Depressive Symptoms and Health-Related Quality of Life Among Participants in the Pasos Adelante Chronic Disease Prevention and Control Program, Arizona, 2005-2008

Introduction Chronic diseases are the leading causes of death in the United States and have been associated with depressive symptoms and poor health-related quality of life (HRQOL). This study examined whether depressive symptoms and HRQOL indicators changed among participants in Pasos Adelante, a chronic disease prevention and control program implemented in a US–Mexico border community. Methods Pasos Adelante was a 12-week promotora-led program that included educational sessions and walking groups. We used the Centers for Epidemiologic Studies Depression Scale (CES-D) and the Center for Disease Control’s “Healthy Days” measures to measure depressive symptoms and HRQOL. We used linear mixed-effects models and general estimating equations to analyze changes in CES-D scores and HRQOL indicators from baseline to postprogram and from postprogram to 3-month follow-up. Results At baseline, participants had a mean of 7.1 physically unhealthy days, 7.4 mentally unhealthy days, and 3.9 days of activity limitation. The mean number of physically and mentally unhealthy days declined significantly from baseline to postprogram, but the mean number of activity limitation days did not. At baseline, 42.6% of participants reported their health as fair/poor; 20.8% of participants reported frequent mental distress, and 31.8% had a CES-D score of 16 or more. All 3 proportions declined from baseline to postprogram. No significant changes occurred between postprogram and follow-up. Conclusion Participants in Pasos Adelante showed improvement in depressive symptoms and several HRQOL indicators. Future studies should use an experimental design with a comparison group to determine whether these findings can be replicated and to examine potential mediators and moderators of program effects

Depressive Symptoms and Health-Related Quality of Life Among Participants in the Pasos Adelante Chronic Disease Prevention and Control Program, Arizona, 2005-2008

Introduction Chronic diseases are the leading causes of death in the United States and have been associated with depressive symptoms and poor health-related quality of life (HRQOL). This study examined whether depressive symptoms and HRQOL indicators changed among participants in Pasos Adelante, a chronic disease prevention and control program implemented in a US–Mexico border community. Methods Pasos Adelante was a 12-week promotora-led program that included educational sessions and walking groups. We used the Centers for Epidemiologic Studies Depression Scale (CES-D) and the Center for Disease Control’s “Healthy Days” measures to measure depressive symptoms and HRQOL. We used linear mixed-effects models and general estimating equations to analyze changes in CES-D scores and HRQOL indicators from baseline to postprogram and from postprogram to 3-month follow-up. Results At baseline, participants had a mean of 7.1 physically unhealthy days, 7.4 mentally unhealthy days, and 3.9 days of activity limitation. The mean number of physically and mentally unhealthy days declined significantly from baseline to postprogram, but the mean number of activity limitation days did not. At baseline, 42.6% of participants reported their health as fair/poor; 20.8% of participants reported frequent mental distress, and 31.8% had a CES-D score of 16 or more. All 3 proportions declined from baseline to postprogram. No significant changes occurred between postprogram and follow-up. Conclusion Participants in Pasos Adelante showed improvement in depressive symptoms and several HRQOL indicators. Future studies should use an experimental design with a comparison group to determine whether these findings can be replicated and to examine potential mediators and moderators of program effects

Effectiveness of the Pasos Adelante Chronic Disease Prevention and Control Program in a US-Mexico Border Community, 2005-2008

Introducción "Pasos Adelante" es un programa de intervención sobre hábitos saludables facilitado por trabajadores de salud comunitaria o"promotores de salud" destinado a prevenir y controlar enfermedades crónicas en mexicoamericanos. Los estudios iniciales de"Pasos Adelante" mostraron mejoras significativas en la alimentación y la actividad física autorreportadas por los participantes.Este estudio evaluó si los habitantes de una comunidad en la frontera estadounidense que participaron en el programa mostraronmejorías en determinados valores fisiológicos y si los cambios se mantuvieron en el seguimiento a los 3 meses. Métodos El programa se llevó a cabo en sesiones de 12 semanas de enero del 2005 a mayo del 2008 e incluyó grupos de caminata y clases denutrición y actividad física. Se realizaron cuestionarios, mediciones antropométricas y pruebas de laboratorio al inicio delprograma (n = 305), al final (n = 254) y en el seguimiento a los 3 meses (n = 221). Resultados Al compararse los datos iniciales de referencia con los del final del programa, los participantes mostraron reducciones en su índicede masa corporal (P= .04), circunferencia de cintura y cadera (P< .001), presión arterial diastólica y sistólica (P< .001) y colesterol total (P= .008). Ningún valor empeoró significativamente entre la conclusión del programa y el seguimiento, aexcepción de la presión arterial sistólica. Los niveles de glucosa mejoraron entre la finalización y el seguimiento del programa (P=.01). Conclusión Estos resultados sustentan los hallazgos iniciales referidos a la mejoría autorreportada por los participantes en relación conpatrones de alimentación y actividad física al mostrar cambios en medidas objetivas. Este programa basado en la evidenciademuestra el potencial de los programas de control y prevención de enfermedades crónicas llevados a cabo por promotores desalud para mejorar la salud física abordando la prevención primaria y secundaria en organizaciones y comunidades hispanas

