In the first year of implementation, 702 seniors received a wrist screening, education about osteoporosis, and an explanation of their bone density results. The collaborators learned that approximately 60 percent of those screened were "at risk," which is a much higher percentage than was expected. Moreover, the age of those with low bone density in this group seems to average at least 10 years younger than it would be in the Caucasian community. (These findings indicate the need to explore how prevalent the risk is in a broader Latino community - and demonstrate an additional value of conducting more effective outreach.) In year two of the implementation, the collaborating partners expect to screen another 600-800 Latinos, and reach many more through a highly active social marketing campaign that employs Univision's Dr. Aliza Lifshitz as its spokesperson.
The Health Issue
Osteoporosis is a disease characterized by lower bone mass, which makes bones fragile and more likely to break. Hip fracture is a common result. For those over fifty who suffer a hip fracture, about 20-25% die within the next year and many more will never live independently again. Most tested messages and programs that have had some success among other populations have not resonated with Latinos. Therefore, limited awareness of the disease and other health disparity issues make this growing population particularly vulnerable. Current research indicates that 33% of Latinas over 50 years of age have osteoporosis, but this project indicates the numbers may be much greater. Research also indicates the incidence of hip fractures among Latinos in California has doubled over the last 25 years, even as it has leveled off among California Caucasians.
The Health Improvement Strategy
The partners have forged a multi-faceted intervention plan. To raise awareness, La Clínica and FORE train senior promotores (health educators) at La Clínica's Pittsburg and Monument clinics to deliver carefully researched messages at community events and individual visits. Simultaneously, Latino Consultants - media and health care consultants - are implementing a targeted social marketing campaign using a prominent medical spokesperson familiar to the Latino community: Univision's Aliza Lifshitz, MD. The social marketing campaign (¡Huesos fuertes ahora! - Strong Bones Now!) seeks to reach older Latinos through Spanish language television and radio, a new web site, and bus stop billboards in Latino neighborhoods. All of these efforts are designed to raise awareness and attract Latinos to bone density screening events in their neighborhoods that FORE and La Clínica conduct.
In the first year of implementation, the collaborators were alarmed to see a trend developing that indicated some 60 percent of the 702 seniors screened had low bone density - a much higher percentage than was expected. Moreover, the age of those with low bone density in this group seems to average at least 10 years younger than it would be in the Caucasian community. This data confirms the importance of this health collaborative and convinced the partners there is a dramatic need to sustain their interagency efforts after support from the Community Health Fund ends.
Many of the seniors identified with bone loss will need access to no or low-cost osteoporosis medications, an important role for La Clínica's pharmacy assistance program. FORE will work with Safeway to secure ongoing, in-kind donations and FORE will continue to provide free calcium with Vitamin D to La Clínica. For diagnosis, La Clínica will add an in-house bone density machine.
Osteoporosis support groups are also important, and La Clínica's senior promotores will join forces with FORE's bilingual, bicultural community health educator to co-facilitate these groups.
Finally, the collaborative has been working with an experienced professional evaluator - Colleen Denny-Garamendi, DrPH, MPH - to evaluate and document the collaborative process and the health improvements that result from it. The evaluation is examining everything from the number of people reached through awareness, attitudes, and beliefs regarding osteoporosis among older Latinos to compliance with recommended prevention and treatment strategies.