Impact of Delivering a Healthy Lifestyle Intervention: Promotora Findings from Familias Sanas y Activas II.

Background: Community health workers, promotoras, have been identified as effective change agents of their community members' health behaviors and health status. However, few studies have examined the effects of delivering an intervention on the promotoras themselves. Objectives: This study assessed whether promotoras delivering a healthy lifestyle intervention for adults improved their health behaviors and health status from baseline to 6- and 12-months post-baseline. Methods: Volunteer promotoras were trained to promote healthy lifestyles including physical activity through workshops and free group exercise classes throughout their communities. Twenty completed all required trainings and delivered at least one class during the period between baseline and 12-month assessments. The promotoras were measured on the following variables: Systolic and diastolic blood pressure, waist circumference, weight, and height. Additionally, they reported their health behaviors and status including moderate-to-vigorous physical activity, beverage consumption, sleep duration, and depressive symptoms. Results: Repeated measures ANOVAs showed statistically significant decreases from baseline to 6 months for systolic blood pressure (p ≤ 0.05), diastolic blood pressure (p ≤ 0.001) and body mass index (p ≤ 0.05). Changes in self-reported measures were not statistically significant although trends were observed with increases in water consumption. Conclusions: Findings from this study suggest positive effects associated with delivery of a PA intervention. This is one of the first studies to focus on a cohort of promotoras to examine health outcomes from delivering a healthy lifestyle intervention. It is important to further explore these impacts on the community health workers as they have become increasingly essential to the health of some communities.

Facilitators of peer leader retention within a Type 2 diabetes intervention trial for US Latinos/Hispanics of Mexican origin.

Peer support is effective in improving self-management behaviors and health outcomes among individuals with Type 2 diabetes. Volunteer peer support programs offer a cost-effective resource for diabetes self-management support; however, factors affecting the retention of volunteer peer leaders remain understudied. Herein, we examined factors associated with volunteer retention and satisfaction among 34 predominantly Mexican-origin peer leaders who assisted patients from a Federally Qualified Health Center located on the US/Mexico border with their diabetes management. Peer leaders completed surveys with open- and close-ended questions at baseline, 6 months and 12 months. Quantitative and qualitative data analyses were guided by the Volunteer Process Model. Using nonparametric Mann-Whitney U tests, self-efficacy as a peer leader at 6 months was most associated with interest to continue volunteering (P = 0.01), and satisfaction with support from the program at 12 months was most associated with interest to continue volunteering (P = 0.01). The qualitative data indicated that the relationship between the peer leaders and their patients was the primary factor for a satisfying volunteer experience. Future research should focus on increasing peer leaders' self-efficacy and satisfaction with program support and examine how organizations can support the development of the patient-peer relationship. Practitioners should consider appealing to volunteer peers' motivations to promote their retention.

A randomized controlled trial to prevent obesity among Latino paediatric patients.

BACKGROUND: Obesity disproportionately affects Latino youth. Community clinics are an important resource, yet there is little evidence for the efficacy of clinic-based approaches in this population. OBJECTIVE: The purpose of this study was to test the efficacy of a clinic-based intervention to lower body mass index (BMI) and improve body composition among overweight Latino children. METHODS: A randomized trial (2 group × 3 repeated measures) was conducted among 297 randomly sampled, overweight paediatric patients (5-10 years old) and their parents. The 12-month family-based culturally tailored behavioural intervention (Luces de Cambio) was based on the 'traffic light' concepts to address behaviour change and was delivered by clinic health educators and mid-level providers. The primary study outcome was child BMI (kg m-2 ) assessed at baseline, 6-month (n = 191) and 12-month (n = 201) post-baseline. A subsample of the children was examined for overall and site-specific adiposity using dual-energy X-ray absorptiometry (n = 79). RESULTS: There were no significant intervention effects on child BMI (p > 0.05); however, intervention children showed significantly (p < 0.05) lower total and trunk per cent fat compared with the usual care condition. CONCLUSIONS: The Luces intervention did not reduce child BMI, yet small but significant reductions were observed for child per cent body fat. Further research is needed to identify and reduce barriers to recruitment and participation among Latino families.

