Health Fairs Program Manual

Health Fairs
Program Manual
Michael Dalious
Health Fairs Coordinator
La Clínica del Pueblo
2831 15th Street, NW |‌ Washington, DC 20009-4607

T (202) 462-4788 |‌ F (202) 667-3706 |‌ www.lcdp.org
La Clínica del Pueblo Health Fairs Program Manual vi1

Health Fairs Program Manual
2008

Direct funding for the health fairs program in 2008 has come from the District of Columbia’s
Department of Health, the Mayor’s Office for Latino Affairs, and the MedStar Research Institute.
This manual and the study of the health fairs program were funded by the DC Department of
Health’s Preventative Health Block grant (DOH ID# 8H0127) and La Clínica del Pueblo in
collaboration with the George Washington University.
Direct supervision of the study was provided by Dr. Daniel Hoffman, Professor of Epidemiology
and Biostatistics with George Washington University’s School of Public Health.
ACKNOWLEDGEMENTS
La Clínica del Pueblo is proud to present this manual for

the health fairs program for the Latino community of the
Washington, DC Metropolitan Area. The development of
this manual has been a cumulative effort begun by the work
of Dr. Juan Romagoza, the modern day founder of La
Clínica del Pueblo. For 20 years, Dr. Romagoza reached
out to the Latino community to both educate and serve. His
vision of health care access as a basic human right
continues to be the driving force of all health fairs.
Dr. Juan Romagoza
The Community Health Outreach Department was

created within La Clínica del Pueblo in 2006 to
continue the outreach work performed by Dr.
Romagoza. Key collaborators to the health fairs
program from these years include Kristen Boehne,
Eudom Ixthayul, Sarah Koch, Lillian Meza,
Sorangel Posada, Carolina Torres, and Blanca
Tobar. In 2008, the Health Fairs program also
greatly benefited from the work of our two
interns, Amy Robandt and Caroline Rosenberg.
Rigorous scientific support for the program has been obtained from the US Department of Health
through their US Preventative Services Task Force organized by the Agency for Healthcare
Research and Quality, and from the following institutions:
National Heart, Lung and Blood Institute

La Clínica del Pueblo and the
Latino community would
also like to recognize the
continuing work of our
dedicated community health
promoters and volunteers,
without whom the health fairs
would not be possible.

CONTENTS
Acronyms………………………………………………………………….. 6
Foreword…...………………………………………………………………. 7
PROGRAM DESCRIPTION……………………………………………………….8
La Clínica del Pueblo Synopsis……………...…………………………….. 9
Community Health Outreach Department Synopsis………………………. 10
Problem Statement…………………………………………………………. 11
Program Objectives and Activities………………………………………… 12
Target Population…………………………………………………………... 13
Planning Considerations……………………………...……………………. 15
CORE HEALTH FAIR SERVICES………..……………………………………… 17

Registration………………………………………………………………… 18
Screening Sessions……………………………………………………........ 20
Body Mass Index Screening………………………………………. 20
Blood Pressure Screening…………………………………………. 21
Plasma Glucose Screening………………………………………… 22
Total Cholesterol Screening………………………………………. 23
Counseling Sessions………………………………………………………. 24
Nutrition Counseling……………………………………………… 24
Exercise Counseling………………………………………………. 30
Heart Health Counseling………………………………………….. 32
Diabetes Counseling………………………………………………. 34
Cancer Counseling………………………………………………… 39
Colorectal Cancer…………………………………………. 40
Prostate Cancer……………………………………………. 41
Breast Cancer……………………………………………… 42
Cervical Cancer……………………………………………. 43
Exit Counseling……………………………………………………………. 44
Health Insurance Counseling……………………………………………… 45
ADDITIONAL SERVICES……………………………………………………….. 46
HIV Counseling and Testing………………………………………………. 47
Glaucoma Screening……………………………………………………….. 47
Other Health Services……………………………………………………… 47
Non-Health Related Services……………………………………………….48
Children’s Center……………………………………………………………48
POST HEALTH FAIR SERVICES………………………………………………... 49

Patient Navigation System………………………………………………….50
Program Evaluation………………………………………………………... 51
Logic Model………………………………………………………………...52
Recommendations…………………………………………………………. 53

APPENDICES……………………………………………………………………... 54
Appendix A………… 2008 Health Fair Statistics………………………… 55
Appendix B ………... 2008 Health Fair Venues…………………………... 60
Appendix C ………... Health Fairs Program Schedule……………………. 61
Appendix D…………Health Promoter Agreement……………………….. 62
Appendix E………… Health Fairs Program Flyer…………………………64
Appendix F………… Registration Sheet………………………………….. 66
Appendix G…………¼ Page Participant Results Sheet………………….. 68
Appendix H…………Body Mass Index Tables…………………………... 69
Appendix I…………. Nutrition Handouts………………………………… 71
Appendix J…………. Exercise Handouts…………………………………. 73
Appendix K…………Heart Health Handouts…………………………….. 75
Appendix L…………Diabetes Handouts…………………………………. 77
Appendix M………...Cancer Handouts…………………………………... 79
Appendix N…………Exit Counseling “Your Health Levels”……………. 83
Appendix O…………What are Heart Disease and Stroke?......................... 84
Appendix P………….How Can I Reduce High Blood Pressure?................ 88
Appendix Q…………How Can I Lower High Cholesterol?........................ 92
Appendix R………… All about Pre-Diabetes……………………………...96
Appendix S………… Mental Health Resources Handout………………… 100
Appendix T………… Community Clinics in Washington DC……………. 101
Appendix U…………Community Clinics in Maryland and Virginia…….. 103
ENDNOTES……………………………………………………………………….. 105

ACRONYMS
ACS American Cancer Society

ADA American Diabetic Association
AHA American Heart Association
AHRQ Agency for Healthcare Research and Quality
BSE Breast self-examination
BMI Body mass index
CBE Clinical breast examination
CHOD Community Health Outreach Department
DC DOH District of Columbia’s Department of Health
HDL High density lipoprotein
HIV Human immunodeficiency virus
LCDP La Clínica del Pueblo
LDL Low density lipoprotein
NHLBI National Heart, Lung and Blood Institute
NIH National Institute of Health
NCEP National Cholesterol Education Panel
OLA The Mayor’s Office for Latino Affairs
SES Socioeconomic status
STI Sexually transmitted infection
USPSTF United States Preventive Services Task Force

FOREWORD
The intent behind the creation of this manual is threefold. First, the manual serves
to document La Clínica del Pueblo’s 25 years of experience with health fairs. In
this time, the health fairs have evolved to meet the unique needs of the Latino
community in the Washington, DC Metropolitan Area. In documenting our
experiences, we aim to acknowledge the hard work of all those who have
supported the program. Secondly, the manual is considered a tool for LCDP staff
to formalize the health fair procedures and medical protocols. This manual will
be used to ensure that all health fair activities are supported by the current medical
research and recommendations, and that all activities are implemented in a
uniform manner to provide high standard screening and counseling sessions to all
health fair participants. Finally, this manual has been assembled to share our
cumulative experiences and best practices with our funders and other community-
based organizations interested in promoting health access among the Latino
community.
This manual is considered a living document. In the future, the program will
continually adapt to the changes within the Latino community and their health
needs. Over the years, we have observed shifts in Latino residential densities,
country of origins, and various other factors that affect the health needs of the
community. As such, the health fairs program and this manual will continually
adapt to the circumstances of the community. The advancements in medical
research and changes in screening and counseling recommendations will also be
adopted to ensure that the program incorporates emerging best practices. New
recommendations from the United States Preventive Services Task Force
(USPSTF) and other contributing organizations will be continuously reviewed in
order to provide the best service possible and to align with current health care
practices.

PROGRAM DESCRIPTION
“While the diversity of the American

population is one of the Nation’s
greatest assets, one of its greatest
challenges is reducing the profound
disparity in health status of
America’s racial and ethnic
minorities.”
~National Center on Minority Health and Health Disparities

LA CLÍNICA DEL PUEBLO
La Clínica del Pueblo's mission is to provide culturally appropriate
health services to persons in the Latino community regardless of their
ability to pay.
La Clínica del Pueblo was founded in 1983 in response to the growing medical
and mental health care needs of Central American refugees escaping their warn-
torn countries during the 1980s. For many of these individuals, getting access to
any type of medical care was nearly impossible due to their status as refugees and
the cultural and language barriers that come with immigrating to another country.
La Clínica was started in direct response to the health care needs of these
immigrants and began as a one-room clinic, one night per week, by a volunteer
doctor.
Despite its brief hours of operation between 8:00 pm to 5:00 am during its initial
days, La Clínica was always full of patients who would brave the cold of winter
and the heat of summer because this was the only place where they felt
comfortable and where they were treated with respect and dignity.
La Clínica’s services are now offered in a newly renovated, state-of-the-art clinic

located at the crossroads of the Columbia Heights, Mt Pleasant, and Adams
Morgan neighborhoods in the District of Columbia. In 2007, over 7,500 clients
were seen during 55,000 client visits. A staff of almost 80 employees coordinates
over 100 volunteers, the majority of whom are bilingual and culturally competent.
Client Population
• 86% of La Clínica's clients are recent Latino immigrants from Central and South
America; 55% are originally from El Salvador.
• Over 90% have no health insurance and have incomes below the poverty level.
• More than 50% have less than a seventh grade education.
• Over 90% are most comfortable communicating in Spanish.
• 77% of La Clínica's clients live in the District of Columbia; 19% live in
Maryland; and 4% live in northern Virginia.
• 62% are female; 20% are under the age of twenty.
La Clínica del Pueblo Health Fairs Program Manualvi10

COMMUNITY HEALTH OUTREACH DEPARTMENT (CHOD)
Goal – Reduce the health disparities experienced within the Latino community in
the Washington, DC Metropolitan Area.
The objectives of the Community Health Outreach Department (CHOD) of La

Clínica del Pueblo are:
1) To educate the Latino community of the risk factors and symptoms of

chronic illnesses including diabetes, cardiovascular disease, obesity, and
cancer in order to change behaviors that negatively affect the mental and
physical health of the community while enforcing positive culturally
appropriate behaviors.
2) To orient Latinos to the culturally appropriate medical services and health
insurance programs available to them.
3) To integrate preventative services into medical care by providing exercise
and cooking classes, a diabetic patients club, and educational sessions to
the Latino community.
4) To advocate for the right to equal access to health services for
underserved populations through participating in a variety of citywide
coalitions and councils.
In order to achieve these objectives, CHOD has developed several innovative

programs that focus on behavioral change including: the health fairs program; a
comprehensive diabetes education and management program—including exercise
and cooking classes; a cancer prevention program; and a heart health program.
All of the department’s programs are supported by a specially trained group of
health promoters. This group consists of individuals from within the Latino
community who are trained by LCDP staff as health promoters. The health
promoters provide culturally appropriate health screenings and educational
sessions in community health fairs and other educational opportunities in Spanish.

PROBLEM STATEMENT
Medical anthropologists who study the political economy of health care access for ethnic
minorities in the United States identify several barriers to health care access including cost,
language, educational level, cultural beliefs, and legal status.i The literature indicates that the
origins of health care barriers stem both from the neoliberal US health care system as well as the
cultural beliefs and practices of immigrating Latinos. The barriers not only reduce health care
access, but also lead to delayed and often substandard care that negatively impacts the health
outcomes of ethnic minorities. As the Latino population is the fastest growing subgroup in the
United States as of 2008, there are rising concerns that this group will increasingly place excess
stress on the US health care system. As the population ages, elderly Latinos who have not had
access to preventative health care will present higher levels of advanced chronic illnesses that are
expensive to treat and negatively affect their quality of life.
In a study of the state of Latino health in the District of Columbia, McClure and Jerger collect
comprehensive baseline data on Latinos’ health status, knowledge, and access to care.ii Through
a collaborative and community-based effort, they were able to identify and assess the barriers to
health care access of Latinos living in Washington, DC.
Key Health Care Findings:

• 41.5% of respondents had no form of health insurance
• 32% of respondents had not seen a doctor in more than two years
Key Socioeconomic Findings:

• 25% of respondents reported receiving a high school degree or GED
• 62% of respondents reported having an annual household income below $25,000
• 31% of respondents reported cost as their primary reason for not accessing health care
• 59% of respondents reported speaking only Spanish
McClure and Jerger’s findings indicated that Latinos in Washington, DC experience even higher
barriers than the average Latino living in the United States. The national average for uninsured
Latinos is 18% and nationally only 35% of Latinos earn an annual household income of less than
$25,000 per year. Likewise, 59% of Latinos nationally reported having a high school degree or
GED and only 40% reported speaking only Spanish. As a result, 36% of Latinos in DC report
their health as poor or fair, while only 16% of Latinos and 13% of Whites nationally report their
health as poor or fair.
As such, actions must be taken to decrease the health disparities experienced by Latinos living in
Washington, DC. The efforts must acknowledge the barriers in existence and aim to
circumnavigate them in the short-term and eliminate them in the long-term.

