The goal of my program of research is to reduce Mexican-American health disparities in the US-Mexico border region. The current research focus is on reducing tuberculosis (TB) health disparities in Mexican immigrants at the US-Mexico border. The goal is to construct culturally relevant interventions that increase successful completion of preventive therapy treatment in Mexican immigrants diagnosed with latent tuberculosis infection (LTBI).

The first exploratory study (critical ethnography) will focus on Mexican immigrants diagnosed with LTBI at the US-Mexico border and who are at risk of treatment failure for preventive therapy. The aim is to elicit their understanding and experience of tuberculosis and (LTBI) and experiences with the US and Mexican public health systems. A critical ethnographic approach to illuminating the emic or local perspective gives voice to the people, explains their health care systems relative to LTBI in the context of US-Mexico border, builds transcultural nursing knowledge, and informs the development of culturally relevant interventions at multiple levels including binational health policy. A second study will identify the prevalence rate of LTBI, preventive therapy completion rate, and other demographic data of persons diagnosed with LTBI in a rural border county in Arizona. Findings from the above investigations will inform the construction of a prospective study of LTBI in Mexican immigrants in two community health centers at the US-Mexico border.

In addition to my program of research, other clinical scholarship activities include Nuestra Comunidad, Nuestra Salud (NCNS) an interdisciplinary rural health training grant at the US-Mexico border. NCNS has been administered by Marylyn McEwen, PhD, APRN, BC, Co-Principal Investigator and Dr. Marion Slack, PI, College of Pharmacy, since 1994. The investigators recently received an award of $827,295 from the Quentin N. Burdick Program for Rural Interdisciplinary Training of the Health Resources and Services Administration to continue for another three-year period, 2003-2006. NCNS provides undergraduate and graduate students from nursing, pharmacy, medicine, public health, nutrition, and social work with a unique learning opportunity to participate in an interdisciplinary case management model with promotoras (community health workers) and engage with community coalitions to address rural/border health issues in Santa Cruz County. The focus for the next three years is on reducing sedentary lifestyles and obesity in Mexican-American women of childbearing age and their children. “The new grant funding will allow us to go upstream and influence health behaviors that are precursors to diabetes which is 2-3 times more prevalent among Mexican-Americans than Non-Hispanic whites” states McEwen. In addition, students have an opportunity to work with binational health projects such as the triage and stabilization unit in Nogales, Sonora, Mexico and the Binational TB project.

The US-Mexico border, characterized by sharply differentiated development, asymmetrical relationships, cultural heterogeneity, and cross-border interdependence, presents challenges to reducing health disparities experienced by the 11 million residents in this geopolitical region. For example, tuberculosis along the US-Mexico border exceeds the national rate maintaining a reservoir for TB infection. Because of the transnational relocation of Mexican-origin persons in the US borderlands, continued border crossings, the epidemiological shift in LTBI, and the uniqueness of the TB policies in the US and Mexico, it is important to understand the border as context and contributor to TB health disparities. Reduction of TB health disparities requires an understanding of the local (emic) beliefs, values, and norms of behavior. In a recently completed critical ethnographic study, Dr. McEwen illuminated the explanatory model or understanding and experiences of Mexican immigrants at the US-Mexico border diagnosed with LTBI (and who had successfully completed or planned to complete preventive therapy). The study analyzed Mexican immigrants' explanatory model of the cultural context of care in which preventive therapy occurred; described the conflicting US and Mexican professional and popular explanatory models of TB and LTBI; and identified facilitators and barriers to adherence of preventive therapy.