An Evaluation of ¡Haz Espacio Para Papi!, a Culturally Tailored Nutrition and Physical Activity Pilot Program for Mexican-Heritage Fathers.

Fathers are potential leaders of healthy behavior changes in their families. Culturally tailored programs are needed to support behavior changes within families, including Latino families; however, there have been few father-focused nutrition programs for Latino families. This study evaluated the immediate effects of ¡Haz Espacio Para Papi! (Make Room for Daddy!; HEPP), a six-week, father-focused, family-centered program focused on nutrition and physical activity near the Texas-Mexico border. A modified stepped-wedge study design included a treatment group for the HEPP pilot and a wait-listed control group. Pre/post-tests included instant skin carotenoid scores, the self-reported dietary intake of fruits and vegetables (FV), and healthy dietary behavior scores (HDBSs). A 2 × 2 mixed analysis of variance evaluated changes in outcomes across time and between groups for 42 fathers with pre/post-test measures. There were no statistically significant changes in fathers' VM scores and FV intake across time or between groups. Fathers' HDBSs increased across time (p ≤ 0.01, 95% CI [0.23, 1.38]). Age, educational attainment, and the number of children living in the household did not have a significant effect on the program outcomes (p > 0.05). The HEPP program may guide the design of future father-focused nutrition interventions aimed at dietary behavior changes.

Depressive Symptoms and Their Longitudinal Impact on Physical Activity and Sedentary Behaviors Among Mexican-Heritage Youth.

The purpose of this study is to examine the longitudinal impact of depressive symptoms on physical activity (PA) levels, sedentary behavior, and screen time among first-generation, Mexican-heritage youth. Mexican-heritage families were recruited by promotoras de salud from colonias in Hidalgo County, Texas. Participants (n = 200 youth, 116 families in final sample) completed at-home, interviewer-administered surveys once during the summer (June-July) and once during the fall (August-December). Youth PA and sedentary behaviors were assessed using a validated 7-day recall instrument. The validated Center for Epidemiology Studies-Depression Child scale was used to assess depression symptoms. Linear mixed-effects models were used to analyze the relationships of PA and sedentary behavior with depressive symptoms. Results showed that those depression symptoms were significantly associated with decreased number of self-reported minutes of sitting and screen time over time in the full sample and among male youth. Depression symptoms also significantly decreased the number of self-reported active and moderate to vigorous PA minutes over time among male youth. Researchers can build on our findings by identifying the mechanisms driving the relationships between depression and PA/sedentary behavior. Public health-programing efforts should intentionally consider the impact that depressive symptoms have on PA.

Cooking with the Seasons for Health (CwS4H): An Innovative Intervention That Links Nutrition Education, Cooking Skills, and Locally Grown Produce to Increase Vegetable Intake among Limited-Resource Parent-Child Dyads in Rural Washington.

Although children from limited-resource families in rural areas are at great risk for nutrition-related chronic diseases, few hands-on programs have been implemented that simultaneously engage both parents and children and include local produce in a single program. This study reports on the development, implementation, and evaluation of Cooking with the Seasons for Health (CwS4H). Parent-child pairs participated in six sessions (two weekly sessions during each of three growing seasons), which included food tasting, a spotlight vegetable, interactive mini nutrition lesson, a child-focused cooking lesson, hands-on meal preparation, distribution of materials as family guides, and a take-home bag of fresh produce. Pre- and postprogram survey data were collected from 23 parents and 22 children. Children reported improvements in nutrition knowledge, vegetable preference, and self-efficacy in food preparation and cooking. Parents reported gains in nutrition knowledge, nutritional behaviors, vegetable preference, attitude toward food preparation/cooking, involvement of the child in food preparation/cooking, confidence in preparing vegetables, and the child's vegetable intake. Parents commented on the value children placed on food preparation and produce selection and how the program enhanced the parent-child relationship. By focusing CwS4H on a variety of fresh vegetables, this intervention helped to impact children's vegetable intake behaviors by engaging children in preparing and choosing the food they eat.

Nutrition Effects of a Family-Centered Health Promotion Program for Mexican-Heritage Children in the Lower Rio Grande Valley of Texas.