PROGRAM OBJECTIVES AND ACTIVITIES
The current anthropological literature suggests three main approaches to improving health care
access for Latinos despite the heterogeneous population.iii First and foremost, the provision of
affordable or no-cost health insurance can immediately reduce the health care costs barrier that
limits Latino access to health care. Secondly, training medical professionals in cultural
competency allows them to understand the beliefs and behaviors of Latinos and better serve the
Latino population. Finally, educating Latinos about their health risks and their rights to health
care assists Latinos in their health care utilization decision making processes. The provision of
health insurance and culturally competent providers are both the short-term solutions to
increasing health care access and together with increasing education and income levels, they
serve as the long-term strategy for eliminating ethnic inequalities in the US health care system.
The recommendations from the McClure and Jerger study largely coincide with the
anthropological literatureiv, suggesting: active enrollment of Latinos in available health insurance
plans—one of which is provided free of charge to low income Latinos; bilingual health education
focusing on key health issues including obesity, diabetes, cancer, and health care access; and
increased investment in Latino-serving clinics, as their providers have been observed to be more
culturally competent.
These recommendations and the observations of the state of Latino health in the Washington, DC
Metropolitan Area have shaped the health fairs program. The objective of the health fairs is not
to replace medical services, but rather to encourage individuals in the Latino community to
become concerned about their health and to direct them to health care services and insurance
programs. This objective is attended through the implementation of four principle activities, all
of which are supported by the literature as means to circumnavigating barriers to health care
access.
1) Counseling sessions are provided to educate participants about chronic illnesses and the
benefits of preventive and palliative services.
2) Screenings are provided to identify participants at high risk for chronic illness, so that these
individuals pay special attention to the counseling messages and seek out preventive and
palliative health care services.
3) Participants without a primary care physician and participants that have abnormal screening
results for one or more chronic disease indicators are referred to a culturally appropriate clinic
and follow-up calls are made to ensure they were able to make an appointment.
4) Eligible participants are enrolled in the DC Alliance HealthCare insurance program.
These activities may reduce health disparities by overcoming barriers to health care access. In
the short-term, Latinos gain access to preventive and palliative health care services that increase
their quality of life. In the long-term, as Latinos gain access to health insurance and have rising
levels of income and education, they will be better able to continually access health care services
and ultimately have an improving quality of life.

TARGET POPULATION
As La Clínica del Pueblo’s mission is oriented towards the Latino community and funding for
the program comes from the Mayor’s Office for Latino Affairs (OLA) and the District of
Columbia’s Department of Health for Integral Health for Latinos, all health fairs target the Latino
population. The program’s goal is to reduce health disparities by connecting more Latinos to
health service. In this sense, the target Latino population includes those who do not have health
insurance and/or do not have regular access to health services. Among the Latino population,
socio-economic determinants of income and immigration status play a large role in the ability to
access health services. For this reason the health fairs target low-income, recently-immigrated
Latinos.
According to OLA and the official Census figures in 2002, of the District's 564,326 residents,
53,289 (9.4 percent) are Latino, although due to census undercounting the figure is estimated to
be closer to 13 percent.v Latinos in the District demonstrated a 56 percent growth rate from 1990
to 2002, making them the fastest growing ethnic minority in the District. By the year 2010, the
District will have an estimated 70,000 Latino residents. Residency patterns for Latinos show a
concentration in Wards 1 and 4, with marginal increases in Wards 5 and 6, and declines in Wards
2 and 8. Almost half (46.3 percent) of DC Latinos live in Ward 1 neighborhoods. Within Ward
1, three clusters (Kalorama Heights/Adams Morgan/Lanier Heights, Mount Pleasant/Columbia
Heights/Pleasant Plains/Park View, and Howard University/Cardozo/Shaw/Le Droit Park) have a
Latino population of 10 percent or more. The same case is within Ward 4 for Logan Circle/Shaw
cluster; and within Ward 4 for Brightwood/Manor Park/Takoma and Brightwood
Park/Crestwood/Petworth/16th St. Heights.
Much of DC's Latino population growth is due to immigration rather than fertility. Latino
population growth from 1970 to 2000 reflects the newcomer characteristics of the population,
including the concentration of Latinos in certain neighborhoods, high proportion in productive
and reproductive age groups, unstable sex ratios, linguistic isolation, and extended family
structures.
According to OLA, over one-third of DC Latinos identified their country of origin as being in
Central America, the vast majority from El Salvador. This pattern is in stark contrast to the rest
of the Latino population in the US, which is mainly of Mexican, Puerto Rican, Dominican or
Cuban heritages. It is estimate that the proportion of the Latino population in Washington, DC
that is undocumented ranges from 5 percent to 15 percent of the total Latino population.

Hispanic Population in the District of Columbia, 2000
Source: Mayor’s Office for Latino Affairs
Demographic and health care information obtained from health fair participants in 2008 supports
the Census figures and confirms that the health fairs program is effectively reaching its target
population. Most notably, of the 2008 participants, 68% reported that they did not have health
insurance, and 54% reported that in the past year they did not access health care services.
Appendix A contains the full report of 2008 health fair statistics.
Special considerations are taken in the planning of health fairs to ensure that culturally
appropriate services are provided to the target population. Additionally, several assumptions of
the population are made when determining screening necessities and are described in the sections
were they apply. The United States Preventive Service Task Force (USPSTF) recognizes that
clinical or policy decisions involve more considerations that their accumulated evidence alone.
When determining screening protocols the USPSTF acknowledges that clinicians and policy
makers must individualize decision-making to the specific situation, but should do so with an
understanding of the evidence they present.vi Throughout this manual, several considerations
based on the preceding population are made that modify the services offered. These
modifications are noted along with their justifications in each case.

PLANNING CONSIDERATIONS
Venue – The venue for a health fair can be as important as the content of the event in terms of
the ability to positively intervene in the lives of the participants.
• The venue needs to be in an area of high Latino concentration (all health fairs within the
district are planned in areas of high Latino density according to the Mayor’s Office for
Latino Affairs “Washington DC Hispanic Population.”vii)
• Health fairs must be distributed throughout the Washington, DC Metropolitan Area to
provide services to a greater majority of the Latino community.
• The venue is also chosen for its accessibility (It is a place where Latinos normally
congregate).
• The venue needs to have sufficient space to house all services, providing private areas for
HIV screening and adequate space between services to provide confidentiality.
• The community partner responsible for the venue is required to assist in announcing the
health fair to the surrounding Latino community.
Appendix B contains the health fair venues from 2008.
Timing – Timing is another important consideration in the planning of health fairs.

• Health fairs must be timed during periods when the Latino community is free from work
and other social responsibilities (for the Latino community this means holding the
majority of health fairs on the weekends alternating between Saturday and Sunday.
Smaller events can be held during weekday evenings.)
• Health fairs are also timed during the period when Latinos are most active in community
activities (The health fair schedule runs from March to November, which avoids the
coldest part of the year when Latinos are less active in the community.)
• In order to serve all participants, health fairs range from 3 to 6 hours in length.
• The frequency of the health fairs is another important consideration. As the health fairs
aim to connect recently-arrived Latinos with health services, it is important to
continually return to areas with growing number of Latino immigrants. However, the
health fairs are not meant to replace health services and therefore need to be spaced
temporally and advertised to new populations in order to avoid dependence.
Appendix C contains the generalized health fairs schedule.
Health Fair Personnel – The closer the health promoter is to the health fair participant in terms
of socioeconomic status and cultural background the more effective their communication will be
with participants.
• Health promoters are recruited from within the Latino community. (PLEASE NOTE:
There is no racial discrimination in this process, as individuals from any racial or ethnic
background who speak Spanish and are familiar with Latin American culture are
welcomed to participate in the program.)
• As it is recognized that health promoters whom originate from the target population are
highly effective in both creating a welcoming atmosphere and simply communicating
health messages, there is no minimum level of education required to be a participant in

the program. However, health promoter candidates are required to show a strong interest
in serving their community, which is often very strong because they themselves have
recently been in the situation of those they will be serving.
• All new and returning health promoters are required to participate in a six day health
promotion training given by LCDP staff in February prior to the start of the health fair
year. On-going training sessions are provided throughout the year to reinforce the initial
training sessions and to train health promoters on additional topics that will increase their
knowledge for the health fairs and benefit them personally.
• Paid but more importantly appreciated! All health promoters that complete the training
are monetarily compensated for their time during the health fairs. However, the principle
motivation for participating in the program is the sense of pride that comes from serving
the community. LCDP staff reinforce this sense of pride by informing the health
promoters of the benefits of their work, as indicated by the evaluation. Health promoters
are also give ample opportunities to volunteer in additional health outreach events
organized by LCDP staff.
Appendix D contains the health promoter agreement.
Partnering Organizations – In order to multiply our impact in the community, we partner with
community-based organizations such as churches, schools, commercial centers, and community
centers that are able to provide a venue and contacts within the community. We also partner with
service provision organizations such as Planned Parenthood, Latin American Youth Center, DC
Department of Health, OLA, and FIDMi-Tierra, which are able to provide additional services
during the health fair. Due to the diversity among the participating organizations, the following
norms have been established.
• Venue sponsors may not deny access to any individual on grounds of race, sexual
orientation, or language abilities.
• Venue Sponsors and/or the Health Fairs Coordinator may deny access to individuals who
are deemed by them to be dangerous or disruptive.
• Service provision organizations must have 501(c)3 status or be a non-partisan branch of
the government.
• Service providers must respect the beliefs of the venue sponsors (i.e. service
organizations that promote family planning services are occasionally asked to promote
only those services that are found to be acceptable by the church sponsors).
Health Fair Announcements – All health fairs are publicized within the Latino community.
• Flyers are produced by either the venue sponsor or the Health Fairs Coordinator and
distributed in La Clínica del Pueblo and within the target community in the two weeks
leading up to the event.
• Experience has shown that the most effective flyer distribution method is to enlist the
support of a community leader, such as a church or school leader, to distribute the flyers
to potential participants. These trusted individuals are aware of the services offered
during the health fairs and are able to influence community members to attend the event.
• The Health Fairs Coordinator is also responsible for announcing the fairs in a growing
network of media channels including television, radio and newspaper outlets.

Appendix E contains a sample health fair flyer.

CORE HEALTH FAIR SERVICES
“If it hadn’t been for La Clínica del

Pueblo, I never would have known
how serious my diabetes was.”
~ Douglas Rivera
Health fair participant

The following core health fair services are provided at all health fairs. Participant registration is
always completed first and the exit counseling session follows all core services. The Health
Fairs Coordinator reserves the right to modify the order of the screening and counseling services
depending on participant flow and space constraints.
REGISTRATION
The first station of every health fair is the registration table, where information—as listed in Box
1—is obtained from the participant and the order of the services are explained to the participant.
Box 1
The following information is obtained from every participant in this order.

• Name
• Address
• Telephone Number
• Date of Birth
• Age
• Sex
• Race/Ethnic Group
• Country of Origin
• Level of education
• How long the participant has resided within the United States
• If they speak Spanish
• If they speak English
• If they have medical insurance
• If they have visited a clinic in the past 12 month within the United States
• If they suffer from an illness
• If so, what type of illness do they currently suffer from?
• If they smoke
• If they would like to stop smoking
• If they have ever had one of the following exams
o Colonoscopy
o Pap-smear
o Mammogram
o Prostate Exam
All information obtained from participants is held confidentially by LCDP staff. The
information is used to monitor and improve the health fairs program and to contact participants
that are referred to medical services.

Participation Authorization
Upon completion of the questionnaire, all participants are required to sign the registration sheet
acknowledging the statement in Box 2.
Box 2
Authorization: I hereby authorize La Clínica del Pueblo to conduct a series of free

tests designed to detect certain risks posed to my health. I understand that these tests are not
definitive, and that I would need to consult a doctor for a definitive diagnosis and for any
treatment needed. I hereby release and exonerate La Clínica del Pueblo of any
responsibility or liability that could result from these tests.
Appendix F contains the registration sheet used for all health fairs.
Each registration sheet has an accompanying ¼ page where the participant’s test results are
noted, so that the participant retains a copy of all test results when they hand in the registration
sheet at the exit counseling session. On the front side of this page, the participant’s name and
test date are recorded along with the screening results for Body Mass Index, Blood Pressure,
Plasma Glucose Level, and Total Cholesterol Level. On the reverse side of this page, the
participant is provided a guide to help them interpret their screening results and four ways to
prevent high blood pressure.
Appendix G contains the ¼ page that the participant retains with their screening results.

HEALTH SCREENINGS
This section describes the screening performed at the health fairs. Health fair participants are
encouraged to complete all screenings and their results are interpreted after all screenings have
been completed. None of the screenings are considered definitive nor are they the basis for a
diagnosis. The screenings are used to identify participants with higher risk of chronic disease, so
that they may be referred to preventive and palliative health care services.
BODY MASS INDEX SCREENING
The U.S. Preventive Services Task Force (USPSTF) recommends the screening of all adults for
obesity and the referral of obese adults to counseling (B recommendation).viii On the basis on
this recommendation, all health fair participants are screened for obesity using the Body Mass
Index (BMI) screening test. BMI, calculated as weight in kilograms divided by height in meters
squared, is compared to pre-established obesity levels (<25 normal; 25-29.9 overweight; 30-34.9
obese class I; 35-39.9 obese class II; >40 obese class III).
To calculate BMI, the participant’s weight and height is recorded, and the corresponding BMI is
derived from a BMI table.ix A floor scale is used to weigh participants and a tape measure
affixed to a wall is used to measure the height of the participants. Participants with thick heeled
shoes are asked to remove their shoes for both procedures. Additionally, if the individual is
carrying anything with them or has an excessive amount of objects in their pockets, they are
asked to set them down before being weighed.
Participants with a BMI between 30 and 39.9 (obesity classes I and II) are referred to high-
intensity counselingx including both exercise and nutrition components by the exit counselor.
This recommendation is based on the USPSTF findings that high-intensity counseling—
including diet and exercise components—together with behavioral interventions can produce
modest, sustained weight loss which in turn leads to improved glucose metabolism, lipid levels,
and blood pressure (B recommendation).
Participants with a BMI exceeding 39 (obesity class III) are referred to both high-intensity
counseling and medical services by the exit counselor.xi
Appendix H contains the BMI tables used in the health fairs.

