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Salud con Sabor Latino: a culturallysensitive obesity prevention curriculumin an underserved Latino communityChristina Araiza a , Maria Valenzuela a & Bonnie Gance-Cleveland ba Esperança, Inc. , 1911 West Earll Drive, Phoenix , AZ , 85015 ,USAb Center for Improving Health Outcomes in Children, Teens, andFamilies, Arizona State University , 500 North 3rd Street, Mailcode3020, Phoenix , AZ , 85004 , USAPublished online: 19 Apr 2012.

To cite this article: Christina Araiza , Maria Valenzuela & Bonnie Gance-Cleveland (2012)Salud con Sabor Latino: a culturally sensitive obesity prevention curriculum in an underservedLatino community, International Journal of Health Promotion and Education, 50:2, 51-60, DOI:10.1080/14635240.2012.661963

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Salud con Sabor Latino: a culturally sensitive obesity preventioncurriculum in an underserved Latino community

Christina Araizaa*, Maria Valenzuelaa and Bonnie Gance-Clevelandb

aEsperanca, Inc., 1911 West Earll Drive, Phoenix, AZ 85015, USA; bCenter for Improving HealthOutcomes in Children, Teens, and Families, Arizona State University, 500 North 3rd Street,Mailcode 3020, Phoenix, AZ 85004, USA

Salud con Sabor Latino is a culturally sensitive obesity prevention curriculum thatincorporates the traditions and values of the Latino community and family. The 4-weekcurriculum meets twice a week and includes an education and cooking component. Keycomponents of the curriculum are portion size, reading food labels, taking small steps,eating a variety of foods, and the importance of physical activity. The curriculum istaught in English and Spanish by a bicultural promotora. Participants are primarily lowincome and uninsured. Goals of the program are to improve (a) knowledge of fitnessand nutrition, (b) physical activity, (c) healthy eating, and (d) body fat measures. Thisstudy was a pretest and posttest evaluation of nutrition, physical activity, and body fatafter the obesity prevention intervention with Latinos (n ¼ 82). Results indicated asignificant increase in physical activity (t[75] ¼ 26.35, p , 0.01). For nutrition, therewas a significant increase in knowledge (t[59] ¼ 22.58, p ¼ 0.01) and improvedbehavior (t[71] ¼ 25.33, p , 0.01). In addition, there were decreases in waistcircumference (t[73] ¼ 5.66, p , 0.01), percentage of body fat (t[71] ¼ 2.50;p ¼ 0.02), and body mass index (t[75] ¼ 3.31, p , 0.01).

Keywords: obesity; Latinos; nutrition; community-based; promotoras; culturallysensitive health promotion

Introduction

The increased prevalence of obesity in Latinos has been well documented. The prevalence

of obesity among adult Mexican Americans in 2007–2008 was reported as 35.9% for men

and 45.1% for women (Flegal et al. 2010). Mexican American women in the USA have a

higher rate of overweight or obesity than women in Mexico and other Latin American

countries (75% vs. 59%; Martorell 2005), suggesting the possibility of the impact of US

lifestyle factors on the risk for obesity.

Health issues resulting from obesity are prominent. Hispanics have the highest lifetime

risk of developing diabetes (45.4% in males and 52.5% in females), higher than non-

Hispanic Blacks (Narayan et al. 2003). Obesity has led to the onset of type 2 diabetes,

cardiovascular disease, musculoskeletal disorders, and sleep apnea (Visscher and Seidell

2001). Obesity among Hispanics continues to rise, furthering their risk for diabetes and

diabetes-related complications (Babamoto et al. 2009). In addition, among Latina/His-

panic women, some evidence links obesity to greater risk for cancer (Wenten et al. 2002).

