Laura Trejo

Recruitment Strategies and Costs Associated With Community-Based Research in a Mexican-Origin Population

PURPOSE We describe the recruitment strategies and personnel and materials costs associated with two community-based research studies in a Mexican-origin population. We also highlight the role that academic-community partnerships played in the outreach and recruitment process for our studies. We reviewed study documents using case study methodology to categorize recruitment methods, examine community partnerships, and calculate study costs. RESULTS We employed several recruitment methods to identify and solicit 154 female caregivers for participation in qualitative interviews and quantitative surveys. Recruitment approaches included using flyers and word of mouth, attending health fairs, and partnering with nonprofit community-based organizations (CBOs) to sponsor targeted recruitment events. Face-to-face contact with community residents and partnerships with CBOs were most effective in enrolling caregivers into the studies. Almost 70% of participants attended a recruitment event sponsored or supported by CBOs. The least effective recruitment strategy was the use of flyers, which resulted in only 7 completed interviews or questionnaires. Time and costs related to carrying out the research varied by study, where personal interviews cost more on a per-participant basis (

Do Sedentary Older Adults Benefit From Community-Based Exercise? Results From the Active Start Program

1,081) than the questionnaires (

Correlates of Urinary Incontinence in Community-Dwelling Older Latinos

298). However, almost the same amount of time was spent in the community for both studies. IMPLICATIONS Partnerships with CBOs were critical for reaching the target enrollment for our studies. The relationship between the University of California-Los Angeles (UCLA) Resource Center for Minority Aging Research/Center for Health Improvement for Minority Elderly and the Department of Aging provided the infrastructure for maintaining connections with academic-community partnerships. Nevertheless, building partnerships required time, effort, and resources for both researchers and local organizations.

Correlates of 1-Year Incidence of Urinary Incontinence in Older Latino Adults Enrolled in a Community-Based Physical Activity Trial

PURPOSE This study assessed the effectiveness of Active Start, a community-based behavior change and fitness program, designed to promote physical activity among sedentary community-dwelling older adults. DESIGN AND METHODS A quasi-experimental design was used. Data were analyzed using a within-group pretest-post-test design to calculate changes in the intervention group and changes in the waitlist comparison group. Further analyses were conducted after the comparison group completed the intervention. Paired t tests were employed to analyze unadjusted mean changes in physical performance measures from pretest to post-test. Repeated measures analysis of covariance (using SAS Proc Mixed) was then conducted to calculate the adjusted mean change for the intervention group. RESULTS Significant improvement was found on all performance measures (strength, flexibility, and balance) for the intervention group as a whole. Similar improvements were found among subgroups (Whites, African Americans, and Hispanics). No significant changes were found in the comparison group when they were in the control condition; however, they significantly improved on all measures after completing the intervention. IMPLICATIONS This study suggests that a community-based physical activity program benefits sedentary, racially, and ethnically diverse older adults by coupling a behavioral change support group and fitness classes.

Physical Activity, Physical Performance, and Biological Markers of Health among Sedentary Older Latinos

The prevalence of urinary incontinence (UI) has varied in the literature and is reflective of the definition and sampling methodologies used, as well as the age, ethnicity, and sex being studied. The aim of the current study was to measure the prevalence and correlates of UI in a sample of 572 older Latinos participating in Caminemos, a trial of a behavioral intervention to increase walking. Participants completed an in‐person survey and physical performance measures. UI was measured using the International Consultation on Incontinence item: “How often do you leak urine?” Potential correlates of UI included sociodemographic variables, body mass index, smoking, physical activity, medical comorbidity, physical performance, activity of daily living (ADL) impairment, use of assistive ambulatory devices, health‐related quality of life (HRQoL), and depressive symptoms. The prevalence of UI in this sample was 26.9%. Women were more likely to report UI, as were those who were less physically active; used assistive ambulatory devices; and had depressive symptoms, greater medical comorbidity, worse physical performance, greater ADL impairment, worse cognitive function, and lower HRQoL. Multivariate logistic regression revealed that medical comorbidity was independently associated with higher rates of UI (odds ratio (OR)=1.66, 95% confidence interval (CI)=1.30–2.12), whereas better cognitive function (OR=0.73, 95% CI=0.57–0.93) and higher weighted physical activity scores (OR=0.77, 95% CI=0.60–0.98) were independently associated with lower rates of UI. UI is highly prevalent but not ubiquitous among community‐residing older Latinos, suggesting that UI is not an inevitable consequence of aging. Future studies should examine whether interventions that decrease comorbidity and cognitive decline and increase physical activity improve continence status.

