Theresa H. Cruz

The Validity of a Proxy Acculturation Scale Among U.S. Hispanics

This study examines the validity of a proxy acculturation scale composed of four acculturation-related variables. The authors use data from a nationally representative sample of 1,437 U.S. Hispanics. Results indicate good internal scale reliability, a high degree of correlation between the proxy scale and the full acculturation measure, and substantial agreement between dichotomized versions of the two scales. Although reliability declines slightly, validity increases with removal of generational status from the scale. Validity is found to be high for the three largest subpopulations by country of ancestry (Mexico, Puerto Rico, and Cuba). The proxy acculturation scale is a useful tool for the measurement of acculturation level among the majority of U.S. Hispanics when use of a more comprehensive acculturation scale is infeasible or impractical.

Engagement, recruitment, and retention in a trans-community, randomized controlled trial for the prevention of obesity in rural American Indian and Hispanic children.

Engagement, recruitment and retention of participants are critical to the success of research studies but specific strategies are rarely elucidated in the literature. The purpose of this paper is to describe the engagement, recruitment and retention process and outcomes in the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study, and to describe lessons learned in the process. CHILE is a multi-level, group randomized controlled trial of a childhood obesity prevention intervention in rural American Indian and predominantly Hispanic Head Start (HS) centers in New Mexico. Barriers to engagement, recruitment and retention included distrust of researchers, long travel distances, and different HS and community structures. CHILE employed multiple strategies from the onset including the use of formative assessment, building on previous relationships, developing Memoranda of Agreement, using a community engagement specialist, and gaining support of a community champion. As a result of lessons learned, additional strategies were employed, including more frequent feedback to intervention sites, revised permission forms, telephone reminders, increased site visits and over-scheduling of interviews. These strategies resulted in the recruitment of 16 HS centers, 1,879 children, 655 parents, 7 grocery stores and 14 healthcare providers, meeting or exceeding recruitment goals. By combining principles of community engagement, a variety of recruitment strategies, and lessons learned, this study obtained a high level of recruitment and retention.

CHILE: Outcomes of a group randomized controlled trial of an intervention to prevent obesity in preschool Hispanic and American Indian children

OBJECTIVE We examined the outcomes of the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study, a group randomized controlled trial to design, implement, and test the efficacy of a trans-community intervention to prevent obesity in children enrolled in Head Start centers in rural American Indian and Hispanic communities in New Mexico. METHODS CHILE was a 5-year evidence-based intervention that used a socioecological approach to improving dietary intake and increasing physical activity of 1898 children. The intervention included a classroom curriculum, teacher and food service training, family engagement, grocery store participation, and healthcare provider support. Height and weight measurements were obtained four times (fall of 2008, spring and fall of 2009, and spring of 2010), and body mass index (BMI) z-scores in the intervention and comparison groups were compared. RESULTS At baseline, demographic characteristics in the comparison and intervention groups were similar, and 33% of all the children assessed were obese or overweight. At the end of the intervention, there was no significant difference between the two groups in BMI z-scores. CONCLUSIONS Obesity prevention research among Hispanic and AI preschool children in rural communities is challenging and complex. Although the CHILE intervention was implemented successfully, changes in overweight and obesity may take longer than 2years to achieve.

Effects of an Obesity Prevention Intervention on Physical Activity Among Preschool Children: The CHILE Study

Background. Limited research addresses interventions to increase physical activity among American Indian and Hispanic preschool-aged children living in rural areas. We examined the impact of a Head Start-based intervention (Child Health Initiative for Lifelong Eating and Exercise [CHILE]) on physical activity at home. Method. Sixteen Head Start centers in predominantly Hispanic or American Indian communities were group randomized to the six-component intervention or a comparison group for 2 years. Structured surveys were administered at four assessment times to a convenience sample of caregivers of 655 children in the study. Multilevel modeling was used to assess the effects of the intervention on physical activity. Results. The relative change in physical activity in the intervention group compared with the comparison group over the 2-year period was 1.56 (95% confidence interval [1.02, 2.38]; p = .04). Among specific promoted activities (ball playing, dancing, active games, jumping, and walking), dancing increased significantly in the intervention compared with the comparison group (2.9; 95% confidence interval [1.2, 7.1]; p = .02). Conclusions. The CHILE intervention was effective at increasing physical activity at home in preschool children in priority populations. Future research should focus on increasing family involvement and strengthening messaging about physical activity in these populations.

Effect of WIC Food Package Changes on Dietary Intake of Preschool Children in New Mexico.

OBJECTIVES This study examined WIC policy change effects on dietary intake of preschool children from WIC-participating households in rural New Mexico communities. METHODS Dietary intake of children enrolled in Head Start in 8 communities was compared before and after 2009 WIC food package changes. RESULTS Following the policy change, participants reported significantly increased consumption of lower-fat milk, reduced consumption of saturated fat (grams), and decreased consumption of vegetables without potatoes. No significant differences in fruit, fruit juice, vegetables including potatoes, whole-grains and saturated fat (percent-energy) consumption were observed. CONCLUSIONS WIC policy changes have the potential to improve childrens saturated fat intake. More research with robust designs is necessary to examine long-term effects of WIC policy changes.

