Implementing a mailed stool sample screening program in clinics providing care for an underserved Hispanic population.

Colorectal cancer (CRC) is a leading cause of cancer-related deaths in Hispanics in the US. Despite this, Hispanics are being screened for CRC at a much lower rate than their non-Hispanic white counterparts. Implementing mailed fecal immunochemical tests (FITs) is a cost-effective intervention for increasing CRC screening rates in vulnerable populations, such as Hispanic populations in border metroplexes. We aimed to describe the effect of introductory calls coupled with mailed in-home FIT kits on CRC screening completion in two federally qualified health centers (FQHCs) in a US-Mexico border county. This was a prospective, pragmatic, two-arm intervention study with participants allocated to receive a FIT kit with a reminder call (usual care) or usual care preceded by an introductory call. The primary outcome was the percentage of patients who returned the FIT kits. Participants who returned to the FIT were primarily unemployed (54.4%), had less than a high school education (60.2%), lived in the US for at least 20 years (74.4%), and had poor self-reported health (54.4%). In addition, we observed a statistically significant increase in the absolute rate (4.5%, P = 0.003) of FITs returned when a mailed FIT kit was preceded by an introductory call compared with no initial call. This study demonstrated that adding an introductory phone call significantly improved the screening completion rate in a mailed-out CRC screening intervention in the US-Mexico border population.

Best practices for community gardening in a US-Mexico border community.

Minority communities such as those on the US-Mexico border are placed at disproportionate high risk for child and adult obesity, diabetes and cardiovascular diseases. A built environment characterized by an arid desert climate, lack of access to healthy foods, barriers to increasing physical activity, cultural and community norms which deter healthy eating and sustainable food production, shape obesity-related health disparities in these communities. Three pilot community gardens (implemented by two local governmental organizations and one community-based organization) were funded through the local Healthy Eating Active Living (HEAL) initiative in El Paso, Texas, and Las Cruces and Anthony, New Mexico (US-MX border communities with high obesity rates) in order to encourage healthy lifestyles among families in the region. A mixed-methods evaluation (n = 223) examined the implementation process, immediate outcomes and best practices of implementing and sustaining community gardens in these minority binational communities. In addition to nutrition-related outcomes, the potential for psychosocial outcomes from participating in community and school garden projects were observed. The best practices in relation to (i) assessing community norms related to growing food, (ii) increasing access to land and water for community/school gardening and (iii) enhancing social support for gardening are discussed. The implications of these best practices for obesity prevention and implementing community gardens in a minority US-MX border community characterized by cultural, geographical and socioeconomic barriers are examined.