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APHA 2013


ABSTRACTS

 

An ethnographic protocol for determining self-defined community boundaries as the basis for an immigrant Latino health disparities intervention

Mark C. Edberg, PhD, Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, DC
Sean Cleary, PhD, MPH
Elizabeth Andrade, DrPH, MPH, Department of Prevention and Community Health, George Washington University, Washington, DC
Lauren Simmons, MPH, Epidemiology and Biostatistics, George Washington University School of Public Health and Health Services, Washington, DC
Idalina Cubilla, MPH, Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, DC
Glencora Gudger, Department of Anthropology, George Washington University Columbian College of Arts and Sciences, Washington, DC

BACKGROUND: Building on data and results from SAFER Latinos, a CDC-funded, community intervention to prevent youth violence in the Latino immigrant community of Langley Park, MD, the George Washington University School of Public Health and Health Services was recently awarded an exploratory health disparities center grant from the National Institute on Minority Health and Health Disparities. Center activities include an expanded intervention (called ADELANTE) conducted in the same Latino community to address the co-occurrence of substance abuse, violence and sex risk within the youth (12-17 years) and young adult (18-24 years) population. Knowing that this community has grown beyond the available Census data used in evaluating the SAFER Latinos intervention, the ADELANTE research team developed and implemented an innovative ethnographic protocol for eliciting self-defined, and more current, community borders and population information.

METHODS: Beginning with the original Census designated place (CDP) maps as a core, we first mapped service data from partner community organizations for individuals reporting Langley Park residence. This first (GIS) mapping effort indicated that Langley Park residence included areas beyond the CDP boundaries. Next, an ethnographic team including public health professionals and anthropology graduate students conducted multiple visits to the community, collecting descriptive data on the “community” areas falling outside of the CDP boundaries and conducting interviews with residents to assess the geographic extent of self-defined Langley Park residence.

RESULTS: This information was used to create new community boundaries, which are now the basis for the evaluation sampling plan as well as intervention coverage and outreach planning.

 

A mediational analysis of Latino youth violence

Sean Cleary, PhD, MPH, Department of Epidemiology & Biostatistics, George Washington University School of Public Health & Health Services, Washington, DC
Mark Edberg, PhD, Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, DC
Elizabeth Andrade, DrPH, MPH, Department of Prevention and Community Health, George Washington University, Washington, DC

BACKGROUND: The SAFER (Seguridad, Apoyo, Familia, Educacion, y Recursos) Latinos project was developed with community partners to effect change in four key domains that were hypothesized as mediating factors for youth violence: family cohesion; school-related barriers; community cohesion and alienation; and risk behaviors.

METHODS: Randomized cluster-sampling was used to obtain a representative community sample. Baseline youth (aged 12-17 years) survey sample data were used to test a path model of the relationship between family, school, and community measures, and youth violence.

RESULTS: Mediational analyses indicated that friends risk behavior, pro-fighting attitudes, subjects’ tobacco and alcohol use, and familiarity with gangs were mediators of youth violence. The path model fit the data well (CFI = 0.97, RMSEA = .04). Acculturation had a positive direct effect on both fighting and victimization. Expectations for the future had an inverse direct effect on victimization.

Discussion: Results strongly support the hypothesized social ecology model in which immigrant Latino youth, as they become acculturated, are more likely to be socialized via a peer-based ecology of risk because of the difficulties, instabilities, and conflicts in their household, school and social environments. Direct or peripheral gang involvement – for males and females – is tied to increased violence as well as victimization, substance use, and other risks including sexual risk. Additional competencies need to be fostered to promote positive youth development and existing assets within family and community need to be strengthened.

 

Results from the safer latinos project: A PILOT intervention addressing a social ecology of YOUTH violence in an immigrant Latino community

Mark Edberg, PhD, MA, Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, DC
Sean Cleary, PhD, MPH
Elizabeth Andrade, DrPH, MPH, Department of Prevention and Community Health, George Washington University, Washington, DC
Luisa Montero, MS

BACKGROUND: The SAFER Latinos project was developed with community partners to address four key domains (family cohesion, school-related barriers, community cohesion, efficacy and alienation, and gang presence and violence norms) hypothesized as contributing to a social ecology of youth violence in a marginalized Latino immigrant community (Langley Park, MD).

METHODS: Intervention components were designed to address each domain. Evaluation methods were quasi-experimental, using baseline and followup community surveys and focus groups in intervention and comparison communities. Extensive process data were collected. Analyses included factor analysis, correlations, baseline-followup comparisons, mediational analysis, and qualitative coding.

RESULTS: Correlations for youth and young adults in Langley Park between hypothesized mediating variables and violent outcomes were statistically significant, supporting the model, with some qualifications. Mediational analysis supported a social ecology connected to violence. Focus groups portrayed differential risk profiles for recent immigrants vs. more acculturated and U.S.-born youth. Some intervention effects were demonstrated, including a reduction in violence-supportive attitudes, and drops in some violent crime in the intervention community – though community crime data were problematic and only suggestive.

DISCUSSION: The SAFER Latinos pilot project tested implementation and effectiveness of an intervention addressing multiple components of a social ecology, instead of a single component. Data indicate that the model has promise, although a number of factors need further development. Given the demographic significance of this population, testing and development of community-based models is important for ongoing reduction of health disparities. Lessons learned are now being applied to a new intervention.

