See Preventing Chronic Disease supplemental issue

See Border Health Strategic Initiative

Rural Health Outreach Grants
The CRCPHP has a long history of partnering with various community-based organizations in Southern Arizona to improve health and well-being through interventions focusing on chronic disease prevention and control. Using a participatory model of evaluation, the CRCPHP has collaborated in the development and evaluation of programs addressing diabetes, obesity, coronary heart disease, and partner violence.  The Rural Health Outreach Grants provide an example of this model, in which the CRCPHP served as a sub-contractor with recipients of Rural Health Outreach Grants in Yuma, Ajo, Santa Cruz, Cochise, and Graham/Greenlee Counties. These grants created community consortiums, which provided diabetes outreach and self-management classes tailored to the needs of the specific community.  The community health worker (CHW) model was utilized in four of the five grants.  Evaluation was both qualitative and quantitative and included self-reported measures as well as biological markers such as HbA1c. These measures were created in collaboration with the partnering organizations and were utilized by the groups in both program development and sustainability.

Network Analysis
Network analysis is a method for examining the relationships between individuals, groups, or organizations. It involves collecting information from network members, and those who perhaps should be part of the network, on the relationships each maintains with other members of the network. Once this information is collected, it is analyzed using one or more computer programs, such as UCINET. Network analysis procedures provide a method for examining the extent to which collaboration is actually occurring, who is collaborating with whom, in what ways, and how these relationships are evolving over time. The results can be reported back to network members, providing relationship scores for individual members and for the network as a whole. Results can also be displayed graphically, providing an instant picture of what the network looks like. Building collaborative partnerships has become increasingly recognized in public health as an important way for community-based organizations with limited resources to identify critical health needs, to provide and coordinate needed services, and in general, to enhance the overall capacity of a community to address its most pressing health and human service needs. Yet most communities have only a general and often vague understanding of whether or not their network-building efforts are actually resulting in stronger collaboration. Network analysis provides a powerful tool for community leaders to assess their network/partnership-building efforts in a systematic way that can be readily understood by both policy officials and health practitioners.

School Health Index (SHI)
The SHI has been implemented in a tribal school and in 13 Arizona elementary schools, two middle schools and one high school located in Arizona border communities as part of the Border Health Strategic Initiative (BHSI), a USMBHC-ADHS initiative, and the CRCPHP. Individual school action plans varied but most shared one component, to reduce in-school access to "unhealthy foods." Other plans included health curricula and physical education. Three of the five schools completing the SHI implemented an immediate policy change that prohibited unhealthy snacks/candy to be given as rewards or incentives. The following is a partial list of changes that have occurred in the schools:

• Walking clubs have been organized during non-class time;
• The student council is no longer selling unhealthy snacks after school; and
• Bake sales offer nutritious food options (e.g. fruit salad rather than peanut butter cookies).

Feedback from the evaluation indicated that the SHI process builds awareness on the level of school commitment to health. The major barrier found was time, both for individual teachers who needed their time for planning, and also for scheduling groups together to complete a module. Modifications that strengthen the SHI include an external coordinator, especially in schools with limited resources, and school incentives that encourage participation in the SHI. The SHI is a valuable tool for assisting elementary schools to make immediate policy changes resulting in a healthier environment for children. This is important along the Arizona border, where rates of type 2 diabetes are on the rise among children and adolescents and childhood obesity is a major concern. Primary prevention in the schools through healthier nutritional and physical activity policies can decrease the chances of high-risk Hispanic children being diagnosed with diabetes and encourage healthier lifestyle habits. Currently, the Douglas SAG has chosen unhealthy foods in schools as one of its priority policy topics and is working with its schools to implement such policies. The SHI is currently being implemented in Cochise, Santa Cruz, and Yuma counties as part of the Steps to a HealthierUS Initiative.

See publications and presentations by Staten, Lebowitz and Teufel-Shone, listed here.

See CDC School Health Index

Legacy Foundation: Best Practices in Tobacco Control
This is a qualitative study of the administration and implementation of tobacco control programs designed specifically for Hispanic and Native American populations in four states, California, Arizona, New Mexico and Texas. Primary research activities include in-depth interviews with personnel at the state and community levels to assess programs' familiarity and use of CDC's Best Practices Guidelines for Tobacco Control and to document perceived strengths and weaknesses in program administration and implementation at the state and community level.

Building the Hualapai Indian Community's Capacity to Address Youth Wellness
A community based participatory research project designed to address obesity and chronic disease risk factors in elementary school children within the Hualapai Nation. A diverse community wellness team or task force representing the school, tribal administration, the court system, tribal enterprises and the health department, advise and consult with community lay health educators who worked with the school to implement the School Health Index, designed and implemented a formative assessment of local barriers to youth wellness, and designed and are implementing a school-based and family outreach physical activity intervention.

Steps to a HealthierUS Initiative (Arizona)
This is a HHIS/CDC initiative. In 1998, the CRCPHP began working with community partners in four border communities, Yuma, Santa Cruz, and Cochise Counties and the Tohono O’odham Nation to develop and evaluate Border Health ¡SI¡, a comprehensive model to address diabetes prevention and control.  Border Health ¡SI¡ laid the groundwork for the Steps to a Healthier Arizona Initiative, funded by the CDC to the Arizona Department of Health Services (ADHS), which aims to help Americans live longer, better, and healthier lives by reducing the burden of diabetes, overweight, obesity and asthma.  As part of Steps, CRCPHP faculty and staff continue to work collaboratively with community partners in program development and evaluation.  The CRCPHP engages in a participatory model of evaluation in which all partners engage in the process of identifying program outcomes and measures, evaluation instruments, and data collection.  The CRCPHP works closely with Steps partners in the field and provides evaluation results on a regular basis to ensure that findings are integrated into program strategies.  The CRCPHP also collaborates with ADHS to address national evaluation and provides technical assistance to community partners.

See Arizona Department of Health Services Steps to a Healthier Arizona Initiative

Arizona Department of Health Services (ADHS) Nutrition and Physical Activity (NUPA) State Plan
The ADHS NUPA evaluation project is a collaboration between the CRCPHP and ADHS to evaluate and assess the impact of the Nutrition and Physical Activity State Plan released in 2005. The project entails researching and forming an appendix of references from multiple other state nutrition and physical activity plans that would be used to revise the Arizona state plan.

In addition, an online survey aimed at key stakeholders will be circulated to determine useability and relevance of the State Plan. The data collected will then be used to update, improve, and revise the state plan. Key stakeholders are also being asked for a summary of programs targeting physical activity and nutrition to be included in a state level database.