Border View YMCA Project Overview Objective Border View YMCA had the idea of developing a diabetes-prevention program aimed at Hispanic youth ages 6-12 enrolled in YMCA afterschool programs in the South Bay.
Solution The project group enrolled in Research, Design, and Evaluation had the challenge of developing a comprehensive program to tackle the issues of obesity and diabetes in this target population.
Outcome The final project reflects an extremely detailed and feasible program, one that the Border View YMCA hopes to implement with necessary funding in the near future.
' V IT'SFOR I EVERYBODY
3085 Beyer Boulevard. Suite A-I 03 San Diego. California 92 154 Telephone (619) 428-1 168 FAX (6 19) 428-469 1
BORDER VIEW YMCA
March 29, 2007 Ms. Pat Libby Nonprofit Management and Leadership Program University of San Diego 4998 Alcala Park San Diego, CA 92110 Dear Ms. Libby, In the fall of2006, I had the pleasure of working with Katie Ray Jones, Caitlyn McTaggart, Constance Matthews and Tom Cesarini on the development of a Type 2 diabetes prevention program to improve the health of Hispanic/Latino families residing in San Diego's San Ysidro and Otay/Nestor communities. The Border View YMCA is dedicated to improving the quality of human life and helping all people realize their fullest potential through the development of spirit, mind, and body. To that end, the Border View YMCA focuses its programs on helping children of all ages to lead happy and healthy lives. Katie, Caitlyn, Constance and Tom worked diligently with me to ensure that the diabetes prevention program we created met this goal. The group invested a significant amount of time and energy into researching the prevalence of diabetes among Hispanic/Latino youth and gathering input from the Hispanic/Latino fanlilies residing in the San Ysidro and Otay/Nestor communities to ensure that the program that was created met the specific needs of Hispanic/Latino youth. Through this research, the group was able to develop an ilIDovative program based on best practices that took a comprehensive, family-based approach to improving the nutritional habits and increasing the level of physical activity of the Hispanic/Latino youth residing in the Border View YMCA's service community. I was extremely impressed with the quality of the program the group produced. The Border View YMCA Board of Directors was equally impressed with the final product and has decided to pursue funding opportunities to ensure that the program is implemented within the coming months. The Board of Directors and I are confident that this high-quality program will have a tremendous impact on the lives of the Hispanic/Latino families residing in the San Ysidro and OtaylNestor communities by ensuring that they have access to the resources they need to remain healthy.
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Mauricio Gonzalez Executive Director Border View YMCA
MISSION STATEMENT: "The Border View YMCA is dedi cated to improving the quality of human life and to helping ali people realize their fuliest potential as children of God through development of the spirit. mind and body."
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& IIIJN .. 路.1~011 YOIJlllll~lll.j"'II! i(;0111~ll Y (;Olllll~ll . .. 1)011 SIJ SllIJJJ)! A health intervention program for the Border View YMCA families and Community Partners
Tom Cesarini Mauricio Gonzalez Katie Ray Jones Constance Matthews Caitlyn McTaggart
December 16, 2006 University of San Diego EDLD 500
Diabetes Prevention I. Introduction
Within recent years, the prevalence of Type 2 diabetes has become an epidemic among the Hispanic/Latino population living in the United States. According to the National Institute of Health (2005), 2.5 million, or 9.5%, of Hispanic/Latinos over the age of20 have been diagnosed with Type 2 diabetes. Research shows that Hispanic/Latino youth between the ages of 6 and 12 are nearly twice as likely to be diagnosed with Type 2 diabetes as non-Hispanic/Latino youth of similar age (Teufel-Shone, Drummond, & Rawiel, 2005). The high risk of Type 2 diabetes among Hispanic/Latino youth is primarily due to their poor eating and exercise habits (American Obesity Association, 2006; Cohen & Ingram, 2005; Teufel-Shone, Drummond & Rawiel, 2005). II. Needs Assessment Target Population
Sixty-one percent of the residents in the San Ysidro and OtaylNestor communities are Hispanic/Latino, as compared to 25% in San Diego County (SANDAG, 2006). The San Ysidro and OtaylNestor communities are among the most underserved areas in San Diego County, with the average median household income falling at $37,500. This figure is significantly lower than the average median household incomes of San Diego and California, which fall at $54,000 and $48,440, respectively (U.S. Census Bureau, 2006). Additionally, the youth in 20% of the households in the San Ysidro and OtaylNestor communities live below the federal poverty line of$16,600 for a family of three and $20,000 for a family of four (U.S. Census Bureau, 2006). In comparison, the youth in less than 10% of the households in Chula Vista, the neighboring city to San Ysidro and OtaylNestor, live below the federal poverty line (SANDAG, 2006). Additionally, 43% of the adults residing in the San Ysidro and OtaylNestor communities have less than a high school diploma, as compared to 18% of the San Diego County population
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(SANDAG, 2006). Furthermore, SANDAG (2006) reports that 47% of the population over the age of 16 in San Ysidro and OtaylNestor is unemployed and single parent households comprise 23 % of the total number of households. These figures are significantly higher than those for San Diego County, which fall at 34% and 15% respectively (SANDAG, 2006). Target Community
The San Ysidro and OtaylNestor communities are unique from other communities in San Diego County in their proximity to the United States-Mexico border. San Ysidro is the busiest land border crossing in the world, with over 14,000 vehicles and 40 million people entering the United States at the San Ysidro port of entry every year (Wikipedia, 2006). The proximity of San Ysidro and OtaylNestor to the border results in a high undocumented population (Wikipedia, 2006). This high undocumented population poses a challenge in that it is not included in the U.S. Census and therefore skews the communities' demographics (County of San Diego, 2006). The San Ysidro and OtaylNestor communities have the third highest violent crime rate in the City of San Diego (City of San Diego Police Department, 2006). The two communities have a .48 crime rate (per every 1,000 people), whereas communities with similar demographics, such as Paradise Hills and Bay Terraces, have crime rates of .25 and .32 respectively (City of San Diego Police Department, 2006). In addition, unlike other areas of San Diego County, there are limited affordable recreational activities in the San Ysidro and OtaylNestor communities (City of San Diego Parks and Recreation, 2006). There are only three community recreation facilities in the two communities, whereas there are a minimum of 6 recreation facilities in communities of comparable size, such as Clairemont Mesa (City of San Diego Parks and Recreation, 2006). Additionally, the activities offered at the recreation facilities in San Ysidro and OtaylNestor
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range from $30-$70 per child, which many Hispanic/Latino families cannot afford (City of San Diego Parks and Recreation, 2006). Research indicates that the prevalence of Type 2 diabetes among Hispanic/Latino youth is the result of their cultural norms (Teufel-Shone, Drummond, & Rawiel, 2005). The Hispanic/Latino cultural norm is to engage in large family gatherings that revolve around large meals and few physical activities (Teufel-Shone et aI, 2005). As a result, Hispanic/Latino youth adopt eating habits that include large meals high in fat, oil, and carbohydrates (Baranowski, Cullen, lukowski & Rittenberry, 2004). Bloomgarden (2004) found that Hispanic/Latino youth often consume levels of total and saturated fat that are one and a half times greater than the recommended national dietary guidelines of 65 grams and 20 grams, respectively. In addition, they exercise less than half as frequently as non-Hispanic/Latino youth (Bloomgarden, 2004). The American Obesity Association (2002) suggests that Type 2 diabetes is a serious issue for the San Ysidro and OtaylNestor communities due to the fact that one out of every three children residing in the two communities is overweight or at risk of becoming overweight, a factor that has been directly linked to the diagnosis of Type 2 diabetes. In addition, the problem of Type 2 diabetes among the Hispanic/Latino families in the San Ysidro and OtaylNestor communities is exacerbated by the fact that many of them have limited access to health care due to a lack of health insurance, a lack of transportation to medical facilities and a lack of Spanish speaking personnel (Coronado, Thompson, Tejeda, & Godina, 2004). According to the County of San Diego (2006), over 9,000 Hispanic/Latino youth (or 33% of the population) in San Ysidro and OtaylNestor are uninsured and do not have access to the treatment they need to lower their risk for developing Type 2 diabetes. The failure to address these issues will cause the number of
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Type 2 diabetes cases among the Hispanic/Latino youth residing in these communities to skyrocket (American Diabetes Association, 2006).
