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Suggested citation for this article: Mudd-Martin G, Martinez MC, Rayens MK, Gokun Y, Meininger JC. Suboptimal lifestyle factors in combination with genetic susceptibility contribute to cardiovascular disease and type 2 diabetes risk among Latinos. The community-based participatory research was conducted with communities in Kentucky, which has a rapidly growing Latino population. Su Corazon, Su Vida (Your Heart, Your Life) is a Spanish-language, healthy lifestyle educational program to reduce cardiovascular disease and type 2 diabetes risk among Latinos. Postintervention improvements in health-promoting lifestyle choices and genomic knowledge specific to cardiovascular disease and type 2 diabetes suggested that the program may be effective in reducing risk.
These findings indicated that a tailored healthy lifestyle program integrating genomics and family history education was socioculturally appropriate and may feasibly be implemented to reduce cardiovascular disease and type 2 diabetes risk in a Latino community with limited health care resources. Cardiovascular disease (CVD) and type 2 diabetes mellitus (DM) are leading causes of illness and death among US Latinos. In combination with genetic susceptibility, suboptimal lifestyle factors including physical inactivity, unhealthful diet, and obesity contribute to CVD and DM risk among Latinos (4,5).
Interventions facilitated by promotores, laypersons who understand local health issues and are dedicated to improving their communities’ health (7), have effectively promoted healthy lifestyles among Latinos.
The team prioritized CVD and DM prevention through a health-promoting lifestyle intervention because of the high rates of these diseases among Latinos and the potential for the intervention to improve health outcomes in an environment with limited health care resources.
We conducted an extensive literature search to identify existing lifestyle programs with demonstrated effectiveness among Latinos. To guide sociocultural tailoring of the SCSV program, formative research was conducted from 2008 through 2009 (Study 1). Community partners were particularly interested in focusing on Latina women, whom they identified as more influential on family and community health behaviors than Latino men. Twenty Spanish-speaking Latinas identified by community partners as natural leaders participated. The 3 promotores training sessions and 8 SCSV educational modules were presented in Spanish during 11 two-hour sessions, with 1 module presented weekly. Program adaptations in response to feedback included integration of time into each session for participants to identify and discuss context-specific health-promotion strategies. Feedback from focus group sessions supported the value of integrating genomics and family history education into the SCSV program. There was enthusiastic consensus that the promotores-facilitated SCSV program could be successfully implemented in the community to improve health outcomes. To maintain fidelity to the SCSV program, we adhered to the original implementation framework and retained key educational components. For this study, we reached out to North Central Area Health Education Center (NC-AHEC), an organization with an extensive history of providing community education through a well-established promotores program. Two intervention groups were conducted: one at the NC-AHEC office and the other at a local library used for multiple community activities. A promotora with extensive experience conducting community-based health programs and with providing promotores training assisted the PI to collect baseline data.
Comparisons of genomic knowledge and HPLP II scales and subscales from preintervention to postintervention were conducted using paired t tests. Twenty-two participants, which included 1 group of 5 participants and a second group of 17, were enrolled and completed baseline assessments; 10 had previous promotores training. During the postintervention discussion, participants commonly expressed that the program had influenced their behaviors. A difficulty noted by several participants was that, although they were generally aware of the health status of first-degree relatives, they were less aware of that of their second-degree relatives.
Study results indicate that the socioculturally tailored SCSV program integrating genomic and family history education is feasible and appropriate to implement in a community setting among Latinos in a nontraditional area of residence. Community–academic collaboration foundational to CBPR presents both unique opportunities and challenges, both of which were experienced during this study. The outcomes of this study provide preliminary indication that the tailored healthy lifestyle intervention, including integration of genomic and family history education, is socioculturally appropriate and may provide a foundation for a sustainable program of health promotion for Latinos in a community with limited culturally and linguistically suitable health care resources. This research was supported by an internal grant from the University of Kentucky, Lexington, Kentucky. Corresponding Author: Gia Mudd-Martin, MPH, PhD, University of Kentucky College of Nursing, 533 College of Nursing Building, 760 Rose St, Lexington, KY 40536-0232. State profile of general population and housing characteristics: 2010 demographic profile data, Kentucky.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. A 45-year-old man presents with a 4- to 5-year history of an intermittent, asymptomatic, red, circular rash on his trunk.
Sleep Well is a wireless blood glucose monitoring device concept, designed aiming to eliminate the sleepless nights of parents with the tension of getting their kids glucose level down to the extreme level. Sociocultural Tailoring of a Healthy Lifestyle Intervention to Reduce Cardiovascular Disease and Type 2 Diabetes Risk Among Latinos.
We describe a community–academic collaboration that developed and explored the feasibility of implementing a socioculturally tailored, healthy lifestyle intervention integrating genomics and family history education to reduce risk of cardiovascular disease and type 2 diabetes among Latinos. Twenty natural leaders from an urban Latino community in Kentucky participated in sociocultural tailoring of the program and development of a genomics and family history module. Feedback indicated the program was socioculturally acceptable and responsive to community needs. The project highlights contributions of community-based processes in tailoring interventions that are appropriate for community contexts.
