Dietary and Physical Activity Behavioral Intervention

Vivamos Activos

Public Health Problem: Obesity in Starr County

Intervention: Vivamos Activos Theory Project Management Budget Evaluation Sustainability Limitations, Challenges, Policy Implications

What’s Next?

TODAY’S AGENDA

In the United States, 33.8% adults (CDC, 2011)

In Texas, 66.8% of adults are either obese or overweight (DSHS, 2010)

In Starr County, 27.1% of adults are obese (Find

Data, 2012) 95.7% of residents are Hispanic 25% of the population has health

insurance (Census, 201

PREVALENCE OF OBESITY

Obesity related health concerns: Diabetes Heart disease Sleep apnea Hypertension Lower quality of life (Edward, 2010)

Built EnvironmentSleepCulture:

Hispanic population Familismo

HEALTH CONCERNS AND FACTORS THAT EFFECT

OBESITY

Implementers: Health Department in Rio

Grande City

Addresses the individual and environmental

influences of obesity in Starr County, TX

INTERVENTION: VIVAMOS ACTIVOS

Individual Influences:• Gender• Ethnicity

• Socioeconomic status

• Sleeping habits• Biological toxins

Environmental Influences:

•Community promotion of food intake

• Availability of healthy food

• Access to physical activity

• Socioeconomic status of Starr County• Family Unit

THEORY

Behavioral counseling intervention Emphasizes healthy eating and exercise Teaches to manage emotional distress Progresses participants into action/maintenance Stage of Change (Johnson et al, 2008)

Targets Hispanic women Culturally appropriate Capitalizes on a woman’s influence on the

household Disseminates information to family unit

(Galanti, 2003)

WHAT IS VIVAMOS ACTIVOS?

Counseling:Four individual/family counseling sessionsNine group sessions

Goals:1. Decrease BMI

a. Increase physical activityb. Increase healthy eating

VIVAMOS ACTIVOS CONT.

VIVAMOS ACTIVOS: SCHEDULE

Month 1-6 Month 7-12 Month 12-17Group Session 1

Group Session 2Group Session 3Group Session 4Group Session 5Group Session 6Group Session 7Group Session 8Group Session 9

Group Session 10Group Session 11Group Session 12

Group Session 13Group Session 14Group Session 15

Individual Session 1Individual Session 2

Individual Session 3

Individual Session 4

PROJECT MANAGEMENT: STAFF

Project Director

Nursing Staff Counselor

Community Health Worker

Community Health Worker

Counselor

Community Health Worker

Comunity Health Worker

STUDY TIMELINE

Quasi Experimental study specifically a Non-Equivalent Groups Design with aspects of a Time-Series Design

3 ½ Year Timeline

2 Groups Intervention: Roma Family Clinic

Receives Vivamos Activos intervention Control: Nuestra Clinica del Valle

Receives health education and nutrition advise from dieticians at Federally Qualified Health Center

STUDY DESIGN

Study Population: 630 Hispanic Women Ages 18+ BMI > 25

Recruitment: Where:

Two Federally Qualified Health Clinics Nuestra Clinica del Valle in Rio Grande City, TX Roma Family Clinic in Roma, TX

How: Nurses will identify women patients with a BMI >25

and refer them to Vivamos Activos Community Health Workers

STUDY POPULATION & RECRUITMENT

INTERVENTION BUDGET

Total amount: $300,000

2 year timeframe

Major costs: Personnel Operating Expenses Contractual Travel Program Costs Personnel

83%

Operating Costs2%

Contractual1%

Program Costs11%

Travel3%

Primary question: Is there a reduction in obesity among program

participants, who completed Vivamos Activos?Secondary questions:

Do participants eat healthier?Did program participants increase their physical activity?

Sample size calculation ~ 320 people in both the intervention and control groups After attrition, a sample size of ~160 people in

both the intervention and control groups

EVALUATION METHODOLOGY

Qualitative Collected through means of survey questionnaires Questions include topics related to:

Demographic history Employment/Income Physical activity Nutrition assessment Smoking habits Alcohol consumption Medication usage

EVALUATION: PREDICTOR VARIABLES

Quantitative

Collected initially by Vivamos Activos staff

Measurements:

Body Mass Index (BMI)

Waist-to-Height Ratio (WHtR)

Outcome Variables

Plausibility

Benefits

Limitations

EVALUATION: OUTCOME

VARIABLES

Parametric Tests

Two sample t-test

Linear regression

Adjustments

Stratification

EVALUATION: STATISTICAL ANALYSIS

Total amount: ???

1 ½ year timeframe

Major Costs: Personnel Operating Expenses Travel Program Costs

EVALUATION BUDGET

Personnel94%

Operating Costs4%

Program Costs2%

FQHCs are funded by Medicare to provide: Medical Social Services such as cultural implications, health

education, and counseling Weight Measurements Risk Assessment and Counseling

Vivamos Activos can be implemented and funded by the services already provided Their services will require change to fit Vivamos Activos

guidelines

Starr County can have a permanent intervention in place to mitigate the prevalence of obesity.