Focus Group Findings Focus groups conducted with HispaniclLatino parents and children living in the San Ysidro and OtaylNestor communities provided further evidence for the correlation between the population' s eating and exercise habits and the development of Type 2 diabetes. The participants were selected from Juarez Lincoln Elementary School and Los Altos Elementary School. The Border View YMCA' s Executive Director sent a letter home to 50 families with youth ages 6-12 who were enrolled in one of the schools' YMCA after-school programs. Of the 25 families who expressed an interest in the focus groups, 13 were randomly selected to participate. The focus group participants consisted of 32 children (15 females, 17 males) and 11 adults (9 females, 2 males), 97% of whom were Hispanic/Latino. Focus-group responses were transcribed during the session and compiled to address common themes. The objective of the focus groups was to collect information about the youth participants' eating and exercise habits and the extent to which their families and environmental factors influenced those habits. The participants were asked questions that addressed typical meals at home, exercise routines, perceptions of healthy eating and physical fitness, and barriers to adopting healthy eating and exercise habits. Primary barriers included lack oftime and absence of community resources such as affordable health care, safe neighborhoods, access to fitness centers, and access to affordable, nutritious foods. Overall, the focus group results indicated that the Hispanic/Latino adults and youth in the San Ysidro and OtaylNestor communities lack an understanding of what constitutes healthy eating or proper exercise. Only two of the adults said that they prepared nutritionally balanced
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meals that included vegetables, whole grains, lean meat, poultry, or fish. Instead, the adults and youth admitted to eating daily meals consisting of items such as hot dogs, pizza, sausage, pastries, sugar cereal, and chocolate milk. In addition, the adults made note of the multiple fast food restaurants in their communities and admitted that it was often more convenient to pick up dinner than to cook a meal at home. On average, the families ate fast food between two and ten times per week. The focus groups also provided important information about the exercise habits of the Hispanic/Latino youth living in these communities. First, many of the children identified activities such as reading and playing video games as providing them with exercise. Although parents indicated a positive attitude toward exercise and understood its role in the context of healthy behaviors, they admitted that a lack of time and a concern for neighborhood safety prevented them or their children from exercising on a regular basis. As a result, it was determined that the children in the focus groups engage in very few physical activities outside of school, and less than 10% of the parents exercise on a regular basis. These findings, when combined with previous research on Type 2 diabetes, suggest that the growing prevalence of the disease among the Hispanic/Latino population is a serious problem in the San Ysidro and OtaylNestor communities. The literature and focus group findings emphasize the various factors that place the Hispanic/Latino population in these communities at a higher risk for developing Type 2 diabetes, the most significant of which are a poor diet and lack of exercise. The research and findings suggest that a prevention strategy consisting of a healthy eating and exercise program is the first step to reducing the number of Type 2 diabetes cases among Hispanic/Latino youth ages 6-12 residing in the San Ysidro and Otay IN estor communities.
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III. Program Design and Methodology Research indicates that a nutrition and exercise program aimed at decreasing the number of Type 2 diabetes cases among Hispanic/Latino youth ages 6-12 must be comprehensive and dynamic if it is to be effective (Sahota, Rudolf, Dixey, Hill, Barth & Cade, 200 1; Campbell, Waters, O' Meara & Summerbell, 2001 ; Kain, Uauy, Albala, Vio, Cerda & Ley ton, 2004). Programs that have simply disseminated information on nutrition to Hispanic/Latino youth and provided them with a physical activity program have not affected change in their eating and exercise behaviors (Sahota et aI. , 2001; Campbell et aI. , 2001 ; Gahagan & Silverstein, 2003). Therefore, this finding suggests that in order for a nutrition and exercise program to alter the eating and exercise behaviors of Hispanic/Latino youth ages 6-12, it must incorporate more than the standard nutrition education and exercise activities (Cohen & Ingram, 2005). Literature Review Extensive research has been conducted on the impact of school-based nutrition and exercise programs upon the health behaviors of Hispanic/Latino youth (Sahota et aI. , 2001; Campbell et aI. , 2001 ; Kain et aI., 2004). A study by Carmina, Anderson, McQuillen and Yu (2005) found that a school-based nutrition education and exercise program was successful at increasing Hispanic/Latino youth' s receptivity to and willingness to participate in nutrition and exercise activities. However, the study also found that the youth were unable to sustain healthy eating and exercise habits outside of the program (Carmina et aI. , 2005). Similarly, a study by Sahota et al. (2001) found that a school-based program consisting of nutrition classes and playground activities was successful at the school level but had little impact upon the children' s behaviors outside of school. Research attributes the failure of school-based programs to produce sustainable change in Hispanic/Latino youth' s eating and exercise behaviors to the lack of
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familial and community involvement in the intervention (Carmina et aI. , 2005; Teufel-Shone et aI. , 2005). Research indicates that a nutrition and exercise program targeting Hispanic/Latino youth ages 6-12 needs to target their parents, as well (Gahagan & Silverstein, 2003; Teufel-Shone et aI. , 2005 ; Grey, Berry, Davidson, Galesso, Gustafson & Melkus, 2004; Ritchie et aI., 2003). Carmina et aI. (2005) and Teufel-Shone et aI. (2005) found that it is critical to involve the parents in such efforts because they control the availability of healthy food choices and physical activity opportunities within the home. Satterfield et aI. (2003) supported this finding by determining that educational nutrition and exercise programs involving both Hispanic/Latino youth and their parents produced some positive behavior change, while programs that did not engage the parents produced no behavior change. In addition, Grey et aI. (2004) conducted a study with 41 Hispanic and African American at-risk youth that involved the provision of nutrition education and exercise training to the youth and their parents. The results of the study determined an increase in healthy food choices and dietary knowledge, as well as increased physical activity among both the youth and their parents (Grey et aI. , 2004). A follow up survey conducted with the participants six months after the conclusion of the program indicated that 50% had sustained healthy nutrition and exercise behaviors (Grey et aI. , 2004). In addition, nutrition and exercise programs targeting Hispanic/Latino youth must also address the influence of the environment in effecting change in their eating and exercise behaviors (Carmina et aI. , 2005 ; Sahota et aI., 2001; Cohen & Ingram, 2005 ; Abarca & Ramachandran, 2005). It has been shown that families residing in Hispanic/Latino communities tend to eat fast food meals and engage in sedentary activities more so than their nonHispanic/Latino counterparts because of a lack of access to affordable and convenient healthy
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food choices and recreational opportunities (Cohen & Ingram, 2005). Carmina et aI. (2005) determined that their school-based study with youth under 18 was unsuccessful at effecting sustainable eating and exercise behavior change because it failed to involve the participation of community organizations, such as local grocery stores, that were able to provide affordable healthy eating and exercise options to participants once the program had concluded. Furthermore, research points to a need for nutrition and exercise programs targeting HispaniclLatino youth and their families to recognize the role that culture plays in shaping their eating and exercise behaviors (Campbell et aI. , 2001; Kain et aI. , 2004). A study by Sahota et aI. (2001) of children between the ages of 7 and 11 residing in Leeds, England found that a general nutrition and exercise program was not successful because it did not meet the participant's specific cultural needs. In contrast, a study by Macaulay, Parradis, Potvin, Cross, Sadd-Haddad, and McComber (1999) noted that a school-based program for children living in a Mohawk community in Canada was successful at sustaining lifestyle changes among participants because it incorporated Native learning styles and a health promotion model that was designed specifically for Mohawk children. Therefore, this data suggests that a program targeting Hispanic/Latino youth and their parents must take cultural factors, such as the population's belief systems and language barriers, into account in its design (Coronado et aI. , 2004). Coronado et al. (2004) indicates the influence that a biomedical belief system and a folkloric belief system have in the creation of the Hispanic/Latino population' s perceptions ofthe causes, prevention and treatment of diabetes. The biomedical system attributes the causes of diabetes to genetic and lifestyle factors, while the folkloric system attributes the onset of diabetes to experiencing strong emotions (Coronado et aI. , 2004). For example, Coronado et aI. (2004) found in a focus group conducted with 42 Hispanic