BLOOD PRESSURE SCREENING
The USPSTF recommends screening for high blood pressure in adults aged 18 or older based on
the ease of blood pressure monitoring and the benefits of early detection and treatment (A
recommendation).xii The USPSTF states that hypertension is “a very prevalent condition that
contributes to significant adverse health outcomes, including premature deaths, heart attacks,
renal insufficiency, and stroke.”xiii They continue by stating, “The USPSTF found good evidence
that treatment of high blood pressure in adults substantially decreases the incidence of
cardiovascular events.” Both pharmacological and nonpharmacological treatments of
hypertension are available and are effective within the Latino community. On the basis of the
USPSTF recommendation, all participants are screened for high blood pressure.
The blood pressure of all participants is taken with the OMRON Automatic Blood Pressure
Monitor with Arm Cuff (Model HEM-711AC). The manufacture’s directions for proper use are
followed for all screenings. An extra large blood pressure cuff is used to take the blood pressure
of participants that have an arm circumference between 13 to 17 inches. In the event of two
sequential error messages, the Health Fairs Coordinator, a nationally-certified Emergency
Medical Technician, records the participant’s blood pressure manually using a stethoscope and
sphygmomanometer.
Participants with a blood pressure exceeding either a systolic of 130mm Hg or diastolic of 85mm
Hg are informed of four nonpharmacological treatment methods for reducing high blood pressure
including: reduced dietary sodium intake, weight loss, increased physical activity, and reduced
alcohol intake.xiv
Participants with a blood pressure exceeding either a systolic of 140mm Hg or diastolic of 90mm
Hg are referred to medical services for confirmation and the subsequent treatment of
hypertensionxv. These participants are also informed of four nonpharmacological treatment
methods for reducing high blood pressure including: reduced dietary sodium intake, weight loss,
increased physical activity, and reduced alcohol intake.xvi
Emergency Protocol
At the direction of La Clínica’s Medical Director, all participants that have a blood pressure
exceeding 210 mm HG systolic or 120 mm Hg diastolic are asked to wait five minute, after
which a second manual reading is performed by the Health Fairs Coordinator. If the participant’s
blood pressure remains above the previously indicated level, the Health Fairs Coordinator
activates the Emergency Medical System by calling 911 or notifying onsite Emergency Medical
Services and reports the hypertensive emergency.

PLASMA GLUCOSE SCREENING
The USPSTF recommends screening for type 2 diabetes in asymptomatic adults with sustained
blood pressure (either treated or untreated) greater than 135/80 mm Hg (B recommendation).xvii
However, since a baseline blood pressure cannot be established in the single reading at the health
fair, the high prevalence of hypertension in the Latino community, and the low invasiveness of
the non-fasting plasma glucose screening, all participants are screened for type 2 diabetes by
means of a plasma glucose level test.
Plasma glucose level screenings are performed through a contract with Health Pact, Inc using the
One Touch Ultra® glucameter. The manufacture’s directions for proper use are followed for all
screenings. Health Pact staff note whether the participant is fasting or non-fasting. In the health
fairs context, fasting participants are those who have not eaten in the twelve hours preceding the
screening. All other participants are considered non-fasting.
Participants with a non-fasting plasma glucose level exceeding 140 mg/dl or a fasting plasma
glucose level of 126 mg/dl are referred to medical services by the exit counselor.xviii
Emergency Protocol
Hyperglycemia
At the direction of La Clínica’s Medical Director, all participants that have a plasma glucose
level exceeding 250 mg/dl and are non-symptomatic are advised to eat a small dinner and
follow-up with a physician as soon as possible. If the participant’s plasma glucose is exceeding
250 mg/dl and the participant presents with shortness of breath, breath that smells fruity, nausea
and vomiting and/or a very dry mouth, the Health Pact staff member performing the test notifies
the Health Fairs Coordinator, who activates the Emergency Medical System by calling 911 or
notifying onsite Emergency Medical Services and reports the hyperglycemic emergency.
Hypoglycemia
At the direction of La Clínica’s Medical Director, all participants that have a plasma glucose
level below 70 mg/dl and are non-symptomatic are advised to follow-up with a physician as soon
as possible. If the participant’s plasma glucose is below 70 mg/dl and the participant presents
with any of the following symptoms the Health Pact staff member performing the test notifies
the Health Fairs Coordinator, who activates the Emergency Medical System by calling 911 or
notifying onsite Emergency Medical Services and reports the hypoglycemic emergency.
• Shakiness • Sudden moodiness or behavior changes

• Dizziness • Clumsy or jerky movements
• Sweating • Seizure
• Hunger • Difficulty paying attention, and/or confusion
• Headache • Tingling sensations around the mouth
• Pale skin color

TOTAL CHOLESTEROL SCREENING
The USPSTF recommends screening for lipid disorders in (1) men aged 35 and older (A
recommendation) and (2) men aged 20 to 35 and women 20 and older if they are at increased
risk for coronary heart disease (B recommendation).xix Due to the lifestyle of low SES
immigrant Latinos which includes poor dietary intake and low levels of physical activity, all
participants are considered to be at increased risk for coronary heart disease and are screened for
total cholesterol. The USPSTF has declared total cholesterol as an independent predictor of
coronary heart disease risk.xx The National Cholesterol Education Panel, in their ATP III
guidelines, state “if non-fasting test is done and total cholesterol is greater than 200 mg/dl, a
fasting lipoprotein profile is recommended.”xxi The preferred screening method includes a
breakdown between high density lipoproteins (HDL) and low density lipoproteins (LDL).
However in the health fairs, total cholesterol screening is used as an affordable screening to
indicate risk and refer participants for fasting lipoprotein profiles.
Total cholesterol level screenings are performed through a contract with Health Pact, Inc using
the ACCU-CHEK InstantPlus® Cholesterol tester. The manufacture’s directions for proper use
are followed for all screenings.
Participants with a total cholesterol level exceeding 200 mg/dl are referred by the exit counselor
to medical services for a fasting lipoprotein profile.xxii

HEALTH COUNSELING
The following section describes the counseling sessions provided to all participants. Sessions are
given in a one-to-one or small group setting. Each session is meant to last no longer than ten
minutes, including participant participation. The sessions provide targeted health messages that
are aimed to promote behavioral change in diet, exercise, and medical services utilization.
However, the short-term indicator used to measure the success of these sessions is an increase in
health knowledge. In this sense the more immediate goal of the sessions is to augment the
knowledge and to foster discussion of health topics among the target population. The health
promoters responsible for these sessions are trained in participatory education methods and
provided with materials specifically developed for use in LCDP’s health fairs program. The
health promoter is responsible for understanding all of the information in this section, however,
in each session the health promoter tailors the information presented to best communicate with
the participant. Thus all information presented here is not communicated in each session.
NUTRITION COUNSELING
The USPSTF recommends behavioral dietary counseling for patients with known risk factors for
cardiovascular and diet-related chronic disease (B recommendation).xxiii As previously stated,
all health fair participants are considered to be at increased risk for coronary heart disease and
also diet-related chronic disease—most notably type 2 diabetes—due to socioeconomic status
and thus are counseled on components of a healthy diet.
All participants receive a five to ten minute nutritional counseling session where they are taught
how to distinguish the major food groups, the recommended daily intake of each food group, the
main nutritional component of each food group, and the importance of that component to their
health. The health promoter relates the theoretical food pyramid to the daily habits of the
majority of immigrant Latinos and ends by reviewing the “Nutrition Facts” label that appears on
packaged foods. In this session, the health promoter uses real packaged foods with labels and
artificial whole foods such as vegetables and meats to visually communicate the topic. The
health promoter also has an 18” x 24” poster board that contains all of the topics presented
during the session, and each participant receives an 8 1/2” x 11” handout with the same
information. Information for this session came from the ADAxxiv, AHAxxv, and USDAxxvi.
Objectives
1. Explain the Food Pyramid
a. Grains and carbohydrates
b. Vegetables and fruits
c. Dairy and meats
d. Fats, sweets, and oils
2. Determine what is a healthy serving size
3. Discuss what foods and food habits to avoid
4. Teach participants how to read the Nutrition Labels and make healthier food choices

Materials
18” x 24” poster
Handouts of poster material
Play and packaged foods
Content
1. Explain the Food Pyramid
The Food Pyramid shows us how to balance our diets. The base of the pyramid is the largest and
is made of grains and carbohydrates. This means that more of our daily diet should come from
this category of foods. The second level is broken into vegetables and fruits, which should make
up the second largest part of our daily diets. The third level includes dairy and meat products,
which means we should consume less of these items in our daily diet. Lastly, the top of the Food
Pyramid is made up of fats, sweets, and oils. We should consume a limited amount of these types
of foods.
Question for participants: Think to yourselves about what foods you have eaten in the last 24
hours. As we discuss the Food Pyramid, ask yourself these questions: What types of food do I eat
a lot of? What types of food do I not eat enough of?
a. Grains and carbohydrates

Question for participants: Which of the food items on this table would fall into the grains and
carbohydrates category? What are some other foods in the grain group?
Any food made from wheat, rice, oats, cornmeal, barley or another cereal grain is a grain
product. Bread, pasta, oatmeal, breakfast cereals, tortillas, and rice are examples of grain
products.
Question for participants: Why do we need grains and carbohydrates in our diet? How many
servings of grains should we eat each day?
Carbohydrates give us the energy we need to go throughout our day. The recommended number
of servings depends on your age, sex, and type of work you do each day. Adults who do physical
labor or exercise regularly may eat more. Generally 6-11 servings per day are recommended.
b. Vegetables and fruits

Question for participants: Which of the food items on this table would fall into the vegetable
and fruit category? What are some other foods in the vegetable and fruit group?
Any vegetable counts as a member of the vegetable group. Any fruit or 100% fruit juice counts
as part of the fruit group. Vegetables and fruits may be raw or cooked; fresh, frozen, canned, or
dried/dehydrated; and may be whole, cut-up, or mashed. Spinach, peas, zucchini, pineapple,
grapes, and bananas are examples of vegetable and fruit products.
Question for participants: Why do we need vegetables and fruits in our diet? How many
servings of vegetables and fruits should we eat each day?
Vegetables and fruits provide vital nutrients such as vitamin C and fiber for the health and
maintenance of your body. Eating a diet rich in fruits and vegetables may reduce your risk of
stroke, cardiovascular diseases, and type-2 diabetes, and may protect against certain cancers,
such as mouth, stomach, and colon-rectum cancer. The recommended number of servings

depends on your age, sex, and type of work you do each day. Adults who do physical labor or
exercise regularly may eat more. Generally 3-5 servings of vegetables and 2-4 servings of fruit
per day are recommended.
c. Dairy and meats

Question for participants: Which of the food items on this table would fall into the dairy and
meats category? What other foods are in the dairy and meats group?
All fluid milk products and many foods made from milk are considered part of this food group.
Most milk group choices should be fat-free or low-fat. All foods made from meat, poultry, fish,
dry beans or peas, eggs, nuts, and seeds are considered part of this food group. Most meat and
poultry choices should be lean or low-fat.
Question for participants: Why do we need dairy and meat in our diet? How many servings of
dairy and meats should we eat each day?
Consuming milk and milk products can help build and maintain bone mass and reduce the risk of
osteoporosis in later life. This is especially important for children and adolescents. Foods in the
milk group provide nutrients such as calcium, protein, and Vitamin D that are vital for health and
maintenance of your body.
Meat, poultry, fish, dry beans and peas, eggs, nuts, and seeds supply many nutrients, such as
protein, B vitamins, and iron. Proteins help build bones, muscles, cartilage, skin, and blood. B
vitamins play a vital role in the function of the nervous system, aid in the formation of red blood
cells, and help build tissues. Iron is used to carry oxygen in the blood. Many teenage girls and
women in their child-bearing years have iron-deficiency anemia, and they should eat foods high
in iron (meats) and vitamin C.
The recommended number of servings depends on your age, sex, and type of work you do each
day. Adults who do physical labor or exercise regularly may eat more. Generally 2-3 servings of
dairy products and 2-3 servings of meats per day are recommended.
Question for participants: If you or someone in your family is a vegetarian, what foods should
they eat to get the nutrients they need from this food group?
Protein sources from the meat and beans group for vegetarians include eggs, beans, nuts, nut
butters, peas, and soy products (tofu, tempeh, veggie burgers).
d. Fats, sweets, and oils

Question for participants: Which of the food items on this table would fall into the fats, sweets,
and oils category? What other foods are in the fats, sweets, and oils group?
Solid fats are solid at room temperature, like butter and shortening. Solid fats come from many
animal foods and some vegetable oils. Some common solid fats are butter, beef, chicken, and
pork fat (lard), and shortening. Foods high in solid fats include:
• many cheeses • sausage

• cream • poultry skin
• bacon • cookies, donuts, and other pastries

Sweets include sugars and syrups that are added to foods or beverages during processing or
preparation. This does not include naturally occurring sugars such as those that occur in milk and
fruits. Foods that contain most of the added sugars in American diets are:
• sodas or soft drinks

• candy
• cakes
• cookies
• ice cream, pudding, and sweetened yogurt
Oils are fats that are liquid at room temperature, like the vegetable oils used in cooking. Oils
come from many different plants and from fish, and oils from plant sources (vegetable and nut
oils) do not contain any cholesterol. Extra virgin olive oil is the healthiest oil you can buy,
followed by virgin olive oil and canola oil. Peanut, corn, and sesame oils are less healthy because
they contain more polyunsaturated and saturated fats.
Question for participants: Why do we need fats, sweets, and oils in our diet? How many
servings of fats, sweets, and oils should we eat each day?
Because oils contain essential fatty acids, they should be consumed in limited amounts. To lower
risk for heart disease, cut back on foods containing saturated fats, trans fats, high fructose corn
syrup, and cholesterol.
Generally less than 2-3 servings of fats, sweets, and oils are recommended per day. Fats and oils
can be used for flavoring, but should be limited. Sweets should be eaten sparingly, perhaps as a
reward to yourself.
2. Determine what is a healthy portion and serving size

When you sit down to eat lunch or dinner, how much food you eat is also important. When we
talk about a portion, we mean how much food is on your plate. For example, McDonalds serves
large portions of hamburgers, french fries, and sodas. When we talk about a serving, we mean an
amount of food that is approximately the size of the palm of your hand. Everyone’s serving size
will be slightly different, for example, children should eat smaller servings than adult men.
Question for participants: How many servings are…

Grains: In a sandwich?=2 In 1 cup of rice?=2 In a large tortilla?=4
In general, 1 slice of bread or ½ cup of cooked rice, cooked pasta, or cooked cereal is the
equivalent of 1 serving from the grains group.
Vegetables: In 1 cup of broccoli?=1 In one large ear of corn?=1 In a small salad?=1/2
One cup of raw or cooked vegetables or 2 cups of raw leafy greens is considered 1 serving
from the vegetable group.
Fruits: In a large apple?=2 In ½ a cup of raisins or prunes?=1 In a large banana?=1
One cup of fruit or 100% fruit juice, or ½ cup of dried fruit is the equivalent of 1 serving
from the fruit group.
Dairy: In 3 scoops of ice cream?=1 In 1 8oz glass of milk?=1 In 1 slice of hard cheese?=1/2
One cup of milk or yogurt or 1 ½ ounces of natural cheese is the equivalent of 1 serving from
the milk group.