Interactions between individual and perceived environmental factors on Latinas' physical activity.

Background: Latinas have disproportionately low levels of physical activity (PA) and the ecological correlates of their PA remain unclear. This study aims to test interactions between individual and environmental factors on Latinas' PA. Methods: We analyzed baseline data from 436 Latinas participating in a PA randomized controlled trial in San Diego, CA [Fe en Acción/Faith in Action]. Measures included demographics, perceived environment, PA and anthropometrics. Mixed effects models examined interactions between individual and environmental factors on self-reported leisure-time and transportation, and accelerometer-assessed PA. Results: Significant positive associations were found between neighborhood aesthetics and leisure-time moderate-to-vigorous PA (MVPA) and between having destinations within walking distance from home and transportation PA (P < 0.05). We found significant interactions of income with aesthetics and sidewalk maintenance as well as between weight status and safety from crime. Favorable aesthetics was related to more leisure-time MVPA only among lower income women (odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18, 2.08); however, higher income women reporting better sidewalk maintenance reported more leisure-time MVPA (OR = 1.51; 95% CI: 1.06, 2.15). Higher perceived safety from crime was positively related to transportation PA only among overweight/obese women. Conclusions: Subgroup differences should be considered when developing interventions targeting the neighborhood environment to promote Latinas' PA.

Does the social environment moderate associations of the built environment with Latinas' objectively-measured neighborhood outdoor physical activity?

Favorable perceptions of the built and social neighborhood environment may promote outdoor physical activity (PA). However, little is known about their independent and interactive effects on neighborhood-specific outdoor PA. We examined associations of perceived built and social neighborhood environment factors, and their interactions, with objectively-measured neighborhood outdoor moderate-to-vigorous physical activity (MVPA) among a sample of Latina women in San Diego, CA. Analyses included baseline data collected in 2011-2013 from 86 Latinas with ≥ 2 days of combined accelerometer and global positioning system data and complete survey measures. We examined objective neighborhood outdoor MVPA within 500-meter home buffers. Generalized linear mixed models examined associations of 3 perceived built (e.g., sidewalk maintenance) and 3 social environmental (e.g., safety from crime) factors with engaging in any daily neighborhood outdoor MVPA. Models tested interactions between the built and social environmental factors. Although the perceived neighborhood environmental factors were not significantly related to daily neighborhood outdoor MVPA, we found 2 significant interactions: perceived sidewalk maintenance x safety from crime (p = 0.05) and neighborhood aesthetics x neighborhood social cohesion (p = 0.03). Sidewalk maintenance was positively related to daily neighborhood outdoor MVPA only among Latinas that reported low levels of safety from crime. Neighborhood aesthetics was positively related to daily neighborhood outdoor MVPA only among Latinas with high neighborhood social cohesion. Findings suggest several built and social environmental factors interact to influence Latinas' neighborhood outdoor MVPA. Interventions are needed targeting both built and social neighborhood environmental factors favorable to outdoor PA in the neighborhood.

Childhood obesity prevention and control in city recreation centres and family homes: the MOVE/me Muevo Project.