Family history reflects genetic and lifestyle influences on chronic diseases, and family history information can be used to tailor prevention interventions.
Su Corazón, Su Vida (SCSV) is a promotores-facilitated educational program to reduce CVD risk among Latinos through healthy lifestyle promotion (8,9) that has been successfully adapted for DM prevention (10). We describe a community–academic collaboration established in response to health needs of Latino residents in a nontraditional state.
The partnership originated from a longstanding relationship between the principal investigator (PI; G.
Collaborating partners agreed that a promotores-facilitated program would have greatest potential for sustainability with long-term health effects. Flowchart presenting an overview of the process of the formative study (Study 1) and assessment of the intervention program (Study 2), Su Corazon, Su Vida, Kentucky, 2008–2010.

Team consensus was that the SCSV program could be tailored to address community needs and, as a promotores-facilitated intervention, had the greatest potential for sustainability.
This research was followed by exploratory examination of implementation feasibility and acceptability of the tailored curriculum conducted during 2010 (Study 2).
It was decided to specifically engage Latinas in the sociocultural tailoring of the SCSV modules. Natural leaders were defined as women who were representative of area Latinas, involved in community activities, and well respected by community members.
Participants provided feedback on the comprehensibility and sociocultural appropriateness of the modules. Participants valued education about the physiologic bases of the diseases but were most interested in learning about risk factors and risk reduction.
A psychiatric nurse practitioner with stress management expertise assisted with development of stress reduction techniques, including deep breathing and imagery exercises. However, participants suggested that both men and women be included in an educational initiative. The genomics and family history module was structured to complement SCSV, using a presentation format identical to that of other program modules. Guided by participant feedback during the formative research, we decided to recruit both men and women. Educational modules were presented to each group in Spanish by the promotora during 8 weekly 2-hour sessions.
One participant attended all sessions but was unable to attend the final assessment; a second attended several sessions but a work schedule change precluded completing the intervention.
Average total and subscale scores preintervention and postintervention on the Health-Promoting Lifestyle Profile II.
Participants in both groups enthusiastically engaged in discussions on practical strategies for healthy lifestyles. Several shared that positive health effects, particularly weight loss, had occurred during the course of the program. Several participants were hesitant to communicate with family members about health history because of privacy concerns. Outcomes also suggest that the program has potential to improve health behaviors and increase knowledge of genomics and family history of CVD and DM. Community partners were crucial to identifying health needs and guiding development of the research program. First, Study 1 was conducted with Latinas; inclusion of Latino males may have provided differences in program tailoring.
As important, the CBPR process used in program tailoring may provide guidance for addressing the health needs of Latino community members in other nontraditional areas of residence.
Family history in public health practice: a genomic tool for disease prevention and health promotion. New survey shows Louisville’s growing Hispanic population lacks access to health care. Translation of family health history questions on cardiovascular disease and type 2 diabetes with implications for Latina health and nursing practice. The development of a Spanish language instrument to measure genetic knowledge of diabetes mellitus type 2. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.
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Parents can easily review their child’s nightly activities during the middle of the night at their bedside convenient.
The tailored program was presented to 22 participants to explore implementation feasibility and assess appropriateness for community use. Rates of CVD, although lower among Latinos than in other population groups, are projected to increase as the Latino population ages (2). However, effective use of family history information may be hampered by community-level deficits in genomic knowledge (6). Genomics and family history can support risk identification and motivate healthy behaviors (11). We describe the participatory process of tailoring the SCSV program and incorporating genomic and family history education, present results of an exploratory examination of sociocultural acceptability, and discuss the outcomes and public health implications. As a nontraditional Latino state, Kentucky has limited culturally and linguistically appropriate health resources (14).
Specific objectives of the collaboration were to 1) identify and tailor a healthy lifestyle intervention to reduce CVD and DM risk for use among Latino residents in urban Kentucky and 2) explore the feasibility of implementing the community intervention (Figure 1). Three promotores training sessions were also developed by community collaborators to complement the SCSV educational modules. Each also participated in 1 of 4 focus group sessions conducted to guide the integration of culturally relevant family history and genomics education into the program.
To enhance self-efficacy in reducing risk, participants suggested that specific, achievable health-promoting activities be identified early in the program and emphasized throughout.
Educational models complementing program modules were purchased, including a manipulable heart model and a visual display of sugar and salt content of foods commonly consumed in the Latino community. Participants indicated that understanding of family health history and its implications for personal health is limited, and, although they expressed interest in learning about this topic, they also conveyed the importance of reinforcing that a heritable predisposition can be modified through healthy behaviors. Although there was agreement that women strongly influence family health behaviors, participants believed the support of male family members is vital to successful behavior change.
The promotores training modules were not included in the final tailored program but were maintained as a separate training protocol for community development. Perspectives of promotores and lay community members were important for evaluating program acceptability.