Meats: In 1 lean hamburger?=2-3 In 1 can of tuna?=3-4 In ½ a cup of cooked beans?=2 In ½
a small chicken breast?=3
One egg, ¼ cup cooked dry beans, or 1 tablespoon of peanut butter is the equivalent of 1
serving from the meat and beans group.
Fats, sweets, and oils: In 1 can of soda?=1-2 In 1 glazed donut?=1-2 In 1 medium order of
fries?=2-3
3. Discuss what foods and food habits to avoid

Question for participants: Who here eats at fast-food restaurants? How often?
A lot of us eat at fast-food restaurants because it is inexpensive and convenient. Unfortunately,
meals from fast-food chains, as well as other pre-packaged foods (such as Ramen noodles) often
contain high levels of fats, sodium, and carbohydrates, and they are lacking in vitamins, minerals
and other nutrients our bodies need.
4. Teach participants how to read the Nutrition Labels and make healthier food choices
Question for participants: As we have been talking about the different food groups, has anyone
noticed something about their diet they could change in order to eat a more balanced diet?
A good start to improving your diet is to look at the Nutrition Labels on the packaged food you
buy at the grocery store. On the right-hand side of the label you will see percentages based on the
recommended 2000 calorie diet. People who do hard physical labor may eat more than 2000
calories per day, but in general, 2000 calories per day is a good recommendation. Look at the
fats, cholesterol, sugars, and carbohydrates and notice what percent of your daily diet that
product will fill. Try comparing different brands for lowers levels of sodium, fats, or sugars.
Question for participants: Who would like to put together a balanced meal using our food
items? For breakfast? Lunch? Dinner? (continue discussing nutrition recommendations while
participants put together meals)
Other recommendations to incorporate healthier foods into your daily diet:

• Try substituting a whole-grain product for a refined product – such as eating whole-wheat
bread, brown rice, or whole-wheat pasta.
• Buy fresh fruit and vegetables in season. They cost less and are likely to be at their peak
flavor.
• Stock up on frozen vegetables for quick and easy cooking in the microwave.
• Try a salad for lunch. Go light on the salad dressing.
• Include chopped vegetables in pasta sauce or lasagna.
• Keep a bowl of whole fruit on the table, counter, or in the refrigerator.
• Buy fruits that are dried, frozen, and canned (in water or juice) as well as fresh, so that
you always have a supply on hand.
• At breakfast, top your cereal with bananas or peaches.
• At lunch, pack a tangerine, apple, or grapes to eat.
• At dinner, add crushed pineapple, mandarin oranges, or grapes in a tossed salad.
• Drink a glass of fat-free or low-fat milk at meals.

• If you usually drink whole milk, switch gradually to fat-free milk, to lower saturated fat
and calories.
• Choose the leanest cuts of meat for beef and pork, and extra lean ground beef.
• Buy skinless chicken parts, or take off the skin before cooking.
• Trim away all of the visible fat from meats and poultry before cooking.
• Broil, grill, roast, poach, or boil meat, poultry, or fish instead of frying, and drain off any
fat that appears during cooking.
Appendix I contains the Nutrition handouts given to all health fair participants.

EXERCISE COUNSELING
Regular physical activity has been found to prevent cardiovascular disease, hypertension, Type 2
Diabetes, obesity, and osteoporosis, and the benefits of physical activities are seen at even
modest levels of activity—30 minutes per day on most days of the week.xxvii However, the
USPSTF has found insufficient evidence to recommend for or against behavioral counseling to
promote physical activity (I recommendation). LCDP offers aerobic and yoga classes to
patients and these classes have proven to be effective interventions for motivated patients
struggling with chronic disease management. The implementation of this educational session is
aimed to motivate individuals to enroll in exercise classes at LCDP and/or make small changes in
their physical activity level. Information for this session came from the AHA.xxviii
Objectives
1. Identify why exercise is important in maintaining or improving overall health
2. Dispel myths or excuses about the need for exercise
3. Provide examples of small ways to introduce exercise into a daily routine, including
setting goals and exercising with a friend
4. Connect participants to local fitness classes or opportunities for exercise
Materials
18” x 24” Poster
Handout of poster material
Content
1. Identify why exercise is important in maintaining or improving overall health
Question for participants: How often do you exercise a week? What does exercise do for our
health?
It is recommended that you exercise 30 minutes a day, 5 days a week. Exercising regularly has
many benefits, including:
• Reducing the risk of heart disease by improving blood circulation throughout the body
• Keeping weight under control
• Improving blood cholesterol levels
• Preventing and managing high blood pressure
• Preventing bone loss
• Boosting energy level
• Helping manage stress
• Improving the ability to fall asleep quickly and sleep well
• Countering anxiety and depression
• Increasing muscle strength and the ability to do other physical activities
• In older people, helping delay or prevent chronic illnesses and diseases associated with
aging, and maintaining quality of life and independence longer
2. Dispel myths or excuses about the need for exercise

Question for participants: If you don’t exercise regularly, why not? (Ask for excuses)
a. “I’m tired at the end of the day”

= Exercising regularly will increase your energy.
b. “I don’t have time”
= Try to schedule 30 minutes of exercise into your day, or even break it up into
two 15-minute exercises. Once you become accustomed to the routine, it will
become easier.
c. “I do physical labor at work”
= A lot of physical labor (such as construction or cleaning) involves repetitive
movements that can be damaging to your body. Good exercise can build strength
and flexibility to help your body repair itself.
d. “I’m too old to exercise”
= Continued exercise helps prevent chronic diseases in older people, and allows
you to remain more active in your community.
e. “I don’t like exercising”
= There are many ways to exercise, so you can choose something you enjoy
doing, such as dancing, soccer, swimming, yoga, cycling, and running.
3. Provide examples of small ways to introduce exercise into a daily routine

Question for participants: What types of exercise do you enjoy? What changes could you make
in your daily life to be more active?
• Go out for a short walk before breakfast, on your lunch break, or after dinner. Start with
5-10 minutes and work up to 30 minutes.
• Walk or bike to the store instead of driving. When walking, pick up the pace from
leisurely to brisk.
• Stand up while talking on the telephone.
• Park farther away at the shopping mall and walk the extra distance.
• Take the stairs instead of the elevator, or get off a few floors early and take the stairs the
rest of the way.
• Join a fitness center near your job. Work out before or after work to avoid rush-hour
traffic, or drop by for a mid-day workout.
• Get off the bus a few blocks early and walk the rest of the way to work or home.
• Play your favorite music while exercising, something that motivates you.
• Dance with someone or by yourself.
• Set goals and reward yourself for accomplishing them
• Invite a friend or family member to exercise with you
Question for participants: Who do you know that would benefit from or be interested in
exercising with you?
4. Connect visitors to local fitness classes or opportunities for exercise

Questions for participants: Do you know of any gyms, fitness centers, or community
recreation centers near you? Participants are advised of the exercise program run by
LCDP.
Appendix J contains the Exercise handouts given to all health fair participants.

HEART HEALTH COUNSELING
An educational session that elaborates the effects of obesity, high blood pressure, and high
cholesterol on heart health has been developed to ensure that participants understand the
significance of the results from the previous screenings. Previously, similar sessions were
provided as part of the exit counseling for individuals who had elevated test results. However,
due to the high prevalence of chronic disease in the participant population, efforts are now made
to educate all participants on the topic of Heart Health as an increasingly preventative measure.
Information for this session came from the AHA.xxix
Objectives
1. Identify the structure and function of the heart
2. Explain heart disease and the factors that increase risk
a. BMI and obesity
b. Blood pressure
c. Cholesterol
3. Provide examples of how visitors can decrease risks
Materials
Heart model
Artery model with Cholesterol
Brain model
Cholesterol model
Content
1. Identify the structure and function of the heart
Question for participants: What do you know about the heart?
The heart is a muscle the size of a fist that pumps blood filled with nutrients and oxygen through
the arteries to the other organs of the body. Blood circulates throughout the body and returns to
the heart through the veins to repeat the process. The heart pumps approximately 5 liters (20
cups) of blood per minute. Show visitors how to find their pulse.
2. Explain the factors that increase the risk of heart disease (heart attacks)
Question for participants: Does anyone know the leading cause of death in the US?
What is heart disease?
Heart disease is the leading cause of death of Americans, followed by cancer and stroke.
Approximately 94 people in the Latino community die each day of heart diseases (NCLR, 2005).
Question for participants: What are some of the risk factors for heart disease?
a. BMI and obesity
Question for participants: How do we determine obesity?
Obesity is too much body fat. To determine if a person is overweight or obese we compare their
height and weight using the Body Mass index. Encourage visitors to find their BMI score.
Obesity increases your risk of heart disease because the heart has to work harder to circulate

blood throughout the body, and the extra body fat collects in the blood and begins to block
arteries, which can eventually cause a heart attack or stroke. Obesity also increases the risk of
various types of cancer and contributes to other health problems such as arthritis or sleep
disorders.
b. Blood pressure
Question for participants: What is blood pressure?
Blood pressure is the force of blood against the walls of your arteries. This pressure is what
circulates blood throughout the body. Blood pressure is easy to measure, and the reading gives
two scores. The first (systolic) is the pressure of blood when the heart beats. The second
(diastolic) is the pressure of the blood when the heart rests. A healthy reading is 120/80. If you
have between 120-140 or 80-90 you have borderline high blood pressure. If you have a reading
above 140 or 90, you may have high blood pressure. This is an indicator of heart trouble, which
puts you at risk for heart disease, stroke, kidney problems, and blindness.
c. Cholesterol
Question for participants: What is cholesterol?
Cholesterol is a soft waxy substance that comes from the liver and from the foods you eat. Good
cholesterol produced by the liver helps to get rid of fat. Bad cholesterol comes from the food you
eat. This cholesterol builds up in your blood vessels, collects in your arteries, and can obstruct
blood flow, causing a heart attack. This makes the heart work harder and increases your risk of
blood clots and heart attack. Cholesterol levels can be measured with a blood test.
3. Provide examples of how visitors can decrease risks

Question for participants: How can you reduce your risk of heart disease?
a. Maintain a healthy weight
b. Exercise regularly
c. Avoid foods high in salt, saturated fats, and cholesterol (cheese, butter, whole milk, ice
cream, red meat, egg yolks, chicken with skin, donuts and other pastries), and eat more
fruits (2-4 servings) and vegetables (3-5 servings)
d. Quit smoking
e. Consume less alcohol
f. Visit your doctor regularly
Appendix K contains the Heart Health handouts given to all health fair participants.

DIABETES COUNSELING
All participants receive a ten minute educational session in which they learn about the different
types of diabetes and the risk factors and symptoms associated to diabetes. The session draws
off of previously presented information in the nutrition, exercise, and heart health sessions.
Participants are encouraged to discuss their current understanding of and experiences with
diabetes. Health promoters use this understanding to communicate diabetic preventive and
management strategies. Information for this session came from the ADA.xxx
Objectives
1. Define diabetes and explain the four types
2. Identify risk factors and symptoms of diabetes
3. Discuss how diabetes and other health issues are related
4. Dispel myths surrounding diabetes
5. Provide examples of lifestyle changes in order to prevent the onset of diabetes or to
improve the management of diabetes
Materials
Content
1. Define Diabetes and explain the four types
Question for participants: What is diabetes? What do you know about diabetes? What would
you like to learn about diabetes?
Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a
hormone that is needed to convert sugar, starches and other food into energy needed for daily
life. Although the cause of diabetes is unknown, both genetics and environmental factors such as
obesity and lack of exercise play a role. When glucose (sugar) builds up in the blood instead of
going into cells, it starves your cells for energy. Over time, high blood glucose levels can damage
your heart, kidneys, eyes, and nerves.
Question for participants: Do you know anyone with diabetes?
There are 23.6 million children and adults in the United States, or 7.8% of the population, who
have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately,
5.7 million people (or nearly one quarter) are unaware that they have the disease. Diabetes is the
fifth-deadliest disease in the United States, and it has no cure.
There are four variations of diabetes:
a. Type 1 develops when the body does not produce insulin. It was previously known as
juvenile diabetes, and is usually diagnosed in children and young adults
b. Type 2 results from insulin resistance (a condition in which the body fails to properly use
insulin), combined with relative insulin deficiency. Type 2 accounts for about 90% to
95% of all diagnosed cases of diabetes.
c. Gestational diabetes occurs in women during late pregnancy. It develops in 2% to 5% of
all pregnancies but disappears when a pregnancy is over. Women who have had

gestational diabetes or have given birth to a baby weighing more than 9 pounds are at an
increased risk for developing type 2 diabetes later in life.
d. When a person's blood glucose levels are higher than normal but not high enough for a
diagnosis of type 2 diabetes, they are diagnosed with pre-diabetes. Approximately 57
million Americans have pre-diabetes, in addition to the 23.6 million with diabetes.
2. Identify risk factors and symptoms of diabetes
The prevalence of diabetes is at least 2-4 times higher among African American,
Hispanic/Latino, American Indian, and Asian/Pacific Islander women than among white women.
The risk for diabetes also increases with age.
Most people with diabetes have additional health problems or risk factors such as high blood
pressure and cholesterol that increase one's risk for heart disease and stroke. More than 65% of
people with diabetes die from heart disease or stroke.
Question for participants: What are the symptoms of diabetes? When checking for diabetes or
pre-diabetes, what symptoms should you look for?
General symptoms of diabetes
• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision
Question for participants: How do we determine if someone has diabetes?