 

Association between length of time in the US and dental health among foreign-born and US-born Latino youth and young adults

Sean Cleary, PhD, MPH, Department of Epidemiology & Biostatistics, George Washington University School of Public Health & Health Services, Washington, DC
Ann Goldman, MA, MPH, Department of Epidemiology & Biostatistics

BACKGROUND: Significant differences in dental health care among youth have been reported across racial/ethnic groups. Few studies have examined the impact of acculturation on oral health among US born and foreign-born Latinos.

PURPOSE: To examine the association between length of time in the US and dental health in a nationally representative sample of Latino youth and young adults.

METHODS: Data are from the 2007 National Survey of Children’s Health. Eligible respondents (n=8,006) included both US-born and foreign-born Latino youth aged 5 to 17 years. To represent acculturation, respondents were classified by length of time in the US (1-4 years, 5-10 years, 11+ years). Multiple logistic regression was used to assess the association between length of residence and oral health measures. All analyses included design effects and weights using Stata.

RESULTS: Foreign-born Latino children had poorer teeth condition, more oral health problems, and were less likely to have a routine preventive dental care visits. The acculturation hypothesis was supported for no routine preventive dental visits in the past year and for fair/poor teeth condition among the newest immigrant youth, but was not found to hold for any other measure of oral health.

CONCLUSIONS:The acculturation hypothesis of diminishing dental health differences between native-born Latinos and foreign-born Latinos with more years spent in the United States was partially supported by this study. Further study is needed to elucidate individual and structural variables associated with need, access, and barriers to oral health care to ensure dental health among Latino youth and young adults.

 

Evaluating the effectiveness of a community-based hygiene promotion program in santa clara, El Salvador

Elizabeth Andrade, DrPH, MPH, Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, DC
Kathryn Zoerhoff, MPH, MA, Research Triangle International
Emily Putzer, MA, Maryland Multicultural Youth Center, Hyattsville, MD
Jeffrey Bingenheimer, MPH, PhD, School of Public Health & Health Services, George Washington University, Washington, DC
Mark Edberg, PhD, MA, Department of Epidemiology & Biostatistics, George Washington University School of Public Health & Health Services, Washington, DC
Tilly Gurman, DrPH, MPH, Department of Global Health, The George Washington University School of Public Health and Health Services, Washington, DC
Maria Luisa Avalos
David Antonio Interiano
Doris Arminda Alfaro

BACKGROUND: Due to the lack of adequate hygiene, potable water and sanitation, diarrheal disease still poses a substantial threat to human health in developing communities. While there have been considerable advances in the WASH sector, there is still a lack of evidence on theory-based program models for hygiene behavior change. This research study aimed to advance knowledge around hygiene behavior change strategies through the evaluation of a two-year community-based hygiene promotion pilot program implemented in rural Santa Clara, El Salvador by local health promoters.

METHODS: This study used a community-level quasi-experimental pretest-posttest design with repeated follow ups (2008-2010) to determine whether the hygiene promotion program achieved changes in hygiene knowledge and behavior. One community received the intervention while the other served as a comparison. Interviewer-administered surveys were collected from a representative sample using community-based participatory methods. Thirteen measures of hygiene knowledge and behavior for water, sanitation, personal, domestic and food hygiene were constructed using a hygiene cluster framework and were tested for reliability. ANOVA, one-way ANOVA with posthoc analysis using Tukey’s HSD for multiple comparisons and linear regression were used.

RESULTS/DISCUSSION: Hygiene knowledge and behaviors related to sanitation and food hygiene increased more in the intervention than in the comparison community. Study results suggest that limited improvements in water and domestic hygiene may be related to an inadequate enabling environment for behavior change, with water source and availability of mechanisms for adequate trash disposal playing a role in this process. Recommendations for public health practice and research are also offered.

 

Community-based health promoters as change agents: Culturally-appropriate strategies for hygiene behavior modification in a rural salvadoran setting

Elizabeth Andrade, DrPH, MPH, Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, DC
Marie Hoffman, MPH
Mark Edberg, PhD, MA, Department of Epidemiology & Biostatistics, George Washington University School of Public Health & Health Services, Washington, DC
Tilly Gurman, DrPH, MPH, Department of Global Health, The George Washington University School of Public Health and Health Services, Washington, DC
Maria Luisa Avalos
David Antonio Interiano
Doris Arminda Alfaro

BACKGROUND: Informed by Everett Rogers’ Diffusion of Innovations (DOI) theory, this study examined the role of community-based health promoters as change agents for improved hygiene behavior adoption in a two-year hygiene promotion intervention that took place in a rural Salvadoran community setting.

METHODS: We conducted three focus groups and six semi-structured individual interviews to gain a fuller perspective of the health promoter’s role in hygiene behavior modification. We used a grounded theory approach to examine the social processes behind hygiene behavior adoption to elaborate on the role of health promoters in these processes. More specifically, we explored household decision-making dynamics and perceived attributes of recommended hygiene practices. Free-listing was used to identify attributes about the health promoters with regards to how these attributes influenced reception of promotion messages.

RESULTS/DISCUSSION: Findings suggest that program successes may be attributed to the community-based approach and intervention delivery by local, culturally appropriate health promoters, who played a vital role in community members’ acceptance of hygiene messages. Health promoter characteristics identified as important to hygiene behavior change included: amabilidad (kindness), respeto (respect), confianza (trust), homophily, effort, and credibility. The ama de casa, or female homemaker, emerged as a key player in the hygiene behavior adoption process. Community social networks, desired obedience to authority, and dedication to community priorities emerged as key factors in hygiene behavior change. This study offers a deeper understanding of the way in which this theoretical approach and intervention strategy can be applied in a culturally and linguistically appropriate manner.