Scott C Carvajal
- Professor, Public Health
- Interim Department Chair, Health Promotion Sciences
- MPH Health Promotion/Health Education
- University of Texas School of Public Health, Houston, Texas
- Ph.D. Social Psychology
- University of Houston, Houston, Texas
- M.A. Psychology
- University of Houston, Houston, Texas
- B.A. Psychology
- University of Texas at Austin, Austin, Texas
- Mel and Enid Zuckerman College of Public Health, University of Arizona (2014 - Ongoing)
- Mel and Enid Zuckerman College of Public Health, University of Arizona (2010 - 2014)
- Mexican American Studies and Research Center, University of Arizona (2006 - 2009)
- Mexican American Studies and Research Center, University of Arizona (2002 - 2006)
- Mexican American Studies and Research Center, University of Arizona (2000 - 2002)
- Education, Research, Training (ETR) Associates (1998 - 2001)
- Center for Health Promotion Research and Development, The University of Texas School of Public Health-Houston (1996 - 1997)
- American Academy of Health Behavior, Fall 2019
- Senator Andy Nichols Award (To the AzPRC)
- Arizona-Mexico Commission and Governors Doug Ducey (Arizona) and Claudia Artemiza Pavlovich Arellano (Sonora, Mexico)., Summer 2018
- Invited Senior Faculty, NIMHD Health Disparities Research Institute
- National Institute of Minority Health and Health Disparities, National Institutes of Health, Summer 2016
- Awardee (Spring 20014), 2013 Excellence in Research Award.
- Mel and Enid Zuckerman College of Public Health, Summer 2014
- Nominee (Spring 2013) of the Division of Health Promotion Sciences for the Excellence in Research Award
- Mel and Enid Zuckerman College of Public Health, Spring 2013
- Community Based Participatory Research Best Practices Award
- Centers for Disease Control and Preventions National Community Committee., Spring 2011
- Comprehensive Member (portfolio evaluation required), Cancer Prevention and Control Division
- Arizona Cancer Center, Spring 2011
- Full Member (evaluation of contributions to the field required)
- American Academcy of Health Behavior, Spring 2011
- Nominated and Elected as an at-Large Faculty Senate Representative
- University of Arizona Faculty, Spring 2011
Licensure & Certification
- Certified Health Education Specialist (2000-2005) (2000)
No activities entered.
DissertationHPS 920 (Spring 2021)
Master's ReportHPS 909 (Spring 2021)
DissertationHPS 920 (Fall 2020)
Evaluat Public Hlth LiteratureEHS 609 (Fall 2020)
Evaluat Public Hlth LiteratureEPID 609 (Fall 2020)
Evaluat Public Hlth LiteratureHPS 609 (Fall 2020)
Master's ReportHPS 909 (Fall 2020)
Master's ReportHPS 909 (Summer I 2020)
DissertationHPS 920 (Spring 2020)
DissertationHPS 920 (Fall 2019)
Evaluat Public Hlth LiteratureHPS 609 (Fall 2019)
Independent StudyHPS 599 (Fall 2019)
Independent StudyHPS 699 (Fall 2019)
ThesisHPS 910 (Fall 2019)
DissertationHPS 920 (Summer I 2019)
Adv Res Method HPS IIHPS 620B (Spring 2019)
DissertationHPS 920 (Spring 2019)
Adv. Research Methods in HPS IHPS 620A (Fall 2018)
DissertationHPS 920 (Fall 2018)
DissertationHPS 920 (Spring 2018)
Independent StudyHPS 499 (Spring 2018)
Master's ReportHPS 909 (Spring 2018)
ResearchHPS 900 (Spring 2018)
ThesisHPS 910 (Spring 2018)
DissertationHPS 920 (Fall 2017)
Evaluat Public Hlth LiteratureHPS 609 (Fall 2017)
Independent StudyHPS 699 (Fall 2017)
Hlth Disparities & Minor HlthCPH 387 (Spring 2017)
Master's ReportCPH 909 (Spring 2017)
DissertationCPH 920 (Fall 2016)
Independent StudyCPH 699 (Fall 2016)
Master's ReportCPH 909 (Fall 2016)
Tops:Hlth Behavior & PromotionCPH 619 (Fall 2016)
DissertationCPH 920 (Spring 2016)
Hlth Disparities & Minor HlthCPH 387 (Spring 2016)
Master's ReportCPH 909 (Spring 2016)
- Coulter, K., Ingram, M., Lohr, A. M., Bell, M. L., & Carvajal, S. (2020). Examining Associations between Community Health Worker-Rated Health and Mental Health among Latino Adults with Chronic Disease. International journal of environmental research and public health, 18(1).More infoLatinos with chronic disease often experience comorbid depression, but confront barriers to mental health treatment. Community health workers (CHWs) develop trusting relationships with the communities they serve, and may be uniquely positioned to identify Latinos with mental health care needs. Research has not examined whether their rating of clients' health is indicative of their mental health. This mixed-methods study examines CHWs' appraisals of Latino adults' health and their relation to mental health outcomes, and explores factors informing CHWs' rating of health status. The current study utilized baseline data from the Linking Individual Needs to Community and Clinical Services (LINKS) study. We assessed associations between CHW-rated health (CHWRH), or rating of health status as poor-excellent, and mental health outcomes with multilevel linear regression modelling. We qualitatively analyzed CHWs' written perceptions of participants' health status to understand what influenced their health rating. The quantitative results showed that CWHRH was significantly related to depressive symptoms and emotional problems severity. The qualitative results showed that CHWs took a holistic and ecological approach in rating health. The findings suggest that CHWRH could be indicative of mental health among Latino adults. Further studies investigating CHWRH as an independent indicator of mental health are warranted.
- Lott, B. E., Trejo, M. J., Baum, C., McClelland, D. J., Adsul, P., Madhivanan, P., Carvajal, S., Ernst, K., & Ehiri, J. (2020). Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model. BMC public health, 20(1), 654.More infoSub-Saharan Africa (SSA) experiences disproportionate burden of cervical cancer incidence and mortality due in part to low uptake of cervical screening, a strategy for prevention and down-staging of cervical cancer. This scoping review identifies studies of interventions to increase uptake of cervical screening among women in the region and uses the Integrated Behavioral Model (IBM) to describe how interventions might work.
- Lutrick, K., Clark, R., Nuño, V. L., Bauman, S., & Carvajal, S. (2020). Latinx bullying and depression in children and youth: a systematic review. Systematic reviews, 9(1), 126.More infoBullying is associated with negative health outcomes such as depression. Most studies target non-Latinxs, though they often experience higher rates of bullying and depression. This review examines the inclusion of Latinxs in studies of bullying and depression and factors unique to them.
- Peterson, R. L., Butler, E. A., Ehiri, J. E., Fain, M. J., & Carvajal, S. C. (2020). Mechanisms of Racial Disparities in Cognitive Aging: An Examination of Material and Psychosocial Wellbeing. The journals of gerontology. Series B, Psychological sciences and social sciences.More infoWe tested the hypothesis that education's effect on cognitive aging operates in part through measures of material and psychosocial wellbeing.
- Valdez, E. S., Skobic, I., Valdez, L., O Garcia, D., Korchmaros, J., Stevens, S., Sabo, S., & Carvajal, S. (2020). Youth Participatory Action Research for Youth Substance Use Prevention: A Systematic Review. Subst Use Misuse. 2020;55(2):314-328.More infoA growing body of research points to the efficacy of participatory methods in decreasing rates of alcohol, tobacco, and other drug use and other risky behaviors among youth. However, to date, no systematic review of the literature has been conducted on Youth Participatory Action Research (YPAR) for youth substance use prevention. This review draws on the peer-reviewed literature on YPAR in the context of youth substance use prevention published from January 1, 1998 through April 30, 2018. We summarize (1) the published evidence regarding YPAR for youth substance use prevention; (2) the level of youth engagement in the research process; (3) the methodologies used in YPAR studies for youth substance use prevention; and (4) where more research is needed. We used Reliability-Tested Guidelines for Assessing Participatory Research Projects to assess the level of youth engagement in the research process. In all, we identified 15 unduplicated peer-reviewed, English-language articles that referenced YPAR, Community Based Participatory Research, youth, and substance use prevention. Our findings indicated that youth participation in research and social action resulted in increased community awareness of substance use and related solutions. This supports the premise of youth participation as an agent of community change by producing community-specific substance use data and prevention materials. Identified weaknesses include inconsistent levels of youth engagement throughout the research process, a lack of formalized agreements between youth and researchers with regard to project and data management, and a lack of outcome evaluation measures for assessing YPAR for youth substance use prevention.
- Valdez, E. S., Valdez, L., Korchmaros, J., Garcia, D. O., Stevens, S., Sabo, S., & Carvajal, S. (2021). Socioenvironmental Risk Factors for Adolescent Marijuana Use in a United States-Mexico Border Community. American journal of health promotion : AJHP, 35(1), 20-27.More infoWe examined how socioenvironmental risk factors unique to the United States-Mexico border, defined as border community and immigration stress, normalization of drug trafficking, and perceived disordered neighborhood stress, contribute to tobacco, alcohol, and marijuana use among adolescents residing there.
