Latino communities within the U.S. are disproportionately affected by persistent, high levels of untreated mental illness. Limited mental health literacy, stigma, and cultural factors are major contributors to Latino mental health treatment disparities. Although Latino individuals may be reluctant to seek out mental health professionals, they often rely on religious congregations when confronted with mental illness. However, religious congregations report major obstacles to collaborating with the mental health sector including the lack of mental health training, staffing, and resources. Strategic partnerships between religious congregations and community-based organizations can be leveraged to target sources of Latino mental health treatment disparities. The National Alliance on Mental Illness (NAMI), the nation's largest grassroots mental health organization, has developed a host of programs tailored to the different needs and segments of the community affected by mental illness, including programs designed to address culturally diverse and faith-based communities. This cluster-randomized controlled trial leverages the collective resources of NAMI and the Diocese of San Bernardino to deliver and evaluate the effectiveness of a multi-level, parish-based, intervention to decrease stigma, increase mental health literacy, and improve access to mental health services among Latino parishioners. This study will enroll 1400 participants from 14 parishes that will be randomly assigned to receive the intervention immediately or a wait-list control condition. The intervention could enrich awareness of mental health issues, shape norms about mental illness, facilitate treatment access, and add support from religious congregations to target Latino mental health disparities using culturally and faith-based tailored approaches.

Latino communities within the U.S. are disproportionately affected by persistent, high levels of untreated mental illness. Limited mental health literacy, stigma, and cultural factors are major contributors to Latino mental health treatment disparities. Although Latino individuals may be reluctant to seek out mental health professionals, they often rely on religious congregations when confronted with mental illness. However, religious congregations report major obstacles to collaborating with the mental health sector including the lack of mental health training, staffing, and resources. Strategic partnerships between religious congregations and community-based organizations can be leveraged to target sources of Latino mental health treatment disparities. The National Alliance on Mental Illness (NAMI), the nation's largest grassroots mental health organization, has developed a host of programs tailored to the different needs and segments of the community affected by mental illness, including programs designed to address culturally diverse and faith-based communities. This cluster-randomized controlled trial leverages the collective resources of NAMI and the Diocese of San Bernardino to deliver and evaluate the effectiveness of a multi-level, parish-based, intervention to decrease stigma, increase mental health literacy, and improve access to mental health services among Latino parishioners. This study will enroll 1400 participants from 14 parishes that will be randomly assigned to receive the intervention immediately or a wait-list control condition. The intervention could enrich awareness of mental health issues, shape norms about mental illness, facilitate treatment access, and add support from religious congregations to target Latino mental health disparities using culturally and faith-based tailored approaches.

Latino communities within the U.S. are disproportionately affected by persistent, high levels of untreated mental illness. Limited mental health literacy, stigma, and cultural factors are major contributors to Latino mental health treatment disparities. Although Latino individuals may be reluctant to seek out mental health professionals, they often rely on religious congregations when confronted with mental illness. However, religious congregations report major obstacles to collaborating with the mental health sector including the lack of mental health training, staffing, and resources. Strategic partnerships between religious congregations and community-based organizations can be leveraged to target sources of Latino mental health treatment disparities. The National Alliance on Mental Illness (NAMI), the nation's largest grassroots mental health organization, has developed a host of programs tailored to the different needs and segments of the community affected by mental illness, including programs designed to address culturally diverse and faith-based communities. This cluster-randomized controlled trial leverages the collective resources of NAMI and the Diocese of San Bernardino to deliver and evaluate the effectiveness of a multi-level, parish-based, intervention to decrease stigma, increase mental health literacy, and improve access to mental health services among Latino parishioners. This study will enroll 1400 participants from 14 parishes that will be randomly assigned to receive the intervention immediately or a wait-list control condition. The intervention could enrich awareness of mental health issues, shape norms about mental illness, facilitate treatment access, and add support from religious congregations to target Latino mental health disparities using culturally and faith-based tailored approaches.

To implement a multilevel, church-based intervention with diverse disparity populations using community-based participatory research and evaluate feasibility, acceptability, and preliminary effectiveness in improving obesity-related outcomes.,Cluster randomized controlled trial (pilot). Setting: Two midsized (∼200 adults) African American baptist and 2 very large (∼2000) Latino Catholic churches in South Los Angeles, California.,Adult (18+ years) congregants (n = 268 enrolled at baseline, ranging from 45 to 99 per church).,Various components were implemented over 5 months and included 2 sermons by pastor, educational handouts, church vegetable and fruit gardens, cooking and nutrition classes, daily mobile messaging, community mapping of food and physical activity environments, and identification of congregational policy changes to increase healthy meals.,Outcomes included objectively measured body weight, body mass index (BMI), and systolic and diastolic blood pressure (BP), plus self-reported overall healthiness of diet and usual minutes spent in physical activity each week; control variables include sex, age, race–ethnicity, English proficiency, education, household income, and (for physical activity outcome) self-reported health status.,Multivariate linear regression models estimated the average effect size of the intervention, controlling for pair fixed effects, a main effect of the intervention, and baseline values of the outcomes.,Among those completing follow-up (68%), the intervention resulted in statistically significantly less weight gain and greater weight loss (–0.05 effect sizes; 95% confidence interval [CI] = –0.06 to –0.04), lower BMI (–0.08; 95% CI = –0.11 to –0.05), and healthier diet (–0.09; 95% CI = –0.17 to –0.00). There was no evidence of an intervention impact on BP or physical activity minutes per week.,Implementing a multilevel intervention across diverse congregations resulted in small improvements in obesity outcomes. A longer time line is needed to fully implement and assess effects of community and congregation environmental strategies and to allow for potential larger impacts of the intervention.

