This article describes an effort to develop and implement a comprehensive, community-based approach to diabetes prevention and control in selected communities along the U.S.-Mexico border.
The U.S. state of Arizona shares a border with the Mexican state of Sonora. The four Arizona counties on this border are Cochise, Santa Cruz, Pima, and Yuma. In 1996, the University of Arizona and the Arizona Department of Health Services conducted a diabetes survey in the city of Douglas, Cochise County, in conjunction with its U.S. community partners and Mexican counterparts (1). This partnership led to the formation of a diabetes working group in Douglas. In 1998, members of this working group and other stakeholders formed the community advisory board of the newly funded Prevention Research Center (PRC) at the University of Arizona.
In 1999, the PRC community advisory board urged university faculty to focus on studies that prevent or control diabetes. As members also of border communities, community advisory board members felt the personal impact of diabetes among Hispanics. Hispanic Americans are now the largest and fastest growing minority group in the United States, with an estimated growth from 30 million (or 11% of the U.S. population) in 1998 to 97 million (or 25% of the U.S. population) by 2050 (2). In 2000, approximately 2 million of the 30 million Hispanic Americans were diagnosed with diabetes — 1.9 times the rate seen in non-Hispanic whites (2). Among Hispanic Americans aged ≥50 years, 25% to 30% have diagnosed or undiagnosed diabetes (2). Risk factors for diabetes (e.g., family history of diabetes, gestational diabetes, obesity, physical inactivity) are more common among Hispanic whites than non-Hispanic whites (2). Mexican Americans, who make up 64.3% of the total U.S. Hispanic population and live primarily in the south-central and southwestern United States, have the highest rate of diabetes among Hispanic Americans (1). They are twice as likely to have diabetes and have higher rates of diabetic nephropathy, retinopathy, and peripheral vascular disease than non-Hispanic whites (2).
On the U.S.-Mexico border, the impact of diabetes is reaching epidemic proportions. Based on a random household survey of Hispanic populations aged ≥40 years in two Arizona border counties, Pima and Santa Cruz, the prevalence of diabetes was 20%, which is 2–2.5 times higher than non-Hispanic whites (3). In this survey, diabetes was defined as either an affirmative response to the question of whether diabetes had been diagnosed by a physician or having an HbA1c blood test of 7.0% or greater. Between 1995 and 1997, diabetes was the fourth leading cause of death in Mexican communities on the border (4). Furthermore, type 2 diabetes is being diagnosed in increasingly younger individuals, including children and adolescents (5). Reversing these trends would require a comprehensive community-oriented approach focused on diabetes prevention and control (6,7).
The University of Arizona obtained a federal appropriation to develop a comprehensive, community-based approach to diabetes prevention and control. Fortunately, a number of community members and university faculty had a long and successful record of working together. The funding for the initial year of the project was for slightly more than $1 million. We subsequently obtained an additional $1.5 million to continue the project for two more years. The Division of Diabetes Translation at the Centers for Disease Control and Prevention was the project administrative agency.
A major factor in the collaboration was a history of a close working relationship in health promotion efforts between faculty from the Mel and Enid Zuckerman Arizona College of Public Health and Cooperative Extension agents from the College of Agriculture and Life Sciences. The advantage of Cooperative Extension is that each county has a designated agent who resides in that county and knows the key organizations and leaders. In addition, to assure the involvement of community agencies, almost half of the budget went directly to them through nine subcontracts. The project was known as the Border Health Strategic Initiative, or, more usually, Border Health ¡SI!.