Maia Ingram

Interests

Research

Community Based Participatory Research; Community Health Workers; Public Health Advocacy & Policy Change; Implementation Research; Chronic Disease Prevention and Control; Physical Activity and the Built Environment; Community Engagement; Immigration

Teaching

Public Health Advocacy; Community Based Participatory Research; Community Engagement; Health Disparities; Border Health; Qualitative Methods

Courses

Scholarly Contributions

Books

• Ingram, M., & Murrieta, L. (2017). Action Research Methods: Partnering With Community Health Workers to Facilitate Focus Groups With Farmworkers to Improve Mental Health Services in a Community Clinic. SAGE Publications Ltd. doi:10.4135/9781526401106

Chapters

• Ingram, M. (2021). Community Engagement Strategies in a Participatory Action Research Study with Farmworkers.. In Handbook of Social Inclusion(pp 1-20). SAGE. doi:https://doi.org/10.1007/978-3-030-48277-0_82-1
• Redondo-Martinez, F., Ingram, M., Tucker, K., Carter, H., Guernsey de Zapien, J., Sabo, S., Soto, Y., Verdugo, L., Bender, B., Velasco, M., & Fernandez, M. L. (2021). CHW’s Collective Voice: Advocating for their Profession. In Promoting the health of the community: Community health workers describing their roles, competencies and practice(pp 190-205). Springer Nature.
• Ingram, M. (2014). The Violence Against Women Act. In Undocumented Immigrants in the United States Today: An Encyclopedia of their Experiences(pp 761-764). Greenwood.
• Ingram, M., Yuan, N. P., Yuan, N. P., Koss, M. P., & Koss, M. P. (2007). Male Partner Violence. In Encyclopedia of Stress(pp 645-650). Elsevier Inc. doi:10.1016/B978-012373947-6.00246-4
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  This article defines types of male partner violence and describes the physical and mental health impact on victims. The use of posttraumatic stress disorder (PTSD) as the most common psychiatric diagnosis in the United States is discussed. Recommendations for prevention and intervention at the individual and public-policy level are offered.
• Ingram, M. (2006). Caring for the Border Communities. In The Colonia Reader. Springer, Boston, MA. doi:10.1007/0-387-23490-X_20
• Ingram, M. M. (2005). Caring for the Border Communities. In Handbook of Diabetes Management(pp 237--245). Springer US.