Many researchers on the health of Hispanic populations in the USA have documented

significant disparities in diabetes prevalence, treatment outcomes (McBean et al. 2003), and

ISSN 1463-5240 print/ISSN 2164-9545 online

q 2012 Institute of Health Promotion and Education

http://dx.doi.org/10.1080/14635240.2012.661963

http://www.tandfonline.com

*Corresponding author. Email: Christina@esperanca.org

International Journal of Health Promotion and Education

Vol. 50, No. 2, March 2012, 51–60

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access to health services (Babamoto et al. 2009). Maintaining a connection to one’s culture

of origin has been found to be associated with protective factors (e.g. less acculturated

mothers are more likely to breastfeed, Ayala et al. 2008), yet greater assimilation to Anglo

culture is associated with certain protective factors such as increased utilization of

healthcare services (Ayala et al. 2004). The prevalence of obesity has been positively

correlated with low socioeconomic status and education (Kumanyika 2001). Cultural

factors, along with dietary and exercise behaviors, are said to contribute to higher prevalence

of obesity and related conditions in minority groups (American Obesity Association [AOA]

2004). Latinos/Hispanics tend to be younger, less educated, unemployed, or working in

high-risk occupations; they tend to live in poverty, in urban versus rural areas, and in larger

households than non-Latinos/Hispanics in the USA (Pew Hispanic Center 2008). These

factors together form a profile that is commonly associated with poorer health status and

inaccessibility to health care (Singh and Siahpush 2002).

Published studies demonstrate that tailored nutrition education programs can be

effective in altering dietary intake (Baquero et al. 2009). Various factors – ranging from

cultural factors and language issues to healthcare access and insurance problems – deem

necessary ‘community-based, culturally appropriate interventions for minorities’

(Chatterjee et al. 2005). The degree to which health education can prevent obesity has not

been established (Kahn et al. 2002). The inconsistent success of past prevention programs

suggests that interventions need to be matched to ‘local needs and capabilities’ (Kahn et al.

2002). Several studies have recommended ‘comprehensive, multilevel interventions with

appropriate messages and interventions geared towards individuals, providers, organiz-

ations, and communities at large’ (Steckler et al. 1995, Blakely 2003, Bassett and Perl 2004).

Moreover, of the currently existing prevention programs, few target the family system,

are based in a family–theory framework, or incorporate the culture in which the family

lives (James et al. 2008). James and colleagues argued that ‘parents who are supportive

and who change their own weight and eating patterns tend to be more successful with

implementing family change. Because the parent, in most families, is the decision-maker

concerning the foods that are available and the activities in which members engage’,

evaluating and intervening in lifestyle management with the parents as well as with the

children could potentially affect the entire family (Golan 2006). This suggests that if adults

were provided with the ‘means, skills, and opportunities to negotiate their environments in

a more healthful manner, they may be less likely to gain weight’ (Ayala et al. 2004) and

provide healthier choices for their families.

Time constraints can be a strong impediment to proper management of a family’s

ability to practice healthier behaviors (Chatterjee et al. 2005). Incorporating culturally

appropriate time management skills for these families into existing obesity prevention

programs, ‘in addition to emphasizing and teaching behavioral skills such as choosing or

learning to cook healthy diets or finding a buddy to exercise’, can provide the skills

and knowledge for parents to integrate these practices into their daily schedules

(Chatterjee et al. 2005). Studies show that a combined approach of exercise, behavioral

changes that include a decrease in sedentary activities, social support, knowledge of

healthy nutrition, and parental support are vital components of effective programs

(National Institute for Health Care Management 2003).

In one study, Baquero et al. (2009) showed that Latinos preferred health communication

pieces that were ‘culturally adequate, visually interesting, and linguistically appropriate.’

An appropriate reading level is also an important characteristic for tools designed for

low-income audiences. Latinos, who are predominantly Spanish-speaking, are often less

52 C. Araiza et al.

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educated than their counterparts in the USA and require instruments adapted to meet their

literacy level (Banna et al. 2010).