BACKGROUND: Interventions to prevent and control childhood obesity have shown mixed results in terms of short- and long-term changes. OBJECTIVES: 'MOVE/me Muevo' was a 2-year family- and recreation centre-based randomized controlled trial to promote healthy eating and physical activity among 5- to 8-year-old children. It was hypothesized that children in the intervention group would demonstrate lower post-intervention body mass index (BMI) values and improved obesity-related behaviours compared with the control group children. METHODS: Thirty recreation centres in San Diego County, California, were randomized to an intervention or control condition. Five hundred forty-one families were enrolled and children's BMI, diet, physical activity and other health indicators were tracked from baseline to 2 years post-baseline. Analyses followed an intent-to-treat approach using mixed-effects models. RESULTS: No significant intervention effects were observed for the primary outcomes of child's or parent's BMI and child's waist circumference. Moderator analyses, however, showed that girls (but not boys) in the intervention condition reduced their BMI. At the 2-year follow-up, intervention condition parents reported that their children were consuming fewer high-fat foods and sugary beverages. CONCLUSIONS: Favourable implementation fidelity and high retention rates support the feasibility of this intervention in a large metropolitan area; however, interventions of greater intensity may be needed to achieve effects on child's BMI. Also, further research is needed to develop gender-specific intervention strategies so that both genders may benefit from such efforts.

Nutrition communication for a Latino community: formative research foundations.

Formative research techniques were used to develop a tailored health communication nutrition intervention for Latinas and their families. Members of the target community were recruited to participate in focus groups, depth interviews, and participant observations. Women, in particular, were observed preparing meals in their homes and purchasing groceries. The objective was to identify variables that could be used for targeting, segmenting, and tailoring the intervention. Results from these efforts were used to develop a theory-based intervention, which is described at the conclusion of the article.

Evaluation of a first aid and home safety program for Hispanic migrant adolescents.

BACKGROUND: Unintentional injuries are the major cause of death among children, adolescents, and young adults. This article presents an evaluation of an injury-prevention program for 11- to 16-year-old, Hispanic migrant youth. DESIGN: Randomized controlled trial with two conditions: first aid and home safety training and tobacco and alcohol prevention. Participants were assessed at baseline, at immediate post-intervention, and at 1-year follow-up. PARTICIPANTS: A total of 660 Hispanic adolescent and parent pairs participated in a program entitled Sembrando Salud (sowing the seeds of health). INTERVENTION: The intervention consisted of two conditions: first aid and home safety training and tobacco and alcohol prevention. Both groups were exposed to an eight-session, multimedia program presented by bilingual, bicultural college students. The sessions consisted of lectures, discussions, and skills development and practice. OUTCOME MEASURES: To examine the efficacy of the first aid and home safety intervention, adolescents were assessed for changes in first aid confidence, knowledge of items in a first aid kit, knowledge of how to respond in an emergency situation, acquisition of a first aid kit, and behavioral skills testing in response to two emergency scenarios. RESULTS: Similar changes in confidence were observed in both groups after the intervention. Participants in the first aid and home safety program were better able to identify items to include in a first aid kit, how to respond in an emergency situation, and reported fewer erroneous victim-caring procedures than the tobacco and alcohol prevention group. CONCLUSIONS: Sembrando Salud was successful at achieving and maintaining change in confidence and knowledge of first aid and emergency response skills over a yearlong period.

Predictors of cigarette and alcohol susceptibility and use among Hispanic migrant adolescents.

BACKGROUND: Little is known about interpersonal and broader sociocultural factors related to protection from or use of tobacco and alcohol among immigrant adolescents. This study presents the baseline predictors of tobacco and alcohol use and susceptibility to tobacco and alcohol among Hispanic migrant adolescents. METHODS: The sample consisted of 660 Hispanic adolescents (51% male) between the ages of 11 and 16 years enrolled in the Migrant Education Program through the County Office of Education. Slightly more than 75% of the study sample was first generation Hispanics and 79% preferred to speak Spanish. An interviewer-administered survey assessed the following information: standard demographic characteristics, modeling of cigarette smoking (including parental and peer smoking), attitudes (including self-standards and anticipated outcomes), acculturation, communication with parents, amount of social support, and satisfaction with social support. RESULTS: Significant predictors of susceptibility to tobacco and smoking status included age, gender, attitudes toward cigarettes (e.g., anticipated outcomes, self-standards), satisfaction with social support, and parent-child communication. Factors that were also significant predictors of susceptibility to alcohol and drinking status were age, attitudes toward drinking, satisfaction with social support, and level of parent-child communication. In addition, peer and household use of alcohol predicted adolescent outcomes. CONCLUSIONS: Based on these results it is suggested that tobacco and alcohol prevention efforts for first-generation Hispanic adolescents should target not only usual concerns (e.g., availability, peer pressure, modeling, expectancies), but also parent-child communication.

