Tu Salud ¡Sí Cuenta! Your Health Matters! A Community-wide Campaign in a Hispanic Border Community in Texas

Abstract

Objective

To evaluate a community-wide campaign, Tu Salud ¡Si Cuenta! (TSSC), in improving eating behaviors and anthropometric outcomes in Hispanic border communities.

Design

A quasi-experimental study with matched intervention and comparison communities. Cross-sectional assessments with randomly sampled adults, examined by actual exposure and site (unexposed intervention, exposed intervention, and unexposed comparison).

Setting and Participants

Predominately Mexican Americans located in Brownsville, TX (intervention) and Laredo, TX (control).

Intervention

The TSSC campaign included television and radio segments, community health worker discussions, and newsletters delivered in Brownsville from 2005 to 2010.

Main Outcome Measures

Healthy and unhealthy eating indices and average hip and waist circumferences.

Analysis

Univariable and multivariable regression models.

Results

The sample (n = 799; 400 comparison and 399 intervention) was 98% of Mexican origin; 54% had completed grade 9 or higher. Exposure to any TSSC component was associated with a lower rate of unhealthy food consumption. Compared with the unexposed intervention group, the exposed intervention for the newsletter had a higher rate of healthy eating (adjusted rate ratio = 1.18; P < .01). Compared with the unexposed intervention, the exposed intervention for the community health worker discussion had a smaller hip circumference (adjusted mean difference = −5.77 cm; P < .05) and a smaller waist circumference (adjusted mean difference = −5.25 cm; P < .05).

Conclusions and Implications

This study provides evidence for the use of community-wide campaigns for nutrition and obesity-related outcomes in Hispanic communities.

Introduction

Some of the most effective methods for preventing and managing chronic disease include weight reduction for obese or overweight individuals and improved nutrition1, 2, 3, 4, 5, 6; however, strategies to achieve these outcomes among populations experiencing disparities are still needed. The Guide to Community Preventive Services, a resource intended to provide policy makers and program planners with well-informed and evidence-based information on strategies to prevent disease, recommended the use of community-wide campaigns as a population health strategy to increase physical activity.7, 8 These multicomponent, community-wide campaigns include highly visible media messages, social support, and risk factor screenings and often target eating behaviors; however, the Guide did not explicitly recommend community-wide campaigns for eating behaviors or to improve obesity-related anthropometric outcomes.⁹ Limited studies tested the effectiveness of the campaigns for eating behavior and anthropometric outcomes, the results of which were mixed.10, 11, 12, 13, 14, 15, 16 Given these mixed results, there is a need to study further the effect of community-wide campaigns on these outcomes, particularly in a US context.

Although the overall need to know the impact of community-wide campaigns and their components on eating and anthropometric outcomes is clear, studying these campaigns within a primarily Hispanic population is important for several reasons. Hispanic individuals are the largest minority group in the US, and the population is expected to continue to grow.17, 18 Furthermore, they have higher rates of obesity than non-Hispanic white individuals.19, 20 Hispanic border communities experience ever greater disparities; they have a higher prevalence of obesity²¹ and are less likely to meet fruit and vegetable intake guidelines compared with Hispanic people nationally.²² Community-wide campaigns have not been tested as a strategy to affect nutrition and obesity in a predominately Hispanic community or a border community.

This article presents results of a community-wide campaign that compared intervention and comparison communities in an attempt to contribute additional evidence for community-wide campaigns to promote healthy eating behaviors and improve anthropometric outcomes. Many community-wide campaigns did not detail the exposure to and effect of individual components,16, 23, 24 which limits understanding of which components generated positive outcomes or possibly masked important effects of individual components, despite an ineffective overall campaign. The objectives of this study were to assess the associations of exposure to a community-wide campaign with healthy eating, unhealthy eating, and average hip and waist circumference by comparing 2 Hispanic communities, the intervention and comparison groups; and to evaluate the associations of exposure to each of the community-wide campaign components with the outcomes.