There are a number of tests that can determine whether or not a patient has pre-diabetes or
diabetes. If you are fasting, a blood glucose level between 100 and 125 mg/dl signals pre-
diabetes, and a level of 126 mg/dl or higher signals diabetes. If you are not fasting, a blood
glucose level is between 140 and 199 mg/dl signals pre-diabetes, and a blood glucose level at
200 mg/dl or higher signals diabetes.
Question for participants: Why is your blood glucose level important? Does anyone know what
may happen if it is too low or too high?
When you have low blood glucose (sugar) levels you may experience Hypoglycemia.
Hypoglycemia is a condition of diabetes that is potentially very dangerous, and may cause a
seizure. The symptoms of hypoglycemia include:
• Shakiness
• Dizziness
• Sweating

• Hunger
• Headache
• Difficulty paying attention, or confusion
• Tingling sensations around the mouth
• Clumsy or jerky movements
• Pale skin color
• Sudden moodiness or behavior changes, such as crying for no apparent reason
When you have high blood glucose (sugar) levels you may experience Hyperglycemia.
Hyperglycemia occurs when the body has too little insulin, or when the body can't use insulin
properly. This can occur when you eat more or exercise less than planned. The stress of an
illness, such as a cold or flu, or family conflicts could also be the cause. Hyperglycemia may
cause Ketoacidosis, a diabetic coma, which is life-threatening and needs immediate treatment.
Symptoms include:
• Shortness of breath
• Breath that smells fruity
• Nausea and vomiting
• A very dry mouth
3. Discuss how diabetes and other health issues are related
Question for participants: What other health problems are related to diabetes?
Untreated diabetes can lead to serious complications, including:
• Heart disease and stroke - Adults with diabetes have heart disease death rates about 2 to
4 times higher than adults without diabetes.
• Kidney disease - Diabetes is the leading cause of kidney failure, accounting for 44% of
new cases in 2005.
• Blindness - Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each
year, making diabetes the leading cause of new cases of blindness in adults 20-74 years
of age.
• Amputations - More than 60% of non-traumatic lower-limb amputations occur in people
with diabetes.
a. Diabetes and cholesterol:
Diabetes tends to lower "good" HDL cholesterol and raise triglyceride and "bad" LDL
cholesterol levels, which increases the risk for heart disease and stroke.
b. Diabetes and high blood pressure:

High blood pressure increases the risk of coronary heart disease (which leads to heart attack) and
stroke, especially when it's present with other risk factors, such as diabetes. When a person has
high blood pressure and diabetes, his or her risk for cardiovascular disease doubles.
c. Diabetes and obesity:

Even moderate weight loss helps control blood glucose levels, reduces blood pressure and
cholesterol, reduces risk for cardiovascular disease, and can even help prevent diabetes in people
with pre-diabetes.

d. Diabetes and smoking:
Smoking raises your risk of a heart attack, and may trigger a blood clot to form. A clot may
either further narrow the blood vessel or completely block it. This damage can worsen foot ulcers
and lead to blood vessel disease and leg and foot infections.
If you have diabetes, smoking is even worse because you're:
• More likely to get nerve damage and kidney disease.

• Three times more likely than nonsmokers are to die of cardiovascular disease.
• More likely to raise your blood sugar level, making it harder to control your diabetes.
4. Dispel myths surrounding Diabetes
Myth #1 You can catch diabetes from someone else.

No. Although we don’t know exactly why some people develop diabetes, we know diabetes is
not contagious. It can’t be caught like a cold or flu. There seems to be some genetic link in
diabetes, particularly type 2 diabetes. Lifestyle factors also play a part.
Myth #2 People with diabetes can't eat sweets or chocolate.

If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be
eaten by people with diabetes. They are no more “off limits” to people with diabetes than they
are to people without diabetes.
Myth #3 Eating too much sugar causes diabetes.

No. Diabetes is caused by a combination of genetic and lifestyle factors. However, being
overweight does increase your risk for developing type 2 diabetes. If you have a history of
diabetes in your family, eating a healthy meal plan and regular exercise are recommended to
manage your weight.
Myth #4 People with diabetes should eat special diabetic foods.

A healthy meal plan for people with diabetes is the same as that for everyone – low in fat
(especially saturated and trans fat), moderate in salt and sugar, with meals based on whole grain
foods, vegetables and fruit. Diabetic and “dietetic” versions of sugar-containing foods offer no
special benefit. They still raise blood glucose levels, are usually more expensive and can also
have a laxative effect if they contain sugar alcohols.
5. Provide examples of lifestyle changes in order to prevent or improve Diabetes
Question for participants: How can you reduce your risk of developing diabetes? If you are
pre-diabetic, or you have diabetes, what can you do to manage your blood glucose levels?
People with diabetes have to take extra care to make sure that their food is balanced with insulin
and oral medications, and exercise to help manage their blood glucose levels. This might sound
like a lot of work, but your doctor can help you create a meal plan that is best for you.
a. Nutrition

Blood sugar control isn't just about your sugar intake, it’s about carbohydrate intake as well. The
more carbohydrates you take in, the more your blood glucose goes up. By adjusting your insulin
to balance the amount of carbohydrates in your diet, you can maintain the right blood sugar
balance in your diet and reduce your risk of complications from diabetes.
Question for participants: What foods contain carbohydrates?

Carbohydrates are found in many foods including:
• Breads, cereals and pastas and vegetables

• Rice and other grains
• Beans
• Milk and yogurt
• Fruit
• Juice
• Sugar
• Honey, syrup and molasses
Foods like meat, fish, eggs, oils, cheese, butter and margarine contain very few carbohydrates,
but you should still watch your fat intake with these items. In order to reduce blood pressure and
cholesterol, eat a diet low in saturated fats and trans fats.
b. Exercise
Weight control, regular physical activity, and diet help manage glucose levels in the blood, as
well as lower blood pressure and cholesterol. It is recommended that you exercise 30 minutes a
day, five times a week.
c. General Healthcare
When you're sick or under stress, your body releases hormones that help it fight disease.
Unfortunately, these hormones raise blood sugar levels and interfere with the effects of insulin.
As a result, when you are sick, your blood glucose can rise to dangerous levels and cause a
diabetic coma.
When sick, you will still need to continue medicine for your diabetes. You need them because
your body makes extra glucose when you are sick. Always consult with your doctor before
discontinuing medications.
Appendix L contains the Diabetes handouts given to all health fair participants.
CANCER COUNSELING
All participants receive a five to ten minute counseling session focused on the four treatable
forms of cancer when detected in their early stages. The health promoter uses organ models with

cancerous pathologies to demonstrate cancerous growths. The health promoter also has an 18” x
24” poster board that contains all of the topics presented during the session, and each participant
receives an 8 1/2” x 11” handout with the same information. Information for this session came
from the ACS.xxxi
Objectives
1. Define what is cancer and explain the four detectable and treatable types
a. Colorectal
b. Prostate
c. Breast
d. Cervical
Within each type of cancer:
2. Identify potential risk factors
3. Discuss symptoms and early detection
4. Provide examples of how participants can decrease their risks of cancer
Materials
Colon model with pathologies
Prostate model with pathologies
Breast model with pathologies
Cervix model with pathologies
Content
1. Define what is cancer and explain the four types
Questions for participants: Can someone tell us what is cancer? What do you know already
about cancer? What questions do you have about cancer? Does anyone have a personal
experience with cancer?
Cancer is a disease in which cells in part of the body start to reproduce uncontrollably.
Although there are many types of cancer, they all begin with the growth of abnormal cells.
Cancer that is not treated can lead to serious disease and death. Cancer can be caused by external
factors (such as smoking) as well as internal factors (such as genetics), and it can affect anyone.

COLORECTAL CANCER
Health promoter demonstrates where the colon is in the body and the direction in which it works
(From lower right quadrant, up to the rib cage, across the stomach area, and back down the left
side).
Colorectal cancer is the development of abnormal cells in the colon or the rectum. It is the 2nd
most commonly diagnosed cancer among Latino men and women.

a. Age
b. Family history of colorectal cancer or bowel disease
c. Obesity
d. Diet high in fat and red meat
e. Alcohol and tobacco use
f. Diabetes

Question for participants: If you had colorectal cancer, what would be the signs to look
for?
a. Stomach pain or cramping
b. Changes in bowel movements, such as diarrhea or constipation, or a reduction in
the diameter of stool
c. A constant feeling of having to defecate
d. Rectal bleeding or blood in the stool
These changes aren't always caused by cancer. However, if you notice any of these
symptoms, it is important that you speak with a doctor right away. Cancer treatment is
most effective when the cancer detection and treatment occur early.

Question for participants: What can you do to prevent colorectal cancer?
a. Exercise regularly and maintain a healthy weight
b. Consume less alcohol and tobacco
c. Eat a balanced diet high in fruits and vegetables
d. Seek testing from your doctor, including colonoscopy, sigmoidoscopy, and fecal
occult blood tests (FOBT) beginning at age 50 (USPSTF A recommendation and
supported by the ACS)

PROSTATE CANCER
Question for participants: What is the prostate and what does it do? What do you know about
prostate cancer?
The prostate gland is found just below the bladder, in front of the rectum. This gland contains
cells that produce part of the liquid that protects and nourishes sperm. Prostate cancer is the
development of abnormal cells in the prostate, and is the most commonly diagnosed cancer
among Latino men.

a. Age
b. Family history of prostate cancer
c. Obesity
d. Diet high in fat and red meat
e. Alcohol and tobacco use

Question for participants: If you had prostate cancer, what would be the signs to look for?
a. Feeling the need to urinate frequently
b. Difficulty or pain during urination
c. Blood in the urine
d. Trouble having or keeping an erection (impotence)
e. Constant pain in the lower back, pelvis, or upper thighs
symptoms, it is important that you speak with a doctor right away. Cancer treatment is most
effective when the cancer detection and treatment occur early.

Question for participants: What can you do to prevent prostate cancer?
a. Seek blood and rectal exams from a doctor once a year after the age of 50
(USPSTF D Recommendation; Procedure supported by ACS)
b. If you have a family history of prostate cancer, begin yearly screenings after the
age of 40 (USPSTF D recommendation; Procedure supported by ACS)
c. Eat a balanced diet high in fruits and vegetables
d. Consume less alcohol and tobacco

BREAST CANCER
Question for participants: What do you know about breast cancer? Does breast cancer only
affect women?
Breast cancer is the development of abnormal cells in the ducts, the lobules, or other breast
tissues. It is the most commonly diagnosed cancer and the leading cause of cancer death among
Latina women, but it is also important to know that it can also affect men.
Statistic: Latina women are 20% more likely to die from breast cancer than non-Latina women
with the same diagnosis at the same stage of disease. This may be a result of less access or
utilization of timely, high-quality treatment.
-Cancer Facts & Figures for Hispanics/Latinos 2006-2008, American Cancer Society

a. Gender (women are at a higher risk than men)
b. Age
c. Family history of breast cancer
d. Early start of menstruation (before the age of 12)
e. Obesity
f. Alcohol and tobacco use

Question for participants: If you had breast cancer, what would be the signs to look for?
a. A noticeable lump or change in the physical appearance of the breast
b. Swelling or skin irritation of the breast or nipple
c. Pain or discharge from the nipple

Question for participants: What can you do to prevent breast cancer?
a. Exercise regularly and maintain a healthy weight
b. Consume less alcohol and tobacco
c. Pay attention to the appearance and feeling of your breasts, and report any
changes to a doctor (Note: Breast self-examinations are no longer promoted
USPSTF I recommendation, BSE not supported by ACS)
d. Seek a mammogram test once a year (after age 40) (USPSTF B recommendation
and supported by ACS)
Participants are advised to call 1-800-ACS-2345 (1-800-227-2345) to speak with someone about
cancer. This toll-free number provides cancer information in both English and Spanish from the
American Cancer Society.

CERVICAL CANCER
Question for participants: What is the cervix? What do you know about cervical cancer?
The cervix is the lower part of the uterus that connects to the vagina. Cervical cancer is the
development of abnormal cells in the lining of the cervix, and is the 4th most commonly
diagnosed cancer among Latina women.

a. Human papilloma virus (HPV) infection
This is the most important risk factor for cervical cancer. HPV is a group of 100
types of viruses that may cause genital warts or cancer of the cervix. HPV is passed from
one person to another during vaginal, anal, or oral sex.
Risk factors for HPV infection:
i. Having sex at a young age
ii. Having unprotected sex
iii. Having sex with many partners
iv. Having sex with men who have had many partners
v. Having sex with uncircumcised men
b. Family history of cervical cancer
c. Multiple pregnancies
d. Sexually-transmitted infections (STI’s)
e. HIV/AIDS
f. Alcohol and tobacco use

Question for participants: If you had cervical cancer, what would be the signs to look for?
a. Abnormal vaginal discharge
b. Abnormal vaginal bleeding (not your regular period)
c. Bleeding or pain after sex

Question for participants: What can you do to prevent cervical cancer?
a. Use condoms during sex to protect yourself from HPV, HIV, and other STI’s
b. All women should begin having Pap smears approximately 3 years after they start
having sex (vaginal intercourse), but no later than age 21 (USPSTF A
recommendation and supported by ACS).xxxii
c. A HPV vaccine has been approved for girls and young women age 9 to 26. This
vaccine prevents two types of HPV that cause 70% of all cervical cancers, and
two types of HPV that cause 90% of all genital warts.
d. Consume less alcohol and tobacco
Appendix M contains the Cancer handouts given to all participants

EXIT COUNSELING
Upon the completion of all screening and counseling sessions, the participant receives a one-on-
one counseling session with a health promoter. The health promoter first reviews the registration
sheet to obtain information of the previous health service utilization by the participant. The
health promoter then reviews the results of all the screenings with the participant, indicating the
significance of the numbers and makes referrals to medical services if the participant has
elevated screening results. The health promoter will also ask if the participant has any specific
questions concerning the screenings, the counseling sessions, or any other health or social
service-related questions.
If further information is requested, the health promoter at the exit counseling session has at their
disposal several educational handouts concerning health related issues and a list of health clinics
in Washington, DC and in the areas of Maryland and Virginia surrounding Washington, DC. If
the participant requires a referral, the health promoter reviews the list of providers available in
the area where the participant lives and refers the participant to a provider that offers the service
required.
All handouts are included in Appendices O through U.
Appendix O What are Heart Disease and Stroke?

