Lisa Staten

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The Diabetes Impact Project: Partnering with communities and organizations to reduce diabetes burden and improve quality of life

Prior to coming to Indiana, Dr. Lisa Staten served as a faculty member at the University of Arizona where she worked with community partners along the US-Mexico border to reduce risk factors for diabetes in Latino communities. The overarching theme of Dr. Staten’s research is improving health equity through community engagement. A great deal of her work has focused on chronic disease prevention using community-based participatory research methods. More recently, she is shifting her focus to developing interventions that address the social determinants of health. Dr. Staten's current research project is the "Diabetes Impact Project – Indianapolis Neighborhoods (DIP-IN)." This a multi-year, multisector, community engaged project with a holistic approach to reducing diabetes burden in three communities of Indianapolis. Dr. Staten has published several journal articles in the areas of minority health, intervention design and evaluation, community engaged research, and coalition building. Dr. Staten's translation of research into improved quality of life for communities around the U.S. is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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    Effectiveness of the Pasos Adelante Chronic Disease Prevention and Control Program in a US-Mexico Border Community, 2005-2008
    (Centers for Disease Control and Prevention, 2012) Staten, Lisa K.; Cutshaw, Christina A.; Davidson, Christopher; Reinschmidt, Kerstin; Stewart, Rosie; Roe, Denise J.
    Introduction Pasos Adelante is a lifestyle intervention program facilitated by community health workers (promotores) targeting chronic disease prevention and control in Mexican Americans. Initial studies of Pasos Adelante indicated significant improvements in self-reported nutrition and physical activity. This study examined whether Pasos Adelante participants living in a US border community showed improvements in selected physiological measures after participating in the program and whether changes were maintained at 3-month follow-up. Methods The program took place in 12-week sessions from January 2005 to May 2008 and included walking groups and education targeting nutrition and physical activity. Questionnaires, anthropometric measures, and laboratory tests were conducted at baseline (n = 305), conclusion of program (n = 254), and 3-month follow-up (n = 221). Results Participants demonstrated decreases in body mass index (P = .04), waist and hip circumference (P < .001), diastolic and systolic blood pressure (P < .001), and total cholesterol (P = .008) from baseline to program conclusion. No values worsened significantly between program conclusion and follow-up, except systolic blood pressure. Glucose levels improved between conclusion and follow-up (P = .01). Conclusion These results support the initial findings of improvements in participants’ self-reported physical activity and nutrition patterns through changes in objective measures. This evidence-based program demonstrates the potential for a promotores-facilitated chronic disease prevention and control program to improve physical health and targets both primary and secondary prevention in Hispanic communities and organizations.
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    Depressive Symptoms and Health-Related Quality of Life Among Participants in the Pasos Adelante Chronic Disease Prevention and Control Program, Arizona, 2005-2008
    (Centers for Disease Control and Prevention, 2012) Cutshaw, Christina A.; Staten, Lisa K.; Reinschmidt, Kerstin M.; Davidson, Christopher; Roe, Denise J.
    Introduction Chronic diseases are the leading causes of death in the United States and have been associated with depressive symptoms and poor health-related quality of life (HRQOL). This study examined whether depressive symptoms and HRQOL indicators changed among participants in Pasos Adelante, a chronic disease prevention and control program implemented in a US–Mexico border community. Methods Pasos Adelante was a 12-week promotora-led program that included educational sessions and walking groups. We used the Centers for Epidemiologic Studies Depression Scale (CES-D) and the Center for Disease Control’s “Healthy Days” measures to measure depressive symptoms and HRQOL. We used linear mixed-effects models and general estimating equations to analyze changes in CES-D scores and HRQOL indicators from baseline to postprogram and from postprogram to 3-month follow-up. Results At baseline, participants had a mean of 7.1 physically unhealthy days, 7.4 mentally unhealthy days, and 3.9 days of activity limitation. The mean number of physically and mentally unhealthy days declined significantly from baseline to postprogram, but the mean number of activity limitation days did not. At baseline, 42.6% of participants reported their health as fair/poor; 20.8% of participants reported frequent mental distress, and 31.8% had a CES-D score of 16 or more. All 3 proportions declined from baseline to postprogram. No significant changes occurred between postprogram and follow-up. Conclusion Participants in Pasos Adelante showed improvement in depressive symptoms and several HRQOL indicators. Future studies should use an experimental design with a comparison group to determine whether these findings can be replicated and to examine potential mediators and moderators of program effects.
