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Rural Border Health – Resources

Selected recent or important resources focusing on Rural Border Health.

Promising Practice: Educational Partnership Reaches Rural California Communities
Details a promising practice that works to expand health literacy among rural Latinos in California through a partnership between the California State Office of Rural Health and the California Department of Public Health's Office of Binational Border Health. Details the way the program is reaching rural Latinos through community health worker/promotores training.
Date: 08/2019
Type: Document
Sponsoring organization: National Organization of State Offices of Rural Health
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Physical Activity Change after a Promotora-Led Intervention in Low-Income Mexican American Women Residing in South Texas
Examines the physical activity preferences and changes after a community health worker (CHW) led intervention to decrease sedentary time in 620 Mexican American women from mostly rural colonias settlements in Hidalgo County, South Texas on the U.S. Mexico border. The Community Health Activities Model Program for Seniors Physical Activity (CHAMPS) instrument was used to predict an increase in moderate to vigorous physical activity.
Author(s): Jennifer J. Salinas, Deborah Parra-Medina
Citation: BMC Public Health. 2019,(19), 782.
Date: 06/2019
Type: Document
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Influence of Work on Elevated Blood Pressure in Hispanic Adolescents in South Texas
Presents a study on work and blood pressure rates among Hispanic teens in the predominantly rural Hidalgo County, Texas on the U.S-Mexico border. Breaks down data on student participants based on age, race, and physical activity, among other measures.
Author(s): Eva M. Shipp, Sharon P. Cooper, Luohua Jiang, et al.
Citation: International Journal of Environmental Research and Public Health, 16(7), 1096
Date: 04/2019
Type: Document
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Protocol for Links (Linking Individual Needs to Community and Clinical Services): A Prospective Matched Observational Study of a Community Health Worker Community Clinical Linkage Intervention on the U.S.-Mexico Border
Describes Linking Individual Needs to Community and Clinical Services (LINKS), a 3-year observational tool developed to examine the impact of CHW-led interventions using electronic health records and other applications to reduce chronic disease risk and promote well-being among Latinos residing in the U.S. Mexico border region of Arizona.
Author(s): Abby M. Lohr, Maia Ingram, Scott C. Carvajal, Kevin Doubleday, Benjamin Aceves, et al.
Citation: BMC Public Health,19, 399
Date: 04/2019
Type: Document
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Health Equity in New Mexico: 13th Edition
Provides information about the health status of various population groups throughout New Mexico and educates readers on the state's health equity issues. Designed to help policymakers and other stakeholders implement strategies that reduce health disparities and improve health outcomes for all New Mexicans. Includes information and statistics specific to New Mexico's rural regions.
Date: 01/2019
Type: Document
Sponsoring organization: New Mexico Department of Health
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Border Health Status Report to the Legislature 2017-2018
General overview of the current health status of populations living in the California border region including the demographics and significant health indicators. Covers obesity, diabetes, mental health issues, tuberculosis (TB), sexually transmitted infections, HIV/AIDS and vaccine-preventable diseases.
Author(s): Maggie Santibanez, Sandra Yun, Theodore Efthemeou, April Fernandez
Date: 2019
Type: Document
Sponsoring organizations: California Department of Public Health, California Office of Binational Border Health
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The Task Force of Border Health Officials 2018 Biennial Report
Describes the initial efforts of the Task Force of Border Health Officials, which was created by legislation in Texas to help develop recommendations for improving public health in the Texas border region. Summarizes recommendations focusing on 5 areas: public health infrastructure, environmental health, communicable diseases, chronic diseases, and maternal and child health.
Date: 11/2018
Type: Document
Sponsoring organization: Texas Office of Border Public Health
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Continuing Evidence of Chagas Disease Along the Texas-Mexico Border
Explores a study on Chagas Disease on the Texas-Mexico border. Features case studies detailing experiences with the disease in the rural towns of Rio Grande City, TX and San Vicente, Mexico; and in urban centers of Mission, TX and Reynosa, Mexico.
Author(s): Melissa S. Nolan, David Aguilar, Eric L. Brown, et al.