Systemic and social factors, like poverty and food insecurity, negatively influence fruit and vegetable (FV) intake and body mass index (BMI) among Latino/a children. Behavioral programs are needed to support children's nutrition. This study examined program effects on FV intake and BMI outcomes for Mexican-heritage children (9-11 years). The program used a modified stepped-wedge design in the Lower Rio Grande Valley of Texas (2019 and 2020). Promotoras led experiential nutrition education sessions and collected height, weight, and instant skin carotenoid scores (biomarker for FV intake) at pre-test (baseline), post-test (6 weeks), and maintenance (3-4 months after post-test). Mean changes and group differences in skin carotenoid scores, BMI z-scores and percentiles were obtained from analyses of variance. Linear mixed-effects models were used to determine overall program effects. Mexican-heritage children were enrolled (n = 57 and 52.6% female). An overall decrease in skin carotenoid scores was observed at post-test (-15.1; 95% CI: -24.95, -5.33). While scores varied widely (range: 17-498), an increase of 14.8 ± 23.8 points occurred in one intervention group. Compared to the control period, greater reductions in BMI outcomes occurred during the program. These findings provide evidence for the use of strengths-based approaches in behavioral nutrition programs.

Conducting Physical Activity Research on Racially and Ethnically Diverse Adolescents Using Social Network Analysis: Case Studies for Practical Use.

Adolescent physical activity (PA) is significantly impacted by peer behaviors through peer influence, peer selection, and popularity. However, the scales for these social constructs may not fully capture the detailed social networks and mechanisms responsible for PA behavior changes. This level of detail and granularity can be quantified and analyzed through social network analysis (SNA). To demonstrate the variety, utility, and efficacy of SNA in adolescent PA research, this article aims to provide four case studies on the collection of social network and PA data on ethnically and racially diverse adolescents. Through case studies, this article provides tangible ways in which SNA can be used to evaluate social influences on PA behaviors. Case studies are presented on: (1) Youth Engagement in Sport-an egocentric analysis of middle school youth participation in an experiential sport program with 3- and 6-month follow-ups; (2) Summer care program networks-an egocentric and whole network longitudinal study of adolescents at summer care programs; (3) The Convoy method-a qualitative egocentric discussion activity with adolescents from colonias on the Texas-Mexico border; and (4) A father-focused, family-centered health program-an egocentric experimental analysis of children participating in a health program. Data collection procedures are listed and example surveys are provided. Descriptive analyses are included, as are recommendations on further analysis techniques for each type of network data. Using SNA, researchers can understand social contexts in a more specific manner, better positioning interventions to alter such influences.

Promotoras de Salud in a Father-Focused Nutrition and Physical Activity Program for Border Communities: Approaches and Lessons Learned from Collaboration.

Promotoras de salud (promotoras) have been a valuable part of community research for Latino families, such as in the recruitment or delivery of health promotion programs. However, there has been limited discussion of how to integrate a promotora model into a father-focused program to support nutrition and physical activity within Latino families. This manuscript's purpose is to describe how to engage and collaborate with promotoras in a father-focused, family-centered program for Latino families living in colonias near the U.S.-Mexico border. As part of a longstanding community-academic partnership, the authors outline approaches and lessons learned from collaboration with promotoras during the design (including formative work and training), implementation, and evaluation of a behavioral program-¡Haz Espacio para Papi! (HEPP, Make Room for Daddy!). Promotoras' contributions supported the entire program, from design through evaluation. The team of all-female promotoras created a balance between the needs and preferences of the community and the goals and requirements of the research. While there is considerable time and human capital required for collaboration, the mutual benefits can make this work meaningful to all involved.

¿Qué Está Haciendo Papá? Mexican-Heritage Fathers' Physical Activity Networks After a Father-Focused Health Program.

