Cardiovascular disease (CVD) and type 2 diabetes mellitus (DM) are leading causes of illness and death among US Latinos. In the United States in 2010, 13.2% of Latinos aged 18 or older had DM (1). Rates of CVD, although lower among Latinos than in other population groups, are projected to increase as the Latino population ages (2). The public health implications are profound, given that Latinos represent 16.7% of the US population (3).

In combination with genetic susceptibility, suboptimal lifestyle factors including physical inactivity, unhealthful diet, and obesity contribute to CVD and DM risk among Latinos (4,5). Family history reflects genetic and lifestyle influences on chronic diseases, and family history information can be used to tailor prevention interventions. However, effective use of family history information may be hampered by community-level deficits in genomic knowledge (6).

Interventions facilitated by promotores, laypersons who understand local health issues and are dedicated to improving their communities’ health (7), have effectively promoted healthy lifestyles among Latinos. Su Corazón, Su Vida (SCSV) is a promotores-facilitated educational program to reduce CVD risk among Latinos through healthy lifestyle promotion (8,9) that has been successfully adapted for DM prevention (10). Genomics and family history can support risk identification and motivate healthy behaviors (11). Integration of genomic and family history education into the SCSV program may further enhance effectiveness by supporting risk awareness and engagement in risk-reducing behaviors.

Effective intervention using SCSV has been demonstrated in US communities with a longtime Latino presence but not in “nontraditional” states where rapid growth of the Latino population has been more recent (5) and where culturally and linguistically appropriate health resources are limited. We describe a community–academic collaboration established in response to health needs of Latino residents in a nontraditional state. We describe the participatory process of tailoring the SCSV program and incorporating genomic and family history education, present results of an exploratory examination of sociocultural acceptability, and discuss the outcomes and public health implications.

The Latino population of Kentucky, estimated to be 140,000 (3.2% of the state’s population), more than doubled in size between 2000 and 2010, ranking fourth in the rate of growth in US states after South Carolina, Alabama, and Tennessee (12). Similar to the population nationally, most Kentucky Latino residents are from Mexico (61.3%) or other Latin American countries (22%); a smaller percentage are of Puerto Rican (6.4%) and Cuban (6.4%) origin (13). As a nontraditional Latino state, Kentucky has limited culturally and linguistically appropriate health resources (14). Resource limitations in combination with socioeconomic disparities negatively affect the health of Latino residents. More than one-third of Latinos in Kentucky live in poverty. The median annual income of people aged 16 or older is $18,000, and 16% are unemployed; 38% of the population is uninsured (15). The high cost of health care, lack of health care access for the uninsured, and lack of available linguistically and culturally appropriate health resources have been identified as major health-related barriers in surveys and focus group discussions with Latino residents of Louisville and Lexington, the 2 largest Kentucky cities, and are associated with poor health outcomes (16–18).

To address health needs of Kentucky’s Latino residents, a community–academic collaboration was established in 2008. The partnership originated from a longstanding relationship between the principal investigator (PI; G. M.) at the University of Kentucky and community leaders of the Latina Women’s Movement and La Casita Center in Louisville, Kentucky. The Latina Women’s Movement is a grassroots initiative dedicated to improving women’s well-being through programs that honor Latin American cultural traditions. La Casita Center is a community-based organization that provides services supporting Latino community development. Guided by principles of community-based participatory research (CBPR), the collaboration emerged from a mutually recognized need for a sustainable health promotion initiative, and a research team was formed that included the PI, the director of La Casita Center (who served as co-investigator; M. C. M.), and the founder of the Latina Women’s Movement (who was the project director).

The team prioritized CVD and DM prevention through a health-promoting lifestyle intervention because of the high rates of these diseases among Latinos and the potential for the intervention to improve health outcomes in an environment with limited health care resources. Collaborating partners agreed that a promotores-facilitated program would have greatest potential for sustainability with long-term health effects. Specific objectives of the collaboration were to 1) identify and tailor a healthy lifestyle intervention to reduce CVD and DM risk for use among Latino residents in urban Kentucky and 2) explore the feasibility of implementing the community intervention (Figure 1).

We conducted an extensive literature search to identify existing lifestyle programs with demonstrated effectiveness among Latinos. Team consensus was that the SCSV program could be tailored to address community needs and, as a promotores-facilitated intervention, had the greatest potential for sustainability. The program consisted of 8 educational sessions and a ninth review/evaluation session. Program details have been described previously (8).

To guide sociocultural tailoring of the SCSV program, formative research was conducted from 2008 through 2009 (Study 1). This research was followed by exploratory examination of implementation feasibility and acceptability of the tailored curriculum conducted during 2010 (Study 2). Both studies were approved by the University of Kentucky institutional review board.

Study results indicate that the socioculturally tailored SCSV program integrating genomic and family history education is feasible and appropriate to implement in a community setting among Latinos in a nontraditional area of residence. Outcomes also suggest that the program has potential to improve health behaviors and increase knowledge of genomics and family history of CVD and DM.

Program tailoring was guided by CBPR principles that included building on and extending community-academic relationships; mutual identification of community health needs and approaches to address these; and sociocultural tailoring, implementation, and evaluation of a risk-reduction program. Community partners were crucial to identifying health needs and guiding development of the research program. The academic component of the partnership was important in guiding scientific aspects of research. Participant collaborators in the formative research provided feedback critical for tailoring the SCSV program and informing development of the genomics and family history educational module. Strategizing with NC-AHEC representatives and the collaborative efforts of a promotora with the organization were essential to successful program implementation.

Community–academic collaboration foundational to CBPR presents both unique opportunities and challenges, both of which were experienced during this study. Effective communication among partners is vital to successful collaboration. In our study, collaborative processing, brainstorming, and problem-solving provided a solid foundation for relationship building and maintenance. Flexibility is also essential, as highlighted by study protocol changes guided by community partners. These resulted in improved outcomes but required significant cooperation and mutual engagement in the research process.

There were several study limitations. First, Study 1 was conducted with Latinas; inclusion of Latino males may have provided differences in program tailoring. However, outcomes from the exploratory study indicate the tailored intervention is appropriate for use with men and women. Second, although the small sample size for Study 2 was sufficient to indicate sociocultural appropriateness of the program, demonstrating effective CVD and DM risk reduction will necessitate conducting the intervention in a larger sample with more diverse representation of Latino countries of origin, a more rigorous research design, and a longer follow-up assessment period.

The outcomes of this study provide preliminary indication that the tailored healthy lifestyle intervention, including integration of genomic and family history education, is socioculturally appropriate and may provide a foundation for a sustainable program of health promotion for Latinos in a community with limited culturally and linguistically suitable health care resources. As important, the CBPR process used in program tailoring may provide guidance for addressing the health needs of Latino community members in other nontraditional areas of residence.