conflicts, and transportation challenges) in order to acknowledge the time commitment, minimize attrition, and complete timely and comprehensive assessments; Capturing contextual factors for understanding food- and health-related behaviors. Further, it can be quite difficult to conduct research in a way that is both respectful of the community and residents’ norms, values, and traditions, and that possesses the rigor needed for the academy. A community-academic partnership where university-based researchers develop a partnership with promotoras de salud (promotoras) as research collaborators is one way to address these challenges in a culturally-competent manner.

Empowerment of promotoras as promotora-researchers in the Comidas Saludables & Gente Sana en las Colonias del Sur de Tejas (Healthy Food and Healthy People in South Texas Colonias) program.

Promotoras are trusted members of underserved, at-risk Hispanic communities experiencing social and health inequities. As promotora–researchers, promotoras have the unique ability and opportunity not only to provide outreach and education but also to be actively engaged in conducting research in their communities and serve as a cultural bridge between the community and researchers. In this article, we present a case study of personal and collective empowerment of six promotora–researchers who participated in seven community-based participatory research projects. Data sources included debriefing interviews with the promotora–researchers, milestone tracking and documentation completed during and after each study, and observations by the principal investigator and project managers regarding the role of the promotora–researchers in these studies. We qualitatively analyzed the data to identify the processes and decisions that were developed and implemented in a series of projects, which resulted in promotora–researcher empowerment. We found that active engagement empowered promotora–researchers personally and collectively in all phases of the research study. Common elements that contributed to the empowerment of promotora–researchers were valuing promotora–researchers’ input, enabling promotora–researchers to acquire and utilize new skills, and allowing promotora–researchers to serve as both researchers and traditional promotoras. Together, these elements enabled them to more fully participate in research projects, while allowing them to identify and address needs within their own communities.

Pulga (Flea Market) Contributions to the Retail Food Environment of Colonias in the South Texas Border Region

Accounts of the retail food environment have been limited by research that focused on supermarkets, grocery stores, and restaurants as the principal food sources for consumers. Little is known about alternative retail food sources, especially in rural and underserved areas such as the colonias along the South Texas border with Mexico. Many colonias are located near pulgas (flea markets). This is the first study to examine this alternative food source for colonia residents. This studys purpose is to provide preliminary data on food availability in this unstudied element of the retail food environment. Five pulgas were identified for study by local informants. Two separate teams of two promotores (indigenous community health workers) conducted observations, wrote field notes, and surveyed vendors in each pulga. Traditional foods, prepared foods, and fresh fruits and vegetables were available in the observed pulgas. Traditional foods included staples, meal items, and snacks and sweets. Prepared foods were available in small stands run by independent operators, and each pulga had permanent restaurants that served prepared foods. A large variety of fresh fruits and vegetables were also available. An emphasis on supermarkets and grocery stores will provide an incomplete account of the retail food environment. Further studies should attempt to provide a more complete account by identifying alternative retail sources used by local residents. One such alternative retail food source, the pulga, provides a range of traditional food stuffs, prepared food items, and fruits and vegetables that complement conventionally studied aspects of the retail food environment.

Cultural repertoires and food-related household technology within colonia households under conditions of material hardship

IntroductionMexican-origin women in the U.S. living in colonias (new-destination Mexican-immigrant communities) along the Texas-Mexico border suffer from a high incidence of food insecurity and diet-related chronic disease. Understanding environmental factors that influence food-related behaviors among this population will be important to improving the well-being of colonia households. This article focuses on cultural repertoires that enable food choice and the everyday uses of technology in food-related practice by Mexican-immigrant women in colonia households under conditions of material hardship. Findings are presented within a conceptual framework informed by concepts drawn from sociological accounts of technology, food choice, culture, and material hardship.MethodsField notes were provided by teams of promotora- researchers (indigenous community health workers) and public-health professionals trained as participant observers. They conducted observations on three separate occasions (two half-days during the week and one weekend day) within eight family residences located in colonias near the towns of Alton and San Carlos, Texas. English observations were coded inductively and early observations stressed the importance of technology and material hardship in food-related behavior. These observations were further explored and coded using the qualitative data package Atlas.ti.ResultsTechnology included kitchen implements used in standard and adapted configurations and household infrastructure. Residents employed tools across a range of food-related activities identified as forms of food acquisition, storage, preparation, serving, feeding and eating, cleaning, and waste processing. Material hardships included the quality, quantity, acceptability, and uncertainty dimensions of food insecurity, and insufficient consumption of housing, clothing and medical care. Cultural repertoires for coping with material hardship included reliance on inexpensive staple foods and dishes, and conventional and innovative technological practices. These repertoires expressed the creative agency of women colonia residents. Food-related practices were constrained by climate, animal and insect pests, women’s gender roles, limitations in neighborhood and household infrastructure, and economic and material resources.ConclusionsThis research points to the importance of socioeconomic and structural factors such as gender roles, economic poverty and material hardship as constraints on food choice and food-related behavior. In turn, it emphasizes the innovative practices employed by women residents of colonias to prepare meals under these constraints.