Physical activity (PA) is a public health priority due to holistic health benefits; however, many adults do not meet PA guidelines. Few studies have examined Mexican-heritage fathers' social networks, specifically with whom they are physically active. This study examines changes in Mexican-heritage fathers' PA networks after participation in a father-focused, family-centered health program. Families consisting of child (aged 9-11 years), mother, and father were recruited from colonias on the Texas-Mexico border for participation in a 6-week father-focused, family-centered program concentrated on healthy eating and active living. Fathers reported up to 5 people with whom they were active most in the previous month before and after the program as well as how often they were active with the person and what activities they did most often. Multilevel regression models examined changes in networks. Fathers (n = 42; mean age = 39.07 years, SD = 7.45) were significantly more likely to report more frequent PA with others after the program as compared with before. General active play and conditional support were mentioned most frequently. This study provides context to the social networks and PA behaviors of Mexican-heritage fathers and suggests that a father-focused, family-centered health program can increase the PA frequency with social network connections.

Intrafamilial Characteristics Are Important Predictors of Children's Diets in New Mexico's Border Colonias.

INTRODUCTION: We assessed selected nutritional indicators in Mexican-origin children in two low-income, rural colonias in New Mexico on the U.S.-Mexico border. These children are at higher risk for obesity and other chronic diseases linked to poor nutrition in childhood, but little is known about their diets. METHOD: We surveyed mothers of 202 children 6 to 10 years old about sociodemographic characteristics, family and child attitudes and behaviors, and the child's diet. We compared diet with dietary recommendations and used regression trees to identify significant predictors of recommended intake. RESULTS: Among families, 89.1% participated in Medicaid, and 52.5% participated in a Supplemental Nutrition Program. More children met recommendations for fruit (36.1%) than vegetables (1.5%). Greater vegetable intake was associated with a child's not thinking healthy food tasted bad, greater family activity, and younger maternal age. Only 5.0% of children met the recommendation for <10% of energy from added sugar, with the average child consuming 2.4 times that from sugar-sweetened beverages and snacks. Lower sugar intake was associated with less screen time, not having TV on during meals, and playing team sports. Family access to healthy food and child use of mobile food vendors, vending and convenience stores were not predictive of diet. CONCLUSION: Hispanic children in border colonias have poor diets that put them at risk for obesity and numerous chronic diseases. Addressing this problem will require changing family norms and attitudes toward healthy food, screen time behavior, and physical activity levels within families.

Beyond Walking: An Assessment and Description of Streets as Potential Physical Activity Places in Low-Income Communities.

Low-income communities often have fewer quality community-level physical activity places (PAPs) or resources (e.g., parks, playgrounds). When present, barriers like traffic, distance, and crime often prevent access. Creative solutions and better understanding of current and potential realistic PAPs are necessary for children and families to be active. Streets are rarely considered potential PAPs despite their ubiquity and accessibility. This article describes street segments as potential PAPs in two low-income Mexican-heritage colonias communities along the Texas-Mexico border. Promotora-researchers conducted PAP assessments of all street segments (n=867) in the two communities to describe the availability and quality of their physical activity features (e.g., basketball hoops, bicycles), amenities (e.g., paved driveways, yard space), and incivilities (e.g., vandalism, loose dogs). Streets in these communities did contain features and amenities associated with physical activity promotion. On average, street segments had 6.10 (SD=7.20) physical activity-promoting features, 27.65 (SD=27.30) physical activity-promoting amenities, and both were assessed as good-to-fair quality. Future physical activity programming should consider incorporating streets as potential PAPs to enhance physical activity and active play. Further, evaluating streets as PAPs in this way may provide insight into locations for temporary place-based programs such as Play Streets. Future research should also examine residents' perceptions of their streets as PAPs for safe physical activity and active play, not just as places to walk, and which PAP characteristics matter for safe physical activity and active play to occur on streets.

Rare case of Proteus mirabilis native mitral valve endocarditis in an immunocompromised patient.