Appendix P How Can I Reduce High Blood Pressure?
Appendix Q How Can I Lower High Cholesterol?
Appendix R All About Pre-Diabetes
Appendix S Mental Health Resources Handout
Appendix T Community Clinics in Washington, DC
Appendix U Community Clinics in Maryland and Virginia

HEALTH INSURANCE COUNSELING
Health fair participants that cannot afford private insurance may be eligible for government
subsidized programs that have been designed to help keep individuals in Washington, D.C.
healthy and insured. The following information is presented to interested participants.
DC HealthCare Alliance
The DC HealthCare Alliance (Alliance) program is designed to provide medical assistance to
needy District residents who are not eligible for federally-financed Medicaid benefits. This
includes non-disabled childless adults, non-qualified aliens and some individuals who are over-
income for Medicaid. The Alliance program provides comprehensive health services, including
preventative, primary, acute, and chronic care services such as clinic services, emergency care,
immunizations, in-patient and out-patient hospital care, physician services, and prescription
drugs.
Requirements for eligibility include: live in the District of Columbia; not eligible for Medicaid;
and have income (before taxes) at or below 200% of the federal poverty level.
Required documents for the Alliance application include: proof of DC residence and proof of
income.
DC HealthCare Alliance applications are available for enrollment at all health fairs for eligible
participants. La Clínica del Pueblo is also an Alliance enrollment site.
Medicare
Medicare is a health insurance program for:
• people age 65 or older,
• people under age 65 with certain disabilities, and
• people of all ages with End-Stage Renal Disease (permanent kidney failure requiring
dialysis or a kidney transplant).
Medicare includes:
Hospital Insurance - helps cover inpatient care in hospitals, including critical access hospitals,
and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care
and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Medical Insurance - helps cover doctors' services and outpatient care. It also covers some other
medical services that Hospital Insurance doesn't cover, such as some of the services of physical
and occupational therapists, and some home health care.
Prescription Drug Coverage - Everyone with Medicare can get this coverage that may help
lower prescription drug costs and help protect against higher costs in the future.

ADDITIONAL SERVICES
“Despite advances in screening,

diagnosis, and treatment, sexually
transmitted infections remain an
important cause of morbidity and
mortality in the United States.”
~United States Department of Health and Human Services

HIV SCREENING AND COUNSELING
The USPSTF strongly recommends screening for human immunodeficiency virus (HIV) in all
adolescents and adults at increased risk for HIV infection (A recommendation). A person is
considered at increased risk for HIV infection if he or she reports 1 or more of the following risk
factors:xxxiii
• Men who have sex with men after 1975
• Men and women who have unprotected sex with multiple partners
• Past or present drug users
• Men and women who exchange sex for money or drugs or have sexual partners who do
• Individuals whose past or present partners were HIV infected, bisexual, or injection drug
users
• Persons being treated for sexually transmitted diseases (STDs)
• Persons with a history of blood transfusion between 1978 and 1985
• Persons who request an HIV test despite reporting no individual risk factors (probability
of non-disclosure of high risk behaviors)
Based on the USPSTF recommendations, all participants that disclose one or more of the
individual risk factors or request a HIV test are encouraged to get tested for HIV during the
health fair (if HIV testing and counseling is available—services are provided at approximately
half of the health fairs by LCDP’s HIV Department) or are directed to a HIV testing facility.
MENTAL HEALTH COUNSELING
A screening method for depression is currently being developed. The health promoters serving
as exit counselor will be responsible for identifying participants that may be experiencing
depression, mitigate the stigma associated to depression, advise them on the availability of
mental health services, and refer them to the appropriate services (USPSTF B
recommendation).
GLAUCOMA SCREENING
Glaucoma screening is provided at several health fairs per year by the Friends of the
Congressional Glaucoma Caucus. The USPSTF found insufficient evidence to recommend for
or against screening adults for glaucoma (I recommendation). However, the Latino
population’s high incidence of type 2 diabetes—a risk factor for glaucoma—and the low
invasiveness of the screening coupled with infrequent utilization of ophthalmological services
places Latinos at higher risk of glaucoma and warrants the screening.
OTHER HEALTH SERVICES
Additional health services many be provided during health fairs by partnering organizations
depending on their availability. These services include but are not limited to vaccinations, family
planning and contraceptive counseling, STI screening and counseling, additional mental health

counseling, and substance abuse counseling. The services provided must be deemed beneficial
to the health fair participant population.
NONHEALTH RELATED SERVICES
As health fairs draw large numbers of underserved Latinos, services including but not limited to
financial, legal, and social services may also be offered by partnering organizations at the health
fairs. Participants are encouraged to participate in health related services before participating in
other services; however, participants are never required to participate in services in which they
are not interested.
CHILDREN’S CENTER
In order to improve the health fair experience for parents, a children’s center is constructed at every
health fair where parents can leave their children under the supervision of LDCP health promoters or
volunteers as they go through all screening and counseling sessions. The children’s center is
centrally located so that parents can keep an eye on their children without having the parents
juggling children during the screenings. The creation of the children’s center has lead to an
improvement in service quality for parents and the welcoming nature of the health fair.
The children are provided a variety of materials to color and play. Recent emphasis has been placed
on providing nutritional information to the children in the form of coloring books that teach healthy
eating habits. Drawings of foods that can be colored, cut out, and pasted on paper plates are also
provided and the health promoters and volunteers are encouraged to talk with the children about a
healthy and balanced diet as they play. The intent is that the children and their parents upon leaving
the health fair with the child’s creations will be prompted to talk about what they learned, and thus
reinforce the lessons.

POST HEALTH FAIR SERVICES
“Of all the forms of inequality,

injustice in health care
is the most shocking and inhumane.”
~Martin Luther King, Jr.

PATIENT NAVIGATION SYSTEM
On the first business day following the health fair all of the information from the
registration sheets is entered into a database. Based on this information,
individual participant reports are generated for each participant that was referred
to medical services. With these reports, containing all demographic and screening
information, a health promoter calls all referred participants to ascertain if they
were able to make an appointment with a provider approximately three to five day
after the health fair. The purpose of these calls is first to provide additional
information and support to ensure that participants are able to make a medical
appointment, and secondly to monitor the health utilization behavioral change due
to the health fairs.
Possible call scenarios

• If the participant reports that they have made an appointment, the health
promoter congratulates them, wishes them well, and the process stops.
• If the participant expresses interest in making a medical appointment but
was not able to, the health promoter will give the participant additional
information, and will continue to call the individual until they have been
able to make an appointment.
• If the participant expresses that they are not interested in making a medical
appointment regardless of the advice from the health promoter, the health
promoter will record the reason given for not making an appointment and
the process ends with that call.
• If the participant is unable to be contacted on the first call, the health
promoter will wait two to five days and return the call.
• If the participant is unable to be contacted in two sequential calls, the
process stops.
All information attained from the follow-up calls is also entered into the database
system. This information includes whether or not the telephone number was a
functioning number, if the participant answered the phone, if the participant
decided to make a medical appointment or not, where the appointment was made,
and for what services the appointment was made. Information about other actions
taken and remarks made to the health promoter are also captured.

EVALUATION
Focus
The primary method of evaluating the health fairs program is through assessing the percent of
health fair participants that have changed their medical service consumption patterns – increased
number of medical visits. This is monitored through the participant follow-up calls. Secondary
means of evaluation to monitor the increase of knowledge and behavioral change include verbal
interviews with participants as they are exiting the health fair, feedback given to the health
promoter making the follow-up calls and from the health promoters themselves at the end of
each fair when LCDP staff, health promoters, and volunteers meet to discuss the positive and
negative aspects of the fair.
Data Collection
Data is collected primarily from participant registration sheets and follow-up calls. This
information is used to determine the demographic characteristics of health fair participants and to
establish their pre- and post-health fair utilization of medical services. Subjective data obtained
from participants through interviews and surveys is also collected to complement the objective
data. All data is held confidentially by LCDP staff in a database program indefinitely and on
paper for one full year for verification processes.
Analysis and Interpretation
Database software is used to analysis the objective data and generates reports as seen in
Appendix A. Subjective data sets are combined monthly to supplement the objective data.
A significant amount of the data recorded is self-reported by the participants. All data that is
self-reported is indicated as such in all reports.
Reporting
Monthly, quarterly and annual reporting monitors inputs, outputs and outcomes of the program.
The health fair statistics that are presented in Appendix A represent the full range of information
that is reported annually. Monthly, internal output and outcome reports are produced to ensure
the proper implementation of the program. Quarterly, external reports are produced for funding
agencies that reflect input, output and outcome levels.
Logic Model
A logic model has been developed to describe all inputs, outputs, and outcomes of the program.
The model allows LCDP staff to ensure that the program inputs result in the planned outputs and
that the evaluation is focused on the realization of outcomes while ensuring the proper use of
inputs.

RECOMMENDATIONS
In the foreword, this manual was presented as a living document; one that will continually adapt to
meet the changing needs of the Latino community and new health care developments. In completing
the introspective process of documenting the health fairs program, several potential changes have
also been discovered. They include:
Improved Educational Materials
1) Creating a Health Promoter Training Manual based on the educational content of the health fairs
and other LCDP educational programs, with greater emphasis on participatory education methods.
2) Developing additional health insurance informational materials and increase the involvement of
health insurance providers in the health fairs.
Improved Referral Process
3) Updating and reorganizing the community clinic lists in Washington, DC, Maryland, and
Virginia. (This task, as of 12/10/08, is being undertaken by a group of George Washington
University graduate students who are participating in a community service program, ISCOPES.)
4) Providing direct referrals to clinics in the immediate area of the health fair, by means of an intake
worker present during the health fair.
5) Varying the follow-up calls between day and evening times to increase the contact success rate.
Improved Monitoring and Evaluation Systems
6) Adding an outcome-oriented evaluation to the existing process-oriented evaluation, where the

desired long-term outcomes are monitored through the use of pre- and post-health fair knowledge
and behavior surveys and longitudinal studies of health fair participants to track health behavior and
health care utilization trends.
7) Obtaining additional funding, through improved documentation, monitoring, and evaluation of all
health fair activities, to expand the program to new locations and reach additional individuals in need
of health care services.
Through all of the improvements to the health fairs program, it is essential to not forget the initial
concept of the health fairs. As Dr. Juan Romagoza stated “health care is a basic human right.” In
this light, the barriers that prevent health care access are seen as violating that right. As such, all
changes are made in attempt to improve the program’s ability to circumnavigate and when possible
eliminate barriers to health care access and increase the quality of life for the Latino community in
the Washington, DC metropolitan area.

APPENDICES
“Health Promoters build individual

and community capacity by
increasing health knowledge and
self-sufficiency through a range of
activities such as outreach,
community education, informal
counseling, social support, and
advocacy.”
~District of Columbia Primary Care Association

Appendix A
2008 Health Fair Statistics Reported by: Michael Dalious

March -- November 2008 Health Fairs Coordinator
Number of Events*
Complete events Partial events
20 4
* Complete events include all core services and the completion of registration forms
Number of Participants
Complete events Partial Events Total
1402 ~650 >2000
Following Statistics based on Complete events Note: Information is self-reported

State Distribution of Events Total numbers vary due to the late
DC MD VA Total introduction of some questions
and incomplete participant
14 5 1 20
responses
70% 25% 5%
Residence of Participants
DC MD VA Other Total
664 538 181 5 1388
48% 39% 13% 0%
DC Residences by Zip Code

20001 20002 20005 20007 20008 20009 20010 20011
41 12 11 6 28 145 159 159
6% 2% 2% 1% 4% 22% 24% 24%
20012 20016 20017 20018 Other Total

24 16 7 16 40 664
4% 2% 1% 2% 6%
Age Distribution
<18 18-25 26-35 36-45 46-55 56-65 >65 Total
50 196 362 308 256 147 77 1396
4% 14% 26% 22% 18% 11% 6%
Sex Distribution
Male Female Total

806 594 1400
58% 42%
Ethnic Groups
African Caucasian
Latino American (White) Asian Other Total
1029 24 29 13 2 1098
94% 2% 3% 1% 0%
Country of Origin
El Nicaragu
Salvador Guatemala Mexico Peru Honduras USA Bolivia a
526 227 129 102 100 85 42 30
38% 16% 9% 7% 7% 6% 3% 2%
Dominican
Ecuador Columbia Republic Other Total
26 20 16 6 1385
2% 1% 1% 0%
Education level (at least one year in category)

Average number of
Primary Secondary University Total years in school
427 641 181 1249 9 years
34% 51% 14%
Years in the United States

Average number of
<1 1 to 5 5 to 10 > 10 Total years in the US
120 447 312 392 1271 9.6
9% 35% 25% 31%
Language Ability (Note: Small Sample Size due to late introduction of the question)
Speaks Speaks
Spanish Total English Total
192 201 88 201
96% 44%
Health Insurance
Yes No Total
444 938 1382
32% 68%
Have visited a clinic in the past year Have attended previous LCDP Health Fairs
Yes No Total Yes No Total
635 760 1395 120 837 957
46% 54% 13% 87%

