Por La Vida model intervention enhances use of cancer screening tests among Latinas.

OBJECTIVE: To describe the short-term impact of the intervention known as Por La Vida (PLV) on cancer screening for Latinas in San Diego, California. METHODS: Thirty-six lay community workers (consejeras) were recruited and trained to conduct educational group sessions. Each consejera recruited approximately 14 peers from the community to participate in the program. The consejeras were randomly assigned to either a twelve-week cancer screening intervention group or a control group in which they participated in an equally engaging program entitled "Community Living Skills." Pre- and post-intervention self-report information was obtained from project participants on the use of cancer screening examinations. Outcome measures were changes in the percentages of women who had breast and cervical cancer screening test within the past year before and after the intervention occurred. Experimental and control groups were compared using t-tests. Analyses were conducted using both consejeras and participants as the unit of analysis. RESULTS: The increase in the use of the cancer screening test was higher in the PLV cancer intervention group in comparison to women in the community living skills control group. CONCLUSIONS: Key to the PLV intervention model is the identification of natural helpers in the Latino community and their subsequent training in intervention based on social learning theory using culturally appropriate educational materials. The model is an effective and viable approach for increasing the use of cancer screening tests in Latinas of low socioeconomic level and low level of acculturation.

Por La Vida intervention model for cancer prevention in Latinas.

Our goal was to describe the development and implementation of an intervention on cancer prevention for Latinas in San Diego, Calif. Thirty-six lay community workers ("consejeras") were recruited and trained to conduct educational group sessions. Each consejera recruited approximately 14 peers from the community to participate in the program (total number = 512). Half of the consejeras were randomly assigned to a control group, in which they participated in an equally engaging program entitled "Community Living Skills." Implementation of the intervention was assessed by qualitative and quantitative methods. Preintervention and postintervention self-report information was obtained from project participants on access to health care services, cancer knowledge, preventive measures, and previous cancer-screening examinations. Base-line data suggest that lack of knowledge, costs of cancer-screening tests, and the lack of a regular health care provider are the major obstacles against obtaining cancer-screening tests. Predisposing factors, such as fear and embarrassment, also constitute barriers to getting regular cervical cancer screening. Preliminary analysis indicates that the Por La Vida intervention increases use of cancer-screening tests in comparison to a community living skills control group. Universal access to health care would remove some of the major financial barriers to cancer screening. The Por La Vida program attempts to overcome the substantial barriers by reaching out to low-income Latinas and by providing information regarding the availability, acceptability, and preventive nature of cancer-screening tests.

A family approach to cardiovascular risk reduction: results from the San Diego Family Health Project.

The effectiveness of a family-based cardiovascular disease risk reduction intervention was evaluated in two ethnic groups. Participants were 206 healthy, volunteer low-to-middle-income Mexican-American and non-Hispanic white (Anglo-American) families (623 individuals), each with a fifth or a sixth-grade child. Families were recruited through elementary schools. Half of the families were randomized to a year-long educational intervention designed to decrease the whole family's intake of high salt, high fat foods, and to increase their regular physical activity. Eighty-nine percent of the enrolled families were measured at the 24-month follow-up. Both Mexican- and Anglo-American families in the experimental groups gained significantly more knowledge of the skills required to change dietary and exercise habits than did those in the control groups. Experimental families in both ethnic groups reported improved eating habits on a food frequency index. Anglo families reported lower total fat and sodium intake. There were no significant group differences in reported physical activity or in tested cardiovascular fitness levels. Significant differences for Anglo-American experimental vs. control adult subjects were found for LDL cholesterol. Significant intervention-control differences ranging from 2.2 to 3.4 mmHg systolic and/or diastolic blood pressure were found in all subgroups. Direct observation of diet and physical activity behaviors in a structured environment suggested generalization of behavior changes. There was evidence that behavior change persisted one year beyond the completion of the intervention program. It is concluded that involvement of families utilizing school based resources is feasible and effective. Future studies should focus on the most cost-effective methods of family involvement, and the potential for additive effects when family strategies are combined with other school health education programs.

Direct observation of physical activity and dietary behaviors in a structured environment: effects of a family-based health promotion program.

The effects of cardiovascular risk reduction are typically assessed by self-reported behavior change and physiological outcomes. There is a need to enhance evaluation protocols by including direct observation measures of targeted health behaviors. To improve the evaluation of a family-based diet and physical activity change program, families were observed during a planned visit to the San Diego Zoo. This standardized environment afforded many options for dietary intake and physical activity. Thirty families who had participated in a 1-year intervention program and 30 control families were observed. Caucasian and Mexican-American families were equally represented. Observations in this standard environment discriminated between intervention and control families, and the findings indicated that intervention effects generalized to this novel setting. Intervention families consumed fewer calories, ate less sodium, and walked further than did control families. Ethnic differences were noted.

Recruitment issues, health habits, and the decision to participate in a health promotion program.

To understand the external validity of experimental studies, it is important to estimate the extent to which the participants are representative of the general population. This paper describes recruitment methods and considers the representativeness of participants in the San Diego Family Health Project. The study was designed to experimentally evaluate the effectiveness of a family-based behavior change intervention in Anglo and Mexican-American families. Initial contact with the families was made through a household health survey that was sent home with all fifth- and sixth-grade children in 12 participating elementary schools. The survey asked about a variety of demographic characteristics, dietary habits, and physical activity habits. Parents were also asked if they were interested in participating in the project. Respondents were classified by level of participation into one of three groups: not interested, expressed initial interest but did not attend the recruitment meeting, and volunteered to participate. Level of participation was the independent variable in the analyses. In separate analyses for Anglo and Mexican-American responders, our data suggested many similarities and a few differences among participant groups. The differences that were observed suggest that participants may already have healthier diets than nonparticipants, although only one of four dietary variables differed by participation status in each ethnic group. The external validity of these data and general recruitment issues are discussed.