Journals/Publications

• Ingram, M. (2022). Guided evaluation activities to understand children’s experience of an obesity prevention programme.. Health Education Journal, 31(1), 109-120. doi:0.1177/00178969211052355
• Aceves, B., Denman, C. A., Ingram, M., Torres, J. F., Nuño, T., Garcia, D. O., Madhivanan, P., & Rosales, C. B. (2021). Testing Scalability of a Diabetes Self-Management Intervention in Northern Mexico: An Ecological Approach. Frontiers in public health, 9, 617468.
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  Type 2 diabetes mellitus (T2DM) has become a major issue in Mexico, reporting almost 100,000 attributable deaths in 2016. Low-income Mexican citizens who face various issues associated with T2DM, including the lack of access to self-management services, are particularly affected by the condition. Health centers have been designated to serve T2DM patients by providing resources on chronic disease prevention. (MSD) is a self-management intervention developed to address cardiovascular complications and other health issues within the T2DM population, which have been proven effective and useful for health centers. The intervention was designed for T2DM support groups- (GAMs) located within health centers. From February to June 2019, a binational research team conducted a test scale-up study in Northwest Sonora under the Ministry of Health utilizing the Institute for Healthcare Improvement Framework for scaling up health interventions. Investigators worked in collaboration and trained 19 stakeholders from a regional health system identified from various ecological levels on MSD and implementation process. All five GAMs within the regional health system received and completed the intervention. In total, 72 participants were enrolled with behavioral and biological [HbA1c, blood pressure, body mass index (BMI)] measures taken at baseline. Post-intervention measurements were taken from 72% of participants who completed the intervention. Statistical analysis demonstrated improved behavioral and biological measures when comparing baseline to post-intervention, specifically statistically significant improvements in HbA1c and sugar-sweetened beverage consumption. Implementation fidelity (IF) measures indicated extensive adherence to the intervention curriculum, and moderators specifically demonstrated influences on implementation. Stakeholders from various ecological levels provided support to those facilitating the MSD intervention by allotting time and resources to properly prepare for sessions. An implementation coordinator from the regional health office assisted MSD facilitators by resolving barriers to implementation and worked toward federal accreditation for GAMs to receive additional funding. Results provide evidence for using regional health systems as a scalable unit when implementing chronic disease self-management interventions state- and nationwide. This study will help inform future efforts to scale up the health intervention in various states throughout Mexico. www.ClinicalTrials.gov; https://www.clinicaltrials.gov/ct2/show/NCT02804698?term=NCT02804698&draw=2&rank=1, identifier: NCT02804698.
• Aceves, B., Ruiz, M., Ingram, M., Denman, C., Garcia, D. O., Madhivanan, P., & Rosales, C. (2021). Mental health and diabetes self-management: assessing stakeholder perspectives from health centers in Northern Mexico. BMC health services research, 21(1), 177.
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  People living with diabetes have an increased risk of developing mental health issues. Mexico has observed a high prevalence of people living with diabetes suffering from mental health issues, such as anxiety and depression. Self-management programs have demonstrated promise in helping participants address and prevent not only physiological health complications but mental health issues as well. This qualitative study aimed to understand the mental health benefits of a diabetes self-management intervention for health centers in Northern Mexico and opportunities for improvement through assessing stakeholder perspectives.
• Colina, S., Rodriguez-Guerra, M., Marrone, N. L., Ingram, M., Navarro, K., & Arizmendi, G. (2022). Equity and inclusion in research studies: Does translation hinder equal participation. Ethics and Human Research.
• Fernandez Haddad, M., Aguirre, A., & Ingram, M. (2021). The role of promotoras in community-based social marketing: anti-littering interventions. The Journal of Social Marketing, 1(4), 597-615.
• Ingram, M., Coulter, K., Doubleday, K., Espinoza, C., Redondo, F., Wilkinson-Lee, A. M., Lohr, A. M., & Carvajal, S. C. (2021). An integrated mixed methods approach to clarifying delivery, receipt and potential benefits of CHW-facilitated social support in a health promotion intervention. BMC health services research, 21(1), 793.
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  Social support plays a critical role in physical and emotional health, making it an important component of community health worker (CHW) health promotion interventions. Different types of support operate in different ways, however, and the relationship between the nature of CHW support and the subsequent health benefit for their clients is not well understood.
• Ingram, M., Wolf, A. M., López-Gálvez, N. I., Griffin, S. C., & Beamer, P. I. (2021). Proposing a social ecological approach to address disparities in occupational exposures and health for low-wage and minority workers employed in small businesses. Journal of exposure science & environmental epidemiology, 31(3), 404-411.
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  Occupational disease and injuries are the 8th leading cause of death in the United States. Low-wage and minority workers are more likely to work in hazardous industries and are thus at greater risk. Within the small business sector, in particular, the health of low-wage and minority workers is threatened by a multitude of complex and interrelated factors that increase their risk for injuries, death, and even chronic disease. The COVID-19 pandemic has amplified these concerns, as many low-wage and minority workers are essential workers, and many small businesses are reopening with little to no guidance. The article describes work-related health risks and reviews current research on occupational and social ecological approaches to improving the health of minority and low-wage workers primarily employed by small businesses. We propose a conceptual framework that integrates the social ecological model with the hierarchy of controls to address work-related health among low-wage and minority workers specifically in the small business sector. Community-based strategies are recommended to engage small business owners and workers in efforts to address their immediate needs, while building towards sustainable policy change over time. These strategies are of particular importance as small businesses reopen in the ongoing pandemic.
• Iroz-elardo, N., Iroz-elardo, N., Ingram, M., & Adkins, A. (2021). Measuring perceptions of social environments for walking: A scoping review of walkability surveys.. Health & place, 67, 102468. doi:10.1016/j.healthplace.2020.102468
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  The neighborhood pedestrian environment is an important determinant of physical activity and health. Despite widespread acknowledgment that neighborhoods' social and physical characteristics contribute to a walkable place, constructs and metrics remain focused primarily on the built environment. This scoping review documents the current state of the practice to measure perceived social elements of pedestrian environments in order to identify measurement strategies to understand and support walking, particularly in socially diverse neighborhoods. We identified 20 survey instruments focused on pedestrian environments, walkability, or physical activity at the local (neighborhood) scale and designed to capture residents' perceptions of outdoor walking environments. Across the 20 instruments, we identified and categorized 182 distinct items that measured social environments into four domains (social capital, personal safety, physical signifiers, and general neighborhood descriptors) and thirteen subdomains. Many items emphasized negative social elements, such as crime and disorder. Only a few items focused on community identity. Most instruments cover some aspects of the social environment well, but few provide a holistic inventory of the social environment across domains and subdomains. We also observe that the state of the practice seems frozen, with most instruments in use having originated in 2010 or earlier.
• Landau, A., Sanchez, B., Kiser, L., De Zapien, J., Hall-Lipsy, E., Pina Lopez, D., Ingram, M., & Ahumada, J. (2021). Health Sciences Interprofessional Collaborative: A Perspective on Migration, COVID-19, and the Impact on Indigenous Communities. Frontiers in sociology, 6, 618107.
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  At the United States-Mexico border, the impacts of immigration policy are dynamic with political, humanitarian, and health outcomes. This article highlights the experiences at the Casa Alitas migrant shelter in Tucson, Arizona. Casa Alitas aims to meet the needs of the im/migrants it serves, including the unique needs of indigenous asylum-seekers from Central America. We highlight the importance of community-based humanitarian response to support asylum-seekers in a way that acknowledges our shared humanity and implements specific approaches (e.g., language justice and trauma informed care). The effort at Casa Alitas is unique because in addition to other partnerships, Casa Alitas established an interprofessional collaboration between the University of Arizona Health Sciences Colleges and the Arizona State University School of Social Work. The interprofessional collaboration encourages mutual education amongst our professions and the use of our extended networks to meet the needs of im/migrants and asylum seekers in our community and the United States. We recommend the development of best practices in asylum health care, the importance of creating border-wide networks to build on local resources, and highlight the importance of exposing future health practitioners to trauma informed and culturally and linguistically appropriate care.
• Lee, A. A., Ingram, M., Quijada, C., Yubeta, A., Cortez, I., Lothrop, N., & Beamer, P. (2021). Responsibility for chemical exposures: perspectives from small beauty salons and auto shops in southern metropolitan Tucson. BMC public health, 21(1), 271.
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  Throughout the United States, low-wage, minority workers are disproportionately affected by occupational illnesses and injuries. Chronic exposure to hazardous chemicals at work can lead to serious illnesses, contributing to health inequities. In this article, we expand on theories of 'responsibilization' in an occupational health context to reveal how responsibilities for workplace chemical exposures are negotiated by workers and owners in Latinx-owned small businesses.
• Lohr, A. M., Doubleday, K., Ingram, M., Wilkinson-Lee, A. M., Coulter, K., Krupp, K., Espinoza, C., Redondo-Martinez, F., David, C., & Carvajal, S. C. (2021). A Community Health Worker-Led Community-Clinical Linkage Model to Address Emotional Well-Being Outcomes Among Latino/a People on the US-Mexico Border. Preventing chronic disease, 18, E76.
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  Compared with their non-Hispanic White counterparts, Latino/a people have limited access to health resources that might improve their emotional well-being. Interventions that prioritize the Latino/a population, address social determinants of health, and decrease health disparities are needed. The objective of this study was to describe a community-clinical linkage intervention led by community health workers (CHWs) in 3 Latino/a populations along the US-Mexico border.
• Sabo, S., Wexler, N., O'Meara, L., Dreifuss, H., Soto, Y., Redondo, F., Carter, H., Guernsey de Zapien, J., & Ingram, M. (2021). Organizational Readiness for Community Health Worker Workforce Integration Among Medicaid Contracted Health Plans and Provider Networks: An Arizona Case Study. Frontiers in public health, 9, 601908.
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  Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona - which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff.
• Zapien, J. G., Vasquez, M. D., Rosales, C. B., Nuno, T., Ingram, M., Gonzalez-fagoaga, J. E., Denman, C. A., Cornejo, E., Bell, M. L., Anderson, E. J., & Aceves, B. (2021). Meta Salud Diabetes for cardiovascular disease prevention in Mexico: a cluster-randomized behavioural clinical trial.. International journal of epidemiology. doi:10.1093/ije/dyab072
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  Healthy lifestyle interventions offered at points of care, including support groups, may improve chronic disease management, especially in low-resource populations. We assessed the effectiveness of an educational intervention in type 2 diabetes (T2D) support groups to reduce cardiovascular disease (CVD) risk..We recruited 518 participants to a parallel, two-arm, cluster-randomized, behavioural clinical trial across 22 clinics in Sonora, Mexico, between August 2016 and October 2018. We delivered a 13-week secondary prevention intervention, Meta Salud Diabetes (MSD), within the structure of a support group (GAM: Grupo de Ayuda Mutua) in government-run (community) Health Centres (Centros de Salud). The primary study outcomes were difference in Framingham CVD risk scores and hypertension between intervention (GAM+MSD) and control (GAM usual care) arms at 3 and 12 months..CVD risk was 3.17% age-points lower in the MSD arm versus control at 3 months [95% confidence interval (CI): -5.60, -0.75, P = 0.013); at 12 months the difference was 2.13% age-points (95% CI: -4.60, 0.34, P = 0.088). There was no evidence of a difference in hypertension rates between arms. Diabetes distress was also lower at 3 and 12 months in the MSD arm. Post-hoc analyses showed greater CVD risk reduction among men than women and among participants with HbA1c < 8..MSD contributed to a positive trend in reducing CVD risk in a low-resource setting. This study introduced an evidence-based curriculum that provides T2D self-management strategies for those with controlled T2D (i.e. HbA1c < 8.0) and may improve quality of life.