Although physical activity can help mitigate or prevent multiple chronic diseases, most people in the U.S., especially high-poverty minority groups, engage in insufficient levels of physical activity. To test ways to promote more physical activity in high-poverty area public parks we conducted a randomized controlled intervention trial. After completing baseline measures of park-based physical activity using systematic direct observation three times/day each month for six months and assessing preferences for park programming among 1,445 residents living within 1 mile of study parks, we randomized 48 parks in high poverty neighborhoods in the City of Los Angeles, California during 2013–2014 to four study arms: 1) free physical activity classes over a 6-month period, 2) a frequent user program where participants could win prizes based upon the number of visits they made to the park, 3) both the programs, and 4) neither one (control condition). We re-measured park use in 2014–2015 using the same methods during the six months the intervention programs were in operation. A total of 2,047 free park classes were offered attracting 16,718 participants. The frequent user programs enrolled 1,452 individuals and prizes were awarded to 830. Residents in the two study arms with free classes were more likely to report being aware of and participating in park-based physical activity programs; however, overall observed park-based physical activity increased similarly across all study arms. The process evaluation uncovered several barriers to program implementation, including inconsistent scheduling of classes, partly due to safety concerns among instructors. Multiple social factors interfere with leisure time physical activity among low-income populations, suggesting modest interventions may be insufficient to overcome these issues. Although new park programs can attract users, new programs alone may be insufficient to increase overall park use in low-income neighborhoods at times when the programs are not taking place.

BACKGROUND: Physical inactivity is an important health risk factor that could be addressed at the community level. PURPOSE: The goal of the study was to determine whether using a community-based participatory approach with park directors and park advisory boards (PABs) could increase physical activity in local parks. Whether involving PABs would be more effective than working with park directors alone was also tested. DESIGN: An RCT intervention from October 2007 to April 2012 was used, with partial blinding of observers to the condition. All data were analyzed in 2012. SETTING/PARTICIPANTS: Of 183 eligible parks in the City of Los Angeles, 50 neighborhood park/recreation centers serving diverse populations participated. Parks were randomized to three study arms: (1) park-director intervention (PD-only); (2) PAB intervention (PAB/PD); and (3) a control arm. Physical activity in each park was systematically observed, and park users and residents living within 1 mile of the park were interviewed. INTERVENTION(S): The intervention included assessing park use, obtaining feedback from park users and community residents, training on outreach and marketing, and giving each intervention park $4000 to increase park-based physical activity. The PAB/PD arm required participation and concurrence on all purchases by the PAB. MAIN OUTCOME MEASURE(S): Change in the number of park users and change in the level of park-based physical activity, expressed as MET-hours. RESULTS: Relative to control parks where physical activity declined, in both the PD-only and PAB/PD parks, physical activity increased, generating an estimated average of 600 more visits/week/park, and 1830 more MET-hours of physical activity/week/park. Both residents and park users in the intervention arms in the intervention arms reported increased frequency of exercise. No differences were noted between the PD-only and PAB/PD study arms. CONCLUSIONS: Providing park directors and PABs with training on outreach and marketing, feedback on park users, and modest funds increased the amount of physical activity observed in parks.

With the increase in information derived from clinical research and technology, many in clinical medicine have adopted an evidence-based approach to inform treatment decisionmaking. Such a process forces the physician to obtain relevant scientific information (evidence) from a variety of sources including the patient, and to evaluate continually decisions made against patient health outcomes. Among the various proposed community-based health programs, how do foundations or health care systems decide which programs to fund? Can the evidence-based decisionmaking paradigm adopted by the clinical community support decisionmaking concerning community-based health programs? A literature review was conducted to ascertain what types of evidence concerning community-based health program effectiveness and costs were available. Focus groups and telephone interviews were conducted with persons involved in community-based health program funding decisions to learn how decisions were made and what types of information were used to support those decisions. While there was general support for using more evidence regarding program effectiveness and costs in making funding decisions about community-based programs, there was consensus that little evidence was readily available. There was also a widely held belief that funding decisions could (and should) also take into consideration issues beyond that which can be expressed as evidence. The report concludes with some suggestions regarding how health care systems and private funders can move toward an evidence-based approach to community-based program decisionmaking.