Evidence for Long-Term Impact of Pasos Adelante: Using a Community-Wide Survey to Evaluate Chronic Disease Risk Modification in Prior Program Participants

Effective community-level chronic disease prevention is critical to population health within developed and developing nations. Pasos Adelante is a preventive intervention that aims to reduce chronic disease risk with evidence of effectiveness in US-Mexico residing, Mexican origin, participants. This intervention and related ones also implemented with community health workers have been shown to improve clinical, behavioral and quality of life indicators; though most evidence is from shorter-term evaluations and/or lack comparison groups. The current study examines the impact of this program using secondary data collected in the community 3–6 years after all participants completed the program. A proportional household survey (N = 708) was used that included 48 respondents who indicated they had participated in Pasos. Using propensity score matching to account for differences in program participants versus other community residents (the program targeted those with diabetes and associated risk factors), 148 natural controls were identified for 37 matched Pasos participants. Testing a range of behavioral and clinical indicators of chronic disease risk, logistic regression models accounting for selection bias showed two significant findings; Pasos participants were more physically active and drank less whole milk. These findings add to the evidence of the effectiveness of Pasos Adalente and related interventions in reducing chronic disease risk in Mexican-origin populations, and illustrate the use of innovative techniques for using secondary, community-level data to complement prior evaluation research

Old Colony and General Conference Mennonites in Chihuahua, Mexico: History, representations and women's everyday lives in health and illness

During the early 1920s, Old Colony Mennonites emigrated from Canada to Chihuahua, Mexico in order to continue their traditional ways of life in nearly isolated, agricultural communities. As their ancestors had done for centuries, they continued to live in opposition to "the world." While the Old Colony Mennonites basically succeeded in living their distinct, conservative ideology, economic necessities and real world opportunities caused internal disagreements, excommunications and the formation of a new, liberal church, the General Conference, among their midst. North American Mennonite and some European scholars have recorded the history, political economy, socio-religious organization, linguistic and cultural characteristics of these so-called "Mexican Mennonites." What their large-scale perspectives have failed to capture is the everyday lives of the cultural group, the lives of women in particular. Women's worlds have been invisible in the official discourse on Mennonite history, most of which is male-dominated. This dissertation explores the everyday lives of Mennonites in the colonies near Cuauhtemoc, Chihuahua through Mennonite women's eyes. Women's multiple roles at the household level in times of health and illness, and women's moral identities are its focus. Women's habitus and discourses are central in perpetuating Mennonite gendered and moral identities. These identities, expressed in everyday moral living, are the foundation to Mennonite women's health work and local meanings of health. The ethnographic descriptions of women's lives demonstrate how ideology becomes operationalized, and the contrasting of existing literature with my findings exemplifies the articulation of ideology and gender. As an understanding of local Mennonite women's lives requires an appreciation of Mennonite history, socio-economic structure, and the values and norms reproduced by women during their everyday lives, this dissertation has a comprehensive, four-fold structure: Part I summarizes the history of the Mennonites near Cuauhtemoc and analyzes its representational politics; Part II lays out the anthropological processes of fieldwork and writing; Part III describes the contemporary everyday lives of Mennonite women with a focus on their gendered work, including health work, and socializing practice; Part IV discusses the socialization processes of Mennonite women, inherent challenges in Mennonite social structure, and the ways in which Mennonites cope with these challenges

Using Active Learning Strategies Linked to CBPR Principles in a Semester-long Class Project to Teach Qualitative Research Methods in Public Health

The use of active learning strategies to engage students in public health education has shown to be effective in promoting meaningful learning experiences. These educational approaches include inquiry- or problem-based, and group-based learning that allow for deeper understanding and internalization of the content material. This type of active learning can extend into the community by applying community-based participatory research (CBPR) principles. Utilizing CBPR can engage both the community and students on a project, thus benefiting all parties involved. This article describes the components of a class project that linked the active learning strategies of inquiry and group-based learning to CBPR principles as an innovative teaching approach in public health. The design and implementation of the class project is conceptualized in four activity types: (a) Engaging the community; (b) Working with students; (c) Conducting behind the scenes work; and (d) Bringing students and community together. The project demonstrates the benefits of using CBPR principles in conjunction with active learning principles. It also provides recommendations to public health instructors in higher education, which include the requirements of instructors’ established relationship with the community, commitment to project coordination, flexibility regarding project implementation and class time, and university support for sustaining innovative teaching efforts.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]