- Gerald, J. K., Fisher, J. M., Brown, M. A., Clemens, C. J., Moore, M. A., Carvajal, S. C., Bryson, D., Stefan, N., Billheimer, D., & Gerald, L. B. (2019). School-supervised use of a once-daily inhaled corticosteroid regimen: A cluster randomized trial. The Journal of allergy and clinical immunology, 143, 755-764.More infoSchool-supervised use of a once-daily inhaled corticosteroid regimen (supervised therapy) can improve medication adherence and asthma control.
- Lohr, A. M., Ingram, M., Carvajal, S. C., Doubleday, K., Aceves, B., Espinoza, C., Redondo, F., Coronado, G., David, C., & Bell, M. L. (2019). Protocol for LINKS (linking individual needs to community and clinical services): a prospective matched observational study of a community health worker community clinical linkage intervention on the U.S.-Mexico border. BMC public health, 19(1), 399.More infoLatinos are currently the largest and fastest growing racial/ethnic group in the United States and have the lowest rates nationally of regular sources of primary care. The changing demographics of Latino populations have significant implications for the future health of the nation, particularly with respect to chronic disease. Community-based agencies and clinics alike have a long history of engaging community health workers (CHWs) to provide a broad range of tangible and emotional support strategies for Latinos with chronic diseases. In this paper, we present the protocol for a community intervention designed to evaluate the impact of CHWs in a Community-Clinical Linkage model to address chronic disease through innovative utilization of electronic health records (EHRs) and application of mixed methodologies. Linking Individual Needs to Community and Clinical Services (LINKS) is a 3-year, prospective matched observational study designed to examine the feasibility and impact of CHW-led Community-Clinical Linkages in reducing chronic disease risk and promoting emotional well-being among Latinos living in three U.S.-Mexico border communities.
- Marrone, N., Ingram, M., Bischoff, K., Burgen, E., Carvajal, S. C., & Bell, M. L. (2019). Self-reported hearing difficulty and its association with general, cognitive, and psychosocial health in the state of Arizona, 2015. BMC public health, 19(1), 875.More infoHearing loss is among the leading causes of disability in persons 65 years and older worldwide and is known to have an impact on quality of life as well as social, cognitive, and physical functioning. Our objective was to assess statewide prevalence of self-reported hearing ability in Arizona adults and its association with general health, cognitive decline, diabetes and poor psychosocial health.
- Peterson, R. L., Carvajal, S. C., McGuire, L. C., Fain, M. J., & Bell, M. L. (2019). State inequality, socioeconomic position and subjective cognitive decline in the United States. SSM - population health, 7, 100357.More infoSocial gradients in health have been observed for many health conditions and are suggested to operate through the effects of status anxiety. However, the gradient between education and Alzheimer's disease is presumed to operate through cognitive stimulation. We examined the possible role of status anxiety through testing for state-level income inequality and social gradients in markers of socioeconomic position (SEP) for Alzheimer's disease risk.
- Peterson, R. L., Fain, M. J., A Butler, E., Ehiri, J. E., & Carvajal, S. C. (2019). The role of social and behavioral risk factors in explaining racial disparities in age-related cognitive impairment: a structured narrative review. Neuropsychology, development, and cognition. Section B, Aging, neuropsychology and cognition. Apr 6:1-24. Epub..More infoAlzheimer's disease (AD) is a growing public health concern with large disparities in incidence and prevalence between African Americans (AAs) and non-Hispanic whites (NHWs). The aim of this review was to examine the evidence of association between six modifiable risk factors (education, smoking, physical inactivity, obesity, social isolation, and psychosocial stress) and Alzheimer's disease risk in AAs and NHWs. We identified 3,437 studies; 45 met inclusion criteria and were included in this review. Of the examined risks, education provided the strongest evidence of association with cognitive outcomes in AAs and NHWs. This factor may operate directly on Alzheimer's disease risk through the neurocognitive benefits of cognitive stimulation or indirectly through social status.
- Salerno Valdez, E., Korchmaros, J., Sabo, S., Garcia, D. O., Carvajal, S., & Stevens, S. (2019). How the U.S.-Mexico border influences adolescent substance use: Youth participatory action research using photovoice. The International journal on drug policy, 73, 146-155.More infoThe purpose of this study is to use Youth Participatory Action Research (YPAR) methods and Photovoice to identify the perceived environmental factors that influence substance use among adolescents living at the U.S.-Mexico border.
- Tucker, K. M., Ingram, M., Doubleday, K., Piper, R., & Carvajal, S. C. (2019). La Vida Buena (The Good Life) evaluation: a quasi experimental intervention of a community health worker-led family-based childhood obesity program for Latino children 5-8 years of age on the US-Mexico border. BMC public health, 19(1), 759.More infoDue to multiple and interacting factors, Latino children are disproportionately at risk for overweight and obesity in the United States. Childhood obesity increases the risk for adverse physical and psychosocial outcomes throughout the lifespan. Intensive behavioral interventions recommended in primary care settings may not conform to current practices, and the most vulnerable populations are often unable to access these services. Community Health Workers (CHWs) offer a promising approach to bridging the gap between vulnerable communities and culturally competent services. La Vida Buena (The Good Life) is an 8-week family-focused intervention for Latino children 5-8 years old and their parents or caregivers who are patients at a Federally-Qualified Community Health Center (FQHC). It is a culturally and linguistically appropriate curriculum, facilitated by CHWs, that targets family behaviors to foster a healthy lifestyle in order to prevent and mitigate childhood overweight and obesity.
- Valdez, L. A., Garcia, D. O., Ruiz, J., Oren, E., & Carvajal, S. (2019). Understanding Social and Cultural Contexts of Alcohol Misuse in Mexican-Origin Hispanic Men. Health education & behavior : the official publication of the Society for Public Health Education, 46(4), 648-655.More infoEvidence suggests that Hispanic and non-Hispanic White men (NHW) have comparable prevalence rates of alcohol use. However, Hispanic men consistently have higher prevalence rates of alcohol misuse compared with NHW men. Consequently, Hispanic men experience disproportionate levels of adverse health consequences of alcohol misuse when compared with NHW men. The aim of this study was to explore Hispanic male perspectives and opinions regarding alcohol use patterns that may lead to disparate rates of alcohol misuse in Hispanic males. Demographic data were collected with questionnaires. Twenty semistructured one-on-one interviews were completed in English and Spanish with Mexican-origin Hispanic men (age: 44.6 ± 11.3 years). A thematic analysis was conducted using a hybrid deductive-inductive strategy with an a priori codebook supplemented with iterative analysis of transcripts. Results suggest that alcohol misuse patterns in Hispanic males are influenced by an interaction between alcohol-related social norms and learned expressions of masculinity; a lack of knowledge of the alcohol-related health risks that further perpetuate the normalization of alcohol misuse; and expressions of masculinity and adaptive coping that lead to alcohol misuse as an escape from life stressors. Given the rapid expansion of the Hispanic population in the United States, and the disparate consequences of alcohol misuse in this population, it is imperative to consider the complex and often compounded impact of sociocultural norms and the social context on misuse-related behaviors. Viable prevention and treatment strategies should be addressed thought multicomponent, community-level strategies that more comprehensively address the complexities of alcohol misuse in this population.
- Carvajal, S. C., Huang, S., Bell, M. L., Denman, C., Guernsey de Zapien, J., Cornejo, E., Chang, J., Staten, L. K., & Rosales, C. (2018). Behavioral and subjective health changes in US and Mexico border residing participants in two promotora-led chronic disease preventive interventions. Health education research, 33(6), 522-534.More infoChronic diseases are the primary health burden among Mexican-origin populations and health promotion efforts have not been able to change negative population trends. This research presents behavioral and subjective health impacts of two related community health worker (CHW) interventions conducted in the US-Mexico border region. Pasos Adelante (United States) and Meta Salud (Mexico) are 12-13 week CHW-led preventive interventions implemented with Mexico-origin adults. Curricula include active learning modules to promote healthy dietary changes and increasing physical activity; they also incorporate strategies to promote social support, empowerment and group exercise components responsive to their communities. Questionnaire data at baseline (N = 347 for Pasos; 171 for Meta Salud), program completion and 3-month follow-up were analyzed. Results showed statistically significant improvements in multiple reported dietary, physical activity and subjective health indicators. Furthermore, at follow-up across both cohorts there were ≥10% improvements in participants' meeting recommended physical activity guidelines, consumption of whole milk, days of poor mental health and self-rated health. While this study identifies some robust health improvements and contributes to the evidence base for these interventions current dissemination, the lack of change observed for some targeted behaviors (e.g. time sitting) suggests they may have stronger overall impacts with curricula refinement.
- Garcia, D. O., Carvajal, S. C., Oren, E., Ruiz, J., Flores, M. A., & Valdez, L. A. (2017). Gender and Cultural Adaptations for Diversity: A Systematic Review of Alcohol and Substance Abuse Interventions for Latino Males.. Substance Use and Misuse.
