It Takes a Village: Rural Residents Help Make Their Community Healthier

Step Into Cuba is a community program to reduce chronic disease and improve the health of residents by increasing physical activity through access to natural environments. The program used Task Force findings to build and improve walking trails throughout the community. (Released 2015)

• Take a long-term approach to action. Working with or within an under-resourced community requires a lot of patience. Celebrate little steps of progress and accept the inevitable setbacks before going forward.
• Engage a variety of partners. The project was successful because it engaged public land managers, the state health department, local governments, local schools, nonprofit groups, health care providers, and a university.
• Community-academic partnerships produce results. Step Into Cuba was enhanced by a leadership team that included an academic partner. Gathering feedback and building buy-in from the community were important to carry out the research and evaluation.

Residents of the Village of Cuba, New Mexico, worked together to promote physical activity by constructing and improving walking trails in their community. Their volunteer efforts are part of Step Into Cuba, a community program using recommendations from the Community Preventive Services Task Force (Task Force).

The program aims to reduce chronic disease and improve the health of the Village’s residents by increasing physical activity through access to natural environments.

Step Into Cuba is run by the Step Into Cuba Alliance, a partnership of individuals and organizations that includes the University of New Mexico Prevention Research Center* (UNM PRC), citizens from the Village of Cuba, a local nonprofit organization called The Nacimiento Community Foundation, and various governmental agencies.

UNM PRC handles the research and evaluation component of the program, which is a part of a larger research project called Village Interventions and Venues for Activity (VIVA). The entire community-academic research partnership is named VIVA-Step Into Cuba.

Sally Davis, PhD, is UNM PRC’s director. She says using the Task Force’s findings from the Guide to Community Preventive Services (The Community Guide) website provided a framework for the program.

“The Community Guide has been essential to us, and we’ll continue to use it,” Davis says.

From 2008-2011, the death rate from diabetes in the portion of the county surrounding Cuba was about 55 people per 100,000, which was more than double the national rate.^1-3 Physical activity can help prevent and manage diabetes, yet residents of rural New Mexico communities like Cuba are more likely to be physically inactive than urban residents.^4-5

Coming Together Around a Common Cause

A total of 20 miles of walking trails were created in Cuba. More than 100 community volunteers, including the local mayor, constructed or improved about 9.5 miles of those trails. All of the trails were enhanced with landscaping, including shade trees, benches, parking areas, and signage. Creating or enhancing access to places for physical activity is a Task Force recommended strategy for increasing physical activity.

Currently, Cuba has nine trails two of which were built on donated land that connects the Village to a portion of Santa Fe National Forest and each attracts different users. For example, older adults from the Cuba Senior Center are attracted to the trail near the Village’s library because it is flat and open. It is common to see older adults walking on the trail before their daily bingo game.

Trailheads, sidewalks, street lighting, and crosswalks are components of Cuba’s new local street-scale urban design plan. The Task Force recommends street-scale urban design land use policies to increase physical activity. In 2011, the New Mexico Department of Transportation built a new sidewalk along the community’s main highway, US 550; the VIVA-Step Into Cuba team provided planning support for the sidewalk.

Promoting Physical Activity

A community-wide campaign, yet another strategy recommended by the Task Force, was created to further increase awareness of places to walk, the availability of walking groups, and promote physical activity for health benefits. Cuba residents created, installed, and continue to maintain four kiosks and multiple brochure boxes. The kiosks display maps of places to hike and walk and announce upcoming events, which are also featured in the local newspaper.

The brochure boxes contain information on features of individual trails. These boxes are placed in areas near the trails throughout the Village. The same information available on the kiosks can be found on the project’s website, www.stepintocuba.org. The website also includes testimonial videos from Cuba residents who embrace what the VIVA-Step Into Cuba project is doing.

National Recognition and Serving as a Model

Richard Kozoll, MD, MPH, is credited with creating the Step Into Cuba project. Dr. Kozoll was recognized as a Let’s Move! Champion of Change, as part of President Barack Obama’s “Winning the Future Across America Initiative.” Let’s Move! is an initiative to combat childhood obesity and it was launched by First Lady Michelle Obama. Step Into Cuba also received the 2010 Trails for Health Award of the American Trails National Symposium as well as the 2015 Private Public Partnership Award of the New Mexico Mid-Region Council of Governments.

In partnership with NM Department of Health, a toolkit was created for community groups who want to develop a similar program. The toolkit includes the design of a two-day workshop, a series of fact sheets, instructional and motivational videos, a focus group guide, and templates for community assessments and action plans. The VIVA-Step Into Cuba team is collaborating with the Village to plan a recently funded network of surfaced village park trails. The team has written more proposals for new walkways and bikeways throughout the Village.

*In 1984, Congress authorized the U.S. Department of Health and Human Services (HHS) to create a network of academic health centers to conduct practical public health research. The Centers for Disease Control and Prevention (CDC) was selected to provide leadership, technical assistance, and oversight for this network, which is called the Prevention Research Centers (PRC) Program. Each center conducts at least one core research project with an underserved population that has high rates of disease and disability. UNM PRC has been a funded prevention research center since 1998.

¹New Mexico Department of Health. Small Area 91 Sandoval County Other West. New Mexico’s Indicator-Based Information System (NM-IBIS). Retrieved on March 19, 2015 from https://ibis.health.state.nm.us/indicator/view/DiabDeath.Sarea.html.
²Centers for Disease Control and Prevention. CDC WONDER online database. Retrieved on March 19, 2015 from http://wonder.cdc.gov/ucd-icd10.htm.
³New Mexico Department of Health. New Mexico’s Indicator-Based Information System (NM-IBIS). Retrieved on March 19, 2015 from https://ibis.health.state.nm.us/query/selection/mort/_MortSelection.html.
⁴Centers for Disease Control and Prevention. Be active. Managing diabetes. Retrieved November 9, 2015 from http://www.cdc.gov/diabetes/managing/beactive.html.
⁵New Mexico Department of Health. New Mexico’s Indicator-Based Information System (NM-IBIS). Retrieved on March 19, 2015 from https://ibis.health.state.nm.us/query/result/brfss/PhysInact/PhysInactAA11._html.

University of New Mexico Prevention Research Center

Testimonial Videos

Community Preventive Services Task Force findings referred to in this story:

The Community Guide:

Task Force Findings on Physical Activity

• Physical Activity: Community-Wide Campaigns
• Physical Activity: Creating or Improving Places for Physical Activity
• Physical Activity: Street-Scale Urban Design Land Use Policies