Researchers have also found that culturally tailored outreach and education programs,

delivered by trained community health workers (CHWs), ‘can significantly improve self-

care behaviors and decrease body mass index (BMI)’, when compared with care that case

managers or standard providers offer (Babamoto et al. 2009). ‘CHWs – also known as lay

health educators, community health advocates, community health outreach workers,

community health representatives, or promotores de salud – are members of the

community who provide services to help connect the health care system with the residents

living within the area’ (Babamoto et al. 2009). Taken together, researchers have suggested

that an ‘intervention with Latinas by means of tailored print material and promotoras would

be perceived [by participants] as both appealing and highly credible’ (Elder et al. 2005).

Community-based organizations that work within the context of affected populations

are ideal settings for intervention activities. They may be more closely connected to

families and as a result can develop economically and culturally appropriate interventions,

which may have a substantial influence on future behavior (Kahn et al. 2002).

‘Community centers and after-school programs play an integral role, because most

community centers operate within neighborhoods and have a better understanding and

view of the contextual aspects of lives of families and individuals’ (Chatterjee et al. 2005).

Golden Gate Community Center (GGCC), the setting for this study, was founded in the

1930s as a settlement house for the immigrant poor and serves as a true community center

for residents living in west central Phoenix, Arizona. The mission of GGCC is to provide

programs and services that improve the quality of life for children and families in west

central Phoenix neighborhoods. GGCC is a member of Arizona’s Children Association

Family of Agencies and serves over 6000 children, youth, adults, and seniors annually

through a wide variety of minimal-pay or no-fee programs and services that include Head

Start, English as a Second Language (ESL) courses, computer classes, after-school

recreation programs, aerobics classes, community health fairs, and community health

education workshops. GGCC partners with Esperanca, a nonprofit health and development

organization founded in 1970 that delivers healthcare services in four countries, for health

fairs, preventative health education, and capacity-building initiatives.

Neighborhoods surrounding GGCC are considered to have a high health risk. There is

an overrepresentation of diabetes and obesity, limited or no health insurance, and limited

access to health resources. Most of the families are low income, Latino (primarily of

Mexican origin), and monolingual Spanish-speaking. There are few low-cost medical

providers within a reasonable distance from GGCC, and transportation is often an issue for

many families.

GGCC is also located in both a federally designated medically underserved area and a

state-designated Health Professional Shortage Area, which have been associated with

populations having worse general health status, poor physical health, and less access to

medical services (Liu 2007). There are also limited recreational opportunities for families

in the area. The local elementary schools offer no recreational facilities like a gymnasium

or organized sports.

In 2006, Golden Gate conducted a community needs assessment and surveyed over

200 community residents. The results showed that the most important issue was access to

healthcare services and resources, specifically the need for interventions for obesity-

related conditions, and for more information about how to live healthier and make better

choices regarding nutrition and physical activity.

International Journal of Health Promotion and Education 53

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Curriculum development

To address the healthcare deficits identified in the needs assessment, GGCC was awarded a

grant in 2006 to implement a nationally acclaimed curriculum, Salsa, Sabor y Salud (SSS),

developed by the Latino Children’s Institute. The curriculum was created specifically for

Latino families, and consisted of 16 sessions, implemented over an 8-week period. Despite

widespread adoption of the curriculum, it had not been rigorously evaluated. GGCC

implemented four series of the SSS curriculum over a year period. High attrition rates

among program participants, however, caused the GGCC staff to reassess the SSS

curriculum and its effectiveness in their specific community. An adapted version called

Salud con Sabor Latino (SSL) was developed that would address some of the issues that

were limiting community members’ participation such as changing the curriculum from

8 to 4 weeks, meeting twice a week instead of once a week, adding a hands-on cooking

component, and targeting adults initially instead of entire families. The goals of the SSL

program are to (a) increase awareness of fitness and nutrition issues; (b) increase levels of

physical activity; and (c) improve habits leading to a healthy diet.