Health Impact Assessment, Physical Activity and Federal Lands Trail Policy

OBJECTIVES The objectives of this paper are to describe the application of Health Impact Assessment (HIA) to inform trail decisions affecting a rural, under-resourced community and propose the routine integration of HIAs to enhance NEPA environmental assessments and environmental impact statements for trail decisions on federal lands. METHODS Screening, scoping, assessment, recommendations, reporting, monitoring and evaluation are being used to examine the health impact of trail location and design. RESULTS HIA recommendations are being integrated into the public lands National Environmental Protection Act process for planning access to a new segment of the Continental Divide National Scenic Trail. Potential users from a nearby rural New Mexico community and a region of almost one million may benefit from this HIA-informed planning. CONCLUSIONS HIA can be integrated into the policy and decision-making process for trails on public lands.

Implementing Physical Activity Recommendations in a Tri-Ethnic Rural Community through a Community–University Partnership

Background: A tri-ethnic rural community with limited resources and a university Prevention Research Center (PRC) developed a partnership to promote evidence-based physical activity.Objective: The purpose of this study was to investigate how a community–university partnership can disseminate and implement ἀe Commu nity Guides recommendations for increasing physical activity and create a model for other under-resourced communities experiencing high rates of chronic disease.Methods: Qualitative data collected through 47 semistructured interviews, meeting minutes, and local newspaper articles were coded for themes and analyzed for patterns across the data.Results: Implementation resulted in the creation of new paths and trails, increased walkability throughout the community, local park enhancements, and a community-wide campaign. Lessons learned included the importance of community-defined goals and outcomes, leadership, volunteerism, mutually beneficial goals, synergy, and having nontraditional partners.Conclusion: This research provides a community-university partnership model for implementing evidence-based strategies to increase physical activity in rural communities.

Research to Practice: Implementing Physical Activity Recommendations

INTRODUCTION Dissemination and implementation science focuses on bridging the gap between research and practice. The Community Preventive Services Task Force published recommendations for increasing physical activity based on scientific review and consensus. Little research on the dissemination and implementation of these recommendations has been conducted in under-represented populations at high risk for inactivity and chronic disease. METHODS Partnering with one rural community (beta site), the University of New Mexico Prevention Research Center studied the translation of Community Preventive Services Task Force recommendations to practice. Strategies for increasing physical activity were selected, implemented, and analyzed in 2009-2013. Participant observations; content analysis of meeting minutes, field notes, and other documents; and in-depth interviews were conducted over the 5-year period to identify factors important for carrying out Community Preventive Services Task Force recommendations for physical activity in a rural New Mexico community. RESULTS Included among the implementation outcomes were new sidewalks and trails, a community-wide campaign, social support of walking, and park improvements. The following factors were identified as important to the implementation process: an active community-academic partnership; multiple partners; culturally appropriate strategies; and approaches that fit local context and place characteristics (topography, land ownership, population clusters, existing roadways). CONCLUSIONS This study illustrates how evidence can be translated to practice and identifies key factors in that process. The successful beta model provides a practical blueprint for dissemination and implementation in rural, under-represented populations. This model is currently being disseminated (scaled up) to other rural New Mexico communities.

Advocacy: translating injury research into policy

Advocacy is critical to the passage of injury prevention policies. We need look no further than motor vehicle safety laws and regulations to see the effect that such policies can have on injury morbidity and mortality. Policies can also influence research directions, funding priorities and organisational practices. In order to make sound policy, decision-makers need succinct, accurate and timely information. Policymakers and their staff may not read scientific journals, or know who to call for advice, but establishing personal contact can facilitate the use of scientific evidence.1 Educating policymakers about the science of injury and violence prevention, and advocating for the resources to support research and implementation, are essential but not sufficient. Advocacy also involves the broad discussion of possible solutions to problems. Injury and violence prevention researchers and practitioners are in the best position to inform policymakers about injury prevention policy solutions and …

Advancing safe sleep for infants through translational research

Each year about 4000 infants in the USA die as a result of sudden unexpected infant death (SUID).1 Despite the vast literature on risk factors and the implementation of some successful prevention measures, the death rate has not decreased since 2000.2 As researchers we can play a role in reducing this gap by ensuring that research results are well communicated, both to our colleagues and to the public. In addition to intervention research, we need to study new and innovative methods for dissemination and implementation of evidence-based programmes, policies and practices, especially in high-risk populations. Early prevention research in the USA and many other countries focused only on deaths classified as sudden infant death syndrome (SIDS), a cause assigned to infant deaths that cannot be explained after a thorough case investigation.3 ,4 After death investigations in Europe and Australia …