Abriendo Caminos 2: Clearing the Path to Hispanic Health
Phase: NA
Conditions: Obesity, Childhood Obesity, Nutrient; Excess, Community Health Education
Sponsor: University of Illinois at Urbana-Champaign

 
 
Date: April 6, 2018 
 
 
Study Title: Clearing the Path to Hispanic Children’s Health 
 
 
Principal Investigator: 
Margarita Teran-Garcia MD, PhD, FTOS 
Research Assistant Professor Hispanic Health Programs 
Extension Specialist Hispanic Health Programs 
 
University of Illinois Urbana-Champaign  
2005 Christopher Hall 
904 W. Nevada St. 
Urbana, IL 61801 
Phone: 217-244-2025  
Email: teranmd@illinois.edu  
 

Clearing the Path to Hispanic Health 
 
Teran‐Garcia, M (PI) 
1 
 
PROJECT NARRATIVE  Clearing the Path to Hispanic Children’s Health with a 
Community–Based Extension Curriculum and University Experiential Learning Course 
 
“Abriendo Caminos” could be translated as “Clearing the Path” and the implementation of 
this culturally sensitive, community–based extension curriculum (workshop) in 5 different 
locations across the country (California, Illinois, Iowa, Puerto Rico, and Texas) will help to train 
the next generation of professionals in Extension and communities to deliver programs that meet 
the needs of Hispanic families. The integration of Hispanic college students in program 
implementation via a University Experiential Learning Course (independent study with a 
structured curriculum) will further strengthen the program as well as increase recruitment and 
retention of Hispanic students, increasing the capacity of Hispanic communities to meet their 
own needs in the future.  
This integrated project will address knowledge gaps and barriers for successful 
implementation of childhood obesity prevention programs in Hispanics across the country. 
This proposal targets 6-18 year-old children from Mexican and Puerto Rican-heritage families, 
which represent 74% of the US Hispanic population (Pew Hispanic Center, 2010). The proposed 
curriculum integrates socio-cultural and socio-ecological theory with elements of the health 
belief model to focus on behavior change through multiple levels of influence: individual, 
interpersonal, and community, with proven results (Hammons, Wiley et al. 2013).  
Our multi-function integrated project proposes to (a) Tailor an existing and successful 
community-based program to leverage effectiveness in promoting healthy nutrition and life-
style behaviors among low income, low literacy Hispanic-heritage families and (b) Train 
existing professionals (in Extension and community agencies) and future professionals 
(Hispanic university students) to meet the specific needs of this population. We aim to adapt, 
implement and evaluate the Abriendo Caminos community workshop-based curriculum across 
the country. 
Our central hypothesis is that participation in a 6-week community-based program will 
significantly increase: (a) healthy dietary behavior patterns and basic knowledge of nutrition; (b) 
physical activity levels; and (c) the organization of collective/shared family mealtimes. 
Consequently, excessive weight gain or weight rate among participant children will be slower 
compared to non-participants. This project is based on the Abriendo Caminos pilot study that 
demonstrated an increase in healthy eating behaviors by building on elements of a traditional diet 
(Hammons, Wiley et al. 2013), and preliminary data (presented at conferences and under review) 
indicate improvements in family-meal quality and increased physical activity.  
The Abriendo Caminos program was developed using best-practice principles for working 
with Hispanics, including: i) focus on the whole family at the site of intervention; ii) optimizing 
existing family strengths, building on everyday practices such as shared mealtimes, and iii) 
emphasis on low literacy, with accessible materials and focus on oral presentations and cultural 
relevance including emphasis on healthy traditional foods such as cactus (nopales), amaranth and 
legumes (beans). The immediate beneficiaries of our obesity prevention intervention will be 
children 6 to 18 year-old from Hispanic-heritage families. 
This integrated project will address knowledge gaps about successful implementation of 
childhood obesity prevention programs in Hispanics, improve outreach to this population, 
and seek improvements in recruiting, educating, and retaining Hispanic students in higher 
education. 
Our research, education and extension objectives are interdependent and mutually enriching.  