- Lohr, A. M., Ingram, M., Nuñez, A. V., Reinschmidt, K. M., & Carvajal, S. C. (2018). Community-Clinical Linkages With Community Health Workers in the United States: A Scoping Review. Health Promotion Practice, 19, 349-360.More infoDespite the proliferation of community-clinical linkage (CCL) interventions with community health workers (CHWs), little is known about the components of these programs or how linkages are realized. In this scoping review, we synthesize evidence concerning the role of CHWs in creating and sustaining CCLs aimed at improving individual health outcomes. Our inclusion criteria included peer-reviewed articles that described a CHW intervention in the United States that used a CCL model. A total of 2,776 titles and/or abstracts were screened and 47 articles underwent full text review. Two independent reviewers rated the screened articles based on additional criteria including the CHW connection to community and evidence of linkage follow up rather than simple referral. For the 11 peer-reviewed articles included in the final review, we describe the CHW's relationship to the community, training, and role within the intervention, linkage, and outcomes. We used a standardized framework to determine commonalities in CHW roles across the interventions. CCLs with CHWs positively affect the delivery of both clinical care and community resources across a range of disease areas in a variety of contexts. To identify effective CCL models, additional information on CHW training, CCL follow-up methods, and the CHW role in CCLs is recommended.
- Valdez, L. A., Flores, M., Ruiz, J., Oren, E., Carvajal, S., & Garcia, D. O. (2018). Gender and Cultural Adaptations for Diversity: A Systematic Review of Alcohol and Substance Abuse Interventions for Latino Males. Substance use & misuse, 53(10), 1608-1623.More infoLatino men are disproportionately affected by the consequences of alcohol and substance abuse when compared to non-Latino white men. Latino men also face greater barriers to accessing, engaging, and completing alcohol and substance abuse treatment services. Culturally adapted interventions are promoted to overcome these barriers. However, the effectiveness of these efforts is unclear.
- Valdez, L. A., Garcia, D. O., Ruiz, J., Oren, E., & Carvajal, S. (2018). Exploring Structural, Sociocultural, and Individual Barriers to Alcohol Abuse Treatment Among Hispanic Men. American journal of men's health, 12(6), 1948-1957.More infoHispanic men have poor access to alcohol abuse treatment, low treatment engagement, and low treatment completion rates despite the contrasting burden of alcohol-related consequences they face. The purpose of this study was to examine Hispanic male perspectives regarding alcohol abuse treatment-seeking behaviors and the structural, sociocultural, and individual factors that may influence initiation and continued engagement in treatment in this population. Individual interviews were conducted with a sample of 20 Hispanic men (age: 44.6 ± 11.3 years). Thematic analysis was completed using a hybrid deductive-inductive approach centered in an a priori codebook that was further supplemented with iterative exploration of transcripts. Results suggested treatment-seeking behaviors were highly influenced by (a) structural factors related to poor treatment access, as well as lack of linguistic- and cultural-responsiveness of available treatment; (b) sociocultural factors related to difficulties problematizing alcohol abuse due to lack of community awareness, societal normalization of consumption, and stigmatization of alcohol abuse treatment; and (c) individual factors related to lack of individual knowledge. This work highlights the perceived lack of congruency between available treatment and the linguistic, cultural, and gender norms of Hispanic men. There is need for responsive treatment strategies that comprehensively consider the gendered- and sociocultural-factors that govern treatment seeking and engagement behaviors. Findings also suggest a need for targeted alcohol abuse awareness building efforts in the Hispanic community. Specifically, the detrimental effects of alcohol-related problems and potential benefits of treatment should be addressed in order to diminish social stigma of abuse and of treatment.
- Ingram, M., Doubleday, K., Bell, M. L., Lohr, A., Murrieta, L., Velasco, M., Blackburn, J., Sabo, S., Guernsey de Zapien, J., & Carvajal, S. C. (2017). Community Health Worker Impact on Chronic Disease Outcomes Within Primary Care Examined Using Electronic Health Records. American journal of public health, 107(10), 1668-1674.More infoTo investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs).
- Reinschmidt, K. M., Ingram, M., Morales, S., Sabo, S. J., Blackburn, J., Murrieta, L., David, C., & Carvajal, S. C. (2017). Documenting Community Health Worker Roles in Primary Care: Contributions to Evidence-Based Integration Into Health Care Teams, 2015. The Journal of ambulatory care management, 40(4), 305-315.More infoThe Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements.
- Reinschmidt, K. M., Ingram, M., Schachter, K., Sabo, S., Verdugo, L., & Carvajal, S. (2017). The Impact of Integrating Community Advocacy Into Community Health Worker Roles on Health-Focused Organizations and Community Health Workers in Southern Arizona. The Journal of ambulatory care management, 38(3), 244-53.More infoOrganizational environments may encourage community health workers (CHWs) to engage community members in improving their communities. We conducted open-ended interviews and focus groups to explore how participation in the Acción intervention, which trained CHWs in community advocacy, affected organizational capacity to support their CHWs. Supervisors described improved organizational recognition and trust of CHWs. Organizational leaders reported organizational benefits and increased appreciation of CHW leadership. Both expressed increased interest in future advocacy trainings. Limiting factors included organizational mission, CHW position descriptions, and funding. Findings indicate that, with training and funding, CHW community advocacy can be integrated into organizations with congruent missions.
- Rosales, C. B., de Zapien, J. E., Chang, J., Ingram, M., Fernandez, M. L., Carvajal, S. C., & Staten, L. K. (2017). Perspectives on a US-Mexico Border Community's Diabetes and "Health-Care" Access Mobilization Efforts and Comparative Analysis of Community Health Needs over 12 Years. Frontiers in public health, 5, 152.More infoThis paper describes a community coalition-university partnership to address health needs in an underserved US-Mexico border, community. For approximately 15 years, this coalition engaged in community-based participatory research with community organizations, state/local health departments, and the state's only accredited college of public health. Notable efforts include the systematic collection of health-relevant data 12 years apart and data that spawned numerous health promotion activities. The latter includes specific evidence-based chronic disease-preventive interventions, including one that is now disseminated and replicated in Latino communities in the US and Mexico, and policy-level changes. Survey data to evaluate changes in a range of health problems and needs, with a specific focus on those related to diabetes and access to health-care issues-identified early on in the coalition as critical health problems affecting the community-are presented. Next steps for this community and lessons learned that may be applicable to other communities are discussed.
- Sabo, S., Flores, M., Wennerstrom, A., Bell, M. L., Verdugo, L., Carvajal, S., & Ingram, M. (2017). Community Health Workers Promote Civic Engagement and Organizational Capacity to Impact Policy. Journal of community health, 42(6), 1197-1203.More infoCommunity health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted Rstatistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change.
- Winkler, J. L., Walsh, M. E., DeBlois, M., Mare, J., & Carvajal, S. C. (2017). Kind Discipline: Developing a Roadmap through a Concept Mapping Process. Evaluation and Program Planning.
- Winkler, J. L., Walsh, M. E., de Blois, M., Maré, J., & Carvajal, S. C. (2017). Kind discipline: Developing a conceptual model of a promising school discipline approach. Evaluation and program planning, 62, 15-24.More infoThis formative evaluation develops a novel conceptual model for a discipline approach fostering intrinsic motivation and positive relationships in schools. We used concept mapping to elicit and integrate perspectives on kind discipline from teachers, administrators, and other school staff. Three core themes describing kind discipline emerged from 11 identified clusters: (1) proactively developing a positive school climate, (2) responding to conflict with empathy, accountability, and skill, and (3) supporting staff skills in understanding and sharing expectations. We mapped the identified components of kind discipline onto a social ecological model and found that kind discipline encompasses all levels of that model including the individual, relational, environmental/structural, and even community levels. This contrasts with the dominant individual-behavioral discipline approaches that focus on fewer levels and may not lead to sustained student and staff motivation. The findings illustrate the importance of setting and communicating clear expectations and the need for them to be collaboratively developed. Products of the analysis and synthesis reported here are operationalized materials for teachers grounded in a "be kind" culture code for classrooms.
- Herman, P. (2016). A Comparison of Methods for Capturing Patient Preferences for Delivery of Mental Health Services to Low-Income Hispanics Engaged in Primary Care.. The Patient: Patient-Centered Outcomes Research.More infoHerman, P.M., Ingram, M., Cunningham, C.E., Rimas, H s, Murrieta, L. c, Schachter, K., de Zapien, J.G., & Carvajal, S.C. (2016). A Comparison of Methods for Capturing Patient Preferences for Delivery of Mental Health Services to Low-Income Hispanics Engaged in Primary Care. The Patient: Patient-Centered Outcomes Research, Aug;9(4):293-301. PMID: 26689700.
- Herman, P. (2016). Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care.. Administration and Policy in Mental Health.More infoHerman, P.M., Ingram, M., Rimas, H.s, Carvajal, S., & Cunningham, C.E. (2016). Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care. Administration and Policy in Mental Health. PMID: 26410547
- Rosales, C. B., Carvajal, S., & de Zapien, J. E. (2016). Editorial: Emergent Public Health Issues in the US-Mexico Border Region. Frontiers in public health, 4, 93.