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individuals in Washington that Hispanic/Latino individuals commonly attribute the onset of diabetes to a precipitating event or trigger, such as anger resulting from an episode of betrayal or violence (Coronado et aI. , 2004). Therefore, this data indicates the need for programs that are focused on improving Hispanic/Latino's nutrition and exercise habits to acknowledge and reinforce positive aspects of the biomedical and folkloric belief systems in their designs to encourage full participation among the target population (Coronado et aI., 2004). Furthermore, the peer-to-peer learning model is critical to a nutrition and exercise program targeting the Hispanic/Latino population (Teufel-Shone et aI, 2005; Cohen & Ingram, 2005). Studies by Teufel-Shone et aI. (2005) and Cohen and Ingram (2005) indicate that Hispanic/Latino individuals respond positively to health information that is disseminated by an individual of a similar ethnic and economic background. The Promotora model has been proven to be the most effective way of incorporating peer-to-peer learning into a nutrition and exercise program tailored to Hispanic/Latino families (Teufel-Shone et aI., 2005; Cohen & Ingram, 2005). A Promotora is a Hispanic/Latino community resident who is trained in nutrition from a licensed nutritionist and then shares hislher knowledge with hislher peers in the community (Microsoft Network, 2006). The Promotora model is effective among the Hispanic/Latino population because the Promotoras are able to use their knowledge of local context and experience with the target population to create a strategy for health education and information dissemination that meets their needs (Teufel-Shone et aI., 2005). Ritchie, Ganapathy, Woodward-Lopez, Gerstein, and Fleming (2003) also suggest the importance of incorporating interactive activities into a nutrition and exercise program targeting Hispanic/Latino youth ages 6-12. The study found that interactive family-oriented weight loss interventions, such as family based cooking classes, were more successful at effecting positive
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behavior change than standard educational programs (Ritchie at aI., 2003). Satterfield et ai. (2003) also found that children responded more positively to family focused physical fitness programs than they did to individual aerobic exercise programs. Purpose of Study
In summary, research on the prevention of Type 2 diabetes among Hispanic/Latino youth indicates that an effective diabetes prevention program must incorporate interactive, familybased nutrition and exercise activities. The program must incorporate community involvement, and be sensitive to and cognizant of the Hispanic/Latino population's language barriers, belief systems and economic needs. The purpose of the Eat and Run .. . For Your Health! Program is therefore to assess the impact that a family-based, interactive, culturally competent nutrition and exercise program has on the eating and exercise behaviors of Hispanic/Latino families residing in the San Ysidro and Otay/Nestor communities. In doing so, the program will incorporate nutritious cooking classes with a family sports league and will involve local community organizations, such as Lucky Grocery Store and the San Ysidro Health Center, in its efforts to sustain the participants' healthy eating and exercise behaviors. Program Design Narrative
The Eat and Run ... For Your Health! Program will be managed by the Border View YMCA Program Coordinator, with assistance from the Executive Director and Site Supervisors. The program will consist of an 8-session family-based cooking class program. The cooking classes will increase the participants' nutritional knowledge and the frequency by which they eat highly nutritional meals. For purposes of this program, highly nutritional meals are defined as meals that are well balanced amongst the five food groups, low in fat and portion controlled. The cooking classes will be taught by four Promotoras, or Hispanic/Latino adults residing in the
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San Ysidro and OtayiNestor communities, who have at least one child ages 6-12 enrolled at Juarez Lincoln Elementary or Finney Elementary. All Hispanic/Latino parents whose children are enrolled at one of the two schools will be eligible to become a Promotora. Individuals interested in the position will be interviewed by the Border View YMCA Executive Director and Program Coordinator, who will then select the four most qualified candidates. Those individuals selected for the Promotora positions will complete a one month nutritional cooking training program, led by a Certified Nutritionist from the San Ysidro Health Center. The Certified Nutritionist will administer a condensed version of the Center for Disease Control and Prevention' s Nutrition Examination to the Promotoras at the end of the program to ensure that they possess the knowledge necessary to teach the cooking classes. The Promotoras will be required to answer 80% of the questions correctly to pass the exanl. The Promotoras will facilitate the cooking classes in a mobile kitchen that they bring to the Juarez Lincoln and Finney Elementary school sites. The classes will take place at 6:00 pm, when the children are usually picked up by their parent(s). The classes will be administered on two different days at both sites to accommodate for the large number of participants. Twelve families will attend the class on one day and thirteen families will attend the class on the second day. The division of the participants will ensure that the Promotoras have enough time during each session to provide each family with individualized attention. By the end of each cooking class, each family will have prepared three meals that they will be able to take home with them and eat throughout the remainder of the week. The ingredients for the meals will be provided at no cost to the participants by Lucky Grocery Store and the San Diego Food Bank. Lucky Grocery Store will also provide participants with discount cards that will offer them discounts on foods such as fruits, vegetables, and meats. This intervention activity will
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remedy the participants' affordability issues in maintaining healthy eating habits by providing them with a means of accessing healthy foods between cooking classes. Purchases made with the discount cards will be tracked by the Lucky Grocery Store staff in order to provide the Program Coordinator with a count of the number of families who have continued to purchase healthy foods outside of the cooking classes. This information will be beneficial in assessing the cooking classes' impact on the participants' eating habits. The Eat and Run .. .For Your Health! Program will also consist of a ten-week family sports league. This component will entail two weekly one-hour practices, to be held at the Juarez Lincoln and Finney school sites, and one weekly one-hour game, held at Montgomery High School, a location central to the San Ysidro and OtaylNestor communities. Based on the focus group responses, the participants will be willing to devote three hours per week to the sports league because the practices will be held during times that are convenient for them. The San Ysidro Health Center Mobile Clinic staff will physically examine every participant prior to the start of the league to prevent individuals with health disorders from participating, or over-exerting themselves. Additionally, each participant will also undergo a skills assessment to ensure that the teams are well-balanced skill wise. Furthermore, the parents and coaches will complete a pre-league orientation whereby the Program Coordinator will discuss with them the program's goals, as well as the spirit of teamwork and integrity. The Eat and Run ... For Your Health! Program will also involve the creation of a collaborative to work on a plan to incorporate nutritious meals into the Chula Vista Elementary School District school menus. The collaborative will meet on a bi-monthly basis. Due to the school district' s budgetary restrictions, the collaborative will not expect to implement policy change on menus during the funding period but will aim to make progress on development.