Genomic knowledge refers to understanding disease risk in relation to genes, family history, and lifestyle behaviors. Discussion session recordings were transcribed verbatim and transcriptions reviewed by the PI and promotora to identify salient themes.
During presentation of the genomic and family history module, participants expressed much interest in the topic.

They thought family health discussions should occur naturally rather than information sought directly but agreed that increased family history awareness would encourage future discussions.
The academic component of the partnership was important in guiding scientific aspects of research. In our study, collaborative processing, brainstorming, and problem-solving provided a solid foundation for relationship building and maintenance.
However, outcomes from the exploratory study indicate the tailored intervention is appropriate for use with men and women. US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute; 2008. This monitor allows the parents to check their kid’s health without even leaving her bed and can be set to trigger an alarm when the blood sugar level of the child crosses a particular height. Beam is a stylish wearable medical monitoring device that simplifies the way a […]Dr.
Preintervention and postintervention assessments of genomic knowledge and lifestyle behaviors and qualitative postintervention evaluations were conducted. The public health implications are profound, given that Latinos represent 16.7% of the US population (3). Integration of genomic and family history education into the SCSV program may further enhance effectiveness by supporting risk awareness and engagement in risk-reducing behaviors. Resource limitations in combination with socioeconomic disparities negatively affect the health of Latino residents. A final study session included summary review of the SCSV program with in-depth discussion of the potential value for promoting health in the community. The women recommended omitting optional program activities such as fotonovelas (supplemental short illustrated stories) to allow time to discuss practical applications of information. This information supported the development of a genomics and family history module that includes basic education about genes and family history with implications for health and coinciding risk-reduction activities. We therefore extended verbal invitations to participate to 40 promotores with previous training from NC-AHEC. The instrument included 5 items related to genetic predisposition, 8 to family history, 9 to behavioral risk, and 7 to genetic and behavioral risk factors (Table 2). A final session was used to collect postintervention data; feedback on the program was provided during an audiotaped discussion held with each group. Several commented that they had heard of genes and associations with health but better understood this information after the presentation.
Participant collaborators in the formative research provided feedback critical for tailoring the SCSV program and informing development of the genomics and family history educational module. Flexibility is also essential, as highlighted by study protocol changes guided by community partners.
Second, although the small sample size for Study 2 was sufficient to indicate sociocultural appropriateness of the program, demonstrating effective CVD and DM risk reduction will necessitate conducting the intervention in a larger sample with more diverse representation of Latino countries of origin, a more rigorous research design, and a longer follow-up assessment period. Moreover, parents can easily review their child’s nightly activities during the middle of the night at their bedside convenient. Hug : Thermometer Bracelet for Baby Being a parent means that we are responsible for baby’s well being. La Casita Center is a community-based organization that provides services supporting Latino community development.
For example, participants identified and shared healthy recipes for commonly enjoyed foods and suggested time be provided during each session for such activities. Lay community members were recruited through flyers posted at sites frequented by Latino community members.
Of those who completed the assessment, 14 attended all 8 educational sessions; 8 attended 6 to 7 sessions.
Comments regarding positive experiences using relaxation techniques in response to daily stressors and appreciation of the educational models used to support learning indicated the benefit of each.
Many talked about sharing educational materials and information with family members and stated that family members were engaging in more healthful behaviors as a result.
Strategizing with NC-AHEC representatives and the collaborative efforts of a promotora with the organization were essential to successful program implementation. These resulted in improved outcomes but required significant cooperation and mutual engagement in the research process. If an emergency situation takes place, they can rush to their child’s room with the monitor to perform the aid that has to be taken based on the information displayed on the monitor. The median annual income of people aged 16 or older is $18,000, and 16% are unemployed; 38% of the population is uninsured (15). Guided by principles of community-based participatory research (CBPR), the collaboration emerged from a mutually recognized need for a sustainable health promotion initiative, and a research team was formed that included the PI, the director of La Casita Center (who served as co-investigator; M.
To acknowledge their collaboration, participants received a gift card for sessions attended; childcare was also provided.
Including stress reduction techniques and using educational models to support learning were also suggested. Inclusion criteria were being a Latino aged 18 years or older whose primary language was Spanish. Originally developed to assess genomic knowledge associated with DM (20), items relevant to CVD were added for this study. More global comments on the program included positive feedback regarding the format and pace of the educational presentations. Hug is a small bracelet specially designed to allow you tracking of your baby’s condition 24 hours a day, in real […]The Night Sound Wireless Speaker for Big Music Concert or Party Getting a problem in hearing the music in a big concert?
The high cost of health care, lack of health care access for the uninsured, and lack of available linguistically and culturally appropriate health resources have been identified as major health-related barriers in surveys and focus group discussions with Latino residents of Louisville and Lexington, the 2 largest Kentucky cities, and are associated with poor health outcomes (16–18). The Spanish-language version of the Health-Promoting Lifestyle Profile II (HPLP II) instrument (unpublished material, S.N. The total score for the instrument and the 6 subscale scores (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management) were obtained by averaging all relevant items for each; higher scores indicated more healthful choices.

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