title: An ecological model using promotores de salud to prevent cardiovascular disease on the US-Mexico border: the HEART project.
abstract: BACKGROUND
  To address cardiovascular disease risk factors among Hispanics, a community model of prevention requires a comprehensive approach to community engagement. The objectives of our intervention were to reduce cardiovascular disease risk factors in Hispanics living in 2 low-income areas of El Paso, Texas, and to engage the community in a physical activity and nutrition intervention.
  
  
  METHODS
  Drawing on lessons learned in phase 1 (years 2005-2008) of the HEART Project, we used an iterative, community-based process to develop an intervention based on an ecological framework. New community partners were introduced and community health workers delivered several elements of the intervention, including the curriculum entitled "Mi Corazón, Mi Comunidad" ("MiCMiC" [My Heart, My Community]). We received feedback from the project's Community Health Academy and Leadership Council throughout the development process and established a policy agenda that promotes integration of community health workers into the local and state workforce.
  
  
  RESULTS
  Collaboration with 2 new community partners, the YWCA and the Department of Parks and Recreation, were instrumental in the process of community-based participatory research. We enrolled 113 participants in the first cohort; 78% were female, and the mean age was 41 years. More than 50% reported having no health insurance coverage. Seventy-two (60%) participants attended 1 or more promotora-led Su Corazón, Su Vida sessions, and 74 (62%) participants attended 1 or more of the 15 exercise classes.
  
  
  CONCLUSIONS
  HEART phase 2 includes a multilevel ecological model to address cardiovascular disease risk among Hispanics. Future similarly targeted initiatives can benefit from an ecological approach that also embraces the promotora model.
authors.affiliation: University of Texas, School of Public Health, El Paso Regional Campus, 500 West University CH 400, El Paso, Texas 79968, USA. hector.g.balcazar@uth.tmc.edu
authors.forename: Hector
authors.initials: H
authors.lastname: Balcázar
authors.forename: Sherrie
authors.initials: S
authors.lastname: Wise
authors.forename: E Lee
authors.initials: EL
authors.lastname: Rosenthal
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ochoa
authors.forename: Jose
authors.initials: J
authors.lastname: Rodriguez
authors.forename: Diana
authors.initials: D
authors.lastname: Hastings
authors.forename: Leticia
authors.initials: L
authors.lastname: Flores
authors.forename: Lorraine
authors.initials: L
authors.lastname: Hernandez
authors.forename: Maria
authors.initials: M
authors.lastname: Duarte-Gardea
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003153:Community Health Services / Q000379:methods*; D055812:Community-Based Participatory Research / Q000379:methods*; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D006293:Health Promotion; D006801:Humans; D008297:Male; D008800:Mexico; D015397:Program Evaluation; D011634:Public Health; D012307:Risk Factors; D013781:Texas