Scott C Carvajal
- Professor, Public Health
- 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
- Full Professor (tenured), Mel and Enid Zuckerman College of Public Health, University of Arizona (2014 - Ongoing)
- Associate Professor (tenured), Mel and Enid Zuckerman College of Public Health, University of Arizona (2010 - 2014)
- Associate Professor (tenured), Mexican American Studies and Research Center, University of Arizona (2006 - 2009)
- Assistant Professor, Mexican American Studies and Research Center, University of Arizona (2002 - 2006)
- Associate Research Professor, Mexican American Studies and Research Center, University of Arizona (2000 - 2002)
- Senior Research Associate/Senior Analyst, Education, Research, Training (ETR) Associates (1998 - 2001)
- Post-doctoral fellow, Center for Health Promotion Research and Development, The University of Texas School of Public Health-Houston (1996 - 1997)
- 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 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)
- 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.
- 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.
- 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., Ingram, M., Schachter, K. A., Schachter, K. A., Sabo, S., Sabo, S., Reinschmidt, K. M., Reinschmidt, K. M., Gomez, S., Gomez, S., De Zapien, J. G., De Zapien, J. G., Carvajal, S. C., & 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.
- Carvajal, S. C., Martinez, D. E., & 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.
- 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.
- 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., Sanchez, A., Marrone, N. L., Marrone, N. L., Ingram, M., Ingram, M., Sanchez, D., Sanchez, D., Colina, S., Colina, S., De Zapien, J. G., De Zapien, J. G., Adamovich, S. L., Adamovich, S. L., Carvajal, S. C., & 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.