Currently suffering from an illness
Yes No Total
323 778 1102
29% 71%
Illnesses currently suffered

High High Blood
Cholesterol Pressure Diabetes Pain Asthma Gastritis Athritis Total
67 56 55 25 20 18 16 323
21% 17% 17% 8% 6% 6% 5%
Smokers
Want to * Percentage is of smokers who
Yes Quit * No Total want to quit smoking
84 67 246 331
25% 80% 74%
Cancer Screenings (performed prior to health fair / self-reported)
Colon Cancer Screenings (Colonoscopy or Sigmoidoscopy and/or FOBT)

Participants in screening age range (50-70 yrs)
Yes No Total
47 213 260
18% 82%
Breast Cancer Screenings (Mammogram) Cervical Cancer Screenings (Pap Smear)

Women in screening age range (≥ 40 yrs) Women in screening age range (14 -- 70 yrs)
Yes No Total Yes No Total
178 107 285 245 182 427
62% 38% 57% 43%
Prostate Cancer (DRE and/or PSA)

Men in screening age range (50 -- 70 yrs)
Yes No Total
53 83 136
39% 61%
Screenings (Preformed during health fair / reported by health fair staff)
Body Mass Index (Kg/M²)

Extremely
Normal Overweight Obese Obese
≤ 24 25 -- 29 30 -- 39 ≥ 40 Total

401 595 307 22 1326
30% 45% 23% 2%
Blood Pressure (mmHg)

High High
Systolic Diastolic
≥ 140 Total ≥ 90 Total
322 1372 145 1372
23% 11%
Plasma Glucose Level (mg/dl / Non-fasting) Total Cholesterol Level (mg/dl)

High High
Glucose Cholesterol
≥ 140 Total ≥ 200 Total
114 1326 237 1276
9% 19%
Follow-up with Participants
Advised to seek health care based on screenings and/or lack of cancer screenings
Yes No Total
591 811 1402
42% 58%

Able to be contacted after health fair
Yes No Total
304 287 591
51% 49%
Participants not able to be contacted because telephone number did not work
Total
65 591
11%
Participants not able to be contacted because there was no answer

Total
222 591
38%
Contacted participants that self-reported making a medical appointment

Yes No * Total
155 149 304
51% 49%
* The two main reasons given for not making medical appointments were participant concern about
costs and lack of time to go to an appointment.
Extrapolation of appointments made *

Yes No Total
301 290 591
* Based on the appointment rates of participants contacted

Appendix B
LA CLÍNICA DEL PUEBLO

Health Fairs 2008
Date Place Time Organizer
March 25, 2008 Neighbors Consejo 10am-2pm LCDP
3118 16th St. NW Washington, DC 20009
March 29, 2008 Foundry United Methodist Church 11am-3pm Fathers
1500 16th Street NW
April 6, 2008 Iglesia Adventista del 7 día de la Capital 1pm-5pm LCDP
4800 16th St. NW Washington, DC 20011
May 10, 2008 Iglesia Zion 10am-1pm LCDP
1007 Merrimac Dr. Langley Park, MD
May 18, 2008 Nuestra Señora Reina de las América 10am-2pm LCDP
2200 California St. NW
May 31, 2008 Sacred Heart School 11am-2pm OLA / WASA
1625 Park Road NW
June 7, 2008 All Souls Church 10pm-3pm Fathers
1500 Harvard St NW
June 29, 2008 National HIV Testing Day - La Union 12pm-4pm LCDP
1401 University Blvd E. Hyattsville, MD CASA
July 26, 2008 Sargent Shriver's Elem. School 10am-3pm LCDP
12518 Greenly Drive, Silver Spring, MD
July 31, 2008 Immunization Drive 4pm-7pm OLA
Reeves Center 2000 14th NW
August 2, 2008 Youth Health Fair (LAYC) 12pm-4pm Fathers
1419 Columbia Rd, NW
August 7, 2008 Immunization Drive 4pm-7pm OLA
August 10, 2008 OLA Verano Latino 2008 10am-4pm OLA
3149 16th St NW
August 30, 2008 Langley Park Community Center 10am-3pm LCDP
1500 Merrimac Drive, Langley Park, MD
September 4, 2008 Immunization Drive 4pm-7pm OLA
September 21, 2008 7th Day Adventist Church of Central 10am-3pm LCDP
Washington DC
4917 Georgia Ave NW
October 4, 2008 The Holy Family 10am-2pm LCDP
1007 Merrimac Dr. Langley Park, MD
October 5, 2008 Binational Health Week 10am-3pm OLA
3149 16th St NW
October 11, 2008 Binational Health Week 12pm-5pm OLA
3415 Markham St, Annandale, VA
October 19, 2008 Oyster Bilingual School 9:30am- LCDP
2801 Calvert St. NW 12:30pm
November 2, 2008 Family Fair (DC Armory) 11am-6pm Telemundo
2001 E Capital St, SE
November 15, 2008 All Souls - Diabetes Health Fair 10am- 3pm LCDP
1500 Harvard St NW

Appendix C
Health Fairs Program Schedule

Appendix D
AGREEMENT FOR HEALTH PROMOTERS
This Agreement for providing outreach services and health education is made this
___________ day of __________, 200__ by and between La Clinica del Pueblo, Inc., a District
of Columbia corporation (“LCDP”) and ___________________________________________
(the “Contractor”).
1. Recitals
a. LCDP, in connection with its operations as a health care provider, requires Health
Promoters (promotores de salud) to facilitate the delivery of services to LCDP’s
patients and clients.
b. Contractor is an experienced health promoter (promotor de salud) and is willing to

provide outreach services and health education to community members as an
independent contractor to LCDP subject to the terms and conditions of this
Agreement.
Wherefore, in consideration of the mutual promises and terms set forth in this Agreement,
LCDP and Contractor agree as follows:
2. Term of Agreement. Contractor agrees to serve as an independent, non-exclusive

provider of outreach services and health education to LCDP for the period _______,
20___ to December 31, 20___.
3. Status as Independent Contractor. As an independent contractor to LCDP,

Contractor’s compensation under this Agreement will be paid without deduction for, or
withholding, of federal, social security, state or local taxes. Contractor shall be
responsible for all taxes and other legally required payments to governmental authorities
arising out of Contractor’s engagement by LCDP. Contractor shall not be eligible to
participate in, or receive benefits from, any employee benefit plan applicable to
employees of LCDP.
4. Termination. Either party may terminate this Agreement effective upon written notice to
the other, or the contract will terminate at the end of its term.
5. Services to be Performed. Contractor agrees to conduct outreach activities and provide
culturally appropriate health education services to community members based on La
Clinica’s Community Health Outreach Department’s curricula. Contractor agrees to
fulfill his or her responsibilities as pursuant to this Agreement in accordance with the
following conditions and requirements:
a. Contractor should attend all training deemed necessary for their participation in
the health fair events, and/ or charlas (interactive health talks) program
b. Contractor shall prominently display an ID card and shall dress appropriately
c. Contractor staffing health fairs should perform the tasks assigned by Health Fairs
Coordinator.
d. Contractors staffing health fairs should arrive half an hour earlier to the event to
set up and should stay until the end of the event in order to help clean up
e. Contractors conducting charlas in the community should arrive 45 minutes earlier
to the place where the charla will take place.
f. Contractors shall participate in meetings pertaining to each of the projects that
they are providing services for: health fairs, and/or charlas.
6. Compensation. LCDP will compensate contractors as follows:

a. A $ 50.00 stipend per event for staffing a health fair, when the contractor has been
contacted by the Health Fair Coordinator. If a contractor comes to a health fair
without having been contacted by the Health Fair Coordinator, s/he will not be
compensated for services provided at such particular event.
b. Contractor providing charlas in the community for projects related to the National
Council of La Raza will be paid $ 30.00 per charla.
c. To be compensated contractor must invoice La Clínica by the 25th of each month
for services provided since the 25th of the previous month.
7. Confidentiality/HIPAA. Contractor understands that in the course of his or her work,

Contractor may learn the identity and other information concerning clients and/or
personnel of LCDP. Contractor agrees that all such information is to be treated as
confidential. Contractor understands that LCDP is a “Covered Entity” as defined by and
in accordance with the Health Insurance Portability and Accountability Act of 1996
(“HIPAA”), and that Contractor is acting as LCDP’s “Business Associate” for purposes of
compliance with HIPAA. Contractor agrees to provide Services in compliance with the
Business Associate Contract Addendum attached hereto as Exhibit A. The provisions of
this Paragraph survive termination of this Agreement.
8. Prohibition on Assignment. This Agreement shall not be assigned by either party

without the express written consent of the other party.
Contractor Name: SSN:
Address:
Phone: Fax: Cellular: E-mail:
By:
Contractor La Clínica del Pueblo, Inc (Title)
Appendix E
Appendix F
Appendix G
Appendix H
Appendix I
Appendix J
Appendix K
Appendix L
AppendixM
Appendix N
Appendix O
Appendix P
Appendix Q
Appendix R
Appendix S
Si quiere más información de salud mental habla con su médico o llama a:

• La Clínica del Pueblo (línea de Salud Mental) – 202-448-2838
• Mary’s Center – 202-483-8196
• Departamento de Salud Mental en DC – 202-673-2058
• Women’s Center / Centro de la Mujer – 202-293-4580
¿Está en crisis de salud mental?

Llame a la línea telefónica de ayuda de Washington DC disponible las 24 horas:
1 (888) 793-4357
Llame a la línea telefónica de CrisisLink disponible 24 horas:
1 (888) 628-9454
Si es víctima de un asalto sexual o violación, llame a la línea telefónica de DC
Rape Crisis disponible 24 horas: (202) 333-PARE (7272)
If you need more information about mental health talk with your doctor or
call:
• La Clínica del Pueblo (Mental Health line) – 202-448-2838
• Mary’s Center – 202-483-8196
• DC Department of Mental Health – 202-673-2058
• Women’s Center – 202-293-4580
Are you experiencing a mental health crisis?

Call the Washington DC Helpline available 24 hours a day: 1 (888) 793-4357
Call CrisisLink available 24 hours a day: 1 (888) 628-9454
If you are a victim of sexual assault or rape, call the DC Rape Crisis Hotline
available 24 hours a day: (202) 333-7272
Appendix T
Clínicas Comunitarias
de Washington DC
Centro Católico
1618 Monroe St NW Upper Cardozo Clinic
Washington, DC 20010 3020 14th St NW
Teléfono: 202-939-2400 Washington, DC 20010
Atienden pacientes nuevos Teléfono: 202-745-4300
De MD,DC y VA. Atienden a residentes de DC.
Columbia Road Health

Services Whitman-Walker Clinic
1660 Columbia Rd Elizabeth Taylor Medical Center
Washington, DC 20009 1701 14th St NW
Atienden a residentes de DC. Teléfono: 202-939-7690
Community of Hope
2250 Champlain St. NW Zaccheus Free Medical Clinic
Washington, DC 20009 1525 7th St Nw
Teléfono: 202-265-2400
Atienden nuevos pacientes
Mary’s Center
2333 Ontario Rd NW La Clinica del Pueblo
Washington, DC 20024 2831 15th Street, NW
Atienden pacientes de MD Telefono: 202-448-2854
VA y DC. Atienden pacientes de MD
VA y DC.
ANACOSTIA (Ward 6) Teléfono: 202/610-7160

1328 W Street, SE WIC: 202/610-5491
Washington, DC 20020 Fax: 202/610-7164
Abierto: Washington DC 20032
Lunes, Miercoles, Viernes 8:15am-8:00pm Teléfono: 202/279-1800
Martes, Jueves 8:15am-4:45pm Fax: 202/279-1834
Health Center Manager: Janet Jackson Abierto:
Atienden pacientes nuevos MD, DC y VA. Lunes-Viernes, 8:15 AM - 4:45 PM
Health Center Manager:
SOUTHWEST (Ward 2)** Mary Beth Levin
850 Delaware Ave., SW Atienden pacientes nuevos MD, DC y VA.
Washington, DC 20024
Teléfono: 202/548-4520 HUNT PLACE (Ward 7)**
Fax: 202/548-4538 4130 Hunt Place, NE
Abierto: Washington, DC 20019
Lunes-Viernes, 8:15 AM - 4:45 PM Teléfono: 202/388-8160
Health Center Manager: Fax: 202/388-8746
Gretchen Wooten Abierto: Lunes-Viernes, 8:15 AM - 4:45 PM
Atienden pacientes nuevos MD, VA, DC. Health Center Manager:
Darrin Bowden
WALKER-JONES (Ward 2) Atienden pacientes nuevos MD, DC y VA.
CLINCIA Y SERVICIO DE FARMACIA
1100 First Street, NW WOODBRIDGE (Ward 5)
Washington, DC 20001 2146 24th Place, NE
Teléfono: 202/354-1120 Washington, DC 20018
Fax: 202/354-1150 Teléfono: 202/281-1160
Abierto: Fax: 202/281-1191
Lunes- Viernes, 8:15 AM - 4:45 PM Abierto:
Health Center Manager: Lunes-Viernes, 8:15 AM - 4:45 PM
Libbie Buchele Health Center Manager:
Atienden pacientes nuevos MD, DC y VA. Priscilla Porter
Atienden pacientes nuevos MD, DC y VA.
PHOENIX CENTER (Ward 3)
DC General Hospital
1900 Massachusetts Ave. SE Suite 1242
Washington, DC 20003
Teléfono: 202/548-6500
Fax: 202/548-6534 SERVICIO DE FARMACIA
Abierto: Upper Cardozo Clinic
Lunes-Viernes, 8:15 AM - 4:45 PM 3020 14th St. NW
Health Care Manager: Washington, DC 20010
Melinda O’Brien Teléfono: 202/745-4300
Atienden pacientes nuevos MD, DC y VA. Abierto: Lunes, Martes, Jueves, Viernes 8:30
AM – 12:30 PM, 1:30 PM – 5:00 PM; Miercoles
CONGRESS HEIGHTS (Ward 8) 11:00 AM – 3:30 PM, 4:30 PM- 7:00 PM
3720 Martin Luther King Jr. Avenue Atienden pacientes nuevos MD, DC y VA.
Appendix U Clínicas Comunitarias de Maryland
Gaithersburg Se habla Español