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Methods Research Design
A quasi-experimental design will be used to carry out the Eat and Run ... For Your Health! Program activities. The program staff will identify and screen 100 Hispanic/Latino
families from Juarez Lincoln Elementary and Finney Elementary, and 100 Hispanic/Latino families from Los Altos Elementary and Silver Wing Elementary who are eligible for program participation. The Program Coordinator will then use Microsoft Excel's random number generator to randomly assign 50 families from Juarez Lincoln and Finney Elementary to the experimental group and 50 families from Los Altos Elementary and Silver Wing Elementary to the control group. Study Site
The pre- and post-assessment activities, which will consist of a Health Behaviors Questionnaire (HBQ) and Body Mass Index (BMI) and blood glucose tests, will be conducted at Los Altos Elementary, Juarez Lincoln Elementary, Finney Elementary and Silver Wing Elementary. The cooking classes and sports league practices will take place at Juarez Lincoln Elementary and Finney Elementary, while the weekend games will be held at Montgomery High School, a location central to the San Ysidro and OtaylNestor communities. Participant Recruitment and Selection
The Eat and Run ... For Your Health! Program participants will be recruited from Los Altos Elementary, Juarez Lincoln Elementary, Finney Elementary and Silver Wing Elementary located in the San Ysidro and OtaylNestor communities. The staff will promote the program by distributing posters and brochures to the Hispanic/Latino students and their parents that highlight the benefits of the program, such as the free sports league and food discount cards. The Border
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View YMCA Executive Director will also obtain the permission of each Principal to solicit the families' participation. A letter explaining the program and listing the Program Coordinator' s information will be mailed to each fanlily. The families who contact the Program Coordinator will be screened for ethnicity, the ages of their children and their place of residency to ensure that they are Hispanic/Latino, have at least one youth ages 6-12 and reside in the San Ysidro and OtaylNestor communities. The program staff will identify 200 families who meet these requirements. This number will ensure that the staff is able to randomly assign 50 families from Juarez Lincoln Elementary and Finney Elementary to the experimental group and 50 families from Los Altos Elementary and Silver Wing Elementary to the control group. Instrument Development and Pilot Testing The BMI and blood glucose measurement instruments, as well as the CDC Nutrition Examination, have been tested and approved for reliability and validity by health agencies nationwide (American Obesity Association, 2006; Center for Disease Control, 2006). The experimental group participants' nutrition knowledge, attitudes and behavior, as well as their frequency of physical activity, will be measured by the Health Behaviors Questionnaire (HBQ). The HBQ has been used in research studies with minority youth ages 6-17 (CATCH, 2006). The HBQ will also be adapted to meet the language needs of the adult participants. The two versions of the HBQ will be pilot tested by Hispanic/Latino youth ages 6-12 and their parents enrolled in two non-YMCA elementary schools in the San Ysidro and OtaylNestor communities. The pilot testing will ensure that the questionnaires are language appropriate for the participants and accurately translate into Spanish.
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Staff Training
The YMCA Border View Program Coordinator, Site Supervisors and Promotoras will be required to attend a training addressing the design of the program and the proper techniques to use in its implementation. The training will ensure that the program staff follows the same protocol in carrying out the intervention activities. This goal will be accomplished by using an inter-rater to ensure that the program staff uses the same language when referring to the activities and uses the same strategies for implementing the activities at the various school sites. Intervention vs. Control Protocol
Those families from Juarez Lincoln Elementary and Finney Elementary will be assigned to the experimental group, while the families from Los Altos Elementary and Silver Wing Elementary will be placed in the control group. The separation of the experimental and control groups by schools will prevent the results of the study from being contaminated. Both the experimental and control groups will receive the pre- and post-assessment, which will consist of BMI and blood glucose testing, as well as the completion of the HBQ. However, only the experimental group will participate in the cooking classes and sports league. IV. Social Marketing Campaign
The Eat and Run ... For Your Health! Program will be promoted to the Hispanic/Latino families in the San Ysidro and Otay/Nestor communities through a comprehensive social marketing campaign. The goal of the campaign will be to increase the community ' s involvement in the effort to develop and sustain healthy eating and exercise behaviors among Hispanic/Latino youth ages 6-12. Every component of the campaign will be conducted in English and Spanish to account for the target population' s language needs.
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Audience Segmentation The Eat & Run ... For Your Health! Program's social marketing campaign will target Hispanic/Latino families who have at least one youth ages 6-12 enrolled at Los Altos Elementary, Juarez Lincoln Elementary, Silver Wing Elementary, and Finney Elementary located in the San Ysidro and OtaylNestor communities. The audience will be segmented into Hispanic/Latino youth ages 6-12 and Hispanic/Latino parents. Specifically, the campaign will target those bilingual or Spanish speaking Hispanic/Latino youth and their parents who are at risk for developing Type 2 diabetes, and who do not currently eat healthy and exercise but would do so given greater access to community resources. Additionally, the campaign will appeal to those parents who have limited free time, are bilingual or Spanish speaking and are concerned about their children's health.