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    From Program to Policy: Expanding the Role of Community Coalitions
    (Centers for Disease Control and Prevention, 2007) Hill, Anne; De Zapien, Jill Guernsey; Staten, Lisa K.; McClelland, Deborah Jean; Garza, Rebecca; Moore-Monroy, Martha; Elenes, JoJean; Steinfelt, Victoria; Tittelbaugh, Ila; Whitmer, Evelyn; Meister, Joel S.
    Background Diabetes mortality at the United States–Mexico border is twice the national average. Type 2 diabetes mellitus is increasingly diagnosed among children and adolescents. Fragmented services and scarce resources further restrict access to health care. Increased awareness of the incidence of disease and poor health outcomes became a catalyst for creating community-based coalitions and partnerships with the University of Arizona that focused on diabetes. Context Five partnerships between the communities and the University of Arizona were formed to address these health issues. They began with health promotion as their goal and were challenged to add policy and environmental change to their objectives. Understanding the meaning of policy in the community context is the first step in the transition from program to policy. Policy participation brings different groups together, strengthening ties and building trust among community members and community organizations. Methods Data on progress and outcomes were collected from multiple sources. We used the Centers for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health (REACH) 2010 Community Change Model as the capacity-building and analytic framework for supporting and documenting the transition of coalitions from program to policy. Consequences Over 5 years, the coalitions made the transition, in varying degrees, from a programmatic focus to a policy planning and advocacy focus. The coalitions raised community awareness, built community capacity, encouraged a process of “change in change agents,” and advocated for community environmental and policy shifts to improve health behaviors. Interpretation The five coalitions made environmental and policy impacts by engaging in policy advocacy. These outcomes indicate the successful, if not consistently sustained, transition from program to policy. Whether and how these “changes in change agents” are transferable to the larger community over the long term remains to be seen.
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    Eficacia del programa de control y prevención deenfermedades crónicas "Pasos Adelante" en una comunidad enla frontera de EE. UU. y México, 2005-2008
    (Centers for Disease Control and Prevention, 2012) Staten, Lisa K.; Cutshaw, Christina A.; Davidson, Christopher; Reinschmidt, Kerstin; Stewart, Rosie; Roe, Denise J.
    Introducción "Pasos Adelante" es un programa de intervención sobre hábitos saludables facilitado por trabajadores de salud comunitaria o"promotores de salud" destinado a prevenir y controlar enfermedades crónicas en mexicoamericanos. Los estudios iniciales de"Pasos Adelante" mostraron mejoras significativas en la alimentación y la actividad física autorreportadas por los participantes.Este estudio evaluó si los habitantes de una comunidad en la frontera estadounidense que participaron en el programa mostraronmejorías en determinados valores fisiológicos y si los cambios se mantuvieron en el seguimiento a los 3 meses. Métodos El programa se llevó a cabo en sesiones de 12 semanas de enero del 2005 a mayo del 2008 e incluyó grupos de caminata y clases denutrición y actividad física. Se realizaron cuestionarios, mediciones antropométricas y pruebas de laboratorio al inicio delprograma (n = 305), al final (n = 254) y en el seguimiento a los 3 meses (n = 221). Resultados Al compararse los datos iniciales de referencia con los del final del programa, los participantes mostraron reducciones en su índicede masa corporal (P= .04), circunferencia de cintura y cadera (P< .001), presión arterial diastólica y sistólica (P< .001) y colesterol total (P= .008). Ningún valor empeoró significativamente entre la conclusión del programa y el seguimiento, aexcepción de la presión arterial sistólica. Los niveles de glucosa mejoraron entre la finalización y el seguimiento del programa (P=.01). Conclusión Estos resultados sustentan los hallazgos iniciales referidos a la mejoría autorreportada por los participantes en relación conpatrones de alimentación y actividad física al mostrar cambios en medidas objetivas. Este programa basado en la evidenciademuestra el potencial de los programas de control y prevención de enfermedades crónicas llevados a cabo por promotores desalud para mejorar la salud física abordando la prevención primaria y secundaria en organizaciones y comunidades hispanas.
