Race/ethnicity modifies the relationship between acculturation-related factors and hypertension. Consideration of disease prevalence in origin countries is critical to understanding health patterns in immigrant populations. Validation of self-reported hypertension in Hispanic populations is indicated.
Medical and health educational services are insufficient to control AIDS risk behavior. A new conceptual model that can guide more effective behavioral change strategies for whole communities is required to modify sexual practices and control the AIDS epidemic. We integrated learning theories with an ecological model to create a behavioral-ecological conceptual model of sexual risk behavior. We assumed a developmental process of learning and ongoing social influence. Contingencies of reinforcement and other motivational variables operate among sexual partners, their peers, and family networks in the context of culture. Our model hierarchically arrays learning processes within common social institutions (e.g., schools). Making appropriate changes in numerous social institutions concurrently may culminate in sufficient change in theoretical independent variables to establish safer sexual practices in whole communities. Application to adolescents' sexual development is used to illustrate this model. The behavioral-ecological model suggests that multiple interventions, with emphasis on change in social networks, is necessary to control the AIDS epidemic. If this model is correct, traditional education interventions will fail to ensure safer sexual practices among adolescents and adults.
Introduction
This study examined feasibility of a place-based community health worker (CHW) and health advocate (HA) initiative in five public housing developments selected for high chronic disease burden and described early outcomes.
Methods
This intervention was informed by a mixed-method needs assessment performed December 2014–January 2015 (representative telephone survey, n=1,663; six focus groups, n=55). Evaluation design was a non-randomized, controlled quasi-experiment. Intake and 3-month follow-up data were collected February–December 2015 (follow-up response rate, 93%) on 224 intervention and 176 comparison participants, and analyzed in 2016. All participants self-reported diagnoses of hypertension, diabetes, or asthma. The intervention consisted of chronic disease self-management and goal setting through six individual CHW-led health coaching sessions, instrumental support, and facilitated access to insurance/clinical care navigation from community-based HAs. Feasibility measures included CHW service satisfaction and successful goal setting. Preliminary outcomes included clinical measures (blood pressure, BMI); disease management behaviors and self-efficacy; and preventive behaviors (physical activity).
Results
At the 3-month follow-up, nearly all intervention participants reported high satisfaction with their CHW (90%) and HA (76%). Intervention participants showed significant improvements in self-reported physical activity (p=0.005) and, among hypertensive participants, self-reported routine blood pressure self-monitoring (p=0.013) compared with comparison participants. No improvements were observed in self-efficacy or clinical measures at the 3-month follow-up.
Conclusions
Housing-based initiatives involving CHW and HA teams are acceptable to public housing residents and can be effectively implemented to achieve rapid improvements in physical activity and chronic disease self-management. At 3-month assessment, additional time and efforts are required to improve clinical outcomes.
Using a poverty measure to analyze school-based data will provide a better understanding of the impact of SES on health outcomes. Based on our evaluation, when individual-level information is not available, we propose using school-level %FRPM, which are publicly available throughout the United States.
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