• Zapien, J. G., Wexler, N., Soto, Y., Sabo, S., Redondo, F., O'meara, L., Ingram, M., Dreifuss, H., & Carter, H. (2021). Organizational Readiness for Community Health Worker Workforce Integration Among Medicaid Contracted Health Plans and Provider Networks: An Arizona Case Study.. Frontiers in public health, 9, 601908. doi:10.3389/fpubh.2021.601908
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  Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona - which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff.
• Aceves, B., Ingram, M., Nieto, C., de Zapien, J. G., & Rosales, C. (2020). Non-communicable disease prevention in Mexico: policies, programs and regulations. Health promotion international, 35(2), 409-421.
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  Non-communicable diseases (NCD), such as diabetes and cardiovascular disease, have become a leading cause of the death in Mexico. The federal government has addressed this issue through developing NCD prevention plans, regulations and policies (PRPs) that seek to address social and environmental factors, which was led by the National Institute of Public Health and Ministry of Health in concert with various non-governmental organizations. This review aims to synthesize and summarize national NCD prevention PRPs addressing social and environmental factors passed from 2010 to 2016, and to assess the extent to which these efforts successfully addressed factors contributing to the epidemic. In total nine federal NCD prevention PRPs were identified from a scan that examined executive and legislative PRPs, which identified five documents. A scoping review was conducted for evaluation studies and reports corresponding to these PRPs. The majority of PRPs focused on nutrition, specifically the access and promotion of food. Studies and reports demonstrated that taxation on energy-dense low-nutrient foods and sugar-sweetened beverages were the most effective. Other PRPs had various issues with implementation, mostly related to adherence and resources available. Overall, there lacked evidence of evaluative work on several NCD prevention PRPs, specifically assessing implementation and effectiveness. Additionally, PRPs did not sufficiently address integration of clinical, social, environmental approaches and access to physical activity. While the Mexican federal government has taken the initial steps to address the multifactorial causes of NCD, firm political commitment and investment of significant resources are still needed.
• Bell, M. L., Ingram, M., Marrone, N. L., Marrone, N. L., Ingram, M., & Bell, M. L. (2018). Self-reported hearing difficulty and its association with general, cognitive, and psychosocial health in the state of Arizona, 2015. BMC Public Health.
• Carvajal, S. C., David, C., Coronado, G., Redondo, F., Espinoza, C., Sbarra, D. A., Wilkinson-Lee, A. M., Ingram, M., Lohr, A. M., Doubleday, K., & Krupp, K. F. (2020). The Impact of a Community Health Worker Intervention on Depressive Symptoms among Mexican Americans Living in U.S.-Mexico Border Region. BMC Public Health.
• Coco, L. S., Ingram, M., & Marrone, N. L. (2018). Qualitative Research Methods to Investigate Communication within an Aural Rehabilitation Intervention. American Journal of Audiology.
• Colina, S., Carvajal, S. C., Wong, A., Piper, R., Marrone, N., Ingram, M., Colina, S., & Carvajal, S. C. (2020). Task Sharing in Hearing Care: Putting Principles Into Practice to Advance Access to Hearing Care. Innovation in Aging, 4, 807-807. doi:10.1093/geroni/igaa057.2932
• 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).
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  Latinos 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.
• Coulter, K., Ingram, M., McClelland, D. J., & Lohr, A. (2020). Positionality of Community Health Workers on Health Intervention Research Teams: A Scoping Review. Frontiers in public health, 8, 208.
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  Community health workers (CHWs) are increasingly involved as members of health intervention research teams. Given that CHWs are engaged in a variety of research roles, there is a need for better understanding of the ways in which CHWs are incorporated in research and the potential benefits. This scoping review synthesizes evidence regarding the kinds of health research studies involving CHWs, CHWs' roles in implementing health intervention research, their positionality on research teams, and how their involvement benefits health intervention research. The scoping review includes peer-reviewed health intervention articles published between 2008-2018 in the U.S. A search of PubMed, Embase and CINAHL identified a total of 3,129 titles and abstracts, 266 of which met the inclusion criteria and underwent full text review. A total of 130 articles were identified for a primary analysis of the research and the level of CHWs involvement, and of these 23 articles were included in a secondary analysis in which CHWs participated in 5 or more intervention research phases. The scoping review found that CHWs are involved across the spectrum of research, including developing research questions, intervention design, participant recruitment, intervention implementation, data collection, data analysis, and results dissemination. CHW positionality as research partners varied greatly across studies, and they are not uniformly integrated within all stages of research. The majority of these studies employed a community based participatory research (CBPR) approach, and CBPR studies included CHWs as research partners in more phases of research relative to non-CBPR studies. This scoping review documents specific benefits from the inclusion of CHWs as partners in health intervention research and identifies strategies to engage CHWs as research partners and to ensure that CHW contributions to research are well-documented.
• Daivadanam, M., & Ingram, M. (2018). The role of context in implementation research for non- communicable diseases: answering the 'how-to' dilemma. PLOS One.
• Ingram, M. (2019). Establishing voluntary certification of community health workers in Arizona: A case study of building a unified workforce. Human Resources for Health.
• Ingram, M. (2019). Health disparities, transportation equity and complete streets: A case study of a policy development process through the lens of critical race theory. Journal of Urban Health.
• Ingram, M. (2019). Proposing a social ecological approach to address disparities in occupational safety and health for low-wage workers employed in small businesses.. American Journal of Industrial Medicine.
• Ingram, M. (2020). Immigrants and Access to Care: Public Health Must Lead the Way in Changing the Nation's Narrative. American journal of public health, 110(9), 1260-1261.
• Ingram, M., Denman, C., Cornejo, E., Aceves, B., Ocejo, A. G., Guernsey De Zapien, J. E., & Rosales, C. B. (2018). From implementation to scale up: Qualitative process evaluation of Meta Salud Diabetes, a primary care health promotion intervention to reduce CVD risk among a diabetic population in Sonora, Mexico. BMC Public Health.
• Ingram, M., Leih, R., Adkins, A., Sonmez, E., & Yetman, E. (2020). Health Disparities, Transportation Equity and Complete Streets: a Case Study of a Policy Development Process through the Lens of Critical Race Theory. Journal of urban health : bulletin of the New York Academy of Medicine, 97(6), 876-886.
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  Historic disinvestment in transportation infrastructure is directly related to adverse social conditions underlying health disparities in low-income communities of color. Complete Streets policies offer a strategy to address inequities and subsequent public health outcomes. This case study examines the potential for an equity-focused policy process to address systemic barriers and identify potential measures to track progress toward equity outcomes. Critical race theory provided the analytical framework to examine grant reports, task force notes, community workshop/outreach activities, digital stories, and stakeholder interviews. Analysis showed that transportation inequities are entrenched in historically rooted disparities that are perpetuated in ongoing decision-making processes. Intentional efforts to incorporate equity into discussions with community members and representatives contributed to explicit equity language being included in the final policy. The potential to achieve equity outcomes will depend upon policy implementation. Concrete strategies to engage community members and focus city decision-making practices on marginalized and disenfranchised communities are identified.
• Ingram, M., Sabo, S., Redondo, F., Soto, Y., Russell, K., Carter, H., Bender, B., & de Zapien, J. G. (2020). Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce. Human resources for health, 18(1), 46.
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  Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort.
• Iroz-Elardo, N., Adkins, A., & Ingram, M. (2020). Measuring perceptions of social environments for walking: A scoping review of walkability surveys. Health & place, 67, 102468.
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  The neighborhood pedestrian environment is an important determinant of physical activity and health. Despite widespread acknowledgment that neighborhoods' social and physical characteristics contribute to a walkable place, constructs and metrics remain focused primarily on the built environment. This scoping review documents the current state of the practice to measure perceived social elements of pedestrian environments in order to identify measurement strategies to understand and support walking, particularly in socially diverse neighborhoods. We identified 20 survey instruments focused on pedestrian environments, walkability, or physical activity at the local (neighborhood) scale and designed to capture residents' perceptions of outdoor walking environments. Across the 20 instruments, we identified and categorized 182 distinct items that measured social environments into four domains (social capital, personal safety, physical signifiers, and general neighborhood descriptors) and thirteen subdomains. Many items emphasized negative social elements, such as crime and disorder. Only a few items focused on community identity. Most instruments cover some aspects of the social environment well, but few provide a holistic inventory of the social environment across domains and subdomains. We also observe that the state of the practice seems frozen, with most instruments in use having originated in 2010 or earlier.
• Lohr, A. M., Alves, S., Coulter, K., Redondo-Martinez, F., Coronado, G., David, C., Espinoza, C., Ingram, M., Carvajal, S. C., & Wilkinson-Lee, A. M. (2020). Community Health Worker-Led Community Clinical Linkages on the U.S. / Mexico Border: Lessons Learned. Progress in Community Health Partnerships.
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  We are in the process of writing this manuscript and should submit by end of spring 2020.
• Lohr, A. M., Henry, N., Roe, D., Rodriguez, C., Romero, R., & Ingram, M. (2020). Evaluation of the Impact of School Garden Exposure on Youth Outlook and Behaviors toward Vegetables in Southern Arizona. The Journal of school health, 90(7), 572-581.
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  Our objective was to evaluate the effect of garden-based learning on outlook and behaviors toward vegetables among primarily Latinx students. An educational strategy, garden-based learning is a teaching tool that complements other disciplines.
• Sanchez, D., Adamovich, S. L., Ingram, M., De Zapien, J. G., Harris, F. P., Colina, S., Sanchez, A., & Marrone, N. L. (2016). The Potential in Preparing Community Health Workers to Address Hearing Loss.. Journal of the American Academy of Audiology.
• Aceves, B., Ingram, M., Nieto, C., de Zapien, J. G., & Rosales, C. (2019). Non-communicable disease prevention in Mexico: policies, programs and regulations. Health Promotion International, daz029. doi:https://doi.org/10.1093/heapro/daz029
• Adkins, A., Barillas-Longoria, G., Martinez, D. N., & Ingram, M. (2019). Differences in social and physical dimensions of perceived walkability in Mexican American and non-hispanic white walking environments in Tucson, Arizona. JOURNAL OF TRANSPORT & HEALTH, 14.
• Adkins, A., Barillas-Longoria, G., Martínez, D. N., & Ingram, M. (2019). Differences in social and physical dimensions of perceived walkability in Mexican American and non-hispanic white walking environments in Tucson, Arizona. Journal of transport & health, 14, 100585.
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  Physical activity patterns within the U.S. vary greatly across ethnicity, with data generally indicating lower rates among Hispanic/Latino adults. At the same time, Hispanic/Latino pedestrians face higher rates of injury and fatalities. Despite the importance of supportive physical activity environments on both health and safety outcomes, limited attention has been paid to ethnic or cultural differences in perceptions of supportive environments for walking. To fill this gap, we explore differences in physical and social environment contributors to perceived walkability between pedestrians in predominantly (> 70%) Mexican American and predominantly non-Hispanic white areas in Tucson, Arizona.
• Coco, L., Ingram, M., & Marrone, N. (2019). Qualitative research methods to investigate communication within a group aural rehabilitation intervention. INTERNATIONAL JOURNAL OF AUDIOLOGY.