SUSTAINABILITY

Study Design Lack of randomization Sampling bias Residual confounding Threat to internal validity Retention of participants Generalizability

Coordination of effective communication among stakeholders

Level of competency of staff Community health workers have limited training delivering

counseling & lack technical abilities to address determinants

Diffi culty engaging participant’s family members in counseling sessions

LIMITATIONS

If successful, we recommend that Vivamos Activos become a policy change, to be implemented by

Federally Qualified Health Clinics who serve primarily a Hispanic population.

WHAT’S NEXT?

QUESTIONS?

U . S . C e n s u s B u r e a u . ( 2 0 1 2 ) A m e r i c a n Fa c t Fi n d e r 2 0 1 0 D e m o g r p a h i c P r o fi l e D a t a . h t t p : / / f a c t fi n d e r 2 . c e n s u s . g o v / f a c e s / t a b l e s e r v i c e s / j s f / p a g e s / p ro d u c t v i e w. x h t m l ? p i d = D E C _ 1 0 _ D P _ D P D P 1 & p ro d Ty p e = t a b l e

  Fi n d T h e D a t a . ( 2 0 1 2 ) S t a r r C o u n t y , Tex a s O b e s i t y R a t e s a n d Fa s t Fo o d C o n s u m p t i o n .

h t t p : / / c o u n t y - f o o d . fi n d t h e d a t a . o rg / l / 2 7 3 4 / S t a r r D S H S . ( 2 0 1 0 ) Tex a s O v e r w e i g h t a n d O b e s i t y S t a t i s t i c s . O b e s i t y D a t a S h e e t . Tex a s D e p a r t m e n t o f

S t a t e H e a l t h S e r v i c e s . C D C . ( 2 0 1 1 ) O v e r w e i g h t a n d O b e s i t y. U . S . O b e s i t y Tr e n d s .

h t t p : / / w w w. c d c . g o v / o b e s i t y / d a t a / t r e n d s . H T M L S l a t e r r y , M . L . , S w e e n e y , C . , E d w a rd s , S . , H e r r i c k , J . , M u r t a u g h , M . , B a u m g a r t n e r , K . , . . B y e r s , T. ( 2 0 0 6 ) .

P h y s i c a l Ac t i v i t y Pa t t e r n s a n d O b e s i t y i n H i s p a n i c a n d n o n - H i s p a n i c W h i t e Wo m e n . M e d i c i n e a n d S c i e n c e i n S p o r t s a n d E xe r c i s e , 3 3 - 4 1 .

  Tr u s t f o r A m e r i c a ’ s H e a l t h ( 2 0 1 1 ) . F a s i n f a t : h o w o b e s i t y t h r e a t e n s A m e r i c a ’ s f u t u r e 2 0 1 1 .

h t t p : / / h e a l t h y a m e r i c a n s . o r g / a s s e t s / fi l e s / T FA H 2 0 1 1 Fa s I n Fa t 1 0 . p d f   Tex a s D e p a r t m e n t o f S t a t e H e a l t h S e r v i c e s ( 2 0 0 5 ) . E a t s m a r t , b e a c t i v e . S t r a t e g i c p l a n f o r t h e i n t e r v e n t i o n

o f o b e s i t y i n Te x a s 2 0 0 5 - 2 0 1 0 . w w w. g o o g l e . c o m / u r l ? s a = t & rc t = j & q = & e s r c = s & s o u r c e = w e b & c d = 1 & v e d = 0 C . . .

  Ka h n , Ka t e r i n e A . ( 2 0 0 8 ) A m e r i c a n Ac a d e m y o f Pe d i a t r i c s 2 0 0 8 N a t i o n a l C o n f e r e n c e a n d E x h i b i t i o n . S c h o o l -

B a s e d P h y s i c a l A c t i v i t y I n t e r v e n t i o n s I n e ff e c t i v e f o r C h i l d h o o d O b e s i t y. P re s e n t e d O c t o b e r 1 2 , 2 0 0 8 .   Lo p e z & H y n e s . ( 2 0 0 6 ) B i o M e d C e n t r a l L t d . O b e s i t y, P h y s i c a l A c t i v i t y, a n d t h e U r b a n E n v i r o n m e n t : P u b l i c

h e a l t h R e s e a r c h N e e d s . h t t p : / / w w w. e h j o u r n a l . n e t / c o n t e n t / 5 / 1 / 2 5   M c A l l i s t e r , E . J . , D h u r a n d h a r , N . V. , Ke i t h , S . W. , A r o n n e , L . J . , B a rg e r , J . , B a s k i n , M . , . . . A l l i s o n , D . B .

( 2 0 0 9 ) . Te n p u t a t i v e c o n t r i b u t o r s t o t h e o b e s i t y e p i d e m i c . C r i t i c a l R e v i e w s i n F o o d S c i e n c e a n d N u t r i t i o n , 4 9 , 8 6 8 - 9 1 3 . d o i : 1 0 . 1 0 8 0 / 1 0 4 0 8 3 9 0 9 0 3 3 7 2 5 9 9

G a l a n t i , G . ( 2 0 0 3 ) . T h e H i s p a n i c f a m i l y a n d m a l e - f e m a l e r e l a t i o n s h i p s : A n o v e r v i e w. J o u r n a l o f Tr a n s c u l t u r a l N u r s i n g , 1 4 ( 3 ) , 1 8 0 - 1 8 5 . d o i : 1 0 . 1 1 7 7 / 1 0 4 3 6 5 9 6 0 3 0 1 4 0 0 3 0 0 4

SOURCES