Product and Price Research suggests that a diabetes-prevention program targeting low-income Hispanic/Latino families must offer participants a family based product (Thackeray & Nieger, 2003 ; Wong, Huhman, Heitzler, Asbury, Bretthauer-Mueller, McCarthy & Londe, 2004). Additionally, the focus group findings, as described in the needs assessment, suggest that the families in San Ysidro and OtaylNestor will be the most responsive to a product that focuses on having fun and improving the youth' s health. Therefore, the product offered to participants through the Eat & Run ... For Your Health! Program will include free family based cooking classes and sports leagues. This product will be sensitive to the parents' lack of time and monetary resources, as well as the youth's desire for fun peer-based activities. The Eat & Run ... For Your Health! Program will involve a few non-monetary costs for all participants. Participation in the program will cost the parents three hours of their time every
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week and will require the youth to sacrifice time they normally spend watching television and playing video games. The participants will also be required to share their Body-Mass Index, blood glucose levels, and fitness levels with the San Ysidro Health Center Mobile Clinic staff and YMCA staff. Some participants may not be comfortable disclosing this information. Therefore, to enhance participation in the Eat and Run ... For Your Health! Program, the social-marketing campaign will focus on the increased family time, complimentary meals, discount food cards, and free healthcare services that the participants will receive. The campaign will also alert the participants to the fact that the Promotoras and Mobile Clinic staff will be bilingual and bicultural in hopes of increasing their comfort level with the program. In addition, the campaign will highlight to the youth the benefits of spending time with their friends and family, having fun, and obtaining a trophy (Wong et aI. , 2004). Place and Promotion
According to Wong et ai. (2004), an intervention must be held in a location that is readily accessible to the target population. Therefore, the cooking classes and sports practices will be held at Juarez Lincoln Elementary and Finney Elementary during hours when the parents and children are normally on the campuses. The sports games will take place at Montgomery High School, which is central to the San Ysidro and OtaylNestor communities. In addition, the Program Coordinator will administer the HBQ and the Mobile Health clinic staff will conduct the BMI and blood glucose tests at each of the four school sites involved in the study. The Eat and Run ... For Your Health! Program will be promoted through a culturally
sensitive, bilingual, multimedia campaign. The marketing materials will be created in English and Spanish. Initial marketing efforts will consist of the placement of posters throughout the four target elementary schools and the mailing of brochures to the students' homes. The posters
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and brochures will include images of Hispanic/Latino fan1ilies cooking and playing sports together. Upon the program's conclusion, the marketing campaign will be expanded to include public service announcements (PSAs) on both English and Spanish radio and television stations in order to target those individuals who spend their leisure time listening to and watching Spanish language radio and television (San Diego Hispanic Marketing Council, 2005). The posters and brochures will also at this time be placed in businesses, other schools, organizations, churches and grocery stores throughout the South Bay communities. Partners and Policy Program partners will include Lucky Grocery Store, the San Ysidro Health Center, and the San Diego Food Bank. A Community Advisory Committee (CAC), consisting of program staff and participants, will oversee and monitor the effectiveness of the partnerships. The CAC will also be involved in the plan to develop a policy that will incorporate healthy foods into the local school menus. The Border View YMCA (including the CAC) will partner with the Chula Vista Elementary School District in this effort. This partnership will require the two organizations to create a collaborative that will meet on a bi-monthly basis to work on developing a plan that will achieve this policy change. V. Cultural Competency The Eat and Run ... For Your Health! Program will meet the language needs of both the bilingual and Spanish speaking families residing in the San Ysidro and OtayiNestor communities. The staff will also ensure that the intervention activities are cognizant of the Hispanic/Latino culture's reverence for the sense of family (Carmina et aI., 2005; Teufel-Shone et aI. , 2005). Finally, the Eat and Run ... For Your Health! Program will address the tendency of
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the Hispanic/Latino population to base their perceptions of health issues, such as diabetes, on stories they have been told instead of factual medical information (Coronado et aI. , 2004). Organization's Cultural Experience
The Border View YMCA has been serving the San Ysidro and Otay/Nestor communities since 1984 (Border View YMCA, 2004). The Border View YMCA maintains culturally competent programs by requiring that its Board of Directors and staff be comprised of individuals who are familiar with the community's cultural needs. To that end, sixty percent of the Board members and eighty percent of the staff members are of Hispanic/Latino origin and the majority of them live in the community. The agency also prints its materials in both English and Spanish and requires all Board and staff members to participate in annual cultural awareness trainings, as well as diversity dialogues with the agency's clients (Border View YMCA, 2004). Staffing and Training
The Site Supervisors, Program Coordinator, and Mobile Health Clinic staff will speak Spanish and English and will either be of Hispanic/Latino origin or experts in the culture. This will ensure that the staff possesses first-hand knowledge about the program participants' needs, and is able to ensure that the intervention activities are culturally competent. Additionally, the Promotoras will be residents of the San Ysidro and Otay/Nestor communities, as well. This peer-to-peer model will be beneficial to the program' s success in that the Promotoras will be able to use their familiarity with the local community to design a culturally appropriate cooking class curriculum (Carmina et aI. , 2005; Teufel-Shone et aI., 2005). In addition, the model will ensure that the program participants understand and are receptive to the nutrition information that is presented to them through the cooking classes (Teufel-Shone et aI., 2005).