• Coco, L., Ingram, M., & Marrone, N. (2019). Qualitative research methods to investigate communication within a group aural rehabilitation intervention. International journal of audiology, 58(10), 651-660.
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  Aural Rehabilitation (AR) aims to minimise negative effects of hearing loss. However, there has been limited study of the lived experience of clients receiving Aural Rehabilitation services, particularly for disparity populations. The purpose of this study is to demonstrate the use of an innovative qualitative approach to investigating communication in an AR setting among Hispanic/Latino older adult dyads. We developed a qualitative phenomenology approach using observation methods to document and analyse how individuals experience living with acquired hearing loss within group AR. Trained observers collected systematic, detailed notes on observations of participants over the course of a 5-week community-based AR intervention. In partnership with audiologists, Community Health Workers facilitated the intervention, which focussed on decreasing negative communication impacts of hearing loss for families. Audiometric data and subjective hearing disability results, using the HHIE-S Spanish version, are presented as additional context for observation outcomes. Participants were older Hispanic/Latino adults with hearing loss and their frequent communication partners (five dyads). Four themes related to the experience of communication emerged among dyads in the intervention: (i) emotions related to hearing loss (ii) communication dynamics, (iii) self-management of hearing loss, and (iv) hearing health advocacy. A mixed methods approach that includes group observation would contribute substantially to comprehensively evaluating group AR interventions.
• Daivadanam, M., Ingram, M., Annerstedt, K. S., Parker, G., Bobrow, K., Dolovich, L., Gould, G., Riddell, M., Vedanthan, R., Webster, J., Absetz, P., Alvesson, H. M., Androutsos, O., Chavannes, N., Cortez, B., Devarasetty, P., Fottrell, E., Gonzalez-Salazar, F., Goudge, J., , Herasme, O., et al. (2019). The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma. PLOS ONE, 14(4).
• Daivadanam, M., Ingram, M., Sidney Annerstedt, K., Parker, G., Bobrow, K., Dolovich, L., Gould, G., Riddell, M., Vedanthan, R., Webster, J., Absetz, P., Mölsted Alvesson, H., Androutsos, O., Chavannes, N., Cortez, B., Devarasetty, P., Fottrell, E., Gonzalez-Salazar, F., Goudge, J., , Herasme, O., et al. (2019). The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma. PloS one, 14(4), e0214454.
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  Understanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process.
• Ingram, M., Denman, C. A., Cornejo-Vucovich, E., Castro-Vasquez, M. D., Aceves, B., Ocejo, A. G., de Zapien, J. G., & Rosales, C. (2019). The Implementation Study: Qualitative Methods to Assess Integration of a Health Promotion Intervention Into Primary Care to Reduce CVD Risk Among an Underserved Population With Diabetes in Sonora, Mexico. Frontiers in public health, 7, 347.
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  Within health promotion research, there is a need to assess strategies for integration and scale up in primary care settings. Hybrid interventions that combine clinical effectiveness trials with implementation studies can elicit important contextual information on facilitators and barriers to integration within a health care system. This article describes lessons learned in developing and implementing a qualitative study of a cluster-randomized controlled trial (RCT) to reduce cardiovascular disease (CVD) among people with diabetes in Sonora, Mexico, 2015-2019. The research team worked cooperatively with health center personnel from 12 Centers that implemented the intervention. The study used observations, stakeholder meetings, case studies, staff interviews and decision maker interviews to explore issues such as staff capacity, authority, workflow, space, and conflicting priorities, as well as patients' response to the program within the clinical context and their immediate social environments. Applying a multi-layered contextual framework, two members of the research team coded an initial sample of the data to establish inclusion criteria for each contextual factor. The full team finalized definitions and identified sub nodes for the final codebook. Characteristics of management, staffing, and the local environment were identified as essential to integration and eventual adoption and scale up across the health system. Issues included absence of standardized training and capacity building in chronic disease and health promotion, inadequate medical supplies, a need for program monitoring and feedback, and lack of interdisciplinary support for center staff. Lack of institutional support stemming from a curative vs. preventive approach to care was a barrier for health promotion efforts. Evolving analysis, interpretation, and discussion resulted in modifications of flexible aspects of the intervention to realities of the health center environment. This study illustrates that a robust and comprehensive qualitative study of contextual factors across a social ecological spectrum is critical to elucidating factors that will promote future adoption and scale up of health promotion programs in primary care. Application of conceptual frameworks and health behavior theory facilitates identification of facilitators and barriers across contexts. www.ClinicalTrials.gov, identifier: NCT02804698 Registered on June 17, 2016.
• Ingram, M., Denman, C. A., Cornejo-Vucovich, E., del, C., Aceves, B., Ocejo, A. G., de, Z., & Rosales, C. (2019). The Meta Salud Diabetes Implementation Study: Qualitative Methods to Assess Integration of a Health Promotion Intervention Into Primary Care to Reduce CVD Risk Among an Underserved Population With Diabetes in Sonora, Mexico. FRONTIERS IN PUBLIC HEALTH, 7.
• 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.
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  Latinos 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.
• 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 US-Mexico border. BMC PUBLIC HEALTH, 19.
• 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.
• 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.
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  Hearing 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.
• 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 5-8years of age on the US-Mexico border. BMC PUBLIC HEALTH, 19.
• 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.
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  Due 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.
• Colina, S., Carvajal, S. C., Piper, R., Marrone, N., Ingram, M., Colina, S., Coco, L., & Carvajal, S. C. (2018). COMMUNITY-BASED HEARING LOSS EDUCATION AND SUPPORT GROUPS FOR OLDER HISPANIC/LATINO ADULTS.. Innovation in Aging, 2(suppl_1), 361-361. doi:10.1093/geroni/igy023.1334
• 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(3), 349-360.
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  Despite 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.
• Reinschmidt, K. M., Ingram, M., Morales, S., Sabo, S. J., Blackburn, J., Murrieta, L., David, C., & Carvajal, S. C. (2015). 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.
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  The 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. (2015). 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.
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  Organizational 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., Guernsey De Zapien, J. E., Gonzalez Fagoaga, J. E., Castro Vasquez, M. d., Valencia, C. I., Ingram, M., Cornejo Vucovich, E., Bell, M. L., Denman Champion, C., & Sabo, S. (2018). Meta Salud Diabetes study protocol: a cluster-randomised trial to reduce cardiovascular risk among a diabetic population of Mexico. BMJ Open, 3(8), 1-10. doi:10.1136/bmjopen-2017-020762
• Sabo, S., Denman Champion, C., Bell, M. L., Cornejo Vucovich, E., Ingram, M., Valenica, C., Castro Vasquez, M. D., Gonzalez-Fagoaga, E., Geurnsey de Zapien, J., Rosales, C. B., Sabo, S., Denman Champion, C., Bell, M. L., Cornejo Vucovich, E., Ingram, M., Valenica, C., Castro Vasquez, M. D., Gonzalez-Fagoaga, E., Geurnsey de Zapien, J., & Rosales, C. B. (2018). Meta Salud Diabetes study protocol: a cluster-randomised trial to reduce cardiovascular risk among a diabetic population of Mexico. BMJ open, 8(3), e020762.
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  Northern Mexico has among the highest rates of cardiovascular disease (CVD) and diabetes in the world. This research addresses core gaps in implementation science to develop, test and scale-up CVD risk-reduction interventions in diabetics through a national primary care health system.
• Adkins, A. S., Carrie, M., Scanze, M., Ingram, M., & Luhr, G. (2017). Contextualizing walkability: differences in built environment associations with walking and physical activity across socioeconomic contexts. Journal of the American Planning Association, 83(103), 1-18.
• Carvajal, S. C., Sabo, S. J., Reinschmidt, K. M., Murrieta, L., Morales, S., Ingram, M., David, C., Carvajal, S. C., & Blackburn, J. (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. doi:10.1097/jac.0000000000000178
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  The 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.
• Colina, S., Marrone, N., Ingram, M., & Sánchez, D. (2017). Translation Quality Assessment in Health Research: A Functionalist Alternative to Back-Translation. Evaluation & the health professions, 40(3), 267-293.
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  As international research studies become more commonplace, the importance of developing multilingual research instruments continues to increase and with it that of translated materials. It is therefore not unexpected that assessing the quality of translated materials (e.g., research instruments, questionnaires, etc.) has become essential to cross-cultural research, given that the reliability and validity of the research findings crucially depend on the translated instruments. In some fields (e.g., public health and medicine), the quality of translated instruments can also impact the effectiveness and success of interventions and public campaigns. Back-translation (BT) is a commonly used quality assessment tool in cross-cultural research. This quality assurance technique consists of (a) translation (target text [TT1]) of the source text (ST), (b) translation (TT2) of TT1 back into the source language, and (c) comparison of TT2 with ST to make sure there are no discrepancies. The accuracy of the BT with respect to the source is supposed to reflect equivalence/accuracy of the TT. This article shows how the use of BT as a translation quality assessment method can have a detrimental effect on a research study and proposes alternatives to BT. One alternative is illustrated on the basis of the translation and quality assessment methods used in a research study on hearing loss carried out in a border community in the southwest of the United States.
• Ingram, M., Adkins, A., Hansen, K., Cascio, V., & Somnez, E. (2017). Sociocultural perceptions of walkability in Mexican American neighborhoods: Implications for policy and practice. Journal of transport & health, 7(B), 172-180.
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  Walking is the most fundamental form of active travel, as well as the most popular form of physical activity. The built and social environment, however, may not adequately support active living, especially in low-income communities. While improving the walking infrastructure is essential, assumptions regarding perceptions of walkability based on a standardized norm may fail to address preferences within specific populations. Particularly in low-income and ethnically diverse urban environments, it is not clear whether objective or perceived measures provide the best assessment of an environments' conduciveness to walkability. This qualitative study of five Mexican American neighborhoods used walk-and-talk focus groups (n=20) and intercept surveys (n=108) to investigate residents' perceptions of their walking environments. Respondents differentiated between physical and social attributes in assessing neighborhood walkability. Physical attributes, such as lack of infrastructure, maintenance and traffic, were more salient to residents when describing what discouraged them from walking. Perceptions of the social environment appeared to be of greater significance than the physical environment in encouraging individuals to walk. While respondents were concerned about personal safety, the overall sociability of the neighborhood, nearby family, familiarity between neighbors, and a sense of social activity all contributed to a positive assessment of walkability and expressed desire to walk, Findings revealed complex interactions between characteristics of the social, built, natural, and policy environments. The emphasis on sociocultural influences on perceptions of walkability underscores the importance of engaging neighborhoods in conversations about their walking environments to reveal strategies that better serve the needs of residents.
• 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.
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  To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs).
• Kunz, S., Ingram, M., Piper, R., Wu, T., Litton, N., Brady, J., & Knudson, A. (2017). Rural Collaborative Model for Diabetes Prevention and Management: A Case Study. Health promotion practice, 18(6), 798-805.