We developed the new SSL curriculum to promote healthy lifestyles by incorporating

the traditions and values of the Latino community, recognizing that the family functions as

a unit. Each 4-week series is divided into two components: education and cooking.

The educational component focuses on topics such as watching portion size, taking small

steps to success, eating a variety of foods each day, and integrating physical activity into

daily living. The cooking component puts the educational component of the classes into

practice. The curriculum was taught in Spanish by promotoras who are employed full time

at the community center and by community volunteers. The SSL series was implemented

six times a year. Approximately 10–12 participants graduated from each series, with

approximately 60 participants graduating every year. The curriculum was implemented

with adults, primarily women, at GGCC and various surrounding locations such as Head

Starts, elementary schools, and domestic violence shelters.

Individuals who had graduated from the course co-facilitated the cooking segment

with the promotoras. This allowed the curriculum content to be even more culturally

appropriate, and community members took ownership of the course by getting actively

involved in influencing the health status of their own community. The final week included

a tour of the local supermarket as well as a celebration potluck.

GGCC staff implemented the SSL curriculum for 2 years using a very basic pretest

and posttest that would measure knowledge and behavior regarding nutrition and physical

activity. These tools, however, had not been evaluated to determine if they were in fact

accurately reflecting changes in the behavior and knowledge of those who participated.

In 2009, GGCC received funding to form a formal partnership with ASU College of

Nursing & Health Innovation to develop a more scientifically rigorous evaluation of the

curriculum that would measure participants’ change in behavior, knowledge, and body

fat. The intervention was implemented over a year, during five cohorts of SSL 8-week

classes.

Methodology

This evaluation study of the SSL curriculum was conducted in the community with a

pretest/posttest design. After obtaining IRB approval through ASU, the promotoras and

the staff at GGCC recruited the participants, informed them about the desire to evaluate

the program, and obtained informed consent.

54 C. Araiza et al.

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Sample

A convenience sample of participants who were enrolled in the SSL over a year was

invited to participate. Participants were Spanish-speaking Latino men and women from

the community surrounding the GGCC. Local program coordinators advertised

information about an upcoming series through flyers and presentations at local elementary

schools, local Head Starts, community events, and GGCC activities (e.g. ESL classes,

computer classes, and aerobics). Community members who were interested were asked to

call or visit a promotora to sign up. All interested Latino adults were eligible to participate.

Participation in the program was based on first-come, first-served enrollment. Everyone

enrolled in the course participated in the evaluation. A reminder call was made a day prior

to the initial start of the series.

Measures

Due to the low literacy level of the population, we selected 16 questions from the School

Physical Activity and Nutrition (SPAN) survey, 4th-grade Spanish version, to assess

healthy eating and activity behaviors. An additional three questions were pulled from the

8th-grade to 11th-grade version of the instrument to obtain a more comprehensive

assessment. The SPAN questionnaires are validated in Mexican American populations and

include questions related to physical activity, sedentary behavior, nutrition knowledge and

choices, and attitudes about weight loss and body size (Hoelscher et al. 2003).

An ASU researcher trained GGCC staff, promotoras, and community volunteers

according to the measurement protocol and data collection procedure. We measured

weight in kilograms to the nearest 10th using a standard Tanita HD-314 digital weight

scale, calibrated daily. We used a Seca Road Rod 214 portable stadiometer, calibrated in

1/8 inch intervals, to obtain height. Two independent measurements were obtained, with a

third measurement obtained if there was more than 0.5 cm difference in height between the

first and second height measurement, and more than 0.5 lb difference in the first and

second weight. A research assistant entered all the data into Statistical Package for the

Social Sciences (SPSS) version 6.0, and BMI was calculated from the height and weight

by computer after the data entry.

Analysis

We used a paired t-test to assess the effectiveness of the program, which we determined by

measuring changes in (a) nutrition knowledge and behavior composite scores; (b) physical

activity knowledge and behavior composite scores; and (c) body fat as measured by the

BMI, waist circumference, and body fat analyzer at two time points: before beginning

the SSL series (Time 1, T1) and upon completion of the last SSL class in the series

(Time 2, T2).