Citation: PLoS Neglected Tropical Diseases, 12(11)
Date: 11/2018
Type: Document
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Trends in Hispanic and Non-Hispanic White Cesarean Delivery Rates on the U.S.-Mexico Border, 2000-2015
Reports on a study comparing cesarean delivery rates before and after 2009 for Hispanic and non-Hispanic populations living in border and non-border counties of the four U.S.-Mexico border states. Study data was derived from the National Vital Statistics System U.S. Standard Certificate of Live Birth files, 2000 to 2015.
Author(s): Jill A. McDonald, Anup Amatya, Charlotte C. Gard, Jesus Sigala
Citation: PLoS One, 13(9)
Date: 09/2018
Type: Document
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Patterns of Screen Time Among Rural Mexican-American Children on the New Mexico-Mexico Border
Reports on a study to determine the screen use among children of Mexican ancestry who are 6 to 10 years living in 2 rural communities along the U.S. Mexico border. The focus of this study is to understand accepted social norms, and reduce sedentary behavior to decrease the prevalence of obesity in Hispanic populations.
Author(s): Jill A. McDonald, Christopher Sroka, Elizabeth Olivares, Merranda Marin, Maria Gurrola, Joseph R. Sharkey,
Citation: Preventing Chronic Disease, 2018(15)
Date: 09/2018
Type: Document
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The Role of Social Support and the Neighborhood Environment on Physical Activity in Low-income, Mexican-American Women in South Texas
Presents a study on the effectiveness of a promotora-led intervention aimed at improving the rates of physical activity among low-income Mexican-American women in rural South Texas.
Author(s): Jennifer J. Salinas, Marisol McDaniel, Deborah Parra-Medina
Citation: Journal of Preventive Medicine and Public Health, 51(5), 234-241
Date: 09/2018
Type: Document
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Task Force of Border Health Officials
Provides the annual legislative report from the Task Force of Border Health Officials, highlighting its activities for the inaugural year and identifying future plans. Reports on health conditions, challenges, and needs for the Texas-Mexico border region.
Date: 09/2018
Type: Document
Sponsoring organization: Texas Department of State Health Services
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Addressing Health and Health Care Needs in the United States-Mexico Border Region
Policy position brief describing geography and demographics of the border region, population health and healthcare issues, factors contributing to the health crisis, public policy implications, and suggestions for addressing needs. Comprises Executive Summary and Full Report.
Author(s): Brian Lady, Carrie Henning-Smith, Susan Kunz
Date: 05/2018
Type: Document
Sponsoring organization: National Rural Health Association
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Border 2020: United States-Mexico Environmental Program Highlights Report, Autumn 2018
Highlights the accomplishments of the U.S.-Mexico Environmental Border 2020 Program from 2016 to 2018. Discusses various initiatives addressing air and water quality, solid waste management, emergency preparedness and response, environmental stewardship, and environmental health.
Date: 2018
Type: Document
Sponsoring organization: U.S. Environmental Protection Agency
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First Trimester Prenatal Care Initiation Among Hispanic Women Along the U.S.-Mexico Border
Reports on a study to determine what factors, including barriers, influence pregnant and parenting Hispanic women from counties within the U.S.-Mexico border region to seek first trimester prenatal care – care associated with improved birth outcomes.
Author(s): Katherine Selchau, Maricela Babuca, Kara Bower, Yara Castro, Eugenie Coakley, et al.
Citation: Maternal and Child Health Journal, 21(Suppl 1), 11–18
Date: 12/2017
Type: Document
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Living in Limbo: Latinas' Assessment of Lower Rio Grande Valley Colonias Communities
Highlights the activities conducted by promotoras during an intervention study using community asset mapping (CAM) to identify factors that may facilitate or create barriers to physical activity among Latina residents in the U.S.-Mexico border region of Texas.
Author(s): DeAnne K. Hilfinger Messias, Patricia A. Sharpe, Lulis del Castilo-Gonzalez, Laura Treviño, Deborah Parra-Medina
Citation: Public Health Nursing, 34(3), 267-275
Date: 05/2017
Type: Document
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Health Coverage and Access to Care in the United States-Mexico Border Region: Implications of the Affordable Care Act (ACA)
Discusses the social determinants of health and health disparities found in the population of the U.S. Mexico border region. Describes the effects of the Affordable Care Act (ACA) provisions to improve healthcare access, expand health insurance coverage, and reduce the number of uninsured.