- Denman, C. A., Bell, M. L., Cornejo, E., de Zapien, J. G., Carvajal, S., & Rosales, C. (2015). Changes in health behaviors and self-rated health of participants in Meta Salud: a primary prevention intervention of NCD in Mexico. Global heart, 10(1), 55-61.More infoMeta Salud was a community health worker-facilitated intervention for the prevention of noncommunicable diseases in Northern Mexico.
- Herman, P. M., Ingram, M., Cunningham, C. E., Rimas, H., Murrieta, L., Schachter, K., de Zapien, J. G., & Carvajal, S. C. (2015). A Comparison of Methods for Capturing Patient Preferences for Delivery of Mental Health Services to Low-Income Hispanics Engaged in Primary Care. The patient.More infoConsideration of patient preferences regarding delivery of mental health services within primary care may greatly improve access and quality of care for the many who could benefit from those services.
- Herman, P. M., Ingram, M., Rimas, H., Carvajal, S., & Cunningham, C. E. (2015). Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care. Administration and policy in mental health.More infoWe used a discrete-choice conjoint experiment to model the mental health services preferences of patients of a federally-qualified health center serving a primarily low-income, Hispanic farmworker population in southwestern Arizona. The two attributes that had the largest influence on patient choices (i.e., received the highest importance scores) were where patients receive these services and the language and cultural awareness of the provider who prescribed their treatment. Simulations indicated that the clinic could substantially improve its patients' welfare with even a single change. The single most effective change in terms of patient preferences would be to offer behavioral health services onsite.
- Ingram, M., Murrietta, L., De Zapien, J. G., Herman, P., & Carvajal, S. C. (2015). Community health workers as focus group facilitators: A participatory action research method to improve behavioral health services for farmworkers in a primary care setting. Action Research, 13(1), 48-64. doi:10.1177/1476750314565913
- Ingram, M., Sabo, S. J., Gomez, S., Piper, R., de Zapien, J. G., Reinschmidt, K. M., Schachter, K. A., & Carvajal, S. C. (2015). Taking a community-based participatory research approach in the development of methods to measure a community health worker community advocacy intervention. Progress in community health partnerships : research, education, and action, 9(1), 49-56.More infoPublic health advocacy is by necessity responsive to shifting sociopolitical climates, and thus a challenge of advocacy research is that the intervention must by definition be adaptive. Moving beyond the classification of advocacy efforts to measurable indicators and outcomes of policy, therefore, requires a dynamic research approach.
- Ingram, M., Schachter, K. A., Guernsey de Zapien, J., Herman, P. M., & Carvajal, S. C. (2015). Using participatory methods to enhance patient-centred mental health care in a federally qualified community health center serving a Mexican American farmworker community. Health expectations : an international journal of public participation in health care and health policy, 18(6), 3007-18. doi:10.1111/hex.12284More infoMexican American farmworkers experience high rates of mental health conditions; however, it is difficult for them to access care. Patient-centred care is a systems-wide approach to improving the delivery of services for diverse populations in the primary care setting.
- Nodora, J. N., Carvajal, S. C., Robles-Garcia, R., Agraz, F. P., Daneri-Navarro, A., Meza-Montenegro, M. M., Gutierrez-Millan, L. E., & Martinez, M. E. (2015). Development and Psychometric Assessment of the Measure of Globalization Influence on Health Risk (MGIHR) Among Mexican Women with Breast Cancer. Journal of immigrant and minority health / Center for Minority Public Health, 17(4), 1025-32.More infoLacking in the literature are data addressing the extent to which changes in reproductive and lifestyle factors predispose women in developing nations to higher breast cancer rates, and the degree to which these are due to globalization influences. This article describes the development and psychometric assessment of an instrument intended to measure global, predominantly U.S., influences on breast cancer risk profile among women residing in Mexico. Using investigator consensus and a focus group methodology, the Measure of Globalization Influence on Health Risk (MGIHR) was developed and completed by 341 women. Psychometric analysis support the use of an 11-item Consumerism and Modernity scale and 7-item Reproductive Control and Gender Role scale. The MGIHR is a valid and reliable instrument for understanding changing lifestyle and reproductive factors for breast cancer risk and may provide a more complete understanding of breast cancer development and needed interventions.
- Reinschmidt, K. M., Ingram, M., Schachter, K. A., Sabo, S. J., Verdugo, L., & Carvajal, S. C. (2015). The Impact of Integrating Community Advocacy into Community Health Worker Roles on Health-Focused Organizations and Community Health Workers in Southern Arizona. Journal of Ambulatory Care Management, 38(3), 244-253.
- Carvajal, S. C. (2014). Structural determinants of mortality and the role of behavior: a comment on Whitley et al. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 47(2), 133-4.
- Carvajal, S. C., Kibor, C., McClelland, D. J., Ingram, M., de Zapien, J. G., Torres, E., Redondo, F., Rodriguez, K., Rubio-Goldsmith, R., Meister, J., & Rosales, C. (2014). Stress and Sociocultural Factors Related to Health Status Among US-Mexico Border Farmworkers. Journal of immigrant and minority health / Center for Minority Public Health.More infoThis study examines factors relating to farmworkers' health status from sociocultural factors, including stress embedded within their work and community contexts. A cross-sectional household survey of farmworkers (N = 299) included social-demographics, immigration status descriptors, and a social-ecologically grounded, community-responsive, stress assessment. Outcomes included three standard US national surveillance measures of poor mental, physical, and self-rated health (SRH). Logistic regression models showed that higher levels of stress were significantly associated (Ps
- Denman, C. A., Rosales, C., Cornejo, E., Bell, M. L., Munguía, D., Zepeda, T., Carvajal, S., & Guernsey de Zapien, J. (2014). Evaluation of the community-based chronic disease prevention program Meta Salud in Northern Mexico, 2011-2012. Preventing chronic disease, 11, E154.More infoMeta Salud is a community health worker-facilitated intervention in Hermosillo, Sonora, Mexico, and was adapted from Pasos Adelante, a similar evidence-based intervention developed for a Latino population in the United States-Mexico border region. The objective of this study was to examine outcomes for Meta Salud and compare them with outcomes for Pasos Adelante.
- Ingram, M., Schachter, K. A., Sabo, S. J., Reinschmidt, K. M., Gomez, S., De Zapien, J. G., & Carvajal, S. C. (2014). A community health worker intervention to address the social determinants of health through policy change. The journal of primary prevention, 35(2), 119-23.More infoPublic policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.
- Langellier, B. A., Guernsey de Zapien, J., Rosales, C., Ingram, M., & Carvajal, S. C. (2014). State Medicaid expansion, community interventions, and health care disparities in a United States-Mexico border community. American journal of public health, 104(8), e94-e100.More infoWe investigated whether access to and use of health care services increased among residents of a low-income, predominantly Mexican American border community affected by the expansion of Arizona's Medicaid program in 2001 and multiple community-level programs and policies.
- Sabo, S., Shaw, S., Ingram, M., Teufel-Shone, N., Carvajal, S., de Zapien, J. G., Rosales, C., Redondo, F., Garcia, G., & Rubio-Goldsmith, R. (2014). Everyday violence, structural racism and mistreatment at the US-Mexico border. Social science & medicine, 109, 66-74.More infoImmigration laws that militarize communities may exacerbate ethno-racial health disparities. We aimed to document the prevalence of and ways in which immigration enforcement policy and militarization of the US-Mexico border is experienced as everyday violence. Militarization is defined as the saturation of and pervasive encounters with immigration officials including local police enacting immigration and border enforcement policy with military style tactics and weapons. Data were drawn from a random household sample of US citizen and permanent residents of Mexican descent in the Arizona border region (2006-2008). Qualitative and quantitative data documented the frequency and nature of immigration related profiling, mistreatment and resistance to institutionalized victimization. Participants described living and working in a highly militarized environment, wherein immigration-related profiling and mistreatment were common immigration law enforcement practices. Approximately 25% of respondents described an immigration-related mistreatment episode, of which 62% were personally victimized. Nearly 75% of episodes occurred in a community location rather than at a US port of entry. Participant mistreatment narratives suggest the normalization of immigration-related mistreatment among the population. Given border security remains at the core of immigration reform debates, it is imperative that scholars advance the understanding of the public health impact of such enforcement policies on the daily lives of Mexican-origin US permanent residents, and their non-immigrant US citizen co-ethnics. Immigration policy that sanctions institutional practices of discrimination, such as ethno-racial profiling and mistreatment, are forms of structural racism and everyday violence. Metrics and systems for monitoring immigration and border enforcement policies and institutional practices deleterious to the health of US citizens and residents should be established.
- Schachter, K. A., Ingram, M. -., Jacobs, L., De Zapien, J. G., Hafter, H., & Carvajal, S. C. (2014). Developing an action learning community advocacy/leadership training program for community health workers and their agencies to reduce health disparities in Arizona border communities. Journal of Health Disparities Research and Practice, 7(2), 14.