Results

Five cohorts of SSL participants were evaluated for changes in knowledge and behavior

regarding physical activity, nutrition, and body composition; 85 participants were

consented, 81 completed all measures at T1, and 78 completed measures at T2. The

purpose was to evaluate the differences between participants’ nutrition knowledge,

nutrition behaviors, physical activity knowledge, and physical activity behaviors

composite scores. Results indicated (a) significant increases in physical activity

International Journal of Health Promotion and Education 55

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(t[75] ¼ 26.35, p , 0.01), nutrition knowledge (t[59] ¼ 22.58, p ¼ 0.01), and nutrition

behavior (t[71] ¼ 25.33, p , 0.01) and (b) decreases in waist circumference

(t[73] ¼ 5.66, p , 0.01), percentage of body fat (t[71] ¼ 2.50, p ¼ 0.02), and BMI

(t[75] ¼ 3.31, p , 0.01). Data are summarized in Table 1.

Demographics

The sample (n ¼ 82) consisted of 96% women, 100% Latino, and 100% Spanish speaking.

The ages ranged from 19 to 61 years, with a mean of 33. Acculturation was measured by

the short acculturation scale for Hispanics with a maximum possible of 20 points for

acculturation/language on a scale from 0 (completely Spanish-speaking) to 20 (completely

English-speaking). The mean score for the sample (n ¼ 80) was 1.4, with a standard

deviation of 2.26, indicating a highly unacculturated sample.

Nutrition knowledge

The composite score for nutrition knowledge consisted of a maximum possible points of 7,

with higher points indicating more correct responses. Nutrition knowledge composite

scores were based on participants’ responses to questions concerning optimum daily

servings from different food groups; the links between diet, weight, activity level, and

health problems; and the misconception that skipping meals is the best way to lose weight.

We found a statistically significant increase in the composite scores for nutrition behaviors

from T1 to T2: F(1, 71) ¼ 28.39, p , 0.01.

Nutrition behavior

The composite score for nutrition behaviors consisted of a maximum possible score of 30,

with a higher score indicating more nutritious behavior. Nutrition behavior composite

scores were based on participants’ responses to 10 questions (with possible scores of 0–3

on each): 7 about their intake of red meat, white breads, whole wheat breads, vegetables,

fruits, soft drinks, desserts, and sugary foods; 1 about how often they ate breakfast; 1 about

how many meals they eat per day; and 1 about the type of milk they drank. We found a

statistically significant increase in the composite scores for nutrition knowledge across T1

and T2: F(1, 59) ¼ 6.63, p ¼ 0.01.

Physical activity knowledge

Physical activity knowledge composite scores consisted three items, with higher scores

indicating more correct responses. Participants responded to questions about the link

Table 1. Pretest/posttest differences.

Composite Pretest (SD) Posttest (SD) T df Significance

Nutrition knowledge 4.48 (1.11) 4.82 (0.95) 22.58 59 0.01Nutrition behaviors 17.79 (3.22) 19.85 (3.27) 25.33 71 ,0.01PA knowledge 1.99 (0.86) 1.93 (0.84) 0.49 75 0.63PA behavior 5.88 (2.70) 7.57 (2.58) 26.35 75 ,0.01Waist circumference 37.62 (5.61) 36.11 (5.22) 5.66 73 ,0.01Percentage of body fat 34.74 (6.28) 34.16 (6.43) 2.50 71 0.02BMI 29.29 (5.89) 29.11 (5.93) 3.31 75 ,0.01

56 C. Araiza et al.

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between physical activity and the risk of health problems such as diabetes, high blood

pressure, and high cholesterol; whether or not most people got enough physical activity in

their daily routine; and whether or not only people who needed to lose weight could benefit

from physical activity. We did not find a statistically significant increase in composite

scores for physical activity knowledge across T1 and T2: F(1, 75) ¼ 0.24, p ¼ 0.63.

