Current Centers for Population Health and Health Disparities
University of California, Los Angeles
Family and Neighborhood Interventions To Reduce Heart Disease Risk in East L.A.
Alex Ortega, PhD
UCLA School of Public Health
Department of Health Services
Los Angeles, CA 90095-1772
Alexander N. Ortega, PhD Contact Principal Investigator
Abstract: The University of California, Los Angeles-University of Southern California (UCLA-USC) Center for Population Health and Health Disparities (CPHHD) will focus on reducing cardiovascular disease (CVD) risk among Latinos in East Los Angeles, California (East L.A.). East L.A. is an urban community with high rates of obesity-related chronic diseases, including heart disease, diabetes, hypertension and stroke. East L.A. is over 96 percent Latino; 85 percent have Mexican ancestry, with the rest originating from Central America. Our primary objective is to reduce CVD risk in this underserved area. To accomplish this objective, we have three integrated, complementary projects, two cores, and a Training and Career Development Program. We will use a community-based participatory approach to implement family and neighborhood environment interventions, along with the collection of physiological data that will examine risk in individuals and across generations. The intervention components include several dimensions that affect health outcomes-personal and family factors, systems factors, and environmental factors. Project 1 is an intensive home environment intervention involving families, of which one member is a high-risk case newly enrolled in a local diabetes care clinic. Project 2 will examine vascular function and CVD risk biomarkers for individuals varying in generational and immigrant status to better understand the Latino acculturation paradox in CVD risk. Project 3 will conduct makeovers of corner stores to enable them to market and provide healthier food options, as well as serve as a venue for training community members about healthier food options and meal-preparation strategies. The Center will also capitalize on the inclusion of both promotoras and public health rookies in intervention activities. The public health rookies will be adolescents recruited from a public high school in the community. The two cores provide administrative and research methods resources to the projects; the Training and Career Development Program will provide resources and infrastructure for the public health rookies and will train and mentor graduate students, postdoctoral fellows, and faculty on interdisciplinary disparities-reduction research.
- Provide an interdisciplinary, multilayered approach to reduce CVD risk in East L.A;
- Build on collective expertise and experiences to create innovative, interdisciplinary community and environmentally focused interventions and research questions regarding Latino CVD disparities;
- Organize Center projects that complement and interact with each other to provide a supportive and productive research environment;
- Implement interventions that have environmental prongs and potential sustainability;
- Build long-term capacity and contribute to local and national efforts to reduce and eliminate CVD disparities in high-risk Latino families.
Project 1 will evaluate the impact on vascular function of a program designed to get predominantly Mexican American families at high risk for metabolic syndrome to make their home environments more supportive of healthful lifestyle practices and to take advantage of community assets, such as health-minded corner stores, to sustain healthy eating and physical activity levels.
- Augment existing Latino-tailored lifestyle change protocols with intervention strategies designed to improve the supportiveness of the home environment for sustaining healthier lifestyle choices;
- Recruit, enroll, and randomize 240 study participants to either the Family Environment Cardiovascular Disease Risk Reduction (FECVDRR) program or to the Family Cancer Early Detection attention-control condition;
- After mapping community assets for promoting healthier food choices and increased physical activity, use group health education to highlight how FECVDRR participants can sustain healthier choices by taking advantage of community assets, including health-promoting corner stores;
- Collect baseline, 6-month, 12-month and 24-month data on arterial stiffness (pulse waveform velocity; augmentation index) as the primary outcome measures as well as individual-level data on diet, physical activity, aerobic fitness, television viewing, and community-level data on neighborhood walkability and density of fast food restaurants within a 1-mile buffer of family's census tract;
- Test primary hypothesis that FECVDRR program will reduce arterial stiffness in the designated family member without diabetes more than the attention-control condition will;
- Test a variety of secondary hypotheses related to the hypothesis that the FECVDRR program will reduce risk of metabolic syndrome, an important precursor to CVD, in the designated family member without diabetes;
- Test the hypothesis that the family member enrolled in the diabetes management program whose family members have been participating in the FECVDRR program will report lower long-term glucose levels (HbA1c) than is the case in the attention-control condition;
- Evaluate the modifying effect of community assets (e.g., walkability) on sustaining intervention impact;
- Work collaboratively with CPHHD Project 3 investigators to evaluate potential interaction between FECVDRR intervention and corner-marker-conversion intervention.
Project 2 will evaluate cardiovascular health in Latinos using non-invasive, yet sensitive methodologies, with the goal of increasing knowledge about major social influences on a variety of Latino cardiovascular health measures, and improving understanding of the Latino acculturation paradox.
- Evaluate cardiovascular phenotypes, including arterial stiffness, endothelial function, cardiovascular risk factors, and metabolic syndrome in Latino families living in East L.A.;
- Evaluate the extent to which the Latino paradox holds within these families, based on their generational and immigrant status and level of acculturation.
Project 3 will convert four corner stores in East L.A. to serve as study stores, and make them community assets where people can buy healthy food and learn about healthy food consumption and preparation.
- Identify the factors necessary to persuade and enable corner store owners to convert their stores into community sources of healthy, fresh, and affordable foods;
- Determine best practices for marketing and promotion of healthy food options in resource-poor communities, working with corner stores, youth, and other community partners;
- Describe the factors that are related to maintaining and sustaining corner store conversions in resource-poor Latino communities;
- Assess the impact of corner market store conversions on community-level food and nutrition knowledge, attitudes toward healthy eating, and self-efficacy for food purchasing, preparing, and consuming, as well as food behaviors.