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    The School Health Index as an Impetus for Change
    (Centers for Disease Control and Prevention, 2005-01) Staten, Lisa K.; Teufel-Shone, Nicolette I.; Steinfelt, Victoria E.; Ortega, Nohemi; Halverson, Karen; Flores, Carmen; Lebowitz, Michael D.
    Background The increase in childhood obesity and prevalence of chronic disease risk factors demonstrate the importance of creating healthy school environments. As part of the Border Health Strategic Initiative, the School Health Index was implemented in public schools in two counties along the Arizona, United States-Sonora, Mexico border. Developed in 2000 by the Centers for Disease Control and Prevention, the School Health Index offers a guide to assist schools in evaluating and improving opportunities for physical activity and good nutrition for their students. Context Between 2000 and 2003, a total of 13 schools from five school districts in two counties participated in the School Health Index project despite academic pressures and limited resources. Methods The Border Health Strategic Initiative supported the hiring and training of an external coordinator in each county who was not part of the school system but who was an employee in an established community-based organization. The coordinators worked with the schools to implement the School Health Index, to develop action plans, and to monitor progress toward these goals. Consequences The School Health Index process and school team participation varied from school to school. Individual plans were different but all focused on reducing in-school access to unhealthy foods, identified as high-fat and/or of low nutritional value. Ideas for acting on this focus ranged from changing the content of school lunches to discontinuing the use of nonnutritious foods as classroom rewards. All plans included recommendations that could be implemented immediately as well as those that would require planning and perhaps the formation and assistance of a subcommittee (e.g., for developing or adopting a districtwide health curriculum). Interpretation After working with the School Health Index, most schools made at least one immediate change in their school environments. The external coordinator was essential to keeping the School Health Index results and action plans on the agendas of school administrators, especially during periods of staff turnover. Staff turnover, lack of time, and limited resources resulted in few schools achieving longer term policy changes.
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    The Purdue Extension and Indiana CTSI's Community Health Partnerships collaboration: An innovative, generalizable, state-wide model to help communities build a culture of health
    (Cambridge University Press, 2017-10) Savaiano, Dennis A.; Lynch, Krystal H.; Vandergraff, Donna J.; Wiehe, Sarah E.; Staten, Lisa K.; Miller, Douglas K.; Pediatrics, School of Medicine
    The Indiana Clinical and Translational Sciences Institute's Community Engagement Partners-Purdue Extension collaborative model demonstrates tremendous potential for creating state-wide programmatic efforts and improvements in both the health culture and status of Indiana residents across the state. It can serve as a prototype not only for others interested in pursuing wide geographic health improvements through Clinical and Translational Sciences Award-Cooperative Extension partnerships but also for broader collaborations among United States Department of Agriculture, National Institutes of Health, Centers for Disease Control and Prevention, state and local health departments, and health foundation efforts to improve population health.
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    Evidence for Long-Term Impact of Pasos Adelante: Using a Community-Wide Survey to Evaluate Chronic Disease Risk Modification in Prior Program Participants
    (MDPI, 2013-10) Carvajal, Scott C.; Miesfeld, Noelle; Chang, Jean; Reinschmidt, Kerstin M.; de Zapien, Jill Guernsey; Fernandez, Maria L.; Rosales, Cecilia; Staten, Lisa K.; Social and Behavioral Sciences, School of Public Health
    Effective community-level chronic disease prevention is critical to population health within developed and developing nations. Pasos Adelante is a preventive intervention that aims to reduce chronic disease risk with evidence of effectiveness in US-Mexico residing, Mexican origin, participants. This intervention and related ones also implemented with community health workers have been shown to improve clinical, behavioral and quality of life indicators; though most evidence is from shorter-term evaluations and/or lack comparison groups. The current study examines the impact of this program using secondary data collected in the community 3–6 years after all participants completed the program. A proportional household survey (N = 708) was used that included 48 respondents who indicated they had participated in Pasos. Using propensity score matching to account for differences in program participants versus other community residents (the program targeted those with diabetes and associated risk factors), 148 natural controls were identified for 37 matched Pasos participants. Testing a range of behavioral and clinical indicators of chronic disease risk, logistic regression models accounting for selection bias showed two significant findings; Pasos participants were more physically active and drank less whole milk. These findings add to the evidence of the effectiveness of Pasos Adalente and related interventions in reducing chronic disease risk in Mexican-origin populations, and illustrate the use of innovative techniques for using secondary, community-level data to complement prior evaluation research.
