border view ymca project overview - university of san...

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 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,

3085 Beyer Boulevard. Suite A-I 03

San Diego. California 92 154 Telephone (619) 428-1 168

FAX (6 19) 428-469 1

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.

Sin~,:. y 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."

l~lll' & IIIJN .. ·.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

Diabetes Prevention 2

(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


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


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


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.


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, 2001; 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


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 non

Hispanic/Latino counterparts because of a lack of access to affordable and convenient healthy


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


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


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, family

based 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


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


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.

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


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.


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.


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


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


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


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).


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


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,


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 quasi

experimental 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).


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 Otay IN 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).


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


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.


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 Annual SalaD! % 12 Month Bgt

1 Frr Executive Director 90,000 5% $ 4,500 1 Frr Program Coordinator 31,200 100% 31,200 1 Frr Site Supervisor 24,960 5% 1,248 1 Frr Site Supervisor 24,960 5% 1,248

Sub-Total 38,196 Fica - 2,922 Sui 252 Pension 3,695 Health Insurance 4,680

Total Personnel $ 49,745

Non-Personnel Advertising/Marketing 5,000 Consultant - Evaluation Design 20,000 Equipment - Computer & Printer for Evaluation 1,100

, Insurance W/Compensation 2,051 insurance Liability 1,000 Promotoras (4x$200/mo x12 mos) 9,600 Office Supplies 750 Printing 1,200 Program Supplies - Food 20,000 Program Supplies-Sports Equipment 3,000 Subcontract-San Ysidro Health Center 15,000 2 Mobile Kitchens 40,000 Celebration Ceremony 500 Telephone 900 Utilities

TOTAL DIRECT EXPENSES $ 169,846 Indirect rate 13% (Direct cost - Sub Contracts) 16,815

TOTAL EXPENSES $ 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. Balls (For each sport) b. Stopwatches c. Soccer goals d. Football flag sets e. Field striping materials f. Scorekeeping supplies g. 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-, Euro

and 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, 27 (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. **

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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 of School 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.

Diabetes Prevention

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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

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Macaulay, A., Parradis, G., Potvin, L., Cross, E., Saad-Haddad, C., McComber, A. , et al.

(1999). The Kahnawake schools diabetes prevention project: Intervention,

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Diabetes Prevention

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(2003). Community-based lifestyle interventions to prevent Type 2 diabetes.

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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.

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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 Control Group

I 50 families from two schools with YMCA programs on site

I Pre-test: BMI, blood glucose, questionnaire

I Intervention

I Post-test: BMI, blood glucose, questionnaire

Data Analysis

I 50 families from two schools with YMCA programs on site

I Pre-test: BMI, blood glucose, questionnaire

I No Intervention

I Post-test: BMI, blood glucose, questionnaire

BDI Logic Model

Intervention Determinants of BehaviorlIssue to Activities BehaviorlIssue be addressed Goal

The Border View YMCA will Lack of access to To improve the implement a Promotoras Model y nutritious food due q nutritional value of program wherein community to relatively higher the food intake of members will train other cost, lack of time Hispanic/Latino community members in healthy to prepare youth ages 6-12 To reduce the cooking techniques in partnership nutritious meals and their families. incidence of with the San Diego Food Bank and Type 2 Lucky Grocery Store. To increase the diabetes

Lack of safe frequency of among The Border View YMCA will locations to physical activity Hispanic/ implement a family sports league q exercise, lack of q among Hispanic/ y Latino youth that incorporates various sports time, lack of Latino youth ages ages 6-12 years such as soccer, basketball, and flag programs available 6- 12 and their in the San football at local school sites. families. Ysidro and

Otay IN estor To improve the communities nutritional value of of San Diego

The Border View YMCA will Lack of money, school breakfast County. coordinate bi-monthly collaborative lack of time to and lunch menus meetings with partners to develop a q produce nutritious y in schools located district-wide policy regarding the meals within the Chula incorporation of nutritious meals Vista School into student meal plans. District.

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 l ifestyles 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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