Physical activity behavior

A composite score for physical activity was created with a maximum possible score of 13;

higher scores indicated positive physical activity behavior. Physical activity behavior

scores were based on participants’ responses to two questions about how often they

engaged in at least 20 minutes of exercise and how often they watched television. We

found a statistically significant increase in composite scores for physical activity behaviors

across T1 and T2: F(1, 75) ¼ 40.38, p , 0.01.

BMI, percentage of body fat, and waist circumference

We used a paired t-test to assess the effectiveness of the program in terms of changes in

BMI, percentage of body fat, and waist circumference. We found statistically significant

differences across T1 and T2 for BMI (F[1, 75] ¼ 10.96, p ¼ 0.01), percentage of body fat

(F[1, 71] ¼ 6.25, p ¼ 0.02), and waist circumference (F[1, 73] ¼ 32.03, p , 0.01).

Discussion

The results suggest that the SSL curriculum has potential as an effective intervention on

behavior, knowledge, and anthropometric changes with regard to nutrition and physical

activity within this Latino population. This pretest/posttest evaluation indicated significant

improvement on all measures except for physical activity knowledge. In addition,

feedback from participants was very positive, and they requested more classes for

graduates of the curriculum, children, and other family members. There was also a high

retention rate (96%).

An observed benefit of this program was the transferred learning. The participants

reported that they modified their lifestyles and modeled this for their immediate and

extended families as well as neighbors, and so there was a ripple effect of increased

healthy lifestyles among multiple individuals.

Research has been mixed on positive results of similar interventions. The curriculum’s

success may be attributed to several factors. The curriculum workshops were scheduled

during the day at the community center, or around community groups that were already

formed, making it more convenient for most Latino participants to attend. Usually,

participants would drop their children off at school and then come to the classes. Also,

childcare was provided for those who had small children. All information and activities

were taught by bilingual and bicultural facilitators, who were all raised in a Latin

American country. This was critical in the curriculum’s ability to convey information in a

culturally appropriate manner that went beyond merely speaking the same language.

Facilitators and participants were able to connect around how food, social dynamics, body

image, and health are perceived in the Hispanic culture. When discussing behavior

changes for healthy living, facilitators could also share how the healthier changes

benefitted them or how family members reacted to the changes to encourage participants

to try new behaviors.

International Journal of Health Promotion and Education 57

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The curriculum also included activities and incentives that kept participants very

engaged. For example, participants had the chance to win raffle items during the series.

Raffle items were related to curriculum content such as measuring cups, hand weights,

olive oil, or baskets with food from the week’s menu. Finally, the small group dynamics

seemed to increase the accountability for those who attended. When the participants were

unable to attend, they felt compelled to call prior to the session and explain why they could

not make it. It appears that the small group dynamics also allowed for trust and

relationship building between participants and facilitators. This was not formally tested

and would need to be researched in future studies.

The curriculum tested in this study shows promise for improving the weight, nutrition,

and physical activity in this high-risk group. The use of promotoras to implement the

intervention in a community center for a highly unacculturated population may be a key

factor in the positive outcomes observed. Further research is needed to determine the

efficacy of the intervention.

This study included several limitations. The intervention period was relatively short,

only 4 weeks. For participants to continue to benefit, it may be best to adjust the

intervention period for a longer time, develop a new series for those who have graduated,

or plan follow-up sessions on a regular basis. Participants were eager to learn more and

were interested in attending more courses but due to limited funding, resources, and

personnel, this was not possible. Additionally, there was no control group for this study.

This study stemmed from the community organization’s interest in determining if its

evaluation tools and curriculum were effective. This study met that need. A control group

would help determine if this curriculum is as impactful as it seemed. Finally, the sample

size was relatively small. A year’s worth of series was evaluated.