- Carvajal, S. C., Miesfeld, N., Chang, J., Reinschmidt, K. M., de Zapien, J. G., Fernandez, M. L., Rosales, C., & Staten, L. K. (2013). Evidence for long-term impact of Pasos Adelante: using a community-wide survey to evaluate chronic disease risk modification in prior program participants. International journal of environmental research and public health, 10(10).More infoEffective community-level chronic disease prevention is critical to population health within developed and developing nations. Pasos Adelante is a preventive intervention that aims to reduce chronic disease risk with evidence of effectiveness in US-Mexico residing, Mexican origin, participants. This intervention and related ones also implemented with community health workers have been shown to improve clinical, behavioral and quality of life indicators; though most evidence is from shorter-term evaluations and/or lack comparison groups. The current study examines the impact of this program using secondary data collected in the community 3-6 years after all participants completed the program. A proportional household survey (N = 708) was used that included 48 respondents who indicated they had participated in Pasos. Using propensity score matching to account for differences in program participants versus other community residents (the program targeted those with diabetes and associated risk factors), 148 natural controls were identified for 37 matched Pasos participants. Testing a range of behavioral and clinical indicators of chronic disease risk, logistic regression models accounting for selection bias showed two significant findings; Pasos participants were more physically active and drank less whole milk. These findings add to the evidence of the effectiveness of Pasos Adalente and related interventions in reducing chronic disease risk in Mexican-origin populations, and illustrate the use of innovative techniques for using secondary, community-level data to complement prior evaluation research.
- Carvajal, S. C., Rosales, C., Rubio-Goldsmith, R., Sabo, S., Ingram, M., McClelland, D. J., Redondo, F., Torres, E., Romero, A. J., O'Leary, A. O., Sanchez, Z., & de Zapien, J. G. (2013). The border community and immigration stress scale: a preliminary examination of a community responsive measure in two Southwest samples. Journal of immigrant and minority health / Center for Minority Public Health, 15(2).More infoUnderstanding contemporary socio-cultural stressors may assist educational, clinical and policy-level health promotion efforts. This study presents descriptive findings on a new measure, the border community and immigration stress scale. The data were from two community surveys as part of community based participatory projects conducted in the Southwestern US border region. This scale includes stressful experiences reflected in extant measures, with new items reflecting heightened local migration pressures and health care barriers. Stressors representing each main domain, including novel ones, were reported with frequency and at high intensity in the predominantly Mexican-descent samples. Total stress was also significantly associated with mental and physical health indicators. The study suggests particularly high health burdens tied to the experience of stressors in the US border region. Further, many of the stressors are also likely relevant for other communities within developed nations also experiencing high levels of migration.
- Chang, J., Guy, M. C., Rosales, C., de Zapien, J. G., Staten, L. K., Fernandez, M. L., & Carvajal, S. C. (2013). Investigating social ecological contributors to diabetes within Hispanics in an underserved U.S.-Mexico border community. International journal of environmental research and public health, 10(8).More infoHispanics bear a disproportionate burden of diabetes in the United States, yet relations of structural, socio-cultural and behavioral factors linked to diabetes are not fully understood across all of their communities. The current study examines disparities and factors associated with diabetes in adult Hispanics of Mexican-descent (N = 648) participating in a population survey of an underserved rural U.S.-Mexico border community. The overall rate of diabetes prevalence rate in the sample, based on self-report and a glucose testing, was 21%; much higher than rates reported for U.S. adults overall, for all Hispanic adults, or for Mexican American adults specifically. Acculturation markers and social determinants of health indicators were only significantly related to diabetes in models not accounting for age. Older age, greater BMI (>30), greater waist-to-hip ratio as well as lower fruit and vegetable consumption were significantly related to increased likelihood of diabetes when all structural, cultural, behavioral, and biological factors were considered. Models with sets of behavioral factors and biological factors each significantly improved explanation of diabetes relative to prior social ecological theory-guided models. The findings show a critical need for diabetes prevention efforts in this community and suggest that health promotion efforts should particularly focus on increasing fruit and vegetable consumption.
- Ingram, M. -., Schachter, K. A., Sabo, S. J., Reinschmidt, K. M., Gomez, S., De Zapien, J. G., & Carvajal, S. C. (2014). A community health worker intervention to address the social determinants of health through policy change. Journal of Primary Prevention.
- Ingram, M., Schachter, K. A., Sabo, S., Reinschmidt, K. M., Gomez, S., De Zapien, J. G., Carvajal, S. C., Ingram, M., Schachter, K. A., Sabo, S., Reinschmidt, K. M., Gomez, S., De Zapien, J. G., & Carvajal, S. C. (2014). A community health worker intervention to address the social determinants of health through policy change.. The Journal of Primary Prevention.More infoPublic policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Accion para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Accion CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.
- Sabo, S. J., Ingram, M. -., Reinschmidt, K. M., Schachter, K. A., Jacobs, L., De Zapien, J. G., Robinson, L., & Carvajal, S. C. (2013). Predictors and a Framework for Fostering Community Advocacy as a Community Health Worker Core Function to Eliminate Health Disparities. American Journal of Public Health, 103(7).
- Sabo, S., Ingram, M., Reinschmidt, K. M., Schachter, K., Jacobs, L., Guernsey de Zapien, J., Robinson, L., & Carvajal, S. (2013). Predictors and a framework for fostering community advocacy as a community health worker core function to eliminate health disparities. American journal of public health, 103(7), e67-73.More infoUsing a mixed-method, participatory research approach, we investigated factors related to community health worker (CHW) community advocacy that affect social determinants of health.
- Carvajal, S. C. (2012). Global positive expectancies in adolescence and health-related behaviours: longitudinal models of latent growth and cross-lagged effects. Psychology & health, 27(8), 916-37.More infoConstructs representative of global positive expectancies (GPE) such as dispositional optimism and hope have been theoretically and empirically linked to many positive mental and physical health outcomes. However such expectancies' health implications for adolescents, as well as their trajectory over time, are less well understood than for adult populations. This study tested whether GPE predict the key indicators of adolescents' future physical health status, their health-related behaviours. A prospective longitudinal study design was employed whereby a diverse population-based cohort (N = 744; mean age at baseline = 12) completed three surveys over approximately 18 months. Rigorous tests of causal predominance and reciprocal effects were conducted through latent growth and cross-panel structural equation models. Results showed GPE systematically decreased during the course of the study, yet higher initial levels of GPE predicted less alcohol drinking, healthier food choice and greater physical activity over time. GPE's protective relationships towards health protective behaviours (vs. health risk behaviours that also included tobacco smoking) appear more independent from depressive symptomatology, and the primary findings were robust across socio-demographic groups.
- Garcia, R. Z., Carvajal, S. C., Wilkinson, A. V., Thompson, P. A., Nodora, J. N., Komenaka, I. K., Brewster, A., Cruz, G. I., Wertheim, B. C., Bondy, M. L., & Martínez, M. E. (2012). Factors that influence mammography use and breast cancer detection among Mexican-American and African-American women. Cancer causes & control : CCC, 23(1), 165-73.More infoThis study examined factors that influence mammography use and breast cancer detection, including education, health insurance, and acculturation, among Mexican-American (MA) and African-American (AA) women.
- Ingram, M., Reinschmidt, K. M., Schachter, K. A., Davidson, C. L., Sabo, S. J., De Zapien, J. G., & Carvajal, S. C. (2012). Establishing a professional profile of community health workers: results from a national study of roles, activities and training. Journal of community health, 37(2), 529-37.More infoCommunity Health Workers (CHWs) have gained national recognition for their role in addressing health disparities and are increasingly integrated into the health care delivery system. There is a lack of consensus, however, regarding empirical evidence on the impact of CHW interventions on health outcomes. In this paper, we present results from the 2010 National Community Health Worker Advocacy Survey (NCHWAS) in an effort to strengthen a generalized understanding of the CHW profession that can be integrated into ongoing efforts to improve the health care delivery system. Results indicate that regardless of geographical location, work setting, and demographic characteristics, CHWs generally share similar professional characteristics, training preparation, and job activities. CHWs are likely to be female, representative of the community they serve, and to work in community health centers, clinics, community-based organizations, and health departments. The most common type of training is on-the-job and conference training. Most CHWs work with clients, groups, other CHWs and less frequently community leaders to address health issues, the most common of which are chronic disease, prevention and health care access. Descriptions of CHW activities documented in the survey demonstrate that CHWs apply core competencies in a synergistic manner in an effort to assure that their clients get the services they need. NCHWAS findings suggest that over the past 50 years, the CHW field has become standardized in response to the unmet needs of their communities. In research and practice, the field would benefit from being considered a health profession rather than an intervention.