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The program staff, Mobile Health Clinic staff and the Promotoras will be required to participate in annual cultural competency trainings. The training session curriculum will incorporate cultural competency principles developed by South Bay Community Services, the Office of Minority Health and the California Department of Maternal and Child Health. The program staff will use the principles developed by these three agencies because they have proven to be effective at ensuring the cultural competency of programs targeting the Hispanic/Latino population. The training curriculum will address issues such as the definition of culture, Hispanic/Latino stereotypes, cultural assumptions, and the cultural patterns ofthe San Ysidro and OtayiNestor Hispanic Latino population. Community Representation The program participants will have the opportunity to participate in a public forum where they will be able to ask questions and obtain accurate information from the Mobile Clinic staff about the prevention and treatment of diabetes. Additionally, they will also be able to join the Community Advisory Committee (CAC), which will allow them to share their concerns about the program, as well as assist with activities and participant recruitment strategies (Macaulay et aI. , 1999). The CAC will consist of the YMCA Executive Director, parent and youth representatives, the Program Coordinator, one Promotora, one YMCA Board Member and representatives from the partnering organizations. The CAC parent and youth representatives will be selected by the other participants and will be responsible for collecting and sharing their peers' feedback about the program with the committee. Language and Materials The Eat and Run ... For Your Health! Program staff will speak English and Spanish. They will be able to incorporate the nuances and formalities of the Spanish language into their
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21
translations. All promotional materials will be available in English and Spanish. The CAC members and Andres Verjan, an expert in Hispanic marketing, will review the materials to ensure that they are culturally appropriate and contain accurate translations. All printed materials will be pilot tested by the Hispanic/Latino parents and youth ages 6-12 at two local elementary schools not involved in the Eat and Run .. . For Your Health! Program. This pilot testing will ensure that the materials are language and age appropriate for the target population and will offer the program staff feedback regarding their cultural appropriateness. Evaluation
All evaluation methods incorporated into the Eat and Run .. . For Your Health! Program will be culturally sensitive to the participants' needs. The HBQ will be created in both English and Spanish, and the Mobile Health Clinic will offer to administer the BMI and blood glucose tests in either language, as well. The instruments will be pilot tested for cultural appropriateness by Hispanic/Latino youth and adults at non-YMCA elementary schools in the San Ysidro and Otay/Nestor communities. In addition, the participants will also complete a cultural competency survey at six month intervals during the program. The survey has been used in previous studies with Hispanic/Latino youth and adults residing in San Diego' s South Bay region. The feedback from the survey will ensure that the Eat and Run ... For Your Health! Program is meeting the participants' cultural needs. VI. Evaluation Plan
The evaluation component of the Eat and Run ... For Your Health! Program will be comprehensive and culturally sensitive to the population' s needs. Evaluation tools will consist of the HBQ, as well as BMI and blood glucose tests. Although the HBQ is designed for youth,
Diabetes Prevention
22
the program staff will create a version that is adapted to meet the adults' language needs, as well, in order to ensure that the same data is collected for both age groups. Program Design
The Eat and Run ... For Your Health! Program will be administered through a quasiexperimental design. The Program Coordinator will randomly assign 50 families from Juarez Lincoln Elementary and Finney Elementary to the experimental group and 50 families from Los Altos Elementary and Silver Wing Elementary to the control group. All participants will complete a pre-assessment in month 4 of the funding period that will include the administering of the HBQ and BMI and blood glucose tests. The cooking class and sports league intervention will be administered to the experimental group participants one week after the conclusion of the pre-assessment and will span four months. The post-assessment will be administered to all participants in month 9 of the funding period, one week after the conclusion of the intervention. Evaluation Design
The HBQ will measure the program's first two outcome objectives (see workplan) and will consist of questions from the Coordinated Approach to Child Health (CATCH) HBQ and the CATCH School Physical Activity and Nutrition (SPAN) questionnaire. The HBQ will address the participants' knowledge of the nutritional value of various foods, the recommended dietary guidelines, their desire to engage in healthy eating and exercise and the frequency of which they ate healthy foods and exercised during the previous day and week. BMI and blood glucose tests will be used to evaluate the third objective, or the number of families who improve their collective BMI and blood glucose levels. Research shows that BMI and blood glucose levels are reliable indicators of increased nutrition and/or exercise, and can be lowered within a few months (Carmina et aI. , 2005; Sahota et aI. , 2001; Ritchie et aI. , 2003).
Diabetes Prevention
23
Therefore, the participants' change in BMI and blood glucose levels will be used to support any change in healthy eating and exercise behaviors that they indicate on the HBQ. The recruitment and training of four Promotoras will be measured by the results of the CDC Nutrition Examination administered to the Promotoras at the end of the training program. Additionally, the success of the curriculum objective will be measured by a binder containing written lesson plans and handouts for the cooking classes. Furthermore, the two process objectives pertaining to the creation of the school policy collaborative and the CAC will be measured by member rosters, sign-in sheets and meeting minutes. Evaluation Measures Demographics
The youth participants' demographics will be measured by questions taken from the SPAN questionnaire. The SPAN questionnaire was obtained from the University of Texas, School of Public Health. The questions will use age appropriate language to address the participants' age, gender, grade, ethnicity, and primary language spoken at home. The SPAN demographic questions have been tested for reliability and validity in the Harris County STEPS Consortium study with Hispanic/Latino youth ages 6-12 and will therefore be appropriate for the target population (CATCH, 2006). However, prior to administering the HBQ, the Eat and Run ... For Your Health! Program staff will pilot test the questions among Hispanic/Latino youth
ages 6-12 residing in the San Ysidro and OtayIN estor communities. The demographics questions for the adult participants will be taken from the U.S. Census Bureau. They will address the same demographics as the SPAN questions but will be phrased more appropriately. The demographic questions have been tested for reliability and validity among Hispanic/Latino adults by various government officials (US Census Bureau, 2006).
Diabetes Prevention
24
Knowledge and Attitudes
The HBQ will measure the participants' nutrition knowledge and attitudes about healthy eating and exercise. The HBQ was obtained from the University of Texas, School of Public Health. The questions will be measured on a two-point scale that allows participants the option of selecting one oftwo foods that they believe to be healthier. The attitudes questions will be measured on a 5-point Likert scale. The questions have been proven to be reliable and valid among Hispanic/Latino youth ages 6-12, as well as Hispanic/Latino adults (CATCH, 2006). In addition, the CDC Nutrition Examination will measure the Promotoras' knowledge of nutrition concepts using 3-point Likert, 5-point Likert, and yes/no scales. The CDC Nutrition Examination has been proven to be reliable and valid among Hispanic/Latino women training to be Promotoras (Center for Disease Control, 2006). Behavior
The questions in this section ofthe HBQ will be measured on 5-point Likert and yes/no scales and will address participants' behaviors. The questions were obtained from the University of Texas, School of Public Health. They have been written in English and Spanish and tested for reliability and validity among Hispanic/Latino youth and adults (CATCH, 2006). In addition, the participants' behaviors will also be measured by BMI and blood glucose tests. The test protocol was obtained from the Center for Disease Control and Prevention (2006). Both measures have been proven to be reliable and valid, and have been tested extensively among Hispanic/Latino youth and adults (Center for Disease Control and Prevention, 2006). Evaluation Methods
The San Ysidro Mobile Clinic staff will conduct the BMI and blood glucose levels, in a confidential manner, during a pre- and post-assessment at each of the four school sites. The
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25
Mobile Clinic staff will use the BMI formula (weightlheight x 703) to measure each participant's BMI and a blood glucometer to measure his/her blood glucose level (CDC, 2006). The Border View YMCA Program Coordinator will administer the HBQ to the participants at each of the four school sites. The HBQ will take approximately 30-35 minutes to complete. The pre- and post-assessments will each take place over a two-day period so as not to overwhelm the program staff or participants. A consultant from the University of Texas, School of Public Health will provide ongoing support to program staff in the administration of the tools. Database
The data for the Eat and Run ... For Your Health! Program will be maintained in a Statistical Package for Social Science (SPSS) database. SPSS will be used for this study because it is capable of doing complex data analysis and can import data from Microsoft Excel, Access and other SPSS files. SPSS will also provide the staff with the tracking tools necessary to determine the participants' change in eating and exercise behaviors. Although SPSS can be expensive and difficult to use, the program staff will remedy these barriers by using the Executive Director' s student discount to purchase the software. A data-entry specialist familiar with SPSS will be responsible for entering the data from the pre- and post-assessments into SPSS and conducting a comprehensive data analysis. He/she will then submit reports to the Executive Director, the Program Coordinator and the CAC members.