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  Diabetes disproportionately affects racial and ethnic minorities, rural, and impoverished populations. This case study describes the program components and key lessons learned from implementing Vivir Mejor! (Live Better!), a diabetes prevention and management program tailored for the rural, Mexican American population. The program used workforce innovations and multisector partnerships to engage and activate a rural, mostly Hispanic population. Community health worker (CHW) roles were designed to reach and support distinct populations. Promotoras focused exclusively on health education and patient navigators individually coached patients with chronic disease management issues for the high-risk patient population. To extend diabetes health education to the broader community in Santa Cruz County, promotoras trained lay leaders to become peer educators. Multisector partnerships allowed the program to offer health and social services around diabetes care. The partners also supported provider engagement through continuing education workshops and digital story screening to encourage referrals to the program. Multisector partnerships, including partnering with critical access hospitals, for diabetes management and prevention, as well as using different types of CHWs to implement programs that target high- and low-risk populations are innovative and valuable components of the Vivir Mejor!
• Marrone, N., Ingram, M., Somoza, M., Jacob, D. S., Sanchez, A., Adamovich, S., & Harris, F. P. (2017). Interventional Audiology to Address Hearing Health Care Disparities: Oyendo Bien Pilot Study. Seminars in hearing, 38(2), 198-211.
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  Interventional audiology, specifically community-based outreach, can connect people with the hearing health care system. Community-based participatory research methods were applied in two phases of research to: (1) investigate the needs of families affected by hearing loss in a rural Arizona community on the U.S.-Mexico border; and (2) evaluate an outreach program on hearing health. The needs assessment included interviews with persons with hearing loss and focus groups with family members and the greater community. The needs assessment revealed that despite perceived severity of hearing loss, help-seeking for audiologic care was limited due to barriers, stigma, and low self-efficacy. Results informed development of a community-based pilot study conducted as part of an academic-community partnership between audiology, public health, and community health workers of a federally qualified health center. An outreach program, Oyendo Bien (hearing wellness), a 5-week, Spanish-language health education program for older adults (n = 21) incorporated communication strategies and behavioral change techniques. Postprogram focus groups revealed increased self-efficacy and decreased stigma. After 1 year, 7 of 9 participants with hearing loss contacted for follow-up had sought some form of hearing-related health care. Future research should further investigate interventional audiology approaches to address health disparities.
• 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.
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  This 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.
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  Community 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 R 2 statistics. 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.
• Sánchez, D., Adamovich, S., Ingram, M., Harris, F. P., de Zapien, J., Sánchez, A., Colina, S., & Marrone, N. (2017). The Potential in Preparing Community Health Workers to Address Hearing Loss. Journal of the American Academy of Audiology, 28(6), 562-574.
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  In underserved areas, it is crucial to investigate ways of increasing access to hearing health care. The community health worker (CHW) is a model that has been applied to increase access in various health arenas. This article proposes further investigation into the application of this model to audiology.
• Carvajal, S. C., Rimas, H., Ingram, M., Herman, P. M., Cunningham, C. E., & Carvajal, S. C. (2016). Patient Preferences of a Low-Income Hispanic Population for Mental Health Services in Primary Care.. Administration and policy in mental health, 43(5), 740-749. doi:10.1007/s10488-015-0687-0
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  We 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.
• Colina, S., Marrone, N., & Ingram, M. (2016). Translation Quality Assessment in Health Research: Problems of back-translation. Evaluation and the Health Professions.
• Ingram, M. (2016). Addressing disparities in accessing hearing health care in a U.S. Mexico Border community. Frontiers in Public Health, 4, 169. doi:https://doi.org/10.3389/fpubh.2016.00169
• Ingram, M., Chang, J., Kunz, S., Piper, R., De Zapien, J. G., & Strawdier, K. (2016). Community Health Workers as Change Agents: Evaluation of the Women's Health Leadership Institute. Journal of Health Promotion Practice.
• Ingram, M., Chang, J., Kunz, S., Piper, R., de Zapien, J. G., & Strawder, K. (2016). Women's Health Leadership to Enhance Community Health Workers as Change Agents. Health promotion practice, 17(3), 391-9.
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  Objectives A community health worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. While natural leadership may incline individuals to the CHW profession, they do not always have skills to address broad social issues. We describe evaluation of the Women's Health Leadership Institute (WHLI), a 3-year training initiative to increase the capacity of CHWs as change agents. Methods Pre-/postquestionnaires measured the confidence of 254 participants in mastering WHLI leadership competencies. In-depth interviews with CHW participants 6 to 9 months after the training documented application of WHLI competencies in the community. A national CHW survey measured the extent to which WHLI graduates used leadership skills that resulted in concrete changes to benefit community members. Multivariate logistic regressions controlling for covariates compared WHLI graduates' leadership skills to the national sample. Results Participants reported statistically significant pre-/postimprovements in all competencies. Interviewees credited WHLI with increasing their capacity to listen to others, create partnerships, and initiate efforts to address community needs. Compared to a national CHW sample, WHLI participants were more likely to engage community members in attending public meetings and organizing events. These activities led to community members taking action on an issue and a concrete policy change. Conclusions Leadership training can increase the ability of experienced CHWs to address underlying issues related to community health across different types of organizational affiliations and job responsibilities.
• Ingram, M., Marrone, N. L., Daisey, S. T., Sander, A., Navarro, C., De Zapien, J. G., Colina, S., & Harris, F. P. (2016). Addressing Hearing Health Care Disparities among Older Adults in a US-Mexico Border Community. Frontiers in Public Healt. doi:/dx.doi.org/10.3389/fpubh.2016.00169
• Ingram, M., Marrone, N. L., Daisey, S. T., Sander, A., Navarro, C., De Zapien, J. G., Colina, S., & Harris, F. P. (2016). Addressing Hearing Health Care Disparities among Older Adults in a US-Mexico Border Community. Frontiers in Public Health. doi:/dx.doi.org/10.3389/fpubh.2016.00169
• Kunz, S., Ingram, M., Piper, R., Ochoa, S., Sander, A., Navarro, C., & McKenzie, S. (2016). The Vivir Mejor! Consortium: A Rural, US-México Collaborative Model to Prevent and Treat Diabetes. Journal of health care for the poor and underserved, 27(4A), 39-45.
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  The Vivir Mejor! (Live Better!) System of Diabetes Prevention and Care Consortium is a multi-sector partnership to establish an integrated diabetes system of care in Santa Cruz County, Arizona on the U.S.-Mexico border. Major outcomes include improved healthy eating and active living knowledge and behaviors and lowered HbA1c.
• Reinschmidt, K. M., Ingram, M., Morales, S., Sabo, S. J., Blackburn, J., Murietta, L., David, C., & Carvajal, S. C. (2016). Documenting Community Health Worker Roles in Clinics in Southern Arizona: Contributions to Evidence-based Community Health Worker Integration into Health Care Teams.. Journal of Ambulatory Care Management.
• Schachter, K., Carvajal, S. C., Zapien, J. G., Schachter, K., Rimas, H., Murrieta, L., Ingram, M., Herman, P. M., Cunningham, C. E., & 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, 9(4), 293-301. doi:10.1007/s40271-015-0155-7
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  Consideration 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..This project evaluated the feasibility and usefulness of adding a consumer-products design method to qualitative methods implemented within a community-based participatory research (CBPR) framework..Discrete-choice conjoint experiment (DCE) added to systematic focus group data collection and analysis..Focus group data were collected from 64 patients of a Federally-Qualified Health Center (FQHC) serving a predominantly low-income Hispanic population. A total of 604 patients in the waiting rooms of the FQHC responded to the DCE..The DCE contained 15 choice tasks that each asked respondents to choose between three mental health services options described by the levels of two (of eight) attributes based on themes that emerged from focus group data..The addition of the DCE was found to be feasible and useful in providing distinct information on relative patient preferences compared with the focus group analyses alone. According to market simulations, the package of mental health services guided by the results of the DCE was preferred by patients..Unique patterns of patient preferences were uncovered by the DCE and these findings were useful in identifying pragmatic solutions to better address the mental health service needs of this population. However, for this resource-intensive method to be adopted more broadly, the scale of the primary care setting and/or scope of the issue addressed have to be relatively large.
• Fernandez-Haddad, M., & Ingram, M. (2015). Factors that Influence the Effectiveness of Sanitation Programs. Frontiers in public health, 3, 201.
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  Local governments in both Mexico and the U.S. spend considerable money on public services, which do not always bring the expected results. For instance, a large part of the public budget is destined to solve social and health problems, such as public sanitation. Government has attacked the problem by providing public sanitation infrastructure (such as garbage and recycling receptacles) and by using social ad campaigns. However, these efforts do not always affect the habits of residents and bring the desired changes in city sanitation. This article presents a case study that used a participatory method to address an innovative city sanitation effort: The Clean City Program in Puebla, Mexico. This program adopted social marketing techniques, a discipline born in the 70s when the principles and practices developed to sell products and services started to be applied to sell ideas, attitudes, or behaviors. Social marketing programs have been adopted by governments to change attitudes and behavior in areas such as public services. The article first describes the context and strategies of the program, which included the use of the promotora model to engage community members. The researchers then make use of qualitative data gathered throughout program planning and implementation to evaluate the impact of the social marketing programs and its effectiveness. The article analyzes social, educational, economic, demographic, and cultural factors that influence the effectiveness of sanitation programs and presents recommendations for strategies to engage community members in community sanitation programs.
• 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.
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  Consideration 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.
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  We 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. -., Ingram, M. -., Sabo, S. J., Sabo, S. J., Gomez, S., Gomez, S., Piper, R., Piper, R., Reinschmidt, K. M., Reinschmidt, K. M., Schachter, K. A., Schachter, K. A., Carvajal, S., & Carvajal, S. (2015). Taking the CBPR approach in the development of methods for a CHW community advocacy intervention. Progress in Community Health Partnerships: Research, Education and Action.
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  Ingram M, Sabo S, Gomez S*, Piper S**, Reinschmidt KM, Schachter K, Carvajal S. Taking the CBPR approach in the development of methods for a CHW community advocacy intervention. Progress in Community Health Partnerships: Research, Education and Action
• Ingram, M. -., Murrieta, L., de Zapien, J. G., Herman, P., & Carvajal, S. J. (2015). CHWs as Focus Group Facilitators: A participatory action research method to improve behavioral health services for farmworkers in a primary care setting. Action Research Journal, 13(1), 48-64.
• Ingram, M. -., Samantha, S., Sofia, G., Rosalinda, P., Kerstin, R., Ken, S., & Scott, C. (2015). Taking the CBPR approach in the development of methods for a CHW community advocacy intervention.. Progress in Community Health Partnerships, 9(1), 49-56.
• 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.
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  Public 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.
• Reinschmidt, K. M., Ingram, M., Schachter, K. A., Sabo, S. J., Verdugo, L., & Carvajal, S. (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.
• 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.
• Sabo, S., Ashley, W., Haywood, C., David, P., Redondo, F., Melanie, B., & Ingram, M. (2015). Community Health Worker Professional Advocacy: Voices of Action from the 2014 National Community Health Worker Advocacy Survey. Journal of Ambulatory Care Management, 38(3), 225-235.
• Schachter, K. A., Carvajal, S. C., Zapien, J. G., Schachter, K. A., Ingram, M., 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.12284