Seasoning for the Soul: Empowerment Through Food Preparation Among Mexican Women in the Texas Colonias

This article examines the idea of empowerment through food preparation and applies it to a specific context—that of the life of immigrant Mexican women from two South Texas settlement areas, or colonias. Based on ethnographic data gathered through participant observation by bilingual research teams of promotoras and formally educated health professionals embedded with participant families, we analyze the living situations of low-income Mexican women in the South Texas colonias, particularly their food procurement, storage, and preparation practices for their families. We acknowledge the existence of hegemonic gendered, economic, and racialized structures of domination that surround the womens role in food preparation. However, we also recognize food preparation as the domain in which otherwise oppressed and marginalized women, living a life of isolation filled with severe problems and uncertainties, exercise some degree of power and control within their lives and the well-being of their family members. Included are implications for further research on communal empowerment.

Confronting the Diabetes Disparity: A Look at Diabetes, Nutrition, and Physical Activity Programs in the Lower Rio Grande Valley

Diabetes prevalence is higher along U.S.—Mexico border than in nonborder regions, and numerous community-based organizations are addressing this diabetes disparity through prevention and management programs. However, the nature, scope, and effectiveness of these efforts and programs are not well documented. This study aims at identifying key characteristics of diabetes programs in a Texas—Mexico border region with a predominately Hispanic, underserved population. A survey is administered to 84 community-based organizations in the Lower Rio Grande Valley (LRGV); 25 organizations respond. Nineteen programs related to diabetes and healthy lifestyle behaviors are identified in the LRGV. The majority of the programs are based on guidelines of national and state professional associations and agencies; target low-income and minority populations; are offered at no cost; and include program evaluation activities. Future research should examine the effectiveness, as well as the fidelity of the guidelines, of diabetes programs in the border region.

Developing an evidence-based fall prevention curriculum for community health workers.

This perspective paper describes processes in the development of an evidence-based fall prevention curriculum for community health workers/promotores (CHW/P) that highlights the development of the curriculum and addresses: (1) the need and rationale for involving CHW/P in fall prevention; (2) involvement of CHW/P and content experts in the curriculum development; (3) best practices utilized in the curriculum development and training implementation; and (4) next steps for dissemination and utilization of the CHW/P fall prevention curriculum. The project team of CHW/P and content experts developed, pilot tested, and revised bilingual in-person training modules about fall prevention among older adults. The curriculum incorporated the following major themes: (1) fall risk factors and strategies to reduce/prevent falls; (2) communication strategies to reduce risk of falling and strategies for developing fall prevention plans; and (3) health behavior change theories utilized to prevent and reduce falls. Three separate fall prevention modules were developed for CHW/P and CHW/P Instructors to be used during in-person trainings. Module development incorporated a five-step process: (1) conduct informal focus groups with CHW/P to inform content development; (2) develop three in-person modules in English and Spanish with input from content experts; (3) pilot-test the modules with CHW/P; (4) refine and finalize modules based on pilot-test feedback; and (5) submit modules for approval of continuing education units. This project contributes to the existing evidence-based literature by examining the role of CHW/P in fall prevention among older adults. By including evidence-based communication strategies such as message tailoring, the curriculum design allows CHW/P to personalize the information for individuals, which can result in an effective dissemination of a curriculum that is evidence-based and culturally appropriate.

An Integrated Approach to Falls Prevention: A Model for Linking Clinical and Community Interventions through the Massachusetts Prevention and Wellness Trust Fund

Older adult falls continue to be a public health priority across the United States—Massachusetts (MA) being no exception. The MA Prevention and Wellness Trust Fund (PWTF) program within the MA Department of Public Health aims to reduce the physical and economic burdens of chronic health conditions by linking evidence-based clinical care with community intervention programs. The PWTF partnerships that focused on older adult falls prevention integrated the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Death and Injuries toolkit into clinical settings. Partnerships also offer referrals for home safety assessments, Tai Chi, and Matter of Balance programs. This paper describes the PWTF program implementation process involving 49 MA organizations, while highlighting the successes achieved and lessons learned. With the unprecedented expansion of the U.S. Medicare beneficiary population, and the escalating incidence of falls, widespread adoption of effective prevention strategies will become increasingly important for both public health and for controlling healthcare costs. The lessons learned from this PWTF initiative offer insights and recommendations for future falls prevention program development and implementation.

The Outcome Evaluation of a CHW Cancer Prevention Intervention: Testing Individual and Multilevel Predictors Among Hispanics Living Along the Texas-Mexico Border

This paper evaluates the effectiveness of community health workers/promotores (CHWs) in promoting cancer preventive behaviors in the 2011–2013 Education to Promote Improved Cancer Outcomes (ÉPICO) project. The ÉPICO project utilized CHWs to disseminate cancer education to predominately Spanish-speaking Hispanics living in colonias in the Lower Rio Grande Valley of Texas. The CHWs received training to become Texas-certified CHW instructors and specialized training in message tailoring, and they delivered more than 5000 units of resident education on cancer prevention/detection, treatment, and survivorship for breast, cervical, and colorectal cancer. Using panel data to examine overtime changes in cancer knowledge among Lower Rio Grande Valley residents, the evaluation found significant changes from baseline to both times 1 and 2. Additional individual-level analysis indicated that the increase in resident cancer knowledge was predicted by residents’ perceptions of CHW credibility and intention to change their lifestyles. Multilevel analysis also showed that the increase in cancer prevention knowledge among residents was predicted by attributes of the CHWs who taught them. In particular, CHWs with higher education levels had the most impact on residents’ increased knowledge over time. Unexpectedly, CHWs with more years of experience were less effective teachers than their early-career counterparts.