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26
CLosing Statement
The Eat and Run ... For Your Health! Program' s greatest strength is its recognition of the Hispanic/Latino population' s unique language, economic and social needs. The program' s use of the Promotoras model is also one ofthe program' s strengths in that it addresses the target population' s reverence for peer-to-peer learning. Furthermore, the program's focus on the family and the provision of activities at the four school sites during hours that are convenient to the youth and their parents enhances its potential for creating sustainable change in the participants' eating and exercise behaviors. However, the fact that participation in the Eat and Run ... For Your Health! Program is limited to Hispanic/Latino families may create some hostility towards the YMCA among the community ' s other ethnic groups. Additionally, the high undocumented population makes it difficult to portray accurate demographics for the target population and community. In addition, the small experimental group may make it difficult to apply the findings of the study to the larger population. Finally, time constraints will limit the progress that the program staff is able to make in implementing a policy to improve the Chula Vista Elementary School District's school menus. Continued research on diabetes prevention programs for Hispanic/Latino youth should expand upon the cultural components pertaining to this community. Ensuring a culturally sensitive intervention is vital to effecting positive change in the eating and exercise behaviors of this population. Future studies should incorporate a larger Hispanic/Latino population from the San Ysidro and OtayiNestor communities to enhance the generalizability ofthe findings . In addition, future studies should also focus more heavily on the impact that youth' s peers have upon their eating and exercise habits.
Border View YMCA Eat and Run ... For Your Health! Program Budget
Personnel
1 Frr Executive Director 1 Frr Program Coordinator 1 Frr Site Supervisor 1 Frr Site Supervisor
-
Annual SalaD!
%
90,000
5%
31,200
100%
24,960
5%
24,960
5%
12 Month Bgt
$
Sub-Total
Fica Sui Pension Health Insurance
Total Personnel Non-Personnel Advertising/Marketing Consultant - Evaluation Design Equipment - Computer & Printer for Evaluation , Insurance W/Compensation insurance Liability Promotoras (4x$200/mo x12 mos) Office Supplies Printing Program Supplies - Food Program Supplies-Sports Equipment Subcontract-San Ysidro Health Center 2 Mobile Kitchens Celebration Ceremony Telephone Utilities TOTAL DIRECT EXPENSES Indirect rate 13% (Direct cost - Sub Contracts) TOTAL EXPENSES
$
4,500 31,200 1,248 1,248
38,196 2,922 252 3,695 4,680 49,745
5,000 20,000 1,100 2,051 1,000 9,600 750 1,200 20,000 3,000 15,000 40,000 500 900
$
169,846 16,815
$
186,661
Border View YMCA Eat & Run Program Budget Justifications 1.
5% of the Executive Director's time will be spent on program functions to include: a. Train and supervise the Program Coordinator and Site Supervisors b. Monitoring the progress of the Community Advisory Committee c. Working with the School District leadership around the formation of a healthy student menu policy d. Evaluation of the Program e. Tracking grant expenditures f. Complete grant reporting g. Oversee sub-contract agreements
2. 100% of 1 Program Coordinator's time will be spent on program functions to include: a. Oversee day-to-day program operations b. Conduct outreach for program c. Oversee participant selection process d. Prepare grant reporting e. Train and Supervise Promotoras f. Implement evaluation components of program g. Facilitate Community Advisory Committee Meetings h. Complete data entry of evaluation tools 1. Design social marketing materials 3.
5% of2 Site Supervisors' time will be spent on program functions to include: a. Daily attendance b. Assist with implementation of evaluation components c. Support the work of the Promotoras d. Implement family sports leagues. e. Administration of HBQ and SPAN Surveys
4. AdvertisinglMarketing will cover cost to produce and distribute marketing materials. Additionally, some cost of marketing consultant is built in. 5. Though evaluation of the program will be conducted by staff and collaborative partners such as; the San Ysidro Health Center, additional evaluation functions will be outsourced to qualified evaluation consultants, such as the University of Texas School of Public Health and the purchasing of data tracking system SPSS. $20,000 will be set aside for this purpose. 6. Equipment: A computer and printer will be purchased for use by the program coordinator to complete hislher job duties.
7. 4 Promotoras will be awarded monthly stipends of $200 each per month. Duties include: a. Facilitate nutritious cooking classes to program participants. b. Participate in Community Advisory Committee c. Provide feedback on program design 8. 2 Healthy Eating Mobile kitchens at $20,000 each to bring Healthy Cooking Classes to each site. 9. $20,000 will be used to buy food for all of the classes from the food bank and Lucky stores. This will include three meals per family per session. This will include storage containers to allow families to take food home. 10. Sports equipment for the family sport leagues will be purchased only when the YMCA does not have sufficient supplies to sustain its current program and to accommodate the Eat & Run program. Supplies include: a. b. c. d. e. f. g.
Balls (For each sport) Stopwatches Soccer goals Football flag sets Field striping materials Scorekeeping supplies Supplies for celebration ceremony
11. Celebration Ceremony: To be held at the end of the family sports leagues. This will support food and prize costs: 12. Subcontract to San Ysidro Health Clinic: Covers cost of Mobile Clinic staff and the clinic. Additionally, a nutritionist will provide training to Border View YMCA staff and Promotoras. Mobile clinic staff will implement clinical measures (i.e., BMI and Blood Glucose Test). San Ysidro Health Clinic will also participate in Community Advisory Committee. 13. Indirect rate is calculated @ 13 %
Diabetes Prevention
References Abarca, J. & Ramachandran, S. (2005). Using community indicators to assess nutrition in Arizona-Mexico border communities. Preventing Chronic Disease, 2 (1) , 1-11.
American Diabetes Association. (n.d.) All about diabetes. Retrieved October 25, 2006 from www.diabetes.org/about-diabetes.jsp
American Obesity Association. (2002.) Obesity in youth. Retrieved October 28, 2006 from http://www.obesity.org/subs/fastfacts /obesity youth .shtml.
Baranowski, T. , Cullen, K. , Olivera, N. & Rittenberry, L. (2004). Social-environmental influences on children's diets: Results from focus groups with African-, Euroand Mexican-American children and their parents. Health Education Research
Theory & Practice, 15 (5), 581-590.
Bloomgarden, Z. (2004). Type 2 diabetes in the young: The evolving epidemic.
Diabetes Care, 2 7 (4),998-1010.
Border View YMCA. (2004). Strategy for Cultural Diversity. (1 st ed.). San Ysidro, CA.
Campbell, K. , Waters, E. , O'Meara, S. & Summerbell, C. (2001). Interventions for preventing obesity in childhood: A systematic review. Obesity Review. **
Diabetes Prevention
Carmina, N., Anderson, K., McQuillen, K. & Yu, N. (2005). School-based obesity and Type 2 diabetes prevention programs: A public health perspective. Canadian
Journal a/Diabetes, 29 (3) , 211-219.
Cohen, S. & Ingram, M. (2005). Border health strategic initiative: Overview and introduction to a community-based model for diabetes prevention and control.
Preventing Chronic Disease, 2 (1), 1-5.
Coronado, G. , Thompson, B., Tejeda, S., & Godina, R. (2004). Attitudes and Beliefs among Mexican Americans about Type 2 Diabetes. Journal of Health Care for
the Poor and Underserved. 15. 576-588.