Clearing the Path to Hispanic Health 
 
Teran‐Garcia, M (PI) 
2 
 
Research objectives are to: 1) Identify prevailing factors influencing effective interventions 
on Hispanic children’s unhealthy weight gain; 2) Adapt (culturally/regionally) and implement 
the proven Abriendo Caminos curricula to prevent childhood overweight/obesity (prevent 
excessive weight gain or weight rate); 3) Refine and expand our evidence-based nutrition 
curriculum (e.g. expanding focus on consumption of culturally relevant, affordable, and healthy 
foods such as legumes/dry beans). 
 
Extension objectives are to: 1) Refine and develop low-cost and readily implementable 
curriculum that will be made freely available across the country for use by Extension and 
community educators, 2) Train Extension professionals, lay community members, agency staff, 
and college-students as facilitators to deliver the curriculum and Extension staff to serve in a 
train-the-trainer capacity in the future (supporting sustainability); and 3) Test the implementation 
of alternative culturally-appropriate instructional methodologies with implications for other 
Extension programming.  
 
CURRENT SITUATION/SIGNIFICANCE.  
The high prevalence of early onset obesity is of great concern from a public health 
perspective (Table 1), in part because of the strong persistence of childhood obesity into 
adulthood and given relation of childhood obesity to adult metabolic complications and other 
clinical comorbidities.  
Obesity has many health, social, psychological, and economic consequences including a 
shorter life expectancy than previous generations and increased healthcare costs accounting for 
6.7 to 10.7% of total U.S. annual medical expenditures and up to $147 billion dollars (Trogdon, 
Finkelstein et al. 2012). Because up to 70% of obese adolescents grow up to become obese adults 
(Whitaker, Wright et al. 1997, Freedman, Khan et al. 2001, Wang, Chyen et al. 2008), there are 
high costs to health and to the country. Still, recent data suggest that there is a window of 
opportunity to effectively impact the weight status of a child during childhood (Danielsson, 
Kowalski et al. 2012). 
 
Table 1: Prevalence of High BMI (≥ 85th%'tile of the CDC growth charts) for Children, 2 to 19 years, by sex and 
age. Contrast of all race/Hispanic origin groups (ALL) with Non-Hispanic Whites (NHW) and Hispanic origin 
(Hispanic) groups, US (2011-2012). Modified from: (Ogden, Carroll et al. 2014). 
 
 
AGE group: 
2-19 y (all) 
6-11 y (target population) 12-19 y (target population) 
ALL NHW Hispanic 
ALL 
NHW Hispanic ALL NHW Hispanic 
Overweight or Obese (BMI for Age ≥85th Percentile of the CDC Growth Charts) 
All 
31.8 
28.5 
38.9 
34.2 
29.4 
46.2 
34.5 
31.2 
38.1 
Boys 
32.0 
27.8 
40.7 
33.2 
26.5 
48.7 
35.1 
31.5 
39.6 
Girls 
31.6 
29.2 
37.0 
35.2 
32.7 
43.6 
33.8 
31.0 
36.5 
Obese (BMI for Age ≥95th Percentile of the CDC Growth Charts) 
All 
16.9 
14.1 
22.4 
17.7 
13.1 
26.1 
20.5 
19.6 
22.6 
Boys 
16.7 
12.6 
24.1 
16.4 
8.8 
28.6 
20.3 
18.3 
23.9 
Girls 
17.2 
15.6 
20.6 
19.1 
17.9 
23.4 
20.7 
20.9 
21.3 

Clearing the Path to Hispanic Health 
 
Teran‐Garcia, M (PI) 
3 
 
ONGOING ACTIVITIES & PREVIOUS WORK 
Our team has the background and expertise to develop a program tailored to addressing the 
high obesity weights in Hispanic children. Our proposed curriculum would be developed in 
Illinois and implemented here as well as at each of the 4 partner sites (California, Texas, Puerto 
Rico and Iowa). PDs at each site have relevant expertise and will be responsible for 
implementation. We have received letters of support from collaborators and faculty at other 
academic institutions indicating their interest in the program and curriculum. We also integrated 
an internal and external Advisory Board and included their roles in our management plan. 
 
Our DISSEMINATION plan includes partnerships with stakeholders (LULAC), the Family 
Resilience Center at Illinois and professional societies to expand the reach of dissemination and 
insure participation from multiple disciplines. Dr. Teran-Garcia’s engagement with the Obesity 
Society (Council member) and the American Society for Nutrition (Minority Affairs Committee) 
will be relevant for dissemination. Dr. Wiley’s activities as an Extension Specialist and with the 
National Council for Family Relations (chair of the International Families section) will also aid 
marketing and disseminating the resulting curriculum. The purposeful selection of professional 
societies across multiple disciplines will encourage greater collaboration among academic 
institutions across the nation to address high priority AFRI/NIFA needs in childhood obesity 
prevention, including human nutrition and family science. 
 
 
PROPOSED PROJECT 
We will adapt, implement and evaluate the Abriendo Caminos curriculum in 5 locations in 
partnership with Extension staff and their community partners. In addition, we will develop a 
curriculum template for an experiential learning course to integrate Latino/Hispanic students in 
community participatory research and programing in all participating locations.  
Our overarching goal is to tailor an existing and successful Extension community-based 
program, Abriendo Caminos, to further improve its effectiveness in promoting healthy 
nutrition and life-style behaviors among low income, low literacy Hispanic-heritage 
families and to formalize an associated experiential learning program for Hispanic College-
level students. Specific aims include: 
 
Aim 1: Adapt the Abriendo Caminos curricula (culturally/regionally) across the country among 
Hispanic groups with different cultural histories and social realities. Tasks include: 
a) Conduct structured interviews and focus groups with community members, and  
b) Identify barriers, facilitators (promotive factors), and specific motivators to improve 
implementation and efficacy of community obesity prevention program among Hispanics. 
 
Aim 2: Implement and evaluate the newly adapted Abriendo Caminos curricula. Specifically, the 
goal is to use the curricula to:  
a) Prevent development of overweight/obesity or maintain healthy weight in 6 to 18 year-old 
children from Hispanic-heritage families, and  
b) Evaluate the impact of our evidence-based nutrition and behavioral modification curriculum 
in weight maintenance and obesity prevention in Hispanic children and their families. 
 
 

Clearing the Path to Hispanic Health 
 
Teran‐Garcia, M (PI) 
4 
 
Specific Aim 1 
Adapt the Abriendo Caminos curricula (culturally/regionally) across the country to adjust 
content and delivery methods for cultural and regional differences within the larger Hispanic 
community. The associated tasks to accomplish this aim include: 
a) Conduct structured interviews followed by focus groups with Hispanic community 
members. 
b) Identify barriers, promotive factors, and specific motivators to improve implementation 
and efficacy of community obesity prevention programs. 
Introduction 
The activities of Aim 1 are designed to provide information for tailoring the curriculum to 
meet the needs of diverse Hispanic audiences (varying, for example, by culture-of-origin and 
ethnic density of selected US community). We will employ methodologies that are appropriate 
for our target audience. We will use structured measures that are psychometrically sound for 
Hispanic respondents, in many cases adopting those used in the SOL study (Isasi, Carnethon et 
al. 2014) and those validated instruments used by other USDA-sponsored programs (de la Torre, 
Sadeghi et al. 2013) or the National Collaborative on Childhood Obesity Research (NCCOR) 
catalogue of surveillance systems and measures registry (McKinnon, Reedy et al. 2012). In the 
focus groups (2 to 4 groups at each site, with 8-10 participants per group), we intend to identify 
barriers, promotive factors, and specific motivators that could improve efficacy and 
implementation of the Abriendo Caminos program. Barriers are defined as factors that inhibit 
parents’ ability to identify what is a healthy or unhealthy weight gain in their children, attend 
meetings and meet the goals of prevention programs. Promotive factors are defined as elements 
that foster parents’ ability to provide access to nutritious food, physical activity opportunities, 
and shared mealtimes. Motivators are defined as factors that influence parents to participate in 
obesity prevention programs and implement a healthier lifestyle. We will also ask focus groups 
to discuss traditional culturally relevant foods -such as dried beans, amaranth, cactus (nopales)- 
whether these are available and consumed in their families and communities as well as any 
barriers and promotive factors that may influence consumption or preparation of these in the 
future. 
Experimental design 
Aim 1 activities will be coordinated by each regional program director (PD) to assist in 
tailoring the program to meet the specific needs of target communities. At each of the 
participating sites, we will recruit Hispanic community members (~10 each in Illinois and 
California where the original Abriendo Caminos collaborators are working and ~20 each at the 
currently incorporated sites –Texas, Puerto Rico and Iowa). Based on our Abriendo Caminos 
work, the questions in the structured surveys will be administered as oral interviews, -with 
bilingual assistants- to accommodate potentially low levels of literacy, assure comprehension, 
and optimize completion rates (Table 2 has the list of instruments used to construct the survey). 
Upon completion of the interviews, participants will be assembled into focus groups of about 8-
10 persons each. Focus groups have been used with ethnic minority populations to better 
understand health behaviors (Sonneville, La Pelle et al. 2009) and with low-income ethnic 
minority populations in the development of obesity prevention programs (McGarvey, Collie et 
al. 2006). The focus group methodology is “particularly well suited for research [with] low 
socioeconomic status women of color because: (a) they are communitarian and multi-vocal, (b) 
they generally feel safer than one-on-one interviews, and (c) the conversation is controlled by the 
participants” (McGarvey, Collie et al. 2006).  

Clearing the Path to Hispanic Health 
 
Teran‐Garcia, M (PI) 
5 
 
We will use a semi-structured protocol (Sonneville, La Pelle et al. 2009) to elicit detailed 
information about barriers and promotive factors related to participation in health programming, 
engagement in health-related behaviors such as healthy eating and physical activity. Examples of 
some questions in the focus group protocol include: When do your children eat and who feeds 
them?; How do you get your children to eat? Who does the cooking in your home?; Who does 
the grocery shopping in your home?; In the past few months, has anyone made changes in the 
way they shop or cook?; Do you think you could change the way you cook, shop and eat?; What 
do your children eat after school? What types of snacks do they eat?; How do you motivate your 
child to eat healthful foods?; How many of you set or try to set limits on when or what your 
children should eat?; What kind of limits? How do you do it (e.g., do you use rules)? (Martinez, 
Rhee et al. 2014). The data obtained will contribute to adapt and culturally tailor the intervention. 
 
 
Implementation will be staggered, beginning in Illinois where we have developed the 
program and followed in California where an original team member (Hammons) will lead the 
effort. All focus groups will be digitally recorded and transcribed verbatim. We will check 
transcripts against the voice recordings to confirm accuracy of the transcripts. Following this 
qualitative thematic analysis approach, we will code specific research questions (barriers, 
promotive factors and motivators) with the goal of producing a detailed tailoring (culturally-
sensitive) of our obesity prevention program. Possible limitations of this approach would include 
local problems in assuring simultaneous attendance of focus group participants and facilitator 
bias. However, we will minimize these problems by flexible scheduling and adequate training 
and direct supervision of participating sites. 
 
Expected Outcomes of this activity include optimization of curriculum tailoring and a report 
that identifies and contributes to our understanding of the local barriers, promotive factors, and 
motivators to increase participation in our Abriendo Caminos workshop (Aim 2). Results of this 
activity will be shared with participating teams during the annual meeting, as explained in the 
management plan. Therefore, program directors (PDs) in collaborative sites will be able to 
participate in feedback and learning experiences, to simplify their field work in the next cycle(s). 
A “Lessons learned” report will be submitted for peer-review publication, with leadership of PDs 
at each performance site. The timeline and staggered distribution for survey and focus groups is 
indicated the management plan. 
Table 2 – Instruments 
  
Construct 
  
Demographics 
Socioeconomic Status 
Socio-cultural factors (e.g., Hispanic origin, immigration history, acculturation, acculturative stress) 
Perceptions of Child Weight and Health 
Intentions to Modify Health Environment 
Family Health Behaviors and Access (includes food security and access to grocery stores) 
Neighborhood Safety 
Home Environment and Food Environment 
Physical Activity environment  

Clearing the Path to Hispanic Health 
 
Teran‐Garcia, M (PI) 
6 
 
Specific Aim 2 
Implement and evaluate the newly adapted Abriendo Caminos curricula to reduce Hispanic 
childhood overweight/obesity prevalence, and excessive weight gain by influencing children’s 
consumption of fruits and vegetables and sugar-sweetened beverages, their physical activity, and 
the organization of their family mealtimes. Specifically, the objectives are to:  
a) Prevent development of overweight/obesity [success is defined as prevention of excessive 
weight gain / maintenance of healthy weight status] in 6 to 18 year-old children from 
Hispanic-heritage families for up to 6 months, and  
b) Evaluate the impact of our evidence-based nutrition and behavioral modification 
curriculum in weight maintenance and obesity prevention in Hispanic children and their 
families. 
Introduction 
In 2009, the Robert Wood Johnson Foundation’s Salud America initiative called for the 
development of multifaceted, culturally relevant, and demonstrably effective interventions to 
impact childhood obesity in Hispanic families (http://www.rwjf.org). This was in response to the 
data demonstrating that Hispanics face a number of health disparities, such as heightened risk for 
type 2 diabetes, coronary heart disease, and obesity (National Hispanic Caucus of State 
Legislators). Many Hispanics live in neighborhoods with limited access to healthy foods (Larson, 
Story et al. 2009), and studies have consistently reported that Hispanic children’s daily 
consumption of fruits and vegetables fall short of recommendations (Health and Human Services 
and USDA 2005;(Basch, Zybert et al. 1994, Cullen, Baranowski et al. 2000, Nicklas, Jahns et al. 
2013).  
Sugar-sweetened beverages (SSBs) are the largest contributor of added sugar and a 
considerable source of calories in the diets of children and adolescents in the United States 
(Reedy and Krebs-Smith 2010), and SSB intake has been associated with obesity and type 2 
diabetes (Ebbeling, Feldman et al. 2006, Fiorito, Marini et al. 2009, Malik, Popkin et al. 2010, 
Ebbeling, Feldman et al. 2012, Ebbeling 2014). Consumption of SSBs may also serve to take the 
place of other healthier foods (Malik, Popkin et al. 2010). The consumption of sugar-sweetened 
beverages is disproportionately high among those with low-income (Han and Powell 2013). 
Hispanics may believe that culturally relevant drinks made with sugar, water and fruit (aguas 
frescas) have healthy homemade ingredients (Bogart, Cowgill et al. 2013).  
Low levels of physical activity are associated with overweight and obesity (Borraccino, 
Lemma et al. 2009). At the national level, Mexican American youth evidence higher levels of 
objectively measured physical activity than youth from other groups (Byrd-Williams, Belcher et 
al. 2010). Nevertheless, by adulthood, Hispanics are more likely to have low levels of physical 
activity (Centers for Disease Control and Prevention, (Schoenborn and Adams 2010, Prevention 
2011)). Parents are powerful socializing influences on children’s physical activity (Pugliese and 
Tinsley 2007). Hispanic parents perceive more barriers to their own (Marquez and McAuley 
2006) and their children’s physical activity (Duke, Huhman et al. 2003), and those in lower 
income communities are more likely to be inactive (Lutfiyya, Nika et al. 2008). Less 
acculturated Hispanic immigrant children are also less physically active (Wingo et al., 2009). 
When compared to non-Hispanic whites, Hispanic children are less involved in organized sports 
(Johnston, Delva et al. 2007) or physical activities outside of school and spend more leisure time 
in sedentary activities (Lutfiyya, Nika et al. 2008, Singh, Yu et al. 2008). A host of potential 
structural barriers contribute to disparities in physical activity (Zhu and Lee 2008), as well as 
cultural beliefs and attitudes (Pekmezi, Dunsiger et al. 2012, Larsen, Pekmezi et al. 2013). 

Clearing the Path to Hispanic Health 
 
Teran‐Garcia, M (PI) 
7 
 
Shared family meals (SFMs) organizational features (e.g. planning ahead, assigning roles, 
flexibility during transitions and stressful situations, and straightforward communication) are 
related to youth outcomes including reduced risk for obesity (Jacobs and Fiese 2007), quality of 
life (Fiese 2007), and biological health markers (Schreier and Chen 2010). Meal organization 
and advanced planning improves diet quality (Boutelle, Birnbaum et al. 2003) while eating “on 
the run” (Larson, Story et al. 2009) and outside the home (Woodruff and Hanning 2009) are 
associated with reduced diet quality, including increased fatty and fast food (Larson, Story et al. 
2009). SFMs have rarely been subject to systematic intervention (Hammons and Fiese 2011). 
Two exceptions: the NEAT curriculum for parents of toddlers (Coleman, Horodynski et al. 
2005), and the project EAT for teens and young adults (Larson, Fulkerson et al. 2013). Those 
programs successfully reduced mealtime TV and increased parental allowance of child 
independence during mealtimes (Coleman, Horodynski et al. 2005), and found that having more 
frequent shared meals in young adulthood was associated with greater intake of fruit (Larson, 
Fulkerson et al. 2013). However, none of these programs targeted Hispanic families. Abriendo 
Caminos is the only known intervention that targets and demonstrates improved organization of 
SFMs for Hispanic families (Wiley, Hammons et al. manuscript in preparation).  
 
The Abriendo Caminos program was developed using best-practice principles for working 
with Hispanics, including: i) focus on the whole family at the site of intervention; ii) optimizing 
existing family strengths; iii) building on everyday practices such as shared mealtimes, and iii) 
emphasis on literacy and cultural relevance including a focus on healthy traditional foods such as 
legumes (dry beans), cactus (nopales). It is organized as 6 face-to-face workshop sessions, each 
lasting 2 hours. Each session is divided into 3 segments: healthy eating (30 minutes), physical 
activity (60 minutes), and family togetherness, with a focus on family mealtimes (30 minutes). 
The general topics are illustrated in Table 4. All family members are together except for the 
first part of the healthy eating segment. Children are separated to provide age-tailored nutrition 
information. We are cognizant that culturally some teenagers might be brought by parents to 
participate in the program, at their will or not, and are prepared to offer alternative age-specific 
relevant nutrition lessons that are already offered by other programs (like 4H or RAP). 
Afterwards, they rejoin their parents for the hands-on aspects of the nutrition segments. 
Regardless of segment, the instructional strategies emphasize engaging participants in active 
learning (e.g. enjoyable cooking activities, folk/Zumba dancing, creating a family scrap book). 
 
Each segment involves a mini- (5-10 minutes) lecture and social interaction and discussion 
throughout. The physical activity segments focused on getting all family members active 
together for at least 45 minutes. Homework assignments aimed to extend engagement and 
learning beyond the workshop and included healthy recipes for family cooking, family walking 
with supplied pedometers, and using family mealtime conversation cards. 
 
 
 
 
 
 
 
 

Clearing the Path to Hispanic Health 
 
Teran‐Garcia, M (PI) 
8 
 
Table 4. Overview of the Abriendo Caminos program (6-weeks education).  
Week 
Nutrition Topic 
Family Mealtime Topic 
Physical Activity 
1 
Portions Plus 
Objective: To understand why we 
need to change our eating habits 
and to learn proper portion sizes; 
Valuing Shared Mealtimes 
Objective: Recognize the importance of 
shared mealtimes and rituals and develop 
realistic time expectations; start scrapbook 
Water Demonstration and Walking 
Objective: To emphasize water intake 
and the value and ease of walking 
2 
Fruits and Vegetables 
Objective: Understand the benefits 
of consuming fruits and vegetables 
and learn strategies for integrating 
them into the diet 
Balancing Time during Meals 
Objective: Reduce use of technology at the 
table; and increase positive 
communication at meals; scrapbook 
Introduction to Resistance 
Training 
Objective: Learn the value of 
resistance training and simple ways 
to get it 
3 
Grains & Legumes 
Objective: Understand the benefits 
of consuming whole grains and 
learn strategies for integrating 
them into the diet 
Reducing Screen Time During Meals 
Objective: Reduce screen time and learn 
about TV marketing; scrapbook 
Cardiovascular Activity: Jogging 
Objective: Understand the 
importance of CV activity and try 
jogging as an inexpensive example 
4 
Salt and Sugars 
Objective: Develop a realistic 
understanding of the necessity of 
controlling salt and sugar intake 
and learn strategies for doing so 
Reducing Sibling Conflict During Meals 
Objective: Learn that sib conflict is 
“normal;” learn strategies to reduce sib 
conflicts, increase positive affect and show 
genuine concern; scrapbook 
Other forms of Cardiovascular 
Activity 
Objective: Experience other simple 
and fun types of CV activity such as 
Zumba or salsa dancing  
5 
Fats and Protein 
Objective: Understand the value of 
lean protein and healthy fat and the 
necessity of monitoring fat intake 
Emphasizing Family Traditions 
Objective: Understand that traditions in 
families of origin have meaning and value 
for today; scrapbook 
Resistance Training 
Objective: Experience other simple 
methods of resistance training  
6 
Wrap up, review and fiesta 
Objective: Share healthy recipes, 
food, and fellowship 
Building New Family Traditions 
Objective: Work to create new traditions 
that have meaning and strengthen family; 
share scrapbooks 
Combining Resistance and 
Cardiovascular Activity in an 
everyday workout 
Objective: Learn ways to optimize 
time and effort to get some resistance 
and cardio at home 
 
Experimental design 
Our collaborator sites, plus Illinois, represent a variety of Hispanic cultures and communities 
across the country. The Abriendo Caminos curriculum will be implemented using a random 
control trial design. Materials and validated outcome measures will be adapted to meet the 
specific needs of each site. Adaptation of program will be based on assessment of needs in each 
participating region and results of focus groups conducted prior to implementation (Aim 1, 
measurable outcome). Implementation of intervention will be staggered, beginning in Illinois 
where we have developed the program and then in California where an original team member 
will lead the effort. Whole families will be recruited for participation, targeting those with one or 
more children in the age range of 6 to 18 year-olds and involving as many members as possible. 
Data to evaluate measurable outcomes will be collected at baseline (pre-intervention), after the 6-
week education program (post-intervention) and 6 months after completion of the program 
(maintenance). Hispanic and bilingual Extension educators, local community agency staff, and 
trained college-students will act as facilitators to deliver the program. 
Measures: Basic nutrition knowledge for parents and children (i.e. portion sizes) and food 
consumption surveys (to evaluate weekly consumption of specific items), based on NCCOR 
adapted instruments will be used (McKinnon, Reedy et al. 2012). The Mealtime subscale of the 
Family Ritual Questionnaire (Fiese and Kline 1993) be used to assess mealtime organization. We 
will use the long-form of the International Physical Activity Questionnaire (IPAQ) to assess the 
parent and children’s physical activity levels, as it has been shown that the short form (SF) is not 
useful in Latin-American populations (Hallal, Gomez et al. 2010). Other measures, and sources, 
are presented in Table 5. 

Clearing the Path to Hispanic Health 
 
Teran‐Garcia, M (PI) 
9 
 
 
Table 5 – Instruments to evaluate impact of intervention program (*=main 
outcomes) 
Construct 
 
Demographics and Socioeconomic Status 
Socio-cultural factors (e.g.; Hispanic origin, immigration history, acculturation, acculturative 
stress) 
Perceptions of Child Weight and Health 
Intentions to Modify Health Environment 
Family Health Behaviors and Access (includes food security and access to grocery stores) 
Family Ritual Questionnaire 
*Higher levels of family mealtime organization 
Dietary Patterns for children and parents 
*Increased consumption of fruits, vegetables and legumes 
*Reduced consumption of sugar-sweetened beverages 
Home Environment and Food Environment 
Physical Activity (International Questionnaire, Long Form) 
*Increased minutes of daily physical activity 
*Prevent excessive weight gain or maintain healthy weight in Hispanic Children 6-18 yr-old 
for up to 6 months 
 
Expected outcomes. We expect that participation in a 6-week community-based program 
will result in the following: 
 Increased consumption of fruits, vegetables and legumes 
 Reduced consumption of sugar-sweetened beverages 
 Increased minutes of daily physical activity 
 Higher levels of family mealtime organization  
 Prevent excessive weight gain/maintain healthy weight in Hispanic children (6 to 18 yrs) 
 
Dissemination. This integrated project will result in an effective, low-cost obesity prevention 
intervention (available in Spanish and English) that can be disseminated by Extension 
professionals and community agency staff in other locations across the US, including external 
advisory board members’ coalitions (i.e. LULAC, professional societies). Ultimately, widespread 
implementation of the Abriendo Caminos program will help improve health outcomes in 
difficult-to-engage stakeholders at elevated risk of poor health and will reduce the prevalence of 
childhood overweight and obesity in Hispanics. This sustainable multi-state intervention will 
also strengthen Extension and USDA connections with Hispanic population across the country. 
 
Approach.  
The Implementation and Evaluation phase will execute and test the effectiveness of a 
community workshop-based curriculum Abriendo Caminos to prevent childhood obesity and 
promote healthy nutrition and life-style behaviors among low income, low literacy Hispanic-
heritage families across the country. We will recruit whole families (n=250) with one or more 
children in the target age range and involve as many members as possible.  

Clearing the Path to Hispanic Health 
 
Teran‐Garcia, M (PI) 
10 
 
Data will be collected at baseline (pre-intervention), after the 6-week education program 
(post-intervention) and 6 months after completion of the program (maintenance). Several 
mechanisms are in place to minimize attrition on the follow-up. Implementation will be 
staggered, as indicated before. Participating sites will conduct the program only after Aim 1 is 
completed (Focus groups, survey) to tailor lessons before implementation of the Abriendo 
Caminos curriculum, as indicated in Table 5. 
 
 
We will implement and evaluate the Abriendo Caminos community workshop-based 
curriculum in five different locations (California, Illinois, Iowa, Puerto Rico, and Texas). 
Materials for program implementation and validated outcome measures will be regionally 
adapted (Table 4). The nutrition curriculum will be also refined and expanded to promote 
consumption of inexpensive and culturally-familiar foods such as dry beans (legumes) and other 
regional or cultural foods (cactus-nopales). The physical activity curriculum will promote fun 
activities that the entire family can enjoy including walking and folk dancing (or Zumba) and 
adapted to participating location. Our management plan and regular meetings with Advisory 
Board will contribute to minimize difficulties and challenges to achieve this aim. 
This proposal implements a community-based participatory program (CBPP) approach, and 
integrates socio-cultural and socio-ecological theories with elements of the health belief model to 
focus on behavior change through multiple levels of influence: individual, interpersonal, and at 
community level.  
 
POTENTIAL IMPACT OF THE OVERALL PROJECT AND EXPECTED OUTCOMES. 
The proposed multi-function integrated Research, Education, and/or Extension project will 
result in an effective, low-cost childhood obesity prevention intervention (available in Spanish 
and English) to be disseminated by Extension professionals and community agency staff in other 
locations across the US. Many Extension services across the country have been under increasing 
pressure to reduce staff and engage in a train-the-trainer model of program delivery. We will 
strengthen relationships with relevant community partners as well as grow the Extension “brand” 
as a provider of research-based, effective, affordable, and culturally relevant materials. The 
proposed project aims also to train staff in the 5 participating states in effective methods for 
achieving these goals and provide a model that is applicable more broadly.  
Ultimately, implementation of the Abriendo Caminos program will Clear the Path to 
Hispanic Children’s Health and improve outcomes in difficult-to-engage stakeholders at 
elevated risk. It will reduce the prevalence of childhood overweight and obesity and contribute to 
their well-being.