- Davis, M. F., Adam, M., Carvajal, S., Sechrest, L., & Reyna, V. F. (2011). Using Rasch modeling to measure acculturation in youth. Journal of applied measurement, 12(4), 324-38.More infoEthnic differences in health outcomes are assumed to reflect levels of acculturation, among other factors. Health surveys frequently include language and social interaction items taken from existing acculturation instruments. This study evaluated the dimensionality of responses to typical bilinear items in Latino youth using Rasch modeling. Two seven-item scales measuring Anglo-Hispanic orientation were adapted from Marin and Gamba (1996) and Cuellar, Arnold, and Maldonado (1995). Most of the items fit the Rasch model. However, there were gaps in both the Hispanic and Anglo scales. The Anglo items were not well targeted for the sample because most students reported they always spoke English. The lack of variability found in a heterogeneous sample of Latino youth has negative implications for the common practice of relying on language as a measure of acculturation. Acculturation instruments for youth probably need more sensitive items to discriminate linguistic differences, or to measure other factors.
- Carvajal, S. C., & Young, R. S. (2009). Culturally based substance abuse treatment for American Indians/Alaska Natives and Latinos. Journal of ethnicity in substance abuse, 8(3), 207-22.
- Romero, A. J., Carvajal, S. C., Martinez, D. E., Martinez, D. E., Carvajal, S. C., & Romero, A. J. (2007). Bicultural Stress and Adolescent Risk Behaviors in a Community Sample of Latinos and Non-Latino Whites. Ethnicity & Health, 12(5), 443-463. doi:https://doi.org/10.1080/13557850701616854
- Romero, A. J., Martinez, D., & Carvajal, S. C. (2007). Bicultural stress and adolescent risk behaviors in a community sample of Latinos and non-Latino European Americans. Ethnicity & health, 12(5), 443-63.More infoThe study examined the relation between adolescent risk behaviors and bicultural stress due to discrimination, immigration, and acculturation factors. We hypothesized bicultural stress would be related to increased risk behavior and depressive symptoms independent of socioeconomic status, ethnic self-identification, and acculturation.
- Carvajal, S. C., & Granillo, T. M. (2006). A prospective test of distal and proximal determinants of smoking initiation in early adolescents. Addictive behaviors, 31(4), 649-60.More infoThis study tests a broad array of determinants of utility for developing smoking preventive interventions using a population-based cohort of early adolescents. Multivariable logistic regressions using never-smokers at baseline (N=1137; age 11-14) showed a model of distal determinants was more predictive of initiation within the approximate 10 month follow up period than one of proximal determinants. When all determinants were simultaneously considered, lesser academic achievement and fewer environmental impediments to smoking most strongly predicted initiation. The findings are consistent with some current smoking prevention programs, however such programs may be further potent by using theory-based social development approaches and through reducing tobacco availability or social contexts where youth can smoke without another adult knowing.
- Granillo, T., Jones-Rodriguez, G., & Carvajal, S. C. (2005). Prevalence of eating disorders in Latina adolescents: associations with substance use and other correlates. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 36(3), 214-20.More infoTo estimate the occurrence and correlates of anorexia nervosa and bulimia nervosa-related symptoms in a Latina sample of U.S. adolescents.
- Gritz, E. R., Tripp, M. K., James, A. S., Carvajal, S. C., Harrist, R. B., Mueller, N. H., Chamberlain, R. M., & Parcel, G. S. (2005). An intervention for parents to promote preschool children's sun protection: effects of Sun Protection is Fun!. Preventive medicine, 41(2), 357-66.More infoYoung children are an important focus of sun-protection efforts, but there has been relatively little study of sun-protection interventions developed for preschool-aged children and their parents. This paper reports on the evaluation of Sun Protection is Fun! (S.P.F.), designed to improve parents' practices and psychosocial outcomes related to protecting preschool children from sun exposure.
- Tripp, M. K., Carvajal, S. C., McCormick, L. K., Mueller, N. H., Hu, S. H., Parcel, G. S., & Gritz, E. R. (2003). Validity and reliability of the parental sun protection scales. Health education research, 18(1), 58-73.More infoSkin cancer is the most common cancer diagnosed in the US and its incidence continues to rise. Epidemiological studies have shown that excessive sun exposure received during childhood may increase the risk of developing skin cancer later in life. Yet, there are few published reports on the development of reliable and valid theory-based scales that assess the factors associated with parental sun-protection practices to reduce sun exposure in preschool children. To fill this gap, the Parental Sun Protection Scales were developed and validated. Two series of confirmatory factor analytic models were employed to test the factor structure of the scales and to examine the inter-relationships among the proposed psychosocial factors. Sunscreen-use and sun-avoidance behavioral models were tested in a sample of 384 parents. The results provided a basis for the reliable and valid measurement of psychosocial factors related to parental sun-protection practices. These scales may be useful in more fully understanding the determinants of sun-protection behaviors and in evaluating intervention programs designed to improve such behaviors.
- Carvajal, S. C., Evans, R. I., Nash, S. G., & Getz, J. G. (2002). Global positive expectancies of the self and adolescents' substance use avoidance: testing a social influence mediational model. Journal of personality, 70(3), 421-42.More infoGrounded in theories of global positive expectancies and social influences of behavior, this investigation posited a model in which global positive expectancies are related to substance use as mediated by attitudes, subjective norms, self-efficacy, and intentions. Using a cohort sample (n = 525), structural equation modeling was employed to test the hypothesized predictions of future substance use. The findings suggest that, relative to adolescents with lower global positive expectancies, adolescents with higher global positive expectancies use substances less frequently over time because of their protective attitudinal and control-oriented perceptions towards that behavior. Additionally, results from the current investigation also extend prior findings on the factor structure of global positive expectancies, suggesting these expectancies can be viewed as a second-order factor representing optimism and two components of hope-agency and pathways.
- Carvajal, S. C., Hanson, C. E., Romero, A. J., & Coyle, K. K. (2002). Behavioural risk factors and protective factors in adolescents: a comparison of Latinos and non-Latino whites. Ethnicity & health, 7(3), 181-93.More infoThis study investigated differences in behavioural health protective and risk factors in US Latino and non-Latino White adolescents as well as differences among Latinos with different levels of acculturation using a bicultural acculturation model. The bicultural model is consistent with current understanding of cultural change processes; however it has infrequently been applied to understand adolescent health outcomes. The outcomes included risk and health behaviours as well as mental health factors consistent with Jessor's framework for describing adolescents' health status.
- Basen-Engquist, K., Coyle, K. K., Parcel, G. S., Kirby, D., Banspach, S. W., Carvajal, S. C., & Baumler, E. (2001). Schoolwide effects of a multicomponent HIV, STD, and pregnancy prevention program for high school students. Health education & behavior : the official publication of the Society for Public Health Education, 28(2), 166-85.More infoFew studies have tested schoolwide interventions to reduce sexual risk behavior, and none have demonstrated significant schoolwide effects. This study evaluates the schoolwide effects of Safer Choices, a multicomponent, behavioral theory-based HIV, STD, and pregnancy prevention program, on risk behavior, school climate, and psychosocial variables. Twenty urban high schools were randomized, and cross-sectional samples of classes were surveyed at baseline, the end of intervention (19 months after baseline), and 31 months afterbaseline. At 19 months, the program had a positive effect on the frequency of sex without a condom. At 31 months, students in Safer Choices schools reported having sexual intercourse without a condom with fewer partners. The program positively affected psychosocial variables and school climate for HIV/STD and pregnancy prevention. The program did not influence the prevalence of recent sexual intercourse. Schoolwide changes in condomuse demonstrated that aschool-based program can reduce the sexual risk behavior of adolescents.
- Carvajal, S. C., Baumler, E., Harrist, R. B., & Parcel, G. S. (2001). Multilevel Models and Unbiased Tests for Group Based Interventions: Examples from the Safer Choices Study. Multivariate behavioral research, 36(2), 185-205.More infoFor many large-scale behavioral interventions, random assignment to intervention condition occurs at the group level. Data analytic models that ignore potential non-independence of observations provide inefficient parameter estimates and often produce biased test statistics. For studies in which individuals are randomized by groups to treatment condition, multilevel models (MLMs) provide a flexible approach to statistically evaluating program effects. This article presents an explanation of the need for MLM's for such nested designs and uses data from the Safer Choices study to illustrate the application of MLMs for both continuous and dichotomous outcomes. When designing studies, researchers who are considering group-randomized interventions should also consider the features of the multilevel analytic models they might employ.
- Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G., Banspach, S., Collins, J., Baumler, E., Carvajal, S., & Harrist, R. (2001). Safer choices: reducing teen pregnancy, HIV, and STDs. Public health reports (Washington, D.C. : 1974), 116 Suppl 1, 82-93.More infoThis study evaluated the long-term effectiveness of Safer Choices, a theory-based, multi-component educational program designed to reduce sexual risk behaviors and increase protective behaviors in preventing HIV, other STDs, and pregnancy among high school students.
- Carvajal, S. C., Wiatrek, D. E., Evans, R. I., Knee, C. R., & Nash, S. G. (2000). Psychosocial determinants of the onset and escalation of smoking: cross-sectional and prospective findings in multiethnic middle school samples. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 27(4), 255-65.More infoTo investigate a broad range of social influence-related and global determinants of smoking to aid in the design of comprehensive multiethnic interventions by testing the most important factors of initiation and escalation of smoking across various subgroups.