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  Mexican 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..We describe the application of community-based participatory research methods to assess and address gaps in perceptions of mental health care between providers and migrant workers living in a US-Mexico Border community..A federally qualified health centre (FQHC) serving a community of approximately 60 000 agricultural workers who live in Yuma County and harvest vegetables during the winter season..We conducted patient focus groups (n = 64) and FQHC staff interviews (n = 16) to explore attributes and dimensions of patient-centred mental health care..Patients and staff both prioritized increased access to mental health care and patient-centred care, while patients were more concerned with interpersonal care and providers with coordination of care. All participants stressed the relationship between life events and mental health and the centrality of family in care. Patients also emphasized the importance of a good attitude, the ability to solve problems, positive family relationships and reliance on faith. Patients suggested that the FQHC inform patients about mental health resources, provide community informational talks to address stigma, and offer support groups..The participatory approach of this qualitative study resulted in a wealth of data regarding patient preferences that will enable the FQHC to develop protocols and training to provide patient-centred mental health-care services for their community.
• Carvajal, S. C., Mcclelland, D. J., Rubio-goldsmith, R., Zapien, J. G., Torres, E., Rubio-goldsmith, R., Rosales, C., Rodriguez, K., Redondo, F., Meister, J. S., Mcclelland, D. J., Kibor, C., Ingram, M., & Carvajal, S. C. (2014). Stress and sociocultural factors related to health status among US-Mexico border farmworkers.. Journal of immigrant and minority health, 16(6), 1176-82. doi:10.1007/s10903-013-9853-1
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  This 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 < .001) with increased risk for poor mental health and poor physical health considering all variables. Stress was not associated with SRH. Regarding two of the three outcomes, mental health and physical health, stress added explanatory power as expected. For poor SRH, a known marker for mortality risk and quite high in the sample at 38%, only age was significantly associated. Clinical and systems-level health promotion strategies may be required to mitigate these stressors in border-residing farmworkers.
• Ingram, M., Ingram, M., Schachter, K. A., Schachter, K. A., Sabo, S. J., Sabo, S. J., Reinschmidt, K. M., Reinschmidt, K. M., Gomez, S., Gomez, S., De Zapien, J. G., De Zapien, J. G., Carvajal, S., & Carvajal, S. (2014). A community health worker intervention to address the social determinants of health through policy change.. J Prim Prev., 35(2), 119-123.
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  doi: 10.1007/s10935-013-0335-y, PubMed PMID: 24363179.
• Ingram, M., Schachter, K. A., De Zapien, J. G., Herman, P., & Carvajal, S. (2014). 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, 12.
• Ingram, M., Schachter, K. A., Guernsey de Zapien, J., Herman, P. M., & Carvajal, S. C. (2014). 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.
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  Mexican 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.
• 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.
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  We 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.
• Langellier, B. A., 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.
• Sabo, S. J., Shaw, S. J., Ingram, M. -., Teufel-Shone, N. I., Carvajal, S., De Zapien, J. G., Rosales, C. B., Redondo, F., Garcia, G., & Rubio-Goldsmith, R. (2014). Everyday Violence , Structural Racism and Mistreatment at the US-Mexico Border. Social Science and Medicine, 109, 66-74.
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  Sabo S, Shaw S, Ingram M, , Teufel Shone N, Carvajal S, de Zapien J, Rosales C, Redondo F**, Garcia G**, . Rubio-Goldsmith R. Everyday Violence , Structural Racism and Mistreatment at the US-Mexico Border. Social Science and Medicine.
• Sabo, S., Shaw, S., Ingram, M., Teufel-Shone, N., Carvajal, S., 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.
• 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.
• 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.
• Schachter, M., MBA, K. A., Ingram, M., Hafter, M., Guernsey De Zapien BA, J., & others, . (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), 3.
• Carvajal, S. C., Kibor, C., McClelland, D. J., Ingram, M., Zapien, J. G., Torres, E., Redondo, F., Rodriguez, K., Rubio-Goldsmith, R., Meister, J., & others, . (2013). Stress and Sociocultural Factors Related to Health Status Among US--Mexico Border Farmworkers. Journal of Immigrant and Minority Health, 1--7.
• 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. (2013). Stress and Sociocultural Factors Related to Health Status Among US-Mexico Border Farmworkers. Journal of Immigrant and Minority Health / Center for Minority Public Health.
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  This study examines factors relating to farmworkers
• 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., & others, . (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, 15(2), 427--436.
• Carvajal, S., Carvajal, S., Rosales, C. B., Rosales, C. B., Raquel, G. R., Raquel, G. R., Sabo, S., Sabo, S., Ingram, M. -., Ingram, M. -., McClelland, D., McClelland, D., Redondo, F., Redondo, F., Torres, E., Torres, E., Romero, A. J., Romero, A. J., O'Leary, A. O., , O'Leary, A. O., et al. (2013). The Border Community and Immigration Stress Scale: A Preliminary Examination of a Community Responsive Measure in Two Southwest Samples. Journal of Immigrant & Minority Health, 2(15), 427-436.
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  This article is based on earlier research on Migrant Farmworker health in Yuma, Arizona. The article was first published on-line in 2012, then in print in 2013.
• Ingram, M. -., Schachter, K. A., Sabo, S. J., Reinschmidt, K. M., Gomez, S., De Zapien, J. G., & Carvajal, S. C. (2013). 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. 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. J., Reinschmidt, K. M., Gomez, S., De Zapien, J. G., & Carvajal, S. C. (2013). A Community Health Worker Intervention to Address the Social Determinants of Health Through Policy Change. The Journal of Primary Prevention.
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  Public 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.
• 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.
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  Public 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., Sabo, S. J., Ingram, M. -., Ingram, M. -., Reinschmidt, K. M., Reinschmidt, K. M., Schachter, K. A., Schachter, K. A., Jacobs, L., Jacobs, L., De Zapien, J. G., De Zapien, J. G., Robinson, L., Robinson, L., Carvajal, S. C., & 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).
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  Using a mixed-method, participatory research approach, we investigated factors related to community health worker (CHW) community advocacy that affect social determinants of health.
• Sabo, S., Sabo, S., Ingram, M., Ingram, M., Reinschmidt, K. M., Reinschmidt, K. M., Schachter, K., Schachter, K., Jacobs, L., Jacobs, L., Zapien, J., Zapien, J., Robinson, L., Robinson, L., Carvajal, S., & 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--e73.
• Carvajal, S., Rosales, C., Rubio-Goldsmith, R., Sabo, S., Ingram, M., McClelland, D. J., Redondo, F., Torres, E., Romero, A., OLeary, A. O., & others, . (2012). The Border Community \& Immigration Stress Scale and Associations to Health Outcomes. Journal of Immigrant \& Minority Health.
• Ingram, M., Piper, R., Kunz, S., Navarro, C., Sander, A., & Gastelum, S. (2012). Salud Si: A case study for the use of participatory evaluation in creating effective and sustainable community-based health promotion. Family \& community health, 35(2), 130--138.
• 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.
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  Community 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.
• Rosales, C., Ortega, M. I., De Zapien, J. G., Paniagua, A. D., Zapien, A., Ingram, M., & Aranda, P. (2012). The US/Mexico border: A binational approach to framing challenges and constructing solutions for improving farmworkers’ lives. International journal of environmental research and public health, 9(6), 2159--2174.
• Zawacki, L., Sanchez, Z. C., Martinez, G., Koegel, K. A., Ingram, M., & Henderson, M. A. (2012). Community Profiles: An Evaluation and Planning Tool for Neighborhood Systems and Environmental Change Efforts. Californian Journal of Health Promotion, 10(SI-Latino), 37-51. doi:10.32398/cjhp.v10isi-latino.1481
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  Purpose: Latinos in the US experience health disparities in obesity and related disease outcomes. There is national recognition that modifiable risk factors are influenced by the places that people work, live and play. Latinos are more likely to live in areas with limited access to affordable healthy food and recreational facilities. Design: This paper describes the development and use of neighborhood profiles as a tool for (1) assessing neighborhood built environments and (2) planning for neighborhood-based efforts focused on systems and environmental change. Our neighborhood profiles united four diverse data sources: secondary data, observational assessments, neighborhood connector interviews and resident surveys. Subjects: Twelve mostly urban, largely Latino neighborhoods of high economic disparity in Pima County, Arizona were included. Analysis: Secondary data was analyzed to describe sociodemographic characteristics of neighborhoods, while observational assessments were used to quantify and qualify aspects of the built environment. Neighborhood surveys and connector interviews were analyzed using frequency distributions and content analysis. Results: Neighborhoods varied in healthy food availability and physical activity infrastructure. Overall, residents indicated that community gardens and healthy food options in local stores are priorities. Conclusion: Neighborhood profiles demonstrated potential as an evaluation and community-planning tool to assist communities to create healthy environments.
• Henderson, M. A., Sanchez, Z. C., Koegel, K. A., Zawacki, L., Martinez, G., & Ingram, M. (2011). Community Profiles: An Evaluation and Planning Tool for Neighborhood Systems and Environmental Change Efforts. Californian Journal of Health Promotion, 10, 37--51.
• Rosenthal, E. L., Wiggins, N., Ingram, M., Mayfield-Johnson, S., & De Zapien, J. G. (2011). Community health workers then and now: an overview of national studies aimed at defining the field. The Journal of ambulatory care management, 34(3), 247--259.
• Ingram, M., McClelland, D. J., Martin, J., Caballero, M. F., Mayorga, M. T., & Gillespie, K. (2010). Experiences of immigrant women who self-petition under the Violence Against Women Act. Violence against women, 16(8), 858--880.
• Sabo, S., Ingram, M., & Wennerstrom, A. (2010). THE COMMUNITY HEALTH WORKER MODEL. The Colonias Reader: Economy, Housing, and Public Health in US-Mexico Border Colonias, 190.
• Ingram, M., Ruiz, M., Theresa Mayorga, M., & Rosales, C. (2009). The Animadora Project: identifying factors related to the promotion of physical activity among Mexican Americans with diabetes. American Journal of Health Promotion, 23(6), 396--402.
• TORRES, E., & INGRAM, M. (2009). The Role of Promotoras/Community Lay Health Workers as Spiritual Helpers in Supporting Diabetes Self-management among Mexican Americans. Counseling et spiritualit\'e, 28(1), 109--127.
• Torres, E., & Ingram, M. (2009). Con el favor de Diós: the role of promotoras/community lay health workers as spiritual helpers in supporting diabetes self-management among Mexican Americans. al Counseling et Spiritualite, 28(1), 109-127.
• Ingram, M., Sabo, S., Rothers, J., Wennerstrom, A., & Zapien, J. G. (2008). Community health workers and community advocacy: Addressing health disparities. Journal of Community Health, 33(6), 417--424.
• Drummond, R., Ingram, M., Sabo, S., Staten, L., & Pierce, C. (2007). Third Annual Evaluation Report September 22, 2005—September 21, 2006. Arizona Department of Health Services.
• Ingram, M., Torres, E., Redondo, F., Bradford, G., Wang, C., & O'Toole, M. L. (2007). The impact of promotoras on social support and glycemic control among members of a farmworker community on the US-Mexico border. The Diabetes Educator, 33(Supplement 6), 172S--178S.
• Wennerstrom, A. B., De Zapien, J., Gallegos, P. A., Velez, M. I., Sabo, S., Ingram, M., & Taren, D. (2007). Corporate social responsibility in agriculture: Can in work in Sonora, Mexico?. Annual Meeting.
• Wennerstrom, A. B., De Zapien, J., Ingram, M., & Sabo, S. (2007). Community health worker advocacy study. Annual Meeting.
• Cohen, S. J., & Ingram, M. (2005). Border health strategic initiative: overview and introduction to a community-based model for diabetes prevention and control. Prev Chronic Dis [serial online].
• Ingram, M., Gallegos, G., & Elenes, J. (2005). Diabetes is a community issue: the critical elements of a successful outreach and education model on the US-Mexico border. Prev Chronic Dis [serial online].
• Koss, M., Ingram, M., & Pepper, S. (2001). Male partner violence: Relevance to health care providers. Handbook of health psychology, 541--557.
• Chong, J., Ingram, M., McClelland, D. J., Lopez, D. C., & De Zapien, J. G. (2000). Smoking behavior in a smoking workplace. Journal of substance abuse, 11(3), 231--240.
• Koss, M. P., Ingram, M., & Pepper, S. (1997). Psychotherapists' role in the medical response to male-partner violence.. Psychotherapy: Theory, Research, Practice, Training, 34(4), 386.

