Along the U.S.-Mexico border, Mexican Americans are at increased risk for diabetes and have a 50% greater risk of death from the disease than the general U.S. population. Project collaborators implemented strategies to prevent and control diabetes among Mexican Americans living along the Arizona-Mexico border. The project comprised three interventions focused on people with diabetes, their families, and their neighbors.
The interventions involved community health workers (CHWs), or community residents trained by the researchers, to conduct the interventions. In the patient intervention, staff at a local health center, assisted by CHWs, taught four weekly small-group classes to help patients learn how to manage their diabetes. In the family-based intervention, La Diabetes y la Unión Familiar, CHWs taught patients and their extended families (grandparents, parents, aunts, uncles, cousins, and close friends) how to reduce their risk for diabetes and how to support one another in their efforts to increase physical activity and healthy food choices. In the third intervention, Pasos Adelante, CHWs led a community intervention that involved friends and neighbors in learning to prevent diabetes and in CHW-led walking groups. The family and community interventions also contained lessons and educational materials addressing depression in relation to diabetes.
In total, 494 people participated in at least one intervention, 111 in two, and 14 in all three. Researchers used surveys and body measurements to look at the results of each intervention separately. Pasos Adelante, the community intervention, was associated with significantly decreased key risk factors for cardiovascular disease and diabetes (such as cholesterol, glucose, and body mass index). Many of these improvements persisted for 3 months after the intervention ended. Participants in Pasos Adelante also had significant improvements in Health-Related Quality of Life indicators and depressive symptoms (including the experience of physically and mentally unhealthy days, mental distress, and self-rated health) comparing baseline data with those at the end of the program as well as at 12–18 weeks after the program ended. Researchers continue to analyze data to determine whether participation in more than one intervention increased the likelihood that health behaviors were maintained and whether a single intervention or combination of them had the greatest effect on individual health behavior.
Researchers received guidance, recruitment aid, and feedback for all of the interventions from the Douglas Special Action Group, a coalition created in partnership with the community to address local policies. The group advocated for policies in schools to improve school nutrition, remove soda from vending machines, and return physical education to the curriculum. The coalition continues to work on projects related to the prevention of diabetes, including implementing a local farmer’s market and involving high school students in creating health messages for the community.
Staten LK, Cutshaw CA, Davidson C, Reinschmidt K, Stewart R, Roe DJ. Effectiveness of the Pasos Adelante Chronic Disease Prevention and Control Program in a US-Mexico border community, 2005-2008. Preventing Chronic Disease 2012;9:100301. http://webdev.nccd.cdc.gov/pcd/issues/2012/10_0301.htm. Accessed 1/15/2012.
Cutshaw CA, Staten LK, Reinschmidt KM, Davidson C, Roe DJ. Depressive symptoms and health-related quality of life among participants in the Pasos Adelante chronic disease prevention and control program, Arizona, 2005-2008. Preventing Chronic Disease 2012;9:110020. http://webdev.nccd.cdc.gov/pcd/issues/2012/11_0020.htm. Accessed 1/15/2012.