Author(s): Ryan P. Casey, Hugo Vilchis, Daniel Derksen
Date: 01/2017
Type: Document
Sponsoring organization: Arizona Center for Rural Health
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The United States-Mexico Border Environmental Public Health: The Challenges of Working with Two Systems
Details a report on the availability of information pertaining to environmental and public health in the communities along the U.S.-Mexico border. Bases results on interviews with national and binational programs and makes recommendations to improve information dissemination.
Author(s): Genny Carrillo, Felipe Uribe, Rose Lucio, et al.
Citation: Pan American Journal of Public Health, 41(e98)
Date: 2017
Type: Document
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Emergent Public Health Issues in the US-Mexico Border Region
Features articles on public health issues and disparities in the U.S.-Mexico border region. Covers mental health disorders, maternal and child health, diseases, accidents, access to care, and more.
Date: 10/2016
Type: Document
Sponsoring organization: Arizona Office of Border Health
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Relation of Dietary Inorganic Arsenic to Serum Matrix Metalloproteinase-9 (MMP-9) at Different Threshold Concentrations of Tap Water Arsenic
Study examining the health impact of low-dose arsenic exposure from food and water in four communities along the Arizona-Mexico border. Includes Hispanic and non-Hispanic adults in the study.
Author(s): Margaret Kurzius-Spencer, Robin Harris, Vern Hartz, et al.
Citation: Journal of Exposure Science & Environmental Epidemiology, 26(5), 445-451
Date: 09/2016
Type: Document
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State of the Border Region 2016 - Indicators Interim Report (December 2016)
Details an interim report on environmental health indicators along the U.S.-Mexico border for 2016. Looks at air quality, water contamination, and land pollution, among other indicators. Discusses the bi-national efforts to improve the border environment.
Additional links: En Español, Indicator Metadata and Data Tables
Date: 2016
Type: Document
Sponsoring organization: U.S. Environmental Protection Agency
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U.S.-Mexico Border Needs Assessment and Support Project: Phase II Assessment Report
Describes water and wastewater conditions in the colonias on the U.S. side of the U.S.-Mexico border. Provides county-by-county information on specific challenges in the colonias. Includes recommendations to address the remaining need.
Date: 07/2015
Type: Document
Sponsoring organization: Rural Community Assistance Partnership
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Non-communicable Diseases and Preventive Health Behaviors: A Comparison of Hispanics Nationally and Those Living Along the US-Mexico Border
Reports on a study that compared preventive healthy behaviors of Hispanics in the U.S. and Hispanics living in the U.S.-Mexico border region. Healthy behaviors included physical activity, diets of fruits and vegetables, avoiding heavy alcohol use, and being a non-smoker.
Author(s): Belinda M. Reininger, Jing Wang, Susan P. Fisher-Hoch, et al.
Citation: BMC Public Health, 2015(15), 564
Date: 06/2015
Type: Document
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Healthy Border 2020: A Prevention & Health Promotion Initiative
Reports on the prevailing public health issues occurring in U.S.-Mexico border populations. Identifies an agenda focused on health promotion and disease prevention, and develops a strategy for implementing a coordinated public health response at binational, state and local levels.
Date: 06/2015
Type: Document
Sponsoring organization: United States-México Border Health Commission
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Border Health Epidemiology Report 2015
An overview of the health status of the population living along the California border region. Addresses healthcare access, obesity, diabetes, mental health, tuberculosis, sexually transmissible infections, HIV/AIDS, immunizations, and vaccine preventable diseases.
Author(s): Maggie Santibáñez, Stephanie Yoon, Jennifer Britton, et al.
Date: 05/2015
Type: Document
Sponsoring organization: California Office of Binational Border Health
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Healthy Vinton: A Health Impact Assessment Focused on Water and Sanitation in a Small Rural Town on the U.S.-Mexico Border
Reports on the findings of a Health Impact Assessment (HIA) regarding water quality, sanitation infrastructure, and the health of residents in a predominantly Hispanic rural community along the U.S.-Mexico border.
Author(s): William L. Hargrove, Patricia M. Juárez-Carillo, Marcelo Korc
Citation: International Journal of Environmental Research and Public Health, 12(4), 3864–3888
Date: 04/2015
Type: Document
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Las Colonias in the 21st Century: Progress Along the Texas-Mexico Border
Provides information on demographics, infrastructure, housing, economic opportunity, education, and health in the six Texas counties with the highest concentration of colonias: El Paso, Maverick, Webb, Starr, Hidalgo and Cameron. Offers examples of programs underway that are addressing these issues. Includes data for the colonias compared to Texas and the U.S. as a whole.