BACKGROUND: Bacterial infective endocarditis caused by Proteus mirabilis is rare and there are few cases in the literature. The natural history and treatment of this disease is not as clear but presumed to be associated with complicated urinary tract infection (cUTI). CASE PRESENTATION: A 65-year-old female with a history of rheumatoid arthritis, factor V Leiden hypercoagulability, and prior saddle pulmonary embolism presented to the emergency department following a mechanical fall. Computed Tomography showed evidence of acute/subacute splenic emboli. Complicated UTI was likely secondary to a ureteral stone. Blood and urine cultures also grew out P. mirabilis. Transthoracic echocardiography revealed a mobile echogenic density on the anterior mitral valve (MV) leaflet consistent with a vegetation. The patient underwent MV replacement, and P. mirabilis was isolated from the surgically removed valve. CONCLUSIONS: We hypothesize that the patient's immunocompromised status following steroid and Janus Kinase inhibitor usage for rheumatoid arthritis contributed to Gram-negative bacteremia following P. mirabilis UTI, ultimately seeding the native MV. Additional studies with larger numbers of Proteus endocarditis cases are needed to investigate an association between immunosuppression and Proteus species endocarditis.

Designing for Multilevel Behavior Change: A Father-Focused Nutrition and Physical Activity Program for Mexican-Heritage Families in South Texas Border Communities.

Fathers significantly influence family functioning, as coparents and partners, and must be part of family-based approaches to behavioral health interventions or programs. But little is known regarding how to support Latino fathers in health promotion within their family systems, specifically for Latino families living in border communities. Program development was embedded in a larger community-based grant and part of a longstanding academic-community collaboration. An interdisciplinary research team applied theories related to health behavior, family systems, behavior change, and community engagement to develop a father-focused and family-centered behavioral program for Mexican-heritage fathers and children living near the Texas-Mexico border to support changes in nutrition and physical activity at the individual and family levels. Promotoras de salud (trained community health workers) delivered the program through group sessions, check-in calls, and at-home activities. Group session activities were designed to engage family triads and dyads using experiential education related to nutrition and physical activity, like cooking lessons and active play, over a six-week period. Future research can use the program approach and curricula as a roadmap for designing context-specific and culturally-relevant programs for Latino families. Additional research is needed to explore how approaches like this can support families and their health goals.

¿Qué Pasa Con Papá? Exploring Paternal Responsibilities and Physical Activity in Mexican-Heritage Families.

Mexican-heritage children often achieve less physical activity (PA) than their counterparts and are at greater risk for associated comorbidities. Child PA is greatly influenced by their parents, yet researchers have rarely involved fathers in community health promotion. The purpose of this study is to examine Mexican-heritage fathers' perceptions of responsibilities and self-reported activities. Promotoras recruited fathers (n = 300) from colonies on the Texas-Mexico border and administered Spanish-language surveys including paternal responsibilities, father PA, and PA co-participation. Two researchers coded responses. Open-ended items were coded and cross-tabulations between responsibilities and activities with children were examined. Fathers reported feeling monetary responsibilities most often. Fathers reported engaging in more activities with their sons than daughters; however, fathers engaged in very few activities specifically with their children. Feeling responsible for family expenses was associated with paternal PA co-participation with family and children. This study adds clarity to the role of Mexican-heritage fathers in child PA. Findings highlight potential areas for intervention including supporting fathers to take an active role in their children's PA.

Latino Fathers as Catalistas (Agents of Change): Strategies to Support Latino Fathers in Childhood Obesity Prevention.

Latino children are disproportionately affected by childhood obesity. Prior research has encouraged father engagement to bolster prevention efforts and outlined general strategies for father recruitment, engagement, and retention. However, behavioral nutrition or education programs with a focus on Latino fathers are lacking, which means there is little guidance for working with Latino fathers in motivation and maintenance. This perspective highlights strategies for supporting dietary and activity behaviors with Latino fathers. Researchers can apply strategies to observational studies or program development and implementation, and practitioners can use strategies to tailor education and counseling with Latino fathers as part of obesity prevention.

Active Play Network Influences on Physical Activity Among Children Living in Texas Colonias.

