Implementation and effectiveness of a multi-sectoral promotores de salud intervention in rural Oregon's summer meal program to promote health quality of life among Latine families

7. Project Summary Food insecurity, exposure to ethnic and language discrimination, and lack of access to educational information are common and intersecting social determinants of health (SDOH) that are multi-level (affecting the individual, household, and community) and are precursors to multiple health conditions (e.g., premature mortality, heart disease, type 2 diabetes, hypertension, mental health disorders). Because of the multifinality of their risks (i.e., exposure to a single SDOH can result in multiple adverse health outcomes), it is essential to implement preventive interventions that directly intervene on SDOH at a system level to disrupt the pathways from SDOH to broad health quality-of-life outcomes. These SDOH and health disparities have been replicated in Hispanic/Latine communities and are even worse among Latine families in rural areas. Further, Latine individuals represent an increasing proportion of the U.S. population under age 40, and thus children and their caregivers are a group who could greatly benefit from primary prevention approaches that disrupt SDOH earlier in the lifespan, when biological and social underpinnings of health outcomes are still quite malleable. To address this known health disparity, we propose a bi-phasic research project that builds upon and adapts our Oregon Saludable: Juntos Podemos (OSJP) collaboration with community-based organizations in the health sector to expand the health benefits of the Oregon Department of Education’s summer meal program for Latine families in rural settings in Oregon. We propose a Type 2 hybrid implementation-effectiveness study that uses a dual randomized controlled trial design at 96 summer meal sites nested within 24 school districts. The dual RCT design includes a simultaneous test of the implementation strategy (culturally responsive health worker outreach to Latine families to encourage attendance at the summer meal program) and the OSJP-Familias intervention (on-site brief, psychoeducation combined with resources/support for enrolling in additional year- around services), making a novel contribution to the field. We have six aims that include three Phase 1 Aims tied to measurable transition milestones: (a) collaborative planning with our community advisory board, our health and education partners, and the Multi-Sectoral Preventive Interventions (MSPI) research network, (b) scientific planning to collaboratively adapt our efficacious OSJP outreach and implementation frameworks, implementation strategies, and intervention into OSJP-Familias, and (c) operational planning that includes creating protocols and manuals of procedure for all study elements. Our three Phase 2 Aims include: (a) testing our primary implementation hypothesis, that a greater proportion of Latine children will be served at summer meal program sites in the active outreach implementation condition, (b) testing our primary intervention hypothesis, that OSJP-Familias would be associated with improved health quality-of-life in children and caregivers, and (c) conducting a cost-effectiveness analysis of the health quality-of-life gains relative to implementation costs of OSJP-Familias. Secondary hypotheses test mediators, moderators, and sustainability.