- Koval, J. J., Pederson, L. L., Mills, C. A., McGrady, G. A., & Carvajal, S. C. (2000). Models of the relationship of stress, depression, and other psychosocial factors to smoking behavior: a comparison of a cohort of students in grades 6 and 8. Preventive medicine, 30(6), 463-77.More infoSix specific hypotheses regarding putative mechanisms by which stressful life events might lead to initiation of smoking among adolescents were proposed and tested on a Grade 6 cohort of students in Scarborough, Ontario, Canada. In addition, the data were used to determine the set of risk factors for initiation of smoking most pertinent to the experience of the cohort.
- Vanoss Marín, B., Coyle, K. K., Gómez, C. A., Carvajal, S. C., & Kirby, D. B. (2000). Older boyfriends and girlfriends increase risk of sexual initiation in young adolescents. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 27(6), 409-18.More infoTo explore the prevalence and impact of older boyfriends or girlfriends on sexual behavior in sixth graders (mean age 11.5 years).
- Carvajal, S. C., Parcel, G. S., Banspach, S. W., Basen-Engquist, K., Coyle, K. K., Kirby, D., & Chan, W. (1999). Psychosocial predictors of delay of first sexual intercourse by adolescents. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 18(5), 443-52.More infoThis investigation predicted adolescents' delay of intercourse onset from attitudes, social norms, and self-efficacy about refraining from sexual intercourse. Age, gender, ethnicity, and parental education were also examined as predictors and moderators of the relationships among the 3 psychosocial determinants and onset. The participants (N = 827), part of a cohort initially surveyed in the 9th grade, reported at baseline that they had never engaged in intercourse. The multivariable proportional hazards regression model suggested that adolescents with more positive attitudinal and normative beliefs, as well as those with a parent who graduated from college, were less likely to engage in intercourse in the follow-up period (up to approximately 2 years). Interventions that include an objective to delay onset may benefit from addressing psychosocial determinants, especially attitudes and norms about sexual intercourse.
- Weller, N. F., Tortolero, S. R., Kelder, S. H., Grunbaum, J. A., Carvajal, S. C., & Gingiss, P. M. (1999). Health risk behaviors of Texas students attending dropout prevention/recovery schools in 1997. The Journal of school health, 69(1), 22-8.More infoThis study determined prevalence of health risk behaviors of 9th through 12th grade students attending dropout prevention/recovery alternative schools in Texas in 1997. Participants were 470 youth whose health risk behaviors were assessed using the Youth Risk Behavior Survey in an anonymous, self-administered format. Behaviors measured included frequency of weapon-carrying and fighting, suicide-related behaviors, substance use, and sexual behaviors. A substantial percentage of alternative school students reported participating in behaviors that placed them at acute or chronic health risk. Differences in the prevalence of risk behaviors were noted by gender, racial/ethnic, and age subgroups. In addition, alternative school students frequently engaged in multiple risk behaviors. These findings suggest a need for comprehensive school-based health education/intervention programs to reduce the prevalence of risk behaviors in populations of alternative school students.
- Evans, R. W., Evans, R. I., & Carvajal, S. (1998). Survey of injuries among West End performers. Occupational and environmental medicine, 55(9), 585-93.More infoTo obtain more information about injuries of West End performers.
- Evans, R. W., Evans, R. I., Carvajal, S., & Perry, S. (1996). A survey of injuries among Broadway performers. American journal of public health, 86(1), 77-80.More infoTo obtain more information about injuries of Broadway performers, 313 performers appearing in 23 Broadway companies were surveyed. The percentage of performers injured was 55.5%, with a mean of 1.08 injuries performer. Lower extremity injuries were the most common. Sixty-two percent of performers believed that their injuries were preventable. As this study reports factors that significantly increase the risk of injury for dancers and actors, it may help to heighten concern with reducing the incidence of injuries to professional performers, theatrical students, and nonprofessionals worldwide.
- Beamer, P., Ingram, M., Carvajal, S. C., Bell, M. L., Griffin, S., Lee, A. A., Wertheim, B., Wolf, A. M., Parra, K. L., Lopez-Galvez, N. I., Wagoner, R. S., Cortez, I., Sandoval, F., & Lothrop, N. Z. (2019, Summer). The Feasibility of Identifying and Quantifying Worker Exposures to Volatile Organic Chemicals in Beauty Salons and Auto Shops in the Southwestern USA. International. Society of Exposure Science ConferenceInternational. Society of Exposure Science.
- Beamer, P., Ingram, M., Carvajal, S. C., Bell, M. L., Griffin, S., Lee, A. A., Wertheim, B., Wolf, A. M., Parra, K. L., Lopez-Galvez, N. I., Wagoner, R. S., Cortez, I., Sandoval, F., & Lothrop, N. Z. (2019, Summer). The Feasibility of Identifying and Quantifying Worker Exposures to Volatile Organic Chemicals in Beauty Salons and Auto Shops in the Southwestern USA. Research to Action GranteesNIH/NIEHS.
- Carvajal, S. C., Ingram, M., Coulter, K. M., Lohr, A. M., Wilkinson-Lee, A. M., Ochoa, M., & Espinoza, C. (2019, Fall). Participant Perspectives on a Community-Clinical Linkage Intervention to Reduce Chronic Disease Risk and Promote Well-being. American Public Health Association Annual Meeting. Pittsburgh, PA: APHA.
- Carvajal, S. C., Lohr, A. M., Espinoza, C., Ingram, M., & Coulter, K. M. (2019, Fall). Examining the Associations between Community Health Worker-Rated Health and Depressive Symptomology in Latino Adults. American Public Health Association Annual Meeting. Pittsburgh, PA: APHA.
- Redondo, F., Carvajal, S. C., Ingram, M., Coulter, K. M., David, C., Velasco, M., Lohr, A. M., Wilkinson-Lee, A. M., & Coronado, G. (2019, Fall). Community Health Workers’ and their Supervisors’ Perceptions on a Community-Clinical Linkage Intervention to Reduce Chronic Disease Risk and Promote Well-being. American Public Health Association. Pittsburgh, PA: APHA.
- Carvajal, S. C. (2018, March). Health inequities and resilience in Latinx populations: Concepts, trends and prevention research from the Arizona-Sonora region. Invited Scholar, AAHB's Annual Scientific Meeting “An Equity Approach to Health Behavior Innovation". Portland OR: American Academy of Health Behavior.
- Carvajal, S. C. (2018, November). Six co-authored oral or poster presentations at 2018 APHA in San Diego, CA. American Public Health Association. San Diego.More infoFormative Research for a Health Communication Framing Intervention to Reduce High-Risk Alcohol Consumption in Hispanic Men. Luis Valdez, PhD, MPH, University of Massachusetts - Amherst, Amherst, MA, David O. Garcia, PhD, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, Scott Carvajal, PhD, MPH, CHW-facilitated social support in fostering emotional wellness and chronic disease self-management. Maia Ingram, MPH, University of Arizona, Tucson, AZ, Cynthia Espinoza, Yuma County Health Department, Gloria Coronado, Yuma County Public Health Services District, Yuma, AZ, Martha Ochoa, Arizona Community Health Worker Association, Tucson, AZ, Maria Velasco, BA, El Rio Community Health Center, Tucson, AZ, Abby Lohr, MPH, University of Arizona, Tucson and Scott Carvajal, PhD, MPH, Latino representation in bullying and depression research. Karen Lutrick, MS1, Velia Nuno, PhD, MSW1, Sheri Bauman, PhD1 and Scott Carvajal, PhD, MPH2, University of Arizona, TucsonMechanisms for race and gender disparities in cognitive decline: A systematic review. Rachel Peterson, MPH, MA1, Mindy Fain, MD2, John Ehiri, PhD, MPH, MSc3, Emily Butler, PhD1 and Scott Carvajal, PhD, MPH4, University of Arizona, Tucson, AZYPAR Photovoice Findings: Factors that Influence Adolescent Substance Use on the U.S.-Mexico Border. Elizabeth Salerno Valdez, MPH1, Samantha Sabo, DrPH2, Josephine Korchmaros, Ph.D.1, David O. Garcia, PhD3, Nathan Stupiansky, PhD4 and Scott Carvajal, PhD, MPH5Using Youth Participatory Action Research and Photovoice to Examine Adolescent Substance Use on the U.S.-Mexico Border. Alejandro Duarte1, Elizabeth S. Valdez, MPH2, Samantha Sabo, DrPH3, David O. Garcia, PhD4, Josephine Korchmaros, Ph.D.2 and Scott Carvajal, PhD, MPH5,
- Carvajal, S. C. (2018, November). Social Justice Education and Health Promotion Challenges and Opportunities (Invited Forum Lead). University of New Mexico Health Sciences Center. Albuquerque, NM.
- Carvajal, S. C. (2018, October). Health inequities and resilience in Latino populations: trends and prevention research from the Arizona Prevention Research Center. Colorado School of Public Health (Invited Scholarly Presentation). Aurora, CO.