The Influence of Exercise on Cognitive Function in Older Hispanic/Latino Adults: Results from the "¡Caminemos!" Study

The prevalence of urinary incontinence (UI) among older urban Latinos is high. Insight into etiologies of and contributing factors to the development of this condition is needed. This longitudinal cohort study identified correlates of 1‐year incidence of UI in older community‐dwelling Latino adults participating in a senior center–based physical activity trial in Los Angeles, California. Three hundred twenty‐eight Latinos aged 60 to 93 participating in Caminemos, a randomized trial to increase walking, were studied. Participants completed an in‐person survey and physical performance measures at baseline and 1 year. UI was measured using the International Consultation on Incontinence item: “How often do you leak urine?” Potential correlates of 1‐year incidence of UI included sociodemographic, behavioral, medical, physical, and psychosocial characteristics. The overall incidence of UI at 1 year was 17.4%. Incident UI was associated with age, baseline activity of daily living impairment, health‐related quality of life (HRQoL), mean steps per day, and depressive symptoms. Multivariate logistic regression models revealed that improvement in physical performance score (odds ratio (OR) = 0.69, 95% confidence interval (CI) = 0.50–0.95) and high baseline physical (OR = 0.60, 95% CI = 0.40–0.89) and mental (OR = 0.62, 95% CI = 0.43–0.91) HRQoL were independently associated with lower rates of 1‐year incident UI. An increase in depressive symptoms at 1 year (OR = 4.48, 95% CI = 1.02–19.68) was independently associated with a higher rate of incident UI. One‐year UI incidence in this population of older urban Latino adults participating in a walking trial was high but was lower in those who improved their physical performance. Interventions aimed at improving physical performance may help prevent UI in older Latino adults.

Older Ethnic Minority Women's Perceptions of Stroke Prevention and Walking

Background. Physical activity is associated with better physical health, possibly by changing biological markers of health such as waist circumference and inflammation, but these relationships are unclear and even less understood among older Latinos—a group with high rates of sedentary lifestyle. Methods. Participants were 120 sedentary older Latino adults from senior centers. Community-partnered research methods were used to recruit participants. Inflammatory (C-reactive protein) and metabolic markers of health (waist circumference, HDL-cholesterol, triglycerides, insulin, and glucose), physical activity (Yale physical activity survey), and physical performance (short physical performance NIA battery) were measured at baseline and 6-month followup. Results. Eighty percent of the sample was female. In final adjusted cross-sectional models, better physical activity indices were associated with faster gait speed (P < 0.05). In adjusted longitudinal analyses, change in self-reported physical activity level correlated inversely with change in CRP (β = −0.05; P = 0.03) and change in waist circumference (β = −0.16; P = 0.02). Biological markers of health did not mediate the relationship between physical activity and physical performance. Conclusion. In this community-partnered study, higher physical activity was associated with better physical performance in cross-sectional analyses. In longitudinal analysis, increased physical activity was associated with improvements in some metabolic and inflammatory markers of health.

Study protocol of “Worth the Walk”: a randomized controlled trial of a stroke risk reduction walking intervention among racial/ethnic minority older adults with hypertension in community senior centers

Purpose of the Study We examined the prospective effect of an evidence-based exercise intervention (¡Caminemos!) on cognitive function among older Hispanic/Latino adults and the potential synergistic effects (if any) of an attribution-retraining intervention given to a random sample to counter negative ascriptions of the aging process. Design and Methods We analyzed baseline and follow-up (1- and 2-year) data collected from Hispanics/Latinos ≥60 years (N = 571) who participated in ¡Caminemos! across 27 senior centers. All participants were randomly assigned to either (a) the treatment group-a 1-hr attribution-retraining session plus a 1-hr exercise class or (b) the control group-health education plus a 1-hr exercise class. Mixed-effects linear regression was used to determine the effects of the exercise class and the attribution-retraining component on longitudinal changes in cognitive functioning, as measured by the Modified Mini-Mental State (3MS) examination. Results In analyses adjusted for age, sex, education, income, and medical comorbidities, participants in both trial arms displayed higher cognitive functioning scores at the 1-year (β = 1.76, p = .001) and 2-year (β = 1.37, p = .013) follow-ups when compared with original baseline scores. However, we found no significant difference in cognitive function between the treatment versus control conditions (β = 0.41, p = .582), nor were any differences found across groups over time. Implications The exercise intervention improved cognitive function in older Hispanics/Latinos, regardless of whether it was supplemented with the age-related attribution retraining. These findings suggest that limited access to exercise programs may be a greater obstacle in forestalling cognitive decline in older Hispanics/Latinos than the negative beliefs they might hold of the aging process.

Racial/Ethnic Differences in Expectations Regarding Aging Among Older Adults

OBJECTIVE To inform the development of a tailored behavioral stroke risk reduction intervention for ethnic minority seniors, we sought to explore gender differences in perceptions of stroke prevention and physical activity (walking). METHODS In collaboration with community-based organizations, we conducted 12 mixed-gender focus groups of African American, Latino, Chinese, and Korean seniors aged 60 years and older with a history of hypertension (89 women and 42 men). Transcripts were coded and recurring topics compared by gender. RESULTS Women expressed beliefs that differed from men in 4 topic areas: 1) stroke-related interest, 2) barriers to walking, 3) facilitators to walking, and 4) health behavior change attitudes. Compared with men, women were more interested in their role in response to a stroke and post-stroke care. Women described walking as an acceptable form of exercise, but cited neighborhood safety and pain as walking barriers. Fear of nursing home placement and weight loss were identified as walking facilitators. Women were more prone than men to express active/control attitudes toward health behavior change. CONCLUSIONS Older ethnic minority women, a high-risk population for stroke, may be more receptive to behavioral interventions that address the gender-specific themes identified by this study.