Evaluation of a tobacco and alcohol use prevention program for Hispanic migrant adolescents: promoting the protective factor of parent-child communication.

BACKGROUND: Interventions designed to prevent tobacco and alcohol use targeting high-risk adolescents are limited. In addition, few studies have attempted to improve parent-child communication skills as a way of improving and maintaining healthy youth decision-making. METHODS: A total of 660 Hispanic migrant families participated in a randomized pre-post control group study that was utilized to determine the impact of the intervention on parent-child communication. Both treatment and attention-control groups of youth were exposed to an eight-session culturally sensitive program presented by bilingual/bicultural college students. Parents jointly attended three of the eight sessions and participated in helping their child complete homework assignments supporting the content of each session. The content of the treatment intervention included (1) information about tobacco and alcohol effects, (2) social skills training (i.e., refusal skills), and (3) the specific development of parent-child communication skills to support healthy youth decisions. RESULTS: Significant intervention by household size interactions for both parent and youth perceptions of communication were found indicating that the treatment was effective in increasing communication in families with fewer children. Based on the effect size and the previously established relationship between communication and susceptibility to tobacco and alcohol use, it was determined that the intervention effect could be translated into a future 5 to 10% decrease in susceptibility for these smaller families. CONCLUSIONS: A culturally sensitive family-based intervention for migrant Hispanic youth was found to be effective in increasing perceived parent-child communication in families with fewer children. It is expected that increases in this important protective factor will lead to later observed decreases in tobacco and alcohol use.

Ca2+ channels that activate Ca2+-dependent K+ currents in neostriatal neurons.

It is demonstrated that not all voltage-gated calcium channel types expressed in neostriatal projection neurons (L, N, P, Q and R) contribute equally to the activation of calcium-dependent potassium currents. Previous work made clear that different calcium channel types contribute with a similar amount of current to whole-cell calcium current in neostriatal neurons. It has also been shown that spiny neurons possess both "big" and "small" types of calcium-dependent potassium currents and that activation of such currents relies on calcium entry through voltage-gated calcium channels. In the present work it was investigated whether all calcium channel types equally activate calcium-dependent potassium currents. Thus, the action of organic calcium channel antagonists was investigated on the calcium-activated outward current. Transient potassium currents were reduced by 4-aminopyridine and sodium currents were blocked by tetrodotoxin. It was found that neither 30 nM omega-Agatoxin-TK, a blocker of P-type channels, nor 200 nM calciseptine or 5 microM nitrendipine, blockers of L-type channels, were able to significantly reduce the outward current. In contrast, 400 nM omega-Agatoxin-TK, which at this concentration is able to block Q-type channels, and 1 microM omega-Conotoxin GVIA, a blocker of N-type channels, both reduced outward current by about 50%. These antagonists given together, or 500 nM omega-Conotoxin MVIIC, a blocker of N- and P/Q-type channels, reduced outward current by 70%. In addition, the N- and P/Q-type channel blockers preferentially reduce the afterhyperpolarization recorded intracellularly. The results show that calcium-dependent potassium channels in neostriatal neurons are preferentially activated by calcium entry through N- and Q-type channels in these conditions.

Theories and intervention approaches to health-behavior change in primary care.