Future research should look into capturing more qualitative information. Participants

reported many positive changes that they had made as a result of the curriculum.

For example, they switched from whole milk to skim or 1%. They reported making more

of an effort to walk around the neighborhood, join the GGCC aerobic classes, or walk their

children to and from school. Many participants became members of the aerobic classes

and are still attending, months and years after their initial participation in the intervention.

Participants also shared that they were purchasing healthier items for meals such as olive

or canola oil, turkey and chicken over more fatty meats, and whole-grain breads.

Participants reported that they were looking at food labels before purchasing and were

more aware of their portions when they ate. These are all small changes that cannot be

quantified in the current evaluation tool. Finally, this intervention should be implemented

and evaluated in other communities beyond the neighborhoods surrounding GGCC to

determine if it is effective in other populations.

The process for developing the evaluation study for the curriculum was a learning

process. Since we are a community-based organization, our partnership with an

experienced researcher from a reputable academic institution was critical for the success

of this study, as our experience with developing these types of evaluation studies was

limited. Partnering with an academic institution also helped us gain access to valuable

resources and tools that were otherwise not readily available. During the beginning stages,

the GGCC staff and ASU researchers met several times to determine the goals of the

evaluation tools and review already validated instruments.

During the implementation of the evaluation tools, we found that participants were

more understanding and willing to take the time to answer each question after a clear

explanation for why a pre- and post-questionnaire was needed. We explained that it was

for their benefit and guided the course topics and activities. We limited the questionnaire

58 C. Araiza et al.

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to be completed in approximately 30 minutes and followed it up with an interactive

activity. We also read each question out loud, which helped with issues such as literacy

levels, vision problems, and the misunderstanding of a question. We noted any questions

or clarifications that came up to see if adjustments or changes needed to be made in future

revisions of the questionnaire. Finally, it was very important that we used the evaluation

tools to benefit those participating in the curriculum. When anthropometric measures were

taken during the first session, each participant received a copy and was provided

information regarding recommended healthy measurements and daily nutritional intake

based on his/her height, weight, and body type. Participants set goals for the series based

on their anthropometric measurements. During the last session, the correct answers for

each question, with an explanation, were given.

Acknowledgements

This research was supported by United Healthcare.

Contributors

. Golden Gate Community Center staff, members and community residents

. SSL participants

. Phyllis Habib, MSW, Director of Golden Gate Community Center

. Nancy Vasquez-Amezquita, Promotora de Bienestar

. Zuleyka Aguilar, Promotora de Bienestar

. Sarah Chavez, MSW, Health Coordinator, Golden Gate Community Center

. Linda Luft, BS, Prevention Specialist

. Vanessa Bush, BS, Research Assistant, Arizona State University

. Miranda Kucera, BS, Research Assistant, Arizona State University

References

American Obesity Association, 2004. Obesity in minority populations: a fact sheet [online].Available from: http://www.obesity.org/subs/fastfacts/Obesity_Minority-Pop.shtml [Accessed24 April 2004].

Ayala, G.X., et al., 2004. Correlates of body mass index and waist-to-hip ratio among Mexicanwomen in the United States: implications for intervention development. Women’s Health Issues:Official Publication of the Jacobs Institute of Women’s Health, 14 (5), 155–164.

Ayala, G.X., Baquero, B., and Klinger, S., 2008. A systematic review of the relationship betweenacculturation and diet among Latinos in the United States: implications for future research.Journal of the American Dietetic Association, 108, 1330–1344.

Babamoto, K.S., et al., 2009. Improving diabetes care and health measures among Hispanics usingcommunity health workers: results from a randomized controlled trial. Health Education &Behavior, 36 (1), 113–126.

Banna, J.C., et al., 2010. Using qualitative methods to improve questionnaires for Spanish speakers:assessing face validity of a food behavior checklist. Journal of the American DieteticAssociation, 110 (1), 80–90.

