Part of the Prevention Research Center’s project focuses on Ottumwa’s Latino population, which has grown from just 200 residents in 1980 to represent nearly 12 percent of the town today. Himar Hernández, a member of the Ottumwa Community Advisory Board, says some of that increase is from Cargill’s recruitment of workers for its meat processing plant in Ottumwa. More than 30 nationalities are represented at the plant.
New immigrants, from places like Mexico, El Salvador, and Honduras, have not adjusted their diets and activity to reflect the more sedentary lives they lead in the United States, he says, especially those who left rural areas where walking was the primary mode of travel.
“There is a lot of education we need to do,” says Hernández, associate director for community and economic development for Iowa State University Extension & Outreach. The Latino population is generally younger, with more children but less education and lower income compared to the rest of the population, Hernández says. Some also work the night shift or multiple jobs, which makes leisure activity more challenging.
One of the projects the center has conducted with the Latino community is a men’s health group called Hombres Necios (Stubborn Men).
The Hombres project engaged Latino men in a series of discussions around their understanding of what influences or impacts their health as both Latinos and small town residents in the Midwest. The group was led by Hernández and Jason Daniel-Ulloa, assistant research scientist for the PRC.
The project used the Photovoice methodology, which involves giving participants cameras to record aspects of their lives, in this case images of the food they ate and their physical activity. Diets tend to be high in fat, and soda has become a staple. Some of the workers also immigrated without their wives and children. “The men end up eating out and eating a lot,” Hernández says. “It’s not a good recipe for health.”
Participants in the group are informal community leaders— church volunteers, business owners, and others— who will be able to share “best practices” developed for Ottumwa with residents who trust them, Hernández says.
“We don’t want them to give up their culture,” he says. “But do we always have to have a soda at home or watch TV as we eat dinner?”
The participants presented the Photovoice results at a community forum, and the experience has helped the Hombres participants to better understand health issues, establish a social support group, and increase their confidence and social standing in their community through their newly acquired knowledge, says Daniel-Ulloa. The group is currently exploring next steps, including finding resources for a larger applied health intervention.
Redes de Salud
Another project, Redes de Salud (Network of Health), explored community-based places and networks that Latinos in Ottumwa trust and rely on to conduct business, obtain services, and connect with other Latinos. The study investigator, Barbara Baquero, first established a Latino advisory committee to work with her in developing and implementing the study.
The purpose of the study was to both introduce the UI College of Public Health and the Prevention Research Center to the Latino community in Ottumwa and to explore the social networks, sources of influence, and community-based places that would be important for subsequent health promotion and disease prevention programs for Latinos. In the study, staff interviewed customers, clients and patrons, managers, and owners of these community-based businesses and services to obtain their perceptions of the important community structures for the Latino population as well as the resources available and the needs of the community overall to address the recent influx of Latinos in Iowa.
The Redes study provided valuable information to develop community-based intervention strategies to address Latino health in Ottumwa and other communities. The information has also been used in establishing partnerships with the Latino communities of Iowa City and West Liberty. These studies have not only galvanized the Latino community and stakeholders in Ottumwa to address their health needs and concerns, says Baquero, but also have helped “the Latino community in Ottumwa to establish strong and positive relationships with UI researchers and students.”
Changing physical activity habits on an individual level can be challenging enough, but the University of Iowa Prevention Research Center (PRC) seeks to go beyond the individual level by improving the health of an entire community.
Ottumwa was chosen by the center for a special community based research project focused on physical activity. The U.S. Centers for Disease Control and Prevention (CDC) notes that regular physical activity can help reduce the risk for chronic diseases such as diabetes, heart disease, and cancer. The research project will inform community innovations to enhance the health of Iowans and residents of rural towns elsewhere.
“We considered several communities,” says Edith Parker, principal investigator and director of the PRC, which is based in the UI College of Public Health and funded by the CDC. “We realized we wanted to go where there was a need but also strengths to build upon, and Ottumwa had both.”
With nearly 25,000 residents, Ottumwa, the county seat of Wapello County in southeastern Iowa, was selected because of its health needs, as well as “their willingness to work with us,” says Parker, who also heads the college’s Department of Community and Behavioral Health. A Community Advisory Board was established to collaborate on identifying concerns, developing a community survey, and partnering with the center on other initiatives.
The survey, conducted in 2012-2013 by the research center with more than 1,000 Ottumwa residents, showed that 35.8 percent of respondents reported being obese, compared to 29 percent of Iowans in general. One-third (36 percent) of respondents said they participated in the CDC’s recommended amount of weekly physical activity, compared to 43.9 percent of Iowans. Respondents living at or under median income level were less likely to have met the physical activity guidelines (25 percent) compared with respondents living above (50 percent). Mental health also arose as an issue, which Parker notes is entwined with physical health.
Evidence-based physical activity interventions have been tested in inner-cities and suburban areas, but Parker points out similar efforts in rural communities have been scant.
“While we’re focusing on Ottumwa, we feel what we do can be disseminated and serve a larger regional focus,” she says.
Desiree Johnson, president and CEO of the United Way of Wapello County and a member of the Community Advisory Board, says she appreciates the center’s work.
“We are very honored to have the Prevention Research Center staff here,” she says, adding that the center has opened an office on Ottumwa’s Main Street, another sign of its commitment to the community.
Johnson says the goal is to see Wapello County, currently in the lowest quartile of Iowa in measurements of health, move up to the next quartile in the next 15 years. To meet that goal and as part of the project’s next phase, called Active Ottumwa, residents will work toward becoming active for at least 150 minutes per week, she says.
Some of that activity will take place on the county’s extensive parks and trail system. The project does not provide funding for “bricks and mortar” infrastructure, but works to train lay leaders in evidence-based health practices, says Barbara Baquero, co-principal investigator and deputy director of the PRC.
“That’s the biggest thing we’re going to build,” explains Baquero, who directs the Active Ottumwa research project, “advocates for health in their own community.”
Baquero says at least 20 UI faculty, staff, and students have been involved in the project so far, with that number expected to grow.
“The community engagement approach is not new,” Baquero says. “But how we’re putting it together has never been done before.”
Some of the issues—limited access to healthy foods, mental health issues such as depression, drug abuse, and domestic violence—are due to the lack of services available and because of the ways people cope with stress, she says.
The project will work on preventing those problems for the long-term and will create evidence-based protocols that can be replicated in other Iowa communities, as well as the Midwest, Baquero says, “So this is not just a one-time thing.”
The study also will follow residents over time to assess the community-wide impact of the program.
“Our commitment to Ottumwa is long-term,” Parker says. “We want to establish a lasting relationship. That’s our promise.”
More than 1,000 people in the Ottumwa area took part in a health survey conducted last year by the UI’s Prevention Research Center for Rural Health. The survey results show several interrelated community concerns, including food security, obesity, and lack of physical activity.
“We used the survey to identify where issues were,” said researcher Barbara Baquero, assistant professor of community and behavioral health in the UI College of Public Health. “It pointed to obesity, and now that’s supported by the data. But it’s a multi-faceted problem. When a person is obese, they’re prone to chronic health problems. They’re usually not the ones who are engaging in physical activity. And it’s nutritional: Where are they going to eat? Are they cooking at home? There are so many facets to the problem.”