Proceedings Publications

• Ingram, M. (2013, Fall). Synergy between community-based participatory research and community health worker community advocacy as a force for policy change. In 141st APHA Annual Meeting (November 2-November 6, 2013).

Presentations

• Carvajal, S. C., Bowen, M., Itule-Klasen, L., Figueroa, C., Esparza, M., Monge, S., Espinoza, C., Coronado, G., Lohr, A. M., Ingram, M., Wilkinson-Lee, A. M., Velasco, M., & Coulter, K. (2021, October). Adaptation of Unidos during covid-19: The role of CHWs and implications for practice. American Public Health Association Annual Meeting and Expo. Denver, CO: American Public Health Association.
• David, C., Krupp, K., Ingram, M., Lohr, A. M., Doubleday, K., Aceves, B., Espinoza, C., Redondo-Martinez, F., Coronado, G., & Carvajal, S. C. (2020, Fall). Impact of community health worker (CHW) delivered links intervention on depression symptoms among Latinos living in the US-Mexico border region. merican Public Health Association Annual Meeting. Virtual: APHA.
• Adkins, A. S., Ingram, M., Barillas-Longoria, G., & Hansen, K. (2017, Fall). Investigating the role of physical and social characteristics of walkability using on-street interviews in Mexican American neighborhoods. American Public Health Association Annual Meeting. Atlanta, Georgia: APHA.
• Carvajal, S. C., Coronado, G., Redondo-Martinez, F., Espinoza, C., Aceves, B., Doubleday, K., Lohr, A. M., Ingram, M., Krupp, K., & David, C. (2020, Fall). Impact of community health worker (CHW) delivered links intervention on depression symptoms among Latinos living in the US-Mexico border region. American Public Health Association Annual Meeting. Virtual: APHA.
• Carvajal, S. C., Coulter, K., Wilkinson-Lee, A. M., Ingram, M., Doubleday, K., & Lohr, A. M. (2020, Fall). Linking individual needs to community and clinical services (LINKS): Outcomes of a community-based intervention. American Journal of Public Health Annual Meeting.
• Ingram, M. (2020, Spring). CHW in Health Intervention Research. Community Health Worker Innovation Summit. Virtual: NYU Langone Health Community Health Worker Research and Resource Center.
• Ingram, M., Tucker, K., & Redondo-Martinez, F. (2020, Fall). A CHW workforce assessment to identify and monitor indicators of CHW voluntary certification in Arizona. American Public Health Association Annual Meeting. Virtual: APHA.
• Lohr, A., Doubleday, K., Ingram, M., Wilkinson-Lee, A. M., Coulter, K., & Carvajal, S. C. (2020, fall). Linking individual needs to community and clinical services (LINKS): Outcomes of a community-based intervention. APHA 2020 VIRTUAL Annual Meeting.
• Redondo-Martinez, F., Tucker, K., Ingram, M., Guernsey De Zapien, J. E., & Soto, Y. (2020, Fall). CHW training program approval in Arizona: A shared vision for a unified and sustainable CHW workforce. American Public Health Association Annual Meeting. Virtual: APHA.
• Tucker, K., Ingram, M., Piper, R., Martinez, D., Flores, R., & Sander, A. (2020, Fall). Applying a social ecological framework to understand perceptions of health risk among latinx low-wage workers employed in small business. American Public Health Association Annual Meeting. Virtual: APHA.
• Tucker, K., Sanchez, B., Lopez, D. P., Ahumada, J., Lebensohn, P., Koch, B. D., Kiser, L. H., Ingram, M., Guernsey De Zapien, J. E., Landau, A., & Hall-Lipsy, E. A. (2020, October). Academic-community partnerships to empower students to address the migrant crisis. APHA 2020: Annual Meeting and Expo. Virtual.
• Velasco, M., Espinoza, C., Coronado, G., Redondo-Martinez, F., Lohr, A. M., Wilkinson-Lee, A. M., Ingram, M., Carvajal, S. C., Doubleday, K., & Coulter, K. (2020, Fall). Links: A community health worker led community-clinical linkage intervention addressing emotional wellbeing. American Public Health Association Annual Meeting. Virtual: APHA.
• 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.
• Coronado, G., Wilkinson-Lee, A. M., Lohr, A. M., Velasco, M., David, C., Coulter, K. M., Ingram, M., Carvajal, S. C., & Redondo, F. (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.
• Coulter, K. M., Ingram, M., Espinoza, C., Lohr, A. M., & Carvajal, S. C. (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.
• Espinoza, C., Ochoa, M., Wilkinson-Lee, A. M., Lohr, A. M., Coulter, K. M., Ingram, M., & Carvajal, S. 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.
• Lothrop, N. Z., Sandoval, F., Cortez, I., Wagoner, R. S., Lopez-Galvez, N. I., Parra, K. L., Wolf, A. M., Wertheim, B., Lee, A. A., Griffin, S., Bell, M. L., Carvajal, S. C., Ingram, M., & Beamer, P. (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.
• Carvajal, S. C., Carvajal, S. C., Marrone, N. L., Carvajal, S. C., Colina, S., Colina, S., Wong, A. A., Colina, S., Piper, R., Piper, R., Piper, R., Ingram, M., Coco, L. S., Coco, L. S., Coco, L. S., Coco, L. S., Piper, R., Ingram, M., Ingram, M., , Ingram, M., et al. (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.
• CoCo, L., Marrone, N. L., Ingram, M., Ingram, M., CoCo, L., & Marrone, N. L. (2018, November). A Community Health Worker intervention to improve hearing loss-related communication and quality of life among older Latino adults. APHA Annual Meeting. San Diego, CA: American Public Health Association.
• Ingram, M., Espinoza, C., Velasco, M., Coronado, G., Lohr, A., & Carvajal, S. (2018, November). CHW-facilitated social support in fostering emotional wellness and chronic disease self-management. APHA Official Annual Meeting. San Diego CA: American Public Health Association.
• Redondo, F., Soto, Y., Ingram, M., Sabo, S., de Zapien, J. G., Verdugo, L., & Tucker, K. M. (2018, November). Arizona Community Health Workers Association’s Journey towards a CHW Voluntary Certification. APHA Annual Meeting. San Diego, CA: American Public Health Association.
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  https://apha.confex.com/apha/2018/meetingapp.cgi/Paper/415595
• Denman, C., Cornejo, E., Ingram, M., Sabo, S., De Zapien, J. G., & Rosales, C. B. (2017, Fall). Importance of implementation science in translation of evidence based health promotion programming in Mexico. American Public Health Association Annual Meeting. Atlanta, Georgia: American Public Health Association.
• Hansen, K., Ingram, M., Adkins, A. S., Hanson, V., & Somnez, E. (2017, Spring). Sociocultural influences on perceptions of walking in Mexican American neighborhoods in Tucson AZ. Active Living Research Conferenced. Clearwater Beach, Florida: Active Living Research.
• Ingram, M. (2017, 2017). Binational Collaboration for Healthy Communities in the Arizona-Sonora Border Region Network. Networking presentations. Hermosillo Mexico: CONACYT.
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  I participated in developing presentations for Meta Salud Diabetes and Oyendo Bien for the networking meeting as well as in the meeting.
• Peterson, R., Coco, L. S., Ingram, M., Redondo, F., & Marrone, N. L. (2017, Fall). Training Community Health Workers on hearing health concerns in aging: A feasibility study. American Public Health Association Annual Meeting. Atlanta, Georgia: APHA.
• Ingram, M., Redondo, F., & Sabo, S. J. (2015, Summer). Voices of Action from the National Community Health Worker Advocacy Survey. Rural Population Health Learning Collaborative Webinar. Webinar: Rural Population Health Learning Collaborative.
• Reinschmidt, K. M., Ingram, M., Morales, S., Sabo, S. J., & 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. (2015, June). Perspectives on Community Health Worker Accreditation. Arizona Community Health Worker Association. Phoenix, AZ: AzCHOW.
• 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.
• Marrone, N. L., & Ingram, M. (2015, March). Community-based participatory research on hearing loss in a border/low-resource community. American Auditory Society Annual Meeting. Phoenix, AZ.
• Reondondo, F., Ingram, M., & Sabo, S. (2015, July). Voices of Action from the 2014 National Community Health Worker Advocacy Survey. Unity Conference. Tennesee: University of Southern Missippi.
• Sabo, S. J., Ingram, M., Dreifuss, H., Soto, Y., Carvajal, S. C., Redondo, F., 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.
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  Since 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.
• Sander, A., Piper, R., & Ingram, M. (2015, Fall). Thinking Big in a Small Place: Changing Transportation through CHW advocacy efforts in a US/Mexico Border community. American Public Health Association Annual Meeting. Chicago, IL.
• Ingram, M., Marrone, N., de Zapien, J. G., Carvajal, S., & Harris, F. (2014, Fall). Development of a Community Health Worker Approach to Expand Access to Hearing Health Care. Gerontological Society of America Annual Conference. Washington D.C.: Gerontological Society of America.
• Ingram, M., Sabo, S., de Zapien, J. G., & Verdugo, L. (2014, November). Arizona Community Health Worker Workforce Coalition: History, Process and Outcomes. American Public Health Association Annual Meeting. New Orleans, LA: American Public Health Association.
• Marrone, N. L., Sanchez, D., Ingram, M., De Zapien, J. G., Harris, F. P., Colina, S., Piper, R., Carvajal, S., Marrone, N. L., Sanchez, D., Ingram, M., De Zapien, J. G., Harris, F. P., Colina, S., Piper, R., & Carvajal, S. (2014, November). Development of a Community Health Worker Approach to Expand Access to Hearing Health Care. Gerontological Society of America Scientific Meeting. Washington, DC: Gerontological Society of America.
• Ingram, M. -. (2013, December). Evaluating Policy, Systems and Evaluation Change Initiatives. Healthy Arizona Policy Initiative Evaluation Conference. Phoenix, AZ: APHA.
• Reinschmidt, K. -., Schachter, K., Ingram, M., Sabo, S., de Zapien, J. G., Gomez, S., Contreras, M., Gilligan, J., & Carvjal, S. (2013, Fall). The Evolution of CHW-based and CBPR Interventions to Address Rural and Border Health Issues in Southern Arizona.. 40th Annual Arizona Rural Health Conference. Prescott, AZ: Center for Rural Health.
• Reinschmidt, K. M., Ingram, M. -., Schachter, K. A., Sabo, S. J., Gomez, S., Fernadez, L., & Carvajal, S. (2013, Fall). Impact of a community advocacy intervention on partnering agencies and promotoras in southern Arizona. American Public Health Association Annual Meeting. Boston, MA: American Public Health Association.
• de Zapien, J. G., Denman, C., Cornejo, E., Staten, L. K., Rosales, C., & Maia, I. (2013, Novemeber). Meta Salud: Building Binational Collaboration with Community Health Workers for Prevention of Chronic Disease. American Public Health Association Annual Meeting. Boston, MA: APHA.
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  This presentation will discuss a binational collaboration of El Colegio de Sonora, the Secretaria de Salud in Sonora and the Arizona Prevention Research Center at the University of Arizona College of Public Health to develop and implement a community health worker chronic disease prevention curriculum and intervention in underserved communities in Mexico. The original curriculum, Pasos Adelante, was tested in the U.S.-Mexico border region for more than six years and was modeled after the Su Corazón, Su Vida curriculum developed by NHLBI. The newer Mexican curriculum, MetaSalud, was adapted to be used with the Secretaria de Salud in Sonora and has been implemented in Hermosillo, Sonora, Mexico for the past two years with more than 150 participants. The presentation will include: the adaption process highlighting those areas of the curriculum that were relevant to both populations as well as the changes to the curriculum for the population in Mexico; the similarities and differences of the community health worker role in implementation of the curriculum; results and outcomes of the intervention in the United States and Mexico; and challenges to the institutionalization of the program in both countries. Discussion will focus on lessons learned through this binational collaboration regarding the role of community health workers in chronic disease prevention, and future plans for collaborative binational health promotion interventions in the border region.