Date: 04/2015
Type: Document
Sponsoring organization: Federal Reserve Bank of Dallas
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Emergency Department Use in the US-Mexico Border Region and Violence in Mexico: Is There a Relationship?
Presents a study on the potential correlation between emergency department use and violence in Mexico along the U.S.-Mexico border. Breaks down data by state, payer, and patient characteristics, among other factors.
Author(s): Kimberley H. Geissler, George M. Holmes
Citation: Journal of Rural Health, 31(3), 316-325
Date: 02/2015
Type: Document
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2015 Binational Border Health Research Forum Report
Summarizes an October 21, 2015 meeting of the Binational Border Health Research (BHR) Forum to develop a binational health research agenda for the United States-Mexico border region. Topics discussed include chronic degenerative diseases, infectious diseases, maternal and child health, mental health, addictions, violence, accidents, and injuries. Includes recommendations and suggestions to improve and support research and human resource capacity.
Additional links: En Español
Date: 2015
Type: Document
Sponsoring organization: United States-México Border Health Commission
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Access to Health Care in the U.S.-México Border Region: Challenges and Opportunities
Identifies ways in which the United States-Mexico Border Health Commission and other interested organizations can increase healthcare access for border populations in the U.S. Compares provisions of health reform in both countries to recognize potential binational public health collaborations. Discusses the socioeconomic challenges in healthcare access and the enrollment gaps in health insurance offered through the market place.
Date: 11/2014
Type: Document
Sponsoring organization: United States-México Border Health Commission
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Rural Border Health Chartbook II
Presents an analysis of border counties, both urban and rural, by comparing these counties to other counties within the four border states, and to rural and urban counties in the rest of the U.S. Provides county-level rates and statistics for socio-demographic factors, the physical environment, access to care, and health outcomes.
Additional links: Fact Sheet
Author(s): Grishma P. Bhavsar, Amy Brock Martin, Janice C. Probst, et al.
Date: 10/2014
Type: Document
Sponsoring organization: Rural and Minority Health Research Center
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Uninsurance, Underinsurance, and Health Care Utilization in Mexico by US Border Residents
Examines the relationship between health insurance coverage plans provided in the U.S. and the use of healthcare services accessed in Mexico by residents (immigrants and native-born) who live in the U.S. along the Mexican border.
Author(s): Dejun Su, William Pratt, Jim P. Stimpson, Rebeca Wong, Jose A. Pagán
Citation: Journal of Immigrant and Minority Health, 16(4), 607–612
Date: 08/2014
Type: Document
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Lessons Learned from 20 Years of Diabetes Self-Management Research with Mexican Americans in Starr County, Texas
Provides an overview of research on diabetes self-management education interventions focused on rural Mexican Americans along the Texas-Mexico border. Reports on lessons learned from pilot testing, focus group interviews, and randomized controlled trials. Addresses the impact of culture, behavioral change motivators, and more.
Author(s): Sharon A. Brown, Joseph H. Blades, Craig L. Hanis
Citation: Diabetes Educator, 40(4), 476-487
Date: 07/2014
Type: Document
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Proceedings Report of the Border Reproductive Health Summit
Details the proceedings of the 2014 Reproductive Health Summit held by the U.S.-Mexico Border Health Commission. Discusses reproductive health issues related to sex tourism, sex work, and teen reproductive health. Highlights border and binational programs working on these issues.
Date: 03/2014
Type: Document
Sponsoring organization: United States-México Border Health Commission
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Increasing Cervical Cancer Screening in the United States - Mexico Border Region
Discusses the effects of an intervention delivered by community health workers (CHWs), or Promotores de Salud, on cervical cancer screening rates for Hispanic women in the rural border area of New Mexico who were out of compliance with the recommended screening guidelines.
Author(s): Beti Thompson, Hugo Vilchis, Crystal Moran, Wade Copeland, et al.
Citation: Journal of Rural Health, 30(2), 196-205
Date: 2014
Type: Document
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Nuestra Voz, Nuestra Salud, Nuestro Texas: The Fight for Women's Reproductive Health in the Rio Grande Valley
Examines reproductive health in the Rio Grande Valley region and provides recommendations to improve it. Data was collected from interviews and focus groups in four counties of the Lower Rio Grande Valley where several isolated rural border communities, or colonias, are located. Discusses the impact and results of Texas's policy decisions on Latinas, their families, and their communities as they search for affordable reproductive healthcare.