Community Clinic, Inc. Lunes-Viernes 11:00-6:00p:m
17 E. North Summit Ave Silver Spring
Gaithersburg, MD 20877 Community Clinic, Inc.
301-216-0880 8210 Colonial Lane
www.cciweb.org Silver Spring, MD 20910
Se habla Español 301-585-1250
Lunes-Viernes 8:30am-4:30pm www.cciweb.org
Sábado de 8:30- 12:00 p.m. Se habla Español
Lunes, miércoles y Jueves
Germantown 8:30 am-4:30 pm
Mercy Health Center
12900 Middlebrook Road Holy Cross Hospital Health Center
Germantown, MD 20874 7987 Georgia Ave
240/773/0300 Silver Spring, MD 20910
Se habla Español 301-562-5600
www.mercyhealthclinic.org www.holycrosshealth.org
Lunes-Viernes 9:00am-5:00pm
Hyattsville
Community Clinic, Inc. Centro Católico
7676 New Hampshire Ave. 1015 University Blvd. E
Hyattsville, MD 20783 Silver Spring, Md 20903
301-431-2972 301-434-3999
www.cciweb.org www.centrocatolicohispano.org
Se Habla Español Se habla Español
Lunes-Viernes 8:30am-3:00pm Lunes-Jueves 8:30-5:00p:m
Sabados solo para niños 8:30-11:00 Viernes 8:30-12:00m.
Wheaton People’s Community Wellness Center

Proyecto Salud 3300 Briggs Chaney Rd
2424 Reedie Dr. Silver Spring, MD 20904
Wheaton, MD 20902 301-847-1172
301-962-6173 www.pcw.onehealthylife.org
Se habla español
www.montgomerycountymd.gov Montgomery Volunteer Dental Clinic
Lunes-Jueves 8:30am-8:30pm New Hampshire Ave. #115
Viernes 8:30-4:30 Silver Spring, MD 20904
* Se atienden pacientes solo de Montgomery 301-384-9795
Clínica de Jóvenes (12-24 años) (cerrado 12:00-1:00)
7005 Carroll Ave.
Takoma Park, MD 20912 Mobile Medical Care, Inc.
301-565-0914 Clínica Móvil
www.connectwithteens.com Llame para lugares y horarios
301-493-2400
www.mobilemedicalcare.org
Clínicas de Salud, Hospitales y Agencias de Servicios

Sociales en Virginia
Alexandria Neighborhood Health Services Arlington Department of Human Services (Servicios

Pediatric Center/Centro de Niños para la Familia)
3804 Executive Ave, D-1 3033 Wilson Boulevard Suite 200B
Alexandria, VA 22305 Arlington, VA 22201
(703) 535-5419 (703) 228-4992
Medicina Adulta y Salud de las Mujeres Atienden solo a residentes de Arlington,
2 E. Glebe Rd excepto las enfermedades de transmisión sexual
Alexandria, VA 22305 (aceptan pacientes de DC y MD).
(703) 535-5568
3er Jueves de cada mes cerrado 7:30am-11:00am
Lunes, Miércoles, Viernes 7:30am-5:00pm Arlington Free Clinic
Martes y Jueves 7:30am-7:00pm 2926 Columbia Pike
Atienden a los pacientes de MD, DC, y VA. Arlington, VA 22204
(703) 979-1400
Salud de la Familia y Salud Mental Lunes-Viernes 10am-4pm
3802 Executive Ave, D-1
Alexandria, VA 22305 Joseph Willard Health Center
www.anhsi.org 3750 Old Lee Highway
Lunes, Miercoles 8:30am-5:30pm Fairfax, VA 22030
Martes 8:30am-7:30pm/Jueves 1:30pm-7:30pm (703) 246-7100
Lunes/Miercoles 8:00am-3:00pm
Flora K. Casey Health Center Jueves 10:00am-6:00pm, Viern. 7:30am-12:00pm
1200 N. Howard Street Vacunas solamente
Alexandria, VA 22204
(703) 519-5979 Fairfax County Health Center
Lunes 7:30am-4:30pm 6245 Leesburg Pike, Suite 500
Falls Church, VA 22044
Mount Vernon 703-534-8343
8350 Richmond Highway, Suite 233 www.fairfaxcounty.gov
Alexandria, VA 22306
(703) 704-5203 Fairfax City Health Department
Lunes/Miércoles 8:00am-3:30pm 6245 Leesburg Pike Suite 500
Martes 10:00am-6:00pm Falls Church, VA 22044
Viernes 7:30am-12:00pm (703) 534-8343
Arlington Dept of Human Services Jueves 8:00am-6:00pm, Viernes 7:30am-12:00pm
1800 N Edison St.
Arlington, VA 22207 Herndon-Reston Health Center
(para salud mental): 1850 Cameron Glenn Drive, Suite 100
1725 N George Mason Dr. Reston, VA 22090
Arlington, VA 22205 (703) 481-4242
Martes 10:00am-5:45pm, Viernes 7:30am-11:45pm
Personal Bilingüe, Servicios de Vacunos, Personal Bilingüe
Maternidad, Solo atienden a residentes de Fairfax.
Dental, Familiar, y más.
NVCC Medical Center
Springfield Health Department 6699 Springfield Center Dr.
8136 Old Kene Mill Rd., Suite A100 Springfield, VA 22150
Springfield, VA 22152 (703) 822-6698
703-569-1031 Lunes-Viernes 8:30am-5:00pm
www.fairfaxcounty.gov
Martes 10:00am-6:00pm, Viernes 7:30am-
12:00pm
i
Dalious, Michael 2008 Barriers to Latino Health Care Access: An anthropological literature review. Transcript available
from the Community Health Outreach Department of La Clínica del Pueblo.
ii
McClure, Heather and Kristin Jerger 2005 The State of Latino Health in the District of Columbia. Published by the
Council of Latino Agencies, Washington, D.C.
iii
Dalious, Michael 2008 Barriers to Latino Health Care Access: An anthropological literature review. Transcript available
from the Community Health Outreach Department of La Clínica del Pueblo.
iv
Ibid.
v
Mayor’s Office of Latino Affairs. Document available at: www.ola.dc.gov Viewed 12/12/08.
vi
U.S. Department of Health & Human Services. Agency for Healthcare Research and Quality. The U.S. Preventive
Services Task Force. Available at http://www.ahrq.gov/clinic/USpstfix.htm#Recommendations. Viewed 9/26/08.
vii
Washington DC Hispanic Population. Mayor’s Office of Latino Affairs. Document available at: www.ola.dc.gov
Viewed 12/12/08.
viii
The U.S. Preventive Services Task Force (USPSTF) assigns one of five letter grades to each of its recommendations (A,
B, C, D, or I). The USPSTF changed its grade definitions based on a change in methods in May 2007.
GradeDefinitionSuggestions for PracticeAThe USPSTF recommends the service. There is high certainty that the net
benefit is substantial.Offer or provide this service.BThe USPSTF recommends the service. There is high certainty that the
net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.Offer or provide this
service.CThe USPSTF recommends against routinely providing the service. There may be considerations that support
providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.Offer or
provide this service only if other considerations support the offering or providing the service in an individual patient.DThe
USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the
harms outweigh the benefits.Discourage the use of this service.I Statement The USPSTF concludes that the current
evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or
conflicting, and the balance of benefits and harms cannot be determined.Read the clinical considerations section of USPSTF
Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of
benefits and harms.
U.S. Department of Health & Human Services. Agency for Healthcare Research and Quality. The U.S. Preventive Services
Task Force. Available at http://www.ahrq.gov/clinic/USpstfix.htm#Recommendations. Viewed 9/26/08.
ix
BMI table used at health fairs is a slightly modified table available from the National Institute of Health. Available at
www.nhlbi.nih.gov/guideleines/obesity/bmi_tbl.htm. Viewed 9/26/08.
x
High-intensity counseling is defined by the USPSTF as person-to-person meetings more than once a month for at least the
first 3 months.
xi
The USPSTF supports surgical interventions in cases of class III obesity.
xii
xiii
Ibid.
xiv
Ibid.
xv
The USPSTF defines Hypertension as a blood pressure exceeding 140 mm Hg systolic and/or 90 mm Hg diastolic on at
least 2 visits over a period of 1 to several weeks.
xvi
The USPSTF and AHA have identified these four nonpharmacological treatments for the reduction of high blood
pressure.
xvii
xviii
The USPSTF defines type 2 diabetes as a non-fasting plasma glucose level exceeding 140 mg/dl or a fasting plasma
glucose level of 126 mg/dl.
xix
xx
Services Task Force. Available at http://www.ahrq.gov/clinic/uspstf/uspschol.htm
Viewed 9/26/08.
xxi
NCEP/ATP III guidelines (JAMA 2001 May 16;285(19):2486), editorial can be found in JAMA 2001 May
16;285(19):2508, commentary can be found in JAMA 2001 Nov 21;286(19):2400.
xxii
The American Heart Association deems individuals that have a total cholesterol level over 200 mg/dl at higher risk for
heart attacks and strokes. Information attained from “Do you know what your cholesterol level means?” Available at
http://www.americanheart.org/downloadable/heart/119618151049911%20CholLevels%209_07.pdf
Viewed 9/26/08.
xxiii
xxiv
American Diabetes Association. Information available at www.diabetes.org. Viewed 10/12/08.
xxv
American Heart Association. Information available at www.americanheart.org. Viewed 10/12/08.
xxvi
United States Department of Agriculture. Information available at www.usda.gov. Viewed 10/12/08.
xxvii
xxviii
American Heart Association. Information available at www.americanheart.org. Viewed 10/12/08.
xxix
Ibid.
xxx
American Diabetes Association. Information available at www.diabetes.org. Viewed 10/12/08.
xxxi
American Cancer Society. Information available at www.cancer.org. Viewed 10/12/08.
xxxii
The USPSTF concurs with the American Cancer Society on the necessity and frequency for Pap smears.
xxxiii
Services Task Force. Available at http://www.ahrq.gov/clinic/uspstf/uspshivi.htm. Viewed 9/26/08.

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Health Fairs

2831 15th Street, NW |‌ Washington, DC 20009-4607

La Clínica del Pueblo Health Fairs Program Manual vi1

La Clínica del Pueblo Health Fairs Program Manual vi2

La Clínica del Pueblo is proud to present this manual for

Dr. Juan Romagoza

The Community Health Outreach Department was

National Heart, Lung and Blood Institute

La Clínica del Pueblo Health Fairs Program Manual vi3

La Clínica del Pueblo Health Fairs Program Manual vi4

CORE HEALTH FAIR SERVICES………..……………………………………… 17

POST HEALTH FAIR SERVICES………………………………………………... 49

La Clínica del Pueblo Health Fairs Program Manual vi5

La Clínica del Pueblo Health Fairs Program Manual vi6

ACS American Cancer Society

La Clínica del Pueblo Health Fairs Program Manual vi7

La Clínica del Pueblo Health Fairs Program Manual vi8

“While the diversity of the American

La Clínica del Pueblo Health Fairs Program Manual vi9

La Clínica’s services are now offered in a newly renovated, state-of-the-art clinic

La Clínica del Pueblo Health Fairs Program Manualvi10

The objectives of the Community Health Outreach Department (CHOD) of La

1) To educate the Latino community of the risk factors and symptoms of

In order to achieve these objectives, CHOD has developed several innovative

La Clínica del Pueblo Health Fairs Program Manualvi11

Key Health Care Findings:

Key Socioeconomic Findings:

La Clínica del Pueblo Health Fairs Program Manualvi12

4) Eligible participants are enrolled in the DC Alliance HealthCare insurance program.

La Clínica del Pueblo Health Fairs Program Manualvi13

La Clínica del Pueblo Health Fairs Program Manualvi14

Appendix A contains the full report of 2008 health fair statistics.

La Clínica del Pueblo Health Fairs Program Manualvi15

Appendix B contains the health fair venues from 2008.

Timing – Timing is another important consideration in the planning of health fairs.

Appendix C contains the generalized health fairs schedule.

La Clínica del Pueblo Health Fairs Program Manualvi16

Appendix D contains the health promoter agreement.

La Clínica del Pueblo Health Fairs Program Manualvi17

La Clínica del Pueblo Health Fairs Program Manualvi18

“If it hadn’t been for La Clínica del

La Clínica del Pueblo Health Fairs Program Manualvi19

The following information is obtained from every participant in this order.

La Clínica del Pueblo Health Fairs Program Manualvi20

Authorization: I hereby authorize La Clínica del Pueblo to conduct a series of free

La Clínica del Pueblo Health Fairs Program Manualvi21

BODY MASS INDEX SCREENING

Appendix H contains the BMI tables used in the health fairs.

La Clínica del Pueblo Health Fairs Program Manualvi22

La Clínica del Pueblo Health Fairs Program Manualvi23

• Shakiness • Sudden moodiness or behavior changes

La Clínica del Pueblo Health Fairs Program Manualvi24

La Clínica del Pueblo Health Fairs Program Manualvi25

La Clínica del Pueblo Health Fairs Program Manualvi26

a. Grains and carbohydrates

b. Vegetables and fruits

La Clínica del Pueblo Health Fairs Program Manualvi27

c. Dairy and meats

d. Fats, sweets, and oils

• many cheeses • sausage

La Clínica del Pueblo Health Fairs Program Manualvi28

• sodas or soft drinks

2. Determine what is a healthy portion and serving size