Winkleby Lab In the Prevention Research Center

SALUD! Salinas STEPS to Health

Background/need: The burden of obesity, diabetes, and asthma is high in Monterey County, California despite innovative chronic disease prevention and control programs offered by the Monterey County Heath Department (MCHD), health care providers, and community agencies. This grant will allow the MCHD, the lead agency for this grant, to integrate existing programs and initiate new ones, forming a comprehensive effort that will reach a greater number of people, be more efficacious, and facilitate an infrastructure for long-term sustainability. Our programs will use the Spectrum of Prevention framework that incorporates individual, group, family, and system approaches, and will involve schools, clinics, employers of agricultural workers, fast food restaurants, senior centers, and parishes and churches.

Setting: Our programs will take place in Salinas, a city in Monterey County with a predominately Latino (Hispanic) population and representative in size of many U.S. cities. Salinas currently has a population of 150,300 residents and has a federally classified Health Professional Shortage and Medically Underserved Area within its city limits. In Salinas, 64% of the population is Latino, among whom 75% are of Mexican descent. The other primary ethnic group in Salinas is white, non-Hispanic (24%), within which a large number are poor and also at high risk for chronic diseases.

Community action plan: We will implement, adapt, or expand programs in the following intervention areas:

1. Elementary, middle, and high schools:  Increase asthma education, healthy food options, and physical activity opportunities, for elementary school students.  Increase healthy food options, physical activity opportunities and tobacco cessation for middle and high school students (including high risk independent study and continuation high school students).

2. Health care providers and Latino health clinics: Work with community health care system to establish patient and physician reminder systems that follow current standards of care for obesity, diabetes and asthma, and expand self-management education (individual and/or group sessions) and case management systems. Improve medical care access for patients who are asthmatic, diabetic, and/or obese.

3. Employers of agricultural workers: Expand healthy food choices in cafeterias, vending machines, and field catering trucks; expand diabetes screenings and referrals; initiate smoking cessation program; and improve health insurance coverage for agricultural workers.

4. Fast food restaurants: Partner with fast food franchises to offer and promote healthy food choices, initiate a chronic disease awareness program for customers, offer diabetes & risk assessments onsite, and introduce toys that promote physical activity.

5. Senior centers: Introduce healthy food choices and physical activity programs; expand diabetes screening, referral and education; work with social service agencies to offer on site enrollment for health insurance coverage and food assistance programs.

6. Parishes and churches: Integrate health behavior themes with spiritual messages and church activities. Accompany themes with diabetes screenings, referrals and health risk appraisals, and healthy food and physical activity interventions.

7. Media and information technology: Use bilingual media and information technology for education about chronic disease prevention and control by expanding the MCHD web site, developing programs, public service announcements, and articles for TV, radio, newspapers, and community newsletters.

8. High-risk neighborhoods: Select a 25-block area in East Salinas, which has a population at particular risk of obesity, diabetes, and asthma, for intensive interventions. Conduct a needs appraisal; convene a Town Hall meeting; work with family, community, and health provider groups to expand programs to increase physical activity and healthy food choices; and improve screening, referral and self-management of asthma, diabetes, and obesity.

Evaluation: Program assessment and evaluation will be emphasized the first two years of funding and will focus on evaluations at both the individual and organization level (using both process and quantitative measures). We will conduct annual risk factor surveys of 1,500 women and men from a random community sample, and biennial surveys of 1,500 fifth, seventh, ninth, and eleventh grade students.

Sustainability: This initiative will allow us to build a strong infrastructure to address the prevention, treatment and control of obesity, diabetes, and asthma, linking the MCHD, health care providers, and numerous community agencies. Our multilevel, comprehensive approach to the prevention and control of obesity, diabetes, and asthma will serve as a model to the State of California, other county health departments, and health-related organizations.


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