BACKGROUND:In 2003, the Monterey County Health Department, serving Salinas, California, was awarded one of 12 grants from the Steps to a HealthierUS Program to implement a 5-year, multiple-intervention community approach to reduce diabetes, asthma, and obesity. National adult and youth surveys to assess long-term outcomes are required by all Steps sites; however, site-specific surveys to assess intermediate outcomes are not required.CONTEXT:Salinas is a medically underserved community of primarily Mexican American residents with high obesity rates and other poor health outcomes. The health department's Steps program has partnered with traditional organizations such as schools, senior centers, clinics, and faith-based organizations as well as novel organizations such as employers of agricultural workers and owners of taquerias.METHODS:The health department and the Stanford Prevention Research Center developed new site-specific, community-focused partner surveys to assess intermediate outcomes to augment the nationally mandated surveys. These site-specific surveys will evaluate changes in organizational practices, policies, or both following the socioecological model, specifically the Spectrum of Prevention.CONSEQUENCES:Our site-specific partner surveys helped to 1) identify promising new partners, select initial partners from neighborhoods with the greatest financial need, and identify potentially successful community approaches; and 2) provide data for evaluating intermediate outcomes matched to national long-term outcomes so that policy and organizational level changes could be assessed. These quantitative surveys also provide important context-specific qualitative data, identifying opportunities for strengthening community partnerships.INTERPRETATION:Developing site-specific partner surveys in multisite intervention studies can provide important data to guide local program efforts and assess progress toward intermediate outcomes matched to long-term outcomes from nationally mandated surveys.

Background. U.S. Latino adults have experienced an 80% increase in obesity in the last decade.Methods, A cross-sectional survey of 18-64-year-old Latino women (N = 380) and men (N = 335) from a community sample, and men (N 186) from an agricultural labor camp sample in Monterey County, California, provided data on correlates of obesity.Results. In the community and labor camp samples, prevalences of chronic disease risk factors (high blood pressure and cholesterol, diabetes) were 1.5-7 times higher in the heaviest compared with the leanest weight groups. Higher acculturation (generational status, years lived in the United States) was the strongest correlate of obesity (measured by BMI) in the community sample (P = 0.001), followed by less exercise and poorer diet (P values < 0.05). Women who exercised < 2.5 h/week, watched TV regularly, ate chips/fried snacks, and ate no fruit the previous day were 45 lbs heavier than women with healthier habits, Men who did not exercise, rarely trimmed tat from meat, and ate fried foods the previous day were 16 lbs heavier than men with healthier habits. Discussions with health care providers about diet/exercise were associated with more accurate weight perception and more weight loss attempts in obese participants in both samples.Conclusions. The associations of acculturation, exercise, and diet to BMI implicate societal as well as individual contributors to obesity among U.S. Latinos. (c) 2004 Elsevier Inc. All rights reserved.

Objective. This study examines changes in cancer-related health behaviors and risk factors (overweight/obesity, unhealthy diet, high alcohol use, and smoking), and screening practices related to cervical, breast, and colorectal cancer among Latinos of predominantly Mexican origin in Monterey County, California.Design. Data is from two cross-sectional surveys, conducted in 1990 and 2000, that I included 919 women and 774 men from a community sample, and 276 men from an agricultural labor camp sample (ages 18-64).Results. Over the 10-year period, the prevalence of obesity increased by 48% among community women, 47% among community men, and 91 % among labor camp men. Although consumption of fruits and vegetables remained low and consumption of fried foods remained high, other diet-related behaviors showed significant improvements (e.g. milk consumption shifted from whole-fat to lower-fat among women from the community and men from the labor camps, use of lard or meat fat when cooking decreased among women and men from the community). In addition, alcohol intake decreased among men from both samples, as did smoking among labor camp men. There were large improvements for annual pap and mammography screening (increases from 53 to 71 % for pap testing, and from 15 to 53% for mammography screening) but annual blood stool testing remained infrequent and unchanged.Conclusion. These findings highlight the need for interventions and policies that improve knowledge, preventive care, and social environments to sustain improvements and address areas of special need in cancer prevention for Latinos, especially related to obesity and colorectal screening.

OBJECTIVE:To examine whether cancer-related health behaviors and screening practices differ within a population of Latino adults, including those often missed by cancer surveys.DESIGN:Cross-sectional survey, conducted in 2000. Sample of 461 women and 356 men from the community (75% with unlisted telephones) and 188 men from agricultural labor camps, 18-64 years of age.SETTING:Monterey County, California.OUTCOMES:Six health behaviors and risk factors: obesity, poor nutrition, physical inactivity, high alcohol use, and smoking. Five health practices and screening tests used to detect cervical, breast, and colorectal cancer.RESULTS:Most respondents were born in Mexico, spoke Spanish, and had lived in the United States 10 years or more. In both surveys, more than 60% were overweight including more than 20% who were obese. Men, especially from labor camps, reported high dietary fat intake, low fruit intake, and high alcohol use. For every additional 5 years lived in the United States, the odds of obesity increased 25% for women, and the odds of high-fat/fast food intake and high alcohol use increased 35% and 50%, respectively for labor camp men. Screening rates for cervical and breast cancer were high and met Healthy People 2000 objectives. In contrast, screening rates for colorectal cancer were low; among those 50 and older, approximately 70%-80% of women and men from the community sample and 100% of men from the labor camp sample had never had a blood stool test. Unmarried women, in particular, had poor nutrition and low screening rates.CONCLUSIONS:Cancer control programs for Latinos need a particular focus on weight, nutrition, physical activity, alcohol, and colorectal screening.