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    Investigating Social Ecological Contributors to Diabetes within Hispanics in an Underserved U.S.-Mexico Border Community
    (MDPI, 2013-08) Chang, Jean; Guy, Mignonne C.; Rosales, Cecilia; de Zapien, Jill G.; Staten, Lisa K.; Fernandez, Maria L.; Carvajal, Scott C.; Social and Behavioral Sciences, School of Public Health
    Hispanics bear a disproportionate burden of diabetes in the United States, yet relations of structural, socio-cultural and behavioral factors linked to diabetes are not fully understood across all of their communities. The current study examines disparities and factors associated with diabetes in adult Hispanics of Mexican-descent (N = 648) participating in a population survey of an underserved rural U.S.-Mexico border community. The overall rate of diabetes prevalence rate in the sample, based on self-report and a glucose testing, was 21%; much higher than rates reported for U.S. adults overall, for all Hispanic adults, or for Mexican American adults specifically. Acculturation markers and social determinants of health indicators were only significantly related to diabetes in models not accounting for age. Older age, greater BMI (>30), greater waist-to-hip ratio as well as lower fruit and vegetable consumption were significantly related to increased likelihood of diabetes when all structural, cultural, behavioral, and biological factors were considered. Models with sets of behavioral factors and biological factors each significantly improved explanation of diabetes relative to prior social ecological theory-guided models. The findings show a critical need for diabetes prevention efforts in this community and suggest that health promotion efforts should particularly focus on increasing fruit and vegetable consumption.
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    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, 2017-07-10) Rosales, Cecilia Ballesteros; de Zapien, Jill Eileen Guernsey; Chang, Jean; Ingram, Maia; Fernandez, Maria L.; Carvajal, Scott C.; Staten, Lisa K.; Health Policy and Management, School of Public Health
    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.
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    The Role of Online Social Support in Supporting and Educating Parents of Young Children With Special Health Care Needs in the United States: A Scoping Review
    (JMIR Publications, 2016) DeHoff, Beth A.; Staten, Lisa K.; Rodgers, Rylin Christine; Denne, Scott C.; Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health
    Background: When parents of young children with special health care needs (CSHCN) receive their child’s diagnosis, they encounter information they may not understand, emotions they may not know how to cope with, and questions about their child’s immediate and long-term future that frequently lack answers. The challenge of health care providers is how to prepare parents for caring for their CSHCN, for coping with any resulting challenges, and for accessing the systems and services that can assist them. Objective: The purpose of this work was to review evidence of the information and support needs of parents of young CSHCN and to determine whether online social support can serve as an avenue for learning and empowerment for these parents. Methods: A scoping review identified the challenges, coping mechanisms, and support needs among parents of CSHCN, and the reach and effectiveness of digital technologies with these families and health care providers. We also conducted interviews with professionals serving parents of CSHCN. Results: The literature review and interviews suggested that parents best learn the information they need, and cope with the emotional challenges of raising a CSHCN, with support from other parents of CSHCN, and that young parents in recent years have most often been finding this parent-to-parent support through digital media, particularly social media, consistent with the theory of online social support. Evidence also shows that social media, particularly Facebook, is used by nearly all women aged 18-29 years across racial and socioeconomic lines in the United States. Conclusions: Parents of young CSHCN experience significant stress but gain understanding, receive support, and develop the ability to care for and be advocates for their child through parent-to-parent emotional and informational social support. Online social support is most effective with young adults of childbearing age, with social media and apps being the most useful within the theoretical framework of social support. This opens new opportunities to effectively educate and support parents of young CSHCN. Providers seeking to inform, educate, and support families of CSHCN should develop strategies to help parents find and use social support through digital resources to facilitate their emotional adjustment and practical abilities to care for and access services for their child. [J Med Internet Res 2016;18(12):e333]