CONTENT: Providers typically rely on health information and their professional status to convince patients to change. Health-behavior theories and models suggest more effective methods for accomplishing patient compliance and other behavior change related to treatment regimens. Behavior modification stresses the remediation of skill deficits or using positive and negative reinforcement to modify performance. Like behavior modification, the Health Belief Model stresses a reduction of environmental barriers to behavior. Social Learning Theory suggests that perceptions of skills and reinforcement may more directly determine behavior. Self-management models put the above theories into self-change actions. Social support theories prioritize reinforcement delivered through social networks, whereas the Theory of Reasoned Action emphasizes perceptions of social processes. Finally, the Transtheoretical Model speaks of the necessity to match interventions to cognitive-behavioral stages. Strategies derived from each of these theories are suggested herein.

Ca2+-activated outward currents in neostriatal neurons.

Whole-cell voltage-clamp recordings of outward currents were obtained from acutely dissociated neurons of the rat neostriatum in conditions in which inward Ca2+ current was not blocked and intracellular Ca2+ concentration was lightly buffered. Na+ currents were blocked with tetrodotoxin. In this situation, about 53 +/- 4% (mean +/- S.E.M.; n = 18) of the outward current evoked by a depolarization to 0 mV was sensitive to 400 microM Cd2+. A similar percentage was sensitive to high concentrations of intracellular chelators or to extracellular Ca2+ reduction (<500 microM); 35+/-4% (n=25) of the outward current was sensitive to 3.0 mM 4-aminopyridine. Most of the remaining current was blocked by 10 mM tetraethylammonium. The results suggest that about half of the outward current is activated by Ca2+ entry in the present conditions. The peptidic toxins charybdotoxin, iberotoxin and apamin confirmed these results, since 34 +/- 5% (n = 14), 29 5% (n= 14) and 28 +/- 6% (n=9) of the outward current was blocked by these peptides, respectively. The effects of charybdotoxin and iberotoxin added to that of apamin, but their effects largely occluded each other. There was additional Cd2+ block after the effect of any combination of toxins. Therefore, it is concluded that Ca2+-activated outward currents in neostriatal neurons comprise several components, including small and large conductance types. In addition, the present experiments demonstrate that Ca2+-activated K+ currents are a very important component of the outward current activated by depolarization in neostriatal neurons.

Ca2+-channels involved in neostriatal glutamatergic transmission.

The actions of peptidic toxins that work as Ca2+-channel antagonists were investigated on neostriatal glutamatergic transmission. Both intracellularly recorded excitatory postsynaptic potentials (EPSPs) and extracellularly recorded population spikes (PS) evoked by afferent stimulation were evaluated in the presence of 10 microM bicuculline. Percentage of block (mean +/- SEM; n = 4) for these events (EPSP and PS, respectively) was: omega-AgTxIVA (100-200 nM): 35 +/- 2 and 54 +/- 4%; omega-CgTxGVIA (1 microM): 37 +/- 3 and 63 +/- 6%; omega-CgTxMVIIC (500 nM): 40 +/- 4 and 50 +/- 2%; and calciseptine (500 nM): 5 +/- 4 and 9 +/- 6%. When given together, toxins had additive effects. The calciseptine effects were nonsignificant. The toxins were also tested on Ca2+-dependent random synaptic responses induced by 100 microM 4-AP. Each toxin reduced the frequency of spontaneous EPSPs by more than 60% (n = 2). The summed actions of individual toxins yields more than 100% block (superadditivity); suggesting that several terminals may possess more than one channel type. The reduction in frequency was not accompanied by a reduction in amplitude confirming that toxins' actions were presynaptic. It is concluded that at least three different Ca2+-channel subtypes are involved in glutamate release in neostriatal afferents: N-type, P/Q-type, and a type resistant to the toxins used. The L-type Ca2+-channel had little, if any, participation.

MMPI-2 and MMPI-A research with U.S. Latinos: a bibliography.

This bibliography presents a comprehensive listing of all research conducted on U.S. Latinos, including Puerto Ricans, with the MMPI-2 and MMPI-A beginning in 1989. A total of 52 studies and 6 additional resources are listed. Researchers and clinicians could use this bibliography for the culturally appropriate application of the MMPI-2/MMPI-A with this growing population.