- Carvajal, S. C., Carvajal, S. C., Colina, S., Colina, S., Piper, R., Piper, R., Coco, L. S., Coco, L. S., Ingram, M., Ingram, M., Wong, A. A., Wong, A. A., Marrone, N. L., & Marrone, N. L. (2018, November 15). Community-based Hearing Loss Education and Support Groups for Older Hispanic/Latinx Adults. The Gerontological Society of America 2018 Annual Scientific Meeting. John B. Hynes Veterans Memorial Convention Center in Boston, Massachusetts: The Gerontological Society of America.
- Carvajal, S. C., Colina, S., Piper, R., Coco, L. S., Ingram, M., Wong, A. A., & Marrone, N. L. (2018, November 15). Community-based Hearing Loss Education and Support Groups for Older Hispanic/Latinx Adults. The Gerontological Society of America 2018 Annual Scientific Meeting. John B. Hynes Veterans Memorial Convention Center in Boston, Massachusetts: The Gerontological Society of America.
- Carvajal, S. C., Korchmaros, J. D., Stupiansky, N. W., Garcia, D. O., Sabo, S., & Valdez, E. (2018, November). Using youth participatory action research and photovoice to examine adolescent substance use on the U.S.-Mexico border. Paper presented at the American Public Health Association annual conference. San Diego, CA: American Public Health Association.
- Carvajal, S. C., Stupiansky, N. W., Garcia, D. O., Korchmaros, J. D., Sabo, S., & Valdez, E. (2018, November). YPAR photovoice findings: Factors that influence adolescent substance use on the U.S.-Mexico border. Paper presented at the American Public Health Association annual conference. San Diego, CA: American Public Health Association.
- Carvajal (lead), S. C. (2017, August). Health behavior changes in Latino US-Mexico border residing adults participating in chronic disease preventive interventions .. 31st annual conference of the European Health Psychology Society, Padova, Italy. August 29 –September 2 2017..
- Carvajal (lead), S. C. (2017, Fall). Impacts of two community health worker-led chronic disease preventive interventions on health behavior changes in US-Mexico border residing adults. 145th APHA Annual Meeting & Expo. Atlanta, GA November 3 – November 8, 2017..More infoCarvajal, S., Huang, S., Bell, M., Denman, C., de Zapien, J., Cornejo, E., Chang, J., Staten, LK., & Rosales, R. Impacts of two community health worker-led chronic disease preventive interventions on health behavior changes in US-Mexico border residing adults145th APHA Annual Meeting & Expo. Atlanta, GA November 3 – November 8, 2017.
- Carvajal (lead), S. C. (2017, Fall). The Role of Community Health Workers in Institutional and Community Policy Change in Arizona.. Improving Population Health: Now, Across People’s Lives and Across Generations to Come. Austin TX. October 2 - 4, 2017.More infoCarvajal, S. Ingram, M., Sabo, S., Piper, R., & Reinschmidt, K. The Role of Community Health Workers in Institutional and Community Policy Change in Arizona. Improving Population Health: Now, Across People’s Lives and Across Generations to Come. Austin TX. October 2 - 4, 2017.
- Carvajal, S. C., & Reinschmidt (lead), K. (2017, Spring). Community-clinic linkages to improve emotional well-being among patients with or at risk for chronic disease: Piloting tools for community-based CHWs. 145th APHA Annual Meeting & Expo. Atlanta, GA November 3 – November 8, 2017..More infoReinschmidt, K.M., Sbarra, D.A., Lohr, A., Ingram, M. & Carvajal, S. Community-clinic linkages to improve emotional well-being among patients with or at risk for chronic disease: Piloting tools for community-based CHWs. 145th APHA Annual Meeting & Expo. Atlanta, GA November 3 – November 8, 2017.
- Gerald, L. B., Carvajal, S. C., Billheimer, D. D., Fisher, J., Gerald, J. K., & Lowe, A. (2017, May). Among children with asthma, greater acculturation is associated with having a medical home. American Thoracic Society International Conference. Washington, DC: American Thoracic Society.
- Gerald, L. B., Stefan, N., Bryson, D., Carvajal, S. C., Moore, M. A., Clemens, C. J., Billheimer, D. D., Fisher, J., Brown, M., & Gerald, J. K. (2017, May). Supervised Medicine in Schools: The SAMS Study. American Thoracic Society International Conference. Washington, DC: American Thoracic Society.
- Reinschmidt, K. M., Reinschmidt, K. M., Ingram, M., Ingram, M., Morales, S., Morales, S., Sabo, S. J., Sabo, S. J., Carvajal, S. C., & Carvajal, S. C. (2016, November). Documenting Community Health Worker Roles and Integration in Community Health Centers in Southern Arizona: Contributions to Evidence-based and Locally Relevant CHW Integration.. 144th APHA Annual Meeting & Expo. Denver, CO: APHA.
- Adamovich, S. L., Carvajal, S. C., Ingram, M., De Zapien, J. G., Harris, F. P., Colina, S., & Sanchez, D. (2015, March). Community-based participatory research on hearing loss in a border/low-resource community. American Auditory Society Scientific & Technology Meeting. Scottsdale, Arizona: American Auditory Society.
- Ingram, M., Murrieta, L., de Zapien, J. G., Herman, P., & Carvajal, S. C. (2015, Fall). Community Health Worker-driven participatory action research method to improve behavioral health services for farm workers in a primary care setting. American Public Health Association Annual Meeting. Chicago, IL: APHA.
- Ingram, M., Schachter, K. A., Murrieta, L., De Zapien, J. G., Herman, P., & Carvajal, S. C. (2015, Fall). Engaging the Mexican American farmworker community in improving the delivery of mental health services. American Public Health Association Annual Meeting. Chicago, IL: APHA.
- Sabo, S. J., Ingram, M., Dreifuss, H., Soto, Y., Carvajal, S. C., & Redondo, F. (2015, Fall). Impact of Community Health Workers (CHW) in the Primary Health Care Setting. American Public Health Association. Chicago, IL: APHA - Medical Care Section.More infoSince the 1960s, Community Health Workers (CHWs) have been characterized as community leaders who share the language, socioeconomic status and life experiences of the community members they serve and are recognized as a promising strategy to address glaring health inequities. Testimony the CHW effectiveness is their inclusion in the Affordable Care Act as distinct members of the health care team and the Centers for Medicaid and Medicare services recent guidance that allows for reimbursement of preventive services offered by unlicensed professionals such as CHWs. Objective: In response to such historical shifts in healthcare policy, and in partnership with local and state health departments and CHW professional associations, the Arizona Prevention Research Center (AzPRC) aimed to characterize the CHW workforce and assess the attitudes, barriers and impact of the utilization of CHWs among primary care providers and health plans. Methods: A series of quantitative and qualitative surveys and interviews engaged a large national sample of CHWs (N=1600) and a local sample of primary health care providers and health plans (N=150). Results: Approximately 28% (439) of CHWs surveyed nationally work in a clinical setting. Locally, health care providers reported CHW impact on the quality of care for high cost and high-risk patients, including improved access to care and health outcomes. CHWs improved provider efficiency through health systems navigation, health education and social support. Conclusions: CHWs are an effective member of the primary health care team and improve access to care and management of chronic conditions among high-risk high cost populations.
- Skobic, I., Carvajal, S. C., Gates, M., Haynes, P. L., Yuan, N. P., Yuan, N. P., Gates, M., Haynes, P. L., Skobic, I., & Carvajal, S. C. (2019, November). Stigma and willingness to seek mental health treatment among college students: Exploring potential moderators of a complex association. American Public Health Association 2019 Annual Meeting & Expo. Philadelphia, PA.
- Carvajal, S. C., Ingram, M., Sbarra, D. A., Lohr, A. M., & Reinschmidt, K. M. (2017, Fall). Community-clinic linkages to improve emotional well-being among patients with or at risk for chronic disease: Piloting tools for community-based CHWs. American Public Health Association Annual Meeting. Atlanta, Georgia: APHA.
- Reinschmidt, K. M., Ingram, M., Morales, S., Sabo, S. J., Blackburn, J., Murietta, L., David, C., & Carvajal, S. C. (2016, May). Taking a CBPR Approach to Documenting CHW Roles and Integration into Community Health Centers in Southern Arizona.. First Annual El Rio / The Wright Center Virtual Health Research Fair: “Community-Oriented Primary Care. ”. Tucson, AZ: El Rio Community Health Center.
- Sanchez, A., Marrone, N. L., Ingram, M., Sanchez, D., Colina, S., De Zapien, J. G., Adamovich, S. L., Carvajal, S. C., Sanchez, A., Marrone, N. L., Ingram, M., Sanchez, D., Colina, S., De Zapien, J. G., Adamovich, S. L., & Carvajal, S. C. (2016, October). Family Perspectives on Hearing and Communication Among Mexican American Older Adults. World Congress of Audiology. Vancouver, Canada.More infoSanchez, A., Marrone, N., Ingram, M., Sánchez, D.,Wong, A., Colina, S., de Zapien, J., Adamovich, S., &Carvajal, S. (September 2016) Family perspectives onhearing and communication among Mexican-Americanolder adults. Poster presented at the 33rd World Congressof Audiology. Vancouver, British Columbia, Canada.