Physical activity (PA) is beneficial for child health; however, few children meet PA guidelines. Social relationships impact child PA behaviors; however, little is known about this effect in Mexican-heritage populations. This study aims to understand associations between self-reported play networks and PA among Mexican-heritage children. Mexican-heritage children from colonias along the Texas-Mexico border (n = 44; 54.5% girls; mean age = 9.89 years, SD = 0.97) reported information on up to 5 people they played with most often. Linear regression was used to analyze the relationship between composition of children's social network and minutes of moderate- to vigorous-intensity PA (MVPA) and sedentary minutes per day measured by accelerometers. Children who reported a higher percentage of friends as opposed to family members attained significantly more minutes of MVPA per day (ß = .27, P = .04). Children who reported playing with individuals in their network more often (ß = ‒.28, P = .03) were sedentary for fewer minutes per day. Increasing the connections between children in the neighborhood or community, as well as increasing a child's frequency of active play, may be promising approaches to increasing MVPA and decreasing sedentary behaviors among Mexican-heritage children.

Papás Activos: Associations between Physical Activity, Sedentary Behavior and Personal Networks among Fathers Living in Texas Colonias.

Despite growing health disparities in Latino populations related to lack of physical activity (PA), little is known regarding the impact of social networks on PA and sedentary behavior among a sample of Latino fathers residing in functionally rural colonias. Fathers wore accelerometers and responded to questions regarding their self-efficacy and characteristics of who they were active with most often. Fathers (n = 47) attained a mean of 73.3 min of moderate-to-vigorous PA (SD = 23.8) per day and were sedentary for a mean of 364.0 min (SD = 74.4) per day. In total, fathers reported 205 alters and significantly more family members (M = 3.60, SD = 1.64) than friends (M = 0.77, SD = 1.37). Sedentary time was positively associated with number of peers and inversely related to the number of children reported. Minutes of moderate-to-vigorous PA was significantly associated with greater self-efficacy and number of family members reported. This study contributes to the evidence by further examining PA correlates of Latino fathers from functionally rural colonia communities. Additionally, this study supported both family systems theory and the socio-ecological model as it details the interpersonal and familial influences of PA behavior. Thus, supports for family activity promotion and programs which impact familial norms and activity at the family level may be particularly useful.

Health coalition collaboration network, perceived satisfaction and success.

PURPOSE: The health equity and prosperity of communities is closely linked to the effectiveness and success of local health coalitions. Social network analysis (SNA) is one mechanism to quantify and understand the factors leading to collaboration and effectiveness within these coalitions. This study aims to investigate network characteristics associated with perceived success and satisfaction in a health coalition and determine significant factors related to organizational collaborations. DESIGN/METHODOLOGY/APPROACH: This study examined the Olympic Peninsula Healthy Community Coalition (OPHCC) which aims to prevent chronic disease in rural Clallam County, Washington. Representatives (n = 21) from member organizations (n = 18) were asked to report on organization characteristics, perceived satisfaction in coalition activities, perceived success toward coalition's mission, and collaborations with other organizations in the coalition. Multilevel modeling used to analyze whether an organization's position within the coalition network was associated with their perceived satisfaction and perceived success. Exponential random graph modeling was used to examine what factors may impact collaboration ties between coalition members. FINDINGS: Organization representatives reported a total of 252 collaboration ties. In multilevel models, organization characteristics and network centrality scores accounted for between 61 and 68% of variance displayed in satisfaction scores and 45-61% of variance in perceived success scores. Exponential random graph modeling revealed activity level, for-profit status, and transitivity as significant factors in collaborative tie presence. ORIGINALITY/VALUE: Encouraging consistent active participation, a balance of organizational type, and projects which require more than two collaborators may provide an environment for collaborative ties between organizations.

Physical Activity Space Methodology for Assessment and Prioritization (PASMAP): Combining systematic observations with community perceptions to identify community physical activity resource priorities.