Poster Presentations

• Aceves, B., Ruiz, M., Ortega, A., Ingram, M., Denman, C., Madhivanaan, P., Garcia, D., & Rosales, C. (2020, Fall). Mental health and diabetes self management: Assessing stekeholder perspectives from health center n Northern Mexico. American Public Health Association Annual Meeting. Virtual on line: APHA.
• Ingram, M., Denman, C., Aceves, B., Ocejo, A., Cornejo, E., de Zapien, J. G., & Rosales, C. B. (2018, November). Role of implementation science in addressing chronic disease on a global scale. APHA Annual Meeting. San Diego, CA: American Public Health Association.
• Reinschmidt, K. M., Lohr, A. M., Sbarra, D. A., Ingram, M., & Carvajal, S. C. (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. (2016, October). Family Perspectives on Hearing and Communication Among Mexican American Older Adults. World Congress of Audiology. Vancouver, Canada.
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  Sanchez, 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.
• Adkins, A. S., Ingram, M., & Cascio, V. (2015, February). Perceptions of Walkability and Barriers to Active Transportation in Mexican American Neighborhoods in Tucson, Arizona. Active Living Research. San Diego, CA: Active Living Research and Robert Wood Johnson Foundation.
• Ingram, M. -., Sabo, S., Gomez, S., Piper, R., Reinschmidt, K., de Zapien, J. G., & Carvajal, S. C. (2013, November). Synergy between Community-based Participatory Research and Community Health Worker Community Advocacy as a Force for Policy Change. American Public Health Association Annual Meeting. Boston, MA: APHA.
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  Public health advocacy is by necessity responsive to shifting political climates and thus a challenge of advocacy research is that the intervention must by definition be flexible. Moving beyond the classification of advocacy efforts to measurable indicators of policy change and outcomes therefore requires a dynamic research approach. In this presentation, we will engage in a critical reflection on the use of the community based participatory research approach (CBPR) to develop and measure the impact of Acción, a community advocacy intervention in which community health workers (CHWs) engage community members in making positive changes to their communities. The Kingdon 3-streams model of policy change provided a theoretical framework for the Acción intervention. Research and community partners collaboratively developed research methods to identify and collect Acción intervention data. Over the course of the intervention, the flexible nature of CBPR led to the integration of additional data collection strategies and theoretical frameworks that allowed us to better understand and describe how CHWs were using community advocacy as a form of community engagement. We developed a model to describe the synergistic relationship between the CBPR approach and the Acción intervention in which what we chose to measure influenced intervention activities which concurrently influenced the identification and measurement of research outcomes. Key assumptions of CBPR, community needs driving the research; responsiveness of research measures to community context; and ongoing flexibility in defining research outcomes were crucial in our ability to develop a CHW community advocacy intervention and to adequately document its impact on communities.
• Ingram, M., Sabo, S., Gomez, S., Piper, R., Reinschmidt, K. M., Schachter, K. A., De Zapien, J. G., & Carvajal, S. C. (2013, November). Synergy between community-based participatory research and community health worker community advocacy as a force for policy change.. APHA.
• Reinschmidt, K. -., Ingram, M., Ken, S., Samantha, S., Sofia, G., Fernandez, L., & Carvajal, S. (2013, November). Impact of a Community Advocacy Intervention on Partnering Agencies and Promotoras in Southern Arizona. American Public Health Association Annual Meeting. Boston, MA: APHA.
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  By definition, community health workers (CHWs) advocate not only for individuals, but also for the health of their communities. While individual advocacy is a widely recognized CHW role, recognition and promotion of CHW community advocacy efforts have lagged behind. Given the persistent health disparities in underserved communities, increased training and support for CHWs working toward positive change at the community level is imperative. An important factor for successful CHW community advocacy is the support provided by employing agencies. In 2009, the Arizona Prevention Research Center (AzPRC) collaborated with five health-related organizations to implement Action for Health (Acción), an intervention designed to train and guide CHWs in community advocacy. At the end of this five year project, a CHW community advocacy model will be developed for dissemination. Purpose: We describe the role of organizational environments in promoting CHW community advocacy and how participation in Acción has affected promotoras and their supervisors in partner agencies. Methodology: Using a qualitative approach, we conducted in-depth interviews with organizational leaders, focus groups with promotoras and their supervisors, and took minutes at technical assistant meetings. Data were analyzed thematically and triangulated. Findings were presented to the promotoras for feedback. Findings: Both organizational leaders and promotoras shared new insights and practices in community advocacy and expressed their intention to continue community advocacy. These findings will be presented and the audience will be invited to comment on CHW engagement in community advocacy in their own organizations and whether CHW training and engagement in community advocacy is supported.
• Sabo, S. J., De Zapien, J. G., Ingram, M. -., Rosales, C. B., & Carvajal, S. (2013, November). Everyday violence of immigration related ethno-racial profiling and mistreatment: A mixed methods approach to understanding immigration policy as a structural determinants of health. American Public Health Association Annual Meeting. Boston, MA: American Public Health Association.
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  Public health scholars have called for research into the impact of state level immigration policies on the public's health and have recognized these policies may exacerbate existing racial and ethnic disparities among immigrant populations and their co-ethnics. Objective: The purpose of this study was to apply the theory of everyday violence to explore immigration policy and militarization of the US-Mexico border as a structural determinant of health. Methods: Through qualitative and quantitative data, the prevalence and type of direct and indirect experiences of immigration related ethno- racial profiling, mistreatment and resistance to institutionalized victimization were explored among 499 Mexican border farmworkers during the years 2005-2007. Results: Farmworkers were predominately US citizens and permanent residents with more than two decades working in US agriculture. Approximately 25% described a personally experienced and/ or witnessed immigration related mistreatment encounter, categorized as verbal, physical and or psychological mistreatment by an immigration official. Approximately 75% of all mistreatment encounters occurred in a non US-port of entry community location, and more than half were experienced personally and or reported by female farmworkers who were 30% of the total sample. Conclusion: Farmworkers described living and working in a highly militarized environment, whereby immigration related ethno-racial profiling and mistreatment were common immigration law enforcement practices. This paper argues for the inclusion of immigration policy that sanctions the institutional practices of discrimination, such as ethno-racial profiling and mistreatment by immigration officials, as a structural determinant of health and a form of everyday violence.
• Sabo, S., Ingram, M., De Zapien, J. G., Rosales, C. B., & Carvajal, S. C. (2013, November). Everyday violence of immigration related ethno-racial profiling and mistreatment: A mixed methods approach to understanding immigration policy as a structural determinants of health.. APHA.

Case Studies

• Ingram, M., & Murrieta, L. (2016. Action Research Methods: Partnering With Community Health Workers to Facilitate Focus Groups With Farmworkers to Improve Mental Health Services in a Community Clinic Contributors: Maia Ingram & Lucy Murrieta Pub. Date: 2016 Access Date: January 27, 2017 Academic Level: Postgraduate Publishing Company: SAGE Publications Ltd City: London Online ISBN: 9781526401106 DOI: http://dx.doi.org/10.4135/9781526401106 ©2017 SAGE Publications Ltd. All Rights Reserved. This PDF(p. 5).