Baquero, B., et al., 2009. Secretos de la buena vida: processes of dietary change via a tailorednutrition communication intervention for Latinas. Health Education Research, 24 (5), 855–866.

Bassett, M.T., and Perl, S., 2004. Obesity: the public health challenge of our time. American Journalof Public Health, 94, 1477.

Blakely, D., 2003. Social construction of three influenza pandemics in the New York Times.Journalism & Mass Communication Quarterly, 80, 884–902.

International Journal of Health Promotion and Education 59

Dow

nloa

ded

by [

Uni

vers

ity o

f Pr

ince

Edw

ard

Isla

nd]

at 0

0:44

14

Nov

embe

r 20

14

Chatterjee, N., Blakely, D.E., and Barton, C., 2005. Perspectives on obesity and barriers to controlfrom workers at a community center serving low-income Hispanic children and families.Journal of Community Health Nursing, 22 (1), 23–36.

Elder, J.P., et al., 2005. Interpersonal and print nutrition communication for a Spanish-dominantLatino population: Secretos de la buena vida. Health Psychology: Official Journal of theDivision of Health Psychology, American Psychological Association, 24 (1), 49–57.

Flegal, K.M., et al., 2010. Prevalence and trends in obesity among U.S. adults, 1999–2008.Journal of the American Medical Association, 308 (3), 235–241.

Golan, M., 2006. Parents as agents of change in childhood obesity – from research to practice.International Journal of Pediatric Obesity, 1 (2), 66–76.

Hoelscher, D.M., et al., 2003. Reproducibility and validity of the secondary level school-basednutrition monitoring student questionnaire. Journal of the American Dietetic Association,103 (2), 186–194.

James, K.S., et al., 2008. Family-based weight management with Latino mothers and children.Journal for Specialists in Pediatric Nursing: JSPN, 13 (4), 249–262.

Kahn, E., et al., 2002. The effectiveness of interventions to increase physical activity: a systematicreview. American Journal of Preventive Medicine, 22 (Suppl. 1), 73–107.

Kumanyika, S., 2001. Minisymposium on obesity: overview and some strategic considerations.Annual Review of Public Health, 22, 293–308.

Liu, J., 2007. Health professional shortage and health status and health care access. Journal of HealthCare for the Poor and Undeserved, 18, 590–598.

Martorell, R., 2005. Diabetes and Mexicans. Preventing Chronic Disease, 2 (1), A04.McBean, A.M., et al., 2003. Racial variation in the control of diabetes among elderly Medicare

managed care beneficiaries. Diabetes Care, 26, 3250–3256.Narayan, K.M., et al., 2003. Lifetime risk for diabetes mellitus in the United States. Journal of the

American Medical Association, 290, 1884–1890.National Institute for Health Care Management, 2003. Childhood obesity: advancing effective

prevention and treatment: an overview for health professionals [Issue paper]. Prepared for theNational Institute for Health Care Management Foundation Forum, Washington, DC.

Pew Hispanic Center, 2008. Statistical Portrait of Hispanics in the United States. 2008 [online].Available from: http://pewhispanic.org/factsheets/factsheet.php?FactsheetID¼58 [Accessed18 November 2010].

Singh, G.K., and Siahpush, M., 2002. Ethnic-immigrant differentials in health behaviors, morbidity,and cause-specific mortality in the United States: an analysis of two national data bases.Human Biology, 74 (1), 83–109.

Steckler, A., et al., 1995. Health education intervention strategies: recommendations for futureresearch. Health Education Quarterly, 22, 307–329.

Visscher, T.L.S., and Seidell, J.C., 2001. The public health impact of obesity. Annual Review ofPublic Health, 22, 355–375.

Wenten, M., et al., 2002. Associations of weight, weight change, and body mass with breast cancerrisk in Hispanic and non-Hispanic white women. Annals of Epidemiology, 12, 435–444.

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