Despite benefits of physical activity (PA), most Americans are not regularly active, with notable disparities for residents of low-income communities. PA is positively correlated with resource availability and quality, which can be measured and quantified by PA resource assessment tools. However, community members' perceptions are often not considered. This study incorporates community perceptions with systematic environmental observations to identify community PA resource priorities. The PA Space Methodology for Assessment and Prioritization (PASMAP) includes three phases. Phase 1: Promotora-researchers completed 57 PA Resource Assessments (PARAs) in colonias along the Texas-Mexico border assessing quantity and quality of features, amenities, and incivilities. Characteristics were ranked using average PARA scores from all PA spaces. Phase 2: community advisory board (CAB) members (n = 36 from 3 CABs) ranked the importance of each feature, amenity, and incivility respectively; rankings were averaged and ordered. Phase 3: differences between phases 1 and 2 were calculated. Large differences indicated high discordance between systematic observations and perceived importance. Phase 1: highest ranked PARA characteristics were sidewalks, non-street lighting, and noise. Phase 2: CAB members ranked trails/paths, sidewalks, play equipment, bathrooms, drinking fountains, substance abuse evidence, and litter most important. Phase 3: multiple characteristics had high discordance: trails/paths, fenced-in open fields (features), drinking fountains (amenity), and litter (incivility); low quantity/poor quality yet perceived as highly important. Discordant characteristics identified through PASMAP provide evidence-based, community-valued recommendations on PA resource priorities for planning and advocacy. Future work should incorporate perceptions from additional community members and apply PASMAP methods to other environmental assessments.

"I Try to Keep That Sugar Down." Experiences of Homebound Older Adults With Type 2 Diabetes: Barriers to Self-Management.

Objectives: To study the experiences and challenges of type 2 diabetes (T2D) self-management among homebound older adults who regularly receive home-delivered meals and services.Methods: Participants (n = 31) were recruited by telephone screening and were selected by purposive sampling. Semi-structured interviews were subsequently conducted within participants' homes. The interpretive methodology utilized in this study was developed to systematically assess T2D self-management.Results: Thematic analysis shows that participants felt mostly responsible for their health status, but attributed any noncompliance to lack of social and economic assistance. Most of the seniors in this study felt competent, but often did not have the opportunity to engage in protective measures due to a number of economic, physical, and social barriers.Conclusions: These results contribute to a better understanding of how to approach, support, and motivate homebound older adults with T2D while addressing challenges. Findings offer insight into the development of diabetes self-management education (DSME) and interventions for this population.

Perceptions of drinking water safety and their associations with plain water intake among US Hispanic adults.

We described sociodemographic differences in perceptions of drinking water safety and examined associations between perceptions and plain water intake. We used the 2015 Estilos survey of 1,000 US Hispanic adults conducted in both Spanish and English. Outcome was water intake. Exposures were the level of agreement about water perceptions (My tap water is safe to drink; Community tap water is safe to drink; Bottled water is safer; I would buy less bottled water if my tap water was safe). Covariates were sociodemographics, region, Hispanic heritage, and acculturation. We used chi-square tests and multinomial logistic regression to examine associations of water perceptions and intake. Overall, 24% of Hispanic adults consumed water ≤1 time/day. Although 34% disagreed their home tap water was safe to drink, and 41% disagreed their community tap water was safe to drink, 65% agreed bottled water is safer than tap water, and 69% agreed they would buy less bottled water if they knew their tap water was safe. Perceptions differed by some covariates but were not significantly associated with plain water intake. In conclusion, negative perceptions of tap water were common among US Hispanic adults, which can inform efforts to increase awareness about safe public water systems.

Perceived Physical Activity Barriers of Mexican-Heritage Sibling Dyads.

Objectives: Physical activity (PA) has been linked to many health benefits. Personal, social, and environmental factors can be barriers to PA and reduce odds of meeting PA recommendations. Sibling relationships have been shown to influence PA. This study evaluates PA barriers among siblings over 2 time periods. Methods: Eighty-seven sibling dyads from Mexican-heritage families residing in colonias along the Texas/Mexico border were recruited by promotora-researchers to complete a 21-item PA barrier survey during summer and the school year. Frequencies of responses for each barrier were calculated for older and younger siblings at both time periods. Concordance among sibling PA barriers was assessed using percent agreement and Cohen's kappa statistic (κ). We used exploratory factor analysis (EFA) to examine differences in factor loadings based on season. We calculated mean subscale scores and compared scores using non-parametric Wilcoxon signed-rank tests. Results: Weather, homework, and self-consciousness were most frequently reported barriers. Older siblings reported more barriers than younger siblings during the school year. EFA results suggest different scales for summertime and school year. Conclusions: Sibling relationships may affect perceptions of barriers to PA. Perception of barriers may need to be measured differently depending on season.