Date: 11/2013
Type: Document
Sponsoring organization: National Latina Institute for Reproductive Health
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Prevention and Health Promotion among Vulnerable Populations on the U.S.-México Border: Synthesis Report
Summarizes the findings from six regional United States–Mexico Border Health Commission stakeholder planning meetings organized by the New Mexico Department of Health Office of Border Health and the California Department of Public Health Office of Binational Border Health. The objective of these meetings was to collect information from agencies and organizations that provide health and human services, and/or advocate for improving access to these services for at risk populations on the U.S. side of the U.S.–Mexico border region.
Date: 10/2013
Type: Document
Sponsoring organization: United States-México Border Health Commission
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Housing in the Border Colonias
Details the social, economic, and housing characteristics of the border colonias region. Describes the development of the dominant housing provision along the U.S.-Mexico border and includes information on housing quality.
Date: 08/2013
Type: Document
Sponsoring organization: Housing Assistance Council
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The State of the Border Report: A Comprehensive Analysis of the U.S.-México Border
Examines the management of the U.S.-Mexico border and border region according to four core areas: trade and economic development, security, sustainability, and quality of life.
Author(s): Erik Lee, Christopher E. Wilson, Francisco Lara-Valencia, et al.
Date: 05/2013
Type: Document
Sponsoring organizations: El Colegio de la Frontera Norte, North American Center for Transborder Studies, Woodrow Wilson Center's Mexico Institute
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New Mexico Border Health Report
Compares the overall health of New Mexico's 3 border counties with the rest of the state. Details the demographics and health outcomes in Hidalgo, Luna, and Dona Ana Counties.
Date: 2013
Type: Document
Sponsoring organization: New Mexico Department of Health
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Taking Stock: Rural People, Poverty, and Housing in the 21st Century
Details rural poverty and housing in the U.S. using data from the 2010 Census and American Community Survey (ACS). Covers information on substandard housing in rural areas and addresses rural housing for high poverty areas and populations, including the Border Colonias, Appalachia, the Mississippi Delta, and housing for Native Americans and farm workers.
Date: 12/2012
Type: Document
Sponsoring organization: Housing Assistance Council
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Health in the Americas: United States-Mexico Border Area
Reports on the health status of persons living in California, Arizona, New Mexico, Texas, and the bordering Mexican municipalities. Also includes social, political, economic, environment, and demographic information for these areas.
Date: 2012
Type: Document
Sponsoring organization: Pan American Health Organization
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Compendium of Rural Best Practices/Models: Communities Along the Border, Including Practices in Clinical Setting
Represents NRHA Border Health Initiative's activities to encourage the development of quality healthcare services for rural populations along the U.S.-Mexico border. Compendium highlights communities along the border with models that can be built upon and used by federal, state, and local health agencies for setting priorities in rural border communities.
Date: 12/2010
Type: Document
Sponsoring organization: National Rural Health Association
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Health Research on the U.S.-México Border: Promoting a Binational Agenda
Explores the relationship between research and policy development and the role they play in improving health along the U.S.-Mexico border. Outlines key considerations in the development of a binational border health research agenda including current gaps in border health research, and the need to translate research into policies and effective health interventions.
Date: 11/2010
Type: Document
Sponsoring organization: United States-México Border Health Commission
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Addressing the Health Care Needs in the U.S.-Mexico Border Region
Identifies the healthcare needs and health status prevalent in the U.S.-Mexico border region, and discusses policy implications and recommendations to address the healthcare needs of the population in this region.
Date: 01/2010
Type: Document
Sponsoring organization: National Rural Health Association
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Hispanic/Latino Populations for Nonmetropolitan Counties
Printable map that shows the percent of the U.S. population by county who are Hispanic or Latino. Data source: U.S. Census Bureau, 2010 Decennial Census, Summary File 1.
Date: 2010
Type: Map/Mapping System
Sponsoring organization: Rural Health Information Hub
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Arizona-Sonora Border Region Border Infectious Disease Surveillance
Provides data reports on infectious disease incidence and mortality along the Arizona-Sonora Border Region. Includes weekly reports for Zika Virus, Influenza, Rabies, Arbovirus, and morbidity and mortality, as well as monthly binational case reports.
Type: Website
Sponsoring organization: Arizona Office of Border Health
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Binational Border Infectious Disease Surveillance Program (BIDS)
Details a cooperative program between the CDC and the Mexican Secretariat of Health to monitor infectious diseases along the U.S.-Mexico border. Discusses program governance, the surveillance process, and outbreak response.
Additional links: En Español
Type: Website
Sponsoring organization: Centers for Disease Control and Prevention
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Health Tips/Consejos de Salud
A bilingual, quarterly publication focused on health topics and issues relevant to the farmworker and the general Hispanic population. Subscription required however Federally-Qualified Health Centers (FQHCs) may be eligible for a free subscription.
Type: Journal/Newsletter
Sponsoring organization: National Center for Farmworker Health
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PubMed Search: United States/Mexico Border Health
Searches PubMed's collection of journal article citations on the topic of United States/Mexico border healthcare in the colonias.
Type: Literature Search
Sponsoring organization: U.S. National Library of Medicine
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United States - Mexico Public Health
Provides information on health issues in the U.S.-Mexico border region, border and binational programs and activities, and resources to address border health.
Type: Website
Sponsoring organization: Centers for Disease Control and Prevention
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Community Health Workers Toolkit
Contains eight modules about community health worker programs, how the programs work, and how to use community health workers in the local community.
Type: Website
Sponsoring organization: Rural Health Information Hub
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ERS State Fact Sheet: New Mexico
State-level data on population, poverty, food security, educational attainment, employment, and income. Includes data for rural areas, urban areas, and the state as a whole.
Type: Website
Sponsoring organization: USDA Economic Research Service
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ERS State Fact Sheet: Texas
State-level data on population, poverty, food security, educational attainment, employment, and income. Includes data for rural areas, urban areas, and the state as a whole.
Type: Website
Sponsoring organization: USDA Economic Research Service
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ERS State Fact Sheet: Arizona
State-level data on population, poverty, food security, educational attainment, employment, and income. Includes data for rural areas, urban areas, and the state as a whole.
Type: Website
Sponsoring organization: USDA Economic Research Service
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ERS State Fact Sheet: California
State-level data on population, poverty, food security, educational attainment, employment, and income. Includes data for rural areas, urban areas, and the state as a whole.
Type: Website
Sponsoring organization: USDA Economic Research Service
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Arizona QuickFacts
State-level data on demographics, housing, income, and other social determinants of health, with the option to add data for counties and cities and towns with a population of 5,000 or more. Includes information from multiple U.S. Census Bureau censuses, surveys, and programs.
Type: Website
Sponsoring organization: U.S. Census Bureau
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California QuickFacts
State-level data on demographics, housing, income, and other social determinants of health, with the option to add data for counties and cities and towns with a population of 5,000 or more. Includes information from multiple U.S. Census Bureau censuses, surveys, and programs.
Type: Website
Sponsoring organization: U.S. Census Bureau
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New Mexico QuickFacts
State-level data on demographics, housing, income, and other social determinants of health, with the option to add data for counties and cities and towns with a population of 5,000 or more. Includes information from multiple U.S. Census Bureau censuses, surveys, and programs.
Type: Website
Sponsoring organization: U.S. Census Bureau
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Texas QuickFacts
State-level data on demographics, housing, income, and other social determinants of health, with the option to add data for counties and cities and towns with a population of 5,000 or more. Includes information from multiple U.S. Census Bureau censuses, surveys, and programs.
Type: Website
Sponsoring organization: U.S. Census Bureau
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U.S.-Mexico Border Federal Training Center Collaborative
Offers free training, technical assistance, and capacity-building programs to support clinicians working in the U.S.-Mexico border region. Addresses prevention and treatment of HIV, tuberculosis, hepatitis C, sexually transmitted diseases, reproductive health, and related topics.
Type: Website
Sponsoring organization: AIDS Education and Training Centers National Coordinating Resource Center
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US-Mexico Border 2020 Program
Information on the Border 2020 Program, a bi-national program to address the environmental and public health problems in the U.S.-Mexico border region.
Type: Website
Sponsoring organization: U.S. Environmental Protection Agency
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Additional resources are available related to this guide. See the full list of resources by topic for:


Last Updated: 12/9/2019