Gahagan, S. & Silverstein, J. (2003). Prevention and treatment of Type 2 diabetes mellitus in children, with special emphasis on American Indian and Alaska Native children. Pediatrics, 112 (4) , 228-250.
Grey, M., Berry, D., Davidson, M. , Galesso, P. , Gustafson, E. & Melkus, G. (2004). Preliminary testing of a program to prevent Type 2 diabetes among high-risk youth. Journal ofSchool Health, 74 (1) , 10-15.
Huang, T. , & Goran, M. (2003). Prevention of type 2 diabetes in young people: A theoretical perspective. Pediatric Diabetes, 4 (1), 38-56.
1
Diabetes Prevention
International Community Foundation. (2005). Cross-border healthcare deficits. Retrieved October 29,2006 from http://www.icfdn.org.
Kain, 1., Uauy, R., Albala, F., Vio, F., Cerda, R. & Ley ton, B. (2004). School-based obesity prevention in Chilean primary school children: Methodology and evaluation of acontrolled study. International Journal of Obesity, 28 (4), 483 493 .
Macaulay, A., Parradis, G., Potvin, L., Cross, E., Saad-Haddad, C., McComber, A. , et al. (1999). The Kahnawake schools diabetes prevention project: Intervention, evaluation and baseline results of a diabetes primary prevention program with a native community in Canada. Preventive Medicine, 26, 779-790.
National Institute of Health. (2005). The diabetes epidemic among Hispanic and Latino Americans. Maryland: U.S. Government Printing Office.
Ramirez, R. & De la Cruz, P. (2003). Current Hispanic Population Report: March 2002. Washington, D.C.: US Census Bureau.
Ritchie, L. , Ganapathy, S., Woodward-Lopez, G., Gerstein, D. & Fleming, S. (2003). Prevention of Type 2 diabetes in youth: Etiology, promising interventions and recommendations. Pediatric Diabetes, 4 (4), 174-178.
Diabetes Prevention
Sahota, P., Rudolf, M., Dixey, R., Hill, A., Barth, 1. & Cade, 1. (2001). Randomized controlled trial of primary school based intervention to reduce the risk factors for obesity. British Medical Journal, 323, 1-6.
SANDAG. (2006). Population and housing estimates 2006. Retrieved October 28, 2006 from http://profilewarehouse.sandag.org/profiles/estlzip92154est.pdf.
San Diego Hispanic Marketing Council. (2005). Scarborough Report: 200 Demographic Profile. Retrieved November 14, 2006 from http://www.sandiegoadc1ub.com.
Satterfield, D., Volansky, M., Caspersen, C., Engelgau, M., Bowman, B., Gregg, E., et al. (2003). Community-based lifestyle interventions to prevent Type 2 diabetes. Diabetes Care, 26 (9), 2643-2652.
Teufel-Shone, N., Drummond, R. & Rawiel, U. (2005). Developing and adapting a family based diabetes program at the US-Mexico Border. Preventing Chronic Disease, 2 (1), 1-9.
Thackeray, R. & Nieger, B. (2003). Use of social marketing to develop culturally innovative diabetes interventions. Diabetes Spectrum, 16 (1), 15-20.
Diabetes Prevention Wong, F., Huhman, M. , Asbury, L. , Bretthauer-Mueller, R., McCarthy, S., Londe, P., & Heitzler, C. (2004). VERB- A social marketing campaign to increase physical activityamongyouth. Preventing Chronic Diabetes, 1 (3), 3-7.
Diabetes Research Group Experimental Study Design
Recruit 200 families with children ages 6-12 at four elementary schools in the San Ysidro and OtaylNestor communities in San Diego County.
Identify and screen 100 families with children ages 6-12 at four schools with Border View YMCA programs on site (Los Altos, Juarez-Lincoln, Finney, and Silver Wing)
Using simple random assignment, assign 50 families to experimental group and 50 families to control group
Experimental Group
I
Control Group
I
50 families from two schools with YMCA programs on site
50 families from two schools with YMCA programs on site
I
I
Pre-test: BMI, blood glucose, questionnaire
Pre-test: BMI, blood glucose, questionnaire
I
I
Intervention
No Intervention
I
I
Post-test: BMI, blood glucose, questionnaire
Post-test: BMI, blood glucose, questionnaire
Data Analysis
BDI Logic Model Intervention Activities
Determinants of BehaviorlIssue
The Border View YMCA will implement a Promotoras Model program wherein community members will train other community members in healthy cooking techniques in partnership with the San Diego Food Bank and Lucky Grocery Store.
Lack of access to nutritious food due to relatively higher cost, lack of time to prepare nutritious meals
The Border View YMCA will implement a family sports league that incorporates various sports such as soccer, basketball, and flag football at local school sites.
The Border View YMCA will coordinate bi-monthly collaborative meetings with partners to develop a district-wide policy regarding the incorporation of nutritious meals into student meal plans.
y
q q
Lack of safe locations to exercise, lack of time, lack of programs available
Lack of money, lack of time to produce nutritious meals
BehaviorlIssue to be addressed
q q y
Goal
To improve the nutritional value of the food intake of Hispanic/Latino youth ages 6-12 and their families. To increase the frequency of physical activity among Hispanic/ Latino youth ages 6- 12 and their families. To improve the nutritional value of school breakfast and lunch menus in schools located within the Chula Vista School District.
y
To reduce the incidence of Type 2 diabetes among Hispanic/ Latino youth ages 6-12 years in the San Ysidro and OtayIN estor communities of San Diego County.
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Helping our families get fit ... and fitting it in. There just isn't enough time in the day ... That's a common complaint among families that are trying to balance work with taking care of their homes and families. As a result, our healthy eating and exercise habits often suffer. Yet it's important to live healthy lifestyles to avoid problems such as obesity and Type-2 diabetes, two problems that are rampant in our communities. To address this issue, the Border View YMCA is beginning the Eat & Run .. .For Your Health! Program to help our families cook nutritious foods, participate in physical activities, and receive discounts at local grocery stores. It's important for families to work together to get fit. That's why the program is for children and parents-working together for the common goal of eating better and getting more active. Through cooking classes and sports leagues, children and parents can become more active in their choices of food and physical activities. Best of all, the programs are held at our local schools, at times when children and parents are already there. The Eat & Run ... For Your Health! Program is free, fun, safe, and convenient. And it's only available to our YMCA families . Enroll today, because in today's fast-paced society, you have to learn to eat and run ... for your health!
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ANt'W PROGIIAM TIl HEIJ' OlJlll:AMII.II:S (U:T 1iI:i\l.1'liY The Border View YMCA Eat & Run...For Your Health! (!Comer y Correr... Por Su Salud!) Program is a collaborative effort by the YMCA, San Ysidro lucky, the Chula Vista Elementary School District, and other community partners. Our focus is to provide a means for YMCA families to cook and play together and get more physically fit Through interactive cooking classes and family sports leagues offered at our local schools, YMCA families will have the opportunity to cook healthy meals and . participate in fun sports activities, such as soccer, flag football, and basketball.
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