The Latino population is now the largest minority group in the United States (US). The higher prevalence of obesity among Mexican immigrants and Mexican-Americans (MI-MA) living in the US compared with Non-Hispanic Whites has been linked to socio-demographic and behavioral factors. There is emerging evidence that suggests features of the social environment and neighborhood socio-economic characteristics may have an influence on Latinos' obesity rates. This study was guided by the social-ecological model and used multilevel analytic methods to examine macro, meso and cultural exchange level factors associated with obesity among MI-MA living in the border region of San Diego, CA. Data were collected as part of the San Diego Prevention Research Center Community Survey. Multistage sampling methods were used to recruit participants into the study. Multilevel models were conducted to examine the association of these factors at multiple social-ecological levels on obesity. Three hundred and ninety seven people completed the survey. The mean age of respondents was 43.4±16.9, 72.6% were females and 77% were born in Mexico. Respondents scored high in the Hispanic domain of acculturation and crossed the border about three times per month mostly to visit family and friends in Mexico. Collective efficacy was an average of 3.5 (range 1 to 5). Respondents reported having 4 (0-5) people in their social network with an average reciprocity of 15 times per month. Neighborhoods where respondents live were on average 68% Latino with 27% of home ownership. Almost forty seven percent of respondents were obese. After controlling for micro-level characteristics, health behaviors and neighborhood clustering, the final model suggested that respondents who were employed, with an income below the poverty threshold were less likely to be obese. Middle-aged respondents with larger social networks were more likely to be obese. Two cross-level interactions were significantly associated with obesity. Times crossing the border to Mexico in the last month moderated the effect of collective efficacy on obesity. Neighborhood percentage of home ownership moderated the association between Hispanic domain and obesity. The study provided evidence that the meso, macro and cultural exchange level factors are associated with obesity among MI-MA living in this border region. This study provides the foundation to further investigate the influence of higher social-ecological level determinants of health among MI-MA living in this unique place of influence, the Southern California, US-Mexico border

This article describes a comprehensive process evaluation of an efficacious store-based intervention that increased store customers' fruit and vegetable consumption. The process evaluation plan was designed at study inception and implemented at baseline, during the intervention, and at immediate postintervention. Four Latino food stores were randomly assigned either to an intervention or to a control condition. Data were collected from store managers, employees, and 139 Latino customers. Researchers used manager, employee, and customer interviews; weekly observations of the store environment; and implementation logs to assess reach, dose delivered, dose received, and fidelity. Results indicated that it is possible to reach customers in a store-based intervention. Indicators of dose delivered demonstrated that the intervention was implemented as planned, and in the case of employee training, it exceeded the plan. Dose received data indicated that customers moderately engaged with the intervention activities. Together these suggest that the intervention was delivered with good fidelity. Comprehensive process evaluation efforts can facilitate the identification and elimination of barriers to implementation. This approach can serve as a model for future store-based interventions. The study demonstrated that it is feasible to implement Latino food store-based interventions to increase access to and consumption of fruits and vegetables.

Healthcare settings and systems have been slow to adopt and implement many effective cancer prevention and control interventions. Understanding the factors that determine successful implementation is essential to accelerating the translation of effective interventions into practice. Many scholars have studied the determinants of implementation, and much of this research has been guided by the Consolidated Framework for Implementation Research (CFIR). The CFIR categorizes implementation determinants at five levels (characteristics of the intervention, inner setting, individual, processes, and outer setting). Of these five levels, determinants at the level of the outer setting are the least developed. Extensive research in fields other than healthcare suggest that determinants at the level of the outer setting (e.g., funding streams, contracting practices, and public policy) play a central role in shaping when and how an organization implements new structures and practices. Thus, a more comprehensive understanding of outer-setting determinants is critical to efforts to accelerate the implementation of effective cancer control interventions. The Cancer Prevention and Control Research Network (CPCRN) created a cross-center workgroup to review organizational theories and begin to contribute to the creation of a future framework of constructs related to outer setting determinants. In this paper, we report findings from the review of three organizational theories: Institutional Theory, Transaction Cost Economics, and Contingency Theory. To demonstrate the applicability of this work to implementation science and practice, we have applied findings to three case studies of CPCRN researchers' efforts to implement colorectal cancer screening interventions in Federally Qualified Health Centers.

Implementing interventions that manipulate food store environments are one potential strategy for improving dietary behaviors. The present study evaluated intervention effects, from the El Valor de Nuestra Salud (The Value of Our Health) study, on in-store environmental changes within Latino/Hispanic-focused food stores (tiendas). Sixteen tiendas were randomly assigned to either: a six-month structural and social food store intervention or a wait-list control condition. Store-level environmental measures of product availability, placement, and promotion were assessed monthly from baseline through six-months post-baseline using store audits. Linear mixed effects models tested for condition-by-time interactions in store-level environmental measures. Results demonstrated that the intervention was successful at increasing the total number of fruit and vegetable (FV) promotions (p < 0.001) and the number of FV promotions outside the produce department (p < 0.001) among tiendas in the intervention versus control condition. No changes in product availability or placement were observed. Results suggests changing the marketing mix element of promotions within small stores is measurable and feasible in an in-store intervention. Difficulties in capturing changes in product availability and placement may be due to intervention implementation methods chosen by tiendas. It is important to build upon the lessons learned from these types of interventions to disseminate evidence-based in-store interventions.