ABSTRACT

1. Needs and assets mapping in low-income communities: A case study of using multiple methods and technology to promote physical activity in Latino families Suzanna M. Martinez, MS, Karen J. Coleman, Ph.D., Jeanette Candelaria, Jennifer L. Terpstra, MPH, Barbara Ainsworth, Ph.D., Kevin Patrick, MD, MS, and John Elder, Ph.D. ABSTRACT The San Diego Prevention Research Center (SDPRC) is a community-academic partnership between the Center for Disease Control and Prevention (CDC), San Ysidro Health Center (SYHC), San Diego State University (SDSU), and the University of California, San Diego (UCSD). The primary mission of the SDPRC is to promote physical activity in the U.S./Mexico border community of San Ysidro, CA. As part of this mission an extensive Needs and Assets Mapping project was done using Geographical Information Systems (GIS), behavioral observation, key informant interviews, and surveys. This represents a unique approach to developing physical activity interventions for underserved communities with a combination of community- and technology-driven approaches. Input from environmental, community, and individual levels will be used to develop a tailored program to promote lifetime physical activity for Latino families. This approach can be used nationwide to conduct research on ethnically- and regionally-tailored physical activity promotion as a means for preventing chronic disease. INTRODUCTION In 2003, nearly 39% of Americans did not meet the physical activity recommendation and 15% were inactive (CDC). Lack of physical activity is a risk factor for chronic disease, obesity and overweight. Poor diet and physical inactivity account for 400,000 deaths in the U.S. An estimated 64% of Americans are classified as overweight or obese (CDC). More than 61 million Americans suffer from CVD and 17 million Americans have diabetes. Three quarters of the U.S. health care budget is used to treat chronic diseases, many related to physical inactivity and poor nutrition. These statistics make physical activity promotion a challenge and a major public health priority. The CDC is promoting community collaboration and partnerships to prevent chronic disease in socioeconomically disadvantaged neighborhoods. Researchers are investigating and evaluating new strategies to promote community-wide physical activity (PA). In addition to community-based participatory research (CBPR), technological strategies are being incorporated into research for health promotion. Geographical Information Systems (GIS) are one of these new technological advancements, most commonly used to “map” communities for factors related to barriers and facilitators of PA. This project is the first to date that combines GIS technology with needs and assets mapping from CBPR to fully explore a community’s full potential to enact PA interventions. METHODS Participants Individuals identified as key members in San Ysidro, CA participated in key informant interviews (KII). A total of 18 KII were conducted with persons from San Ysidro agencies. In addition, 50 intercept interviews were conducted with individuals who came to inquire about the SDPRC at a community health fair in San Ysidro, CA. Procedure The KII were conducted by trained interviewers whose purpose was to guide the interviews and to assess past and existing health programs. Perceptions of physical activity, perceived needs and barriers to physical activity in the community, and recommendations for physical activity interventions to promote health behavior were addressed. In addition, the interviews served to identify potential collaboration between agencies within the community, as well as parks, recreation centers, and sports leagues and any type of physical activity clubs present in the community. Interviews were recorded and transcribed for analysis. The 50 brief intercept interviews administered at the community health fair aims were to identify current places for physical activity and potential places that one might go to if it were more convenient. The San Diego Nutrition Network (SDNN) provides a free GIS map viewer (www.cnngis.org) that maps many health-related locations and uses a variety of commonly available databases (i.e. US Census). The SDNN GIS database also includes crime statistics, disease rates, health clinic activities, walking and biking trails, park and school locations, WIC vendors, bus and trolley routes. All data collected was used to build maps of the San Ysidro community environments. A visual representation of both maps are depicted in Figures 1 and 2. RESULTS The community of San Ysidro is located in San Diego County and lies just North of the U.S./Mexico border. In 2004, there were a total of 28,440 people living in San Ysidro, with almost 91% being Latino. The median age was 24.8 and the median household income was $28,611. Of those living in San Ysidro, 34% had less than a 9th grade education, 53% were living in group quarters, and 28% were living below the federal poverty level. The crime statistics for 2005 were lower than in 2003 with the highest rates being vehicle theft (871) and property theft (376). In 2004, reports showed six rapes, 22 armed robberies, 47 street arm robberies, and 70 assaults. Community members and leaders told us that walking, dancing, volleyball, bike riding, and community gardening were the most likely to be accepted as interventions by the San Ysidro community. Some of the barriers to promoting PA are only three bike paths in San Ysidro which are difficult to access, only run North and South, and lead to dead space. There is only one pool in the community, also somewhat inaccessible, and none of the public schools in the area have a certified Physical Education (PE) instructors, offer PE more than once or twice per week, or had success with promoting walk/bike to school initiatives. There were few walking paths within the community and only one track at the high school which was not open to the community. There are several assets identified by both GIS and community agency leaders including community members willing to promote a PA intervention for the community, and schools willing to provide their facilities for community PA. There is a large land reserve with walking paths, however, it is not within walking distance of the community and thus is never used. Two sites have been identified for possible community gardening, one of which was used in previous years. On the intercept survey, 42 of 50 adults indicated that they engaged in PA at one recreation center and 7/12 parks in San Ysidro. Figure 2. GIS map of San Ysidro with WIC vendors, restaurants, food stamp locations, schools, fitness centers, healthcare facilities, and ratio of Food Stamp recipients to % < 130 federal poverty level-2005 • GIS Community Assets/Barriers Summary • 12 Parks • 2 Fitness Gyms • 2 Community Gardens Sites (potential) • 4 Health Agencies • 3 Regional Community Programs • 1 School Health Center • 29 Public Schools (13 Healthy Start Schools) • 5 Private Schools • 8 Public Schools with 2005 FITNESSGRAM Results • 18 WIC vendors and 1 WIC Clinic • 14 Food Stamp Certified Vendors • 10 General Grocers • 3 Trolley Stations • 3 Bus Routes • 15 Seated Restaurants • 16 Fast Food Restaurants, Pizza Vendors, and Delis • 1 Ice Cream Truck Figure 1: GIS map of San Ysidro, CA with bus and trolley stops, and parks.