Taking a broad approach to public health program adaptation: adapting a family-based diabetes education program.

Diabetes health disparities among Hispanic populations have been countered with federally funded health promotion and disease prevention programs. Dissemination has focused on program adaptation to local cultural contexts for greater acceptability and sustainability. Taking a broader approach and drawing on our experience in Mexican American communities at the U.S.-Mexico Border, we demonstrate how interventions are adapted at the intersection of multiple cultural contexts: the populations targeted, the community- and university-based entities designing and implementing interventions, and the field team delivering the materials. Program adaptation involves negotiations between representatives of all contexts and is imperative in promoting local ownership and program sustainability.

A pebble in the pond: the ripple effect of an obesity prevention intervention targeting the child care environment.

Through Steps to a Healthier Arizona, a unique partnership was developed to reach the culturally diverse, rural communities of Southern Arizona. This partnership included local, regional, and state agencies and coalitions focused on reducing the burden of chronic disease and health disparities. This article describes the success of a program aimed at preventing childhood obesity and diabetes. Partners in Yuma County worked with child care providers to implement organizational best practices which promote positive nutrition and physical activity behaviors in young children. As a result of this project, the number of child care centers in Yuma County implementing best practices increased. Additionally a ripple effect has reached beyond the individual child care setting, into broader local and state early childhood development systems. Taking place against the backdrop of state-wide initiatives in early childhood development and health, the Steps to a Healthier Arizona's